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Legrand M, Bagshaw SM, Bhatraju PK, Bihorac A, Caniglia E, Khanna AK, Kellum JA, Koyner J, Harhay MO, Zampieri FG, Zarbock A, Chung K, Liu K, Mehta R, Pickkers P, Ryan A, Bernholz J, Dember L, Gallagher M, Rossignol P, Ostermann M. Sepsis-associated acute kidney injury: recent advances in enrichment strategies, sub-phenotyping and clinical trials. Crit Care 2024; 28:92. [PMID: 38515121 PMCID: PMC10958912 DOI: 10.1186/s13054-024-04877-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 03/17/2024] [Indexed: 03/23/2024] Open
Abstract
Acute kidney injury (AKI) often complicates sepsis and is associated with high morbidity and mortality. In recent years, several important clinical trials have improved our understanding of sepsis-associated AKI (SA-AKI) and impacted clinical care. Advances in sub-phenotyping of sepsis and AKI and clinical trial design offer unprecedented opportunities to fill gaps in knowledge and generate better evidence for improving the outcome of critically ill patients with SA-AKI. In this manuscript, we review the recent literature of clinical trials in sepsis with focus on studies that explore SA-AKI as a primary or secondary outcome. We discuss lessons learned and potential opportunities to improve the design of clinical trials and generate actionable evidence in future research. We specifically discuss the role of enrichment strategies to target populations that are most likely to derive benefit and the importance of patient-centered clinical trial endpoints and appropriate trial designs with the aim to provide guidance in designing future trials.
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Affiliation(s)
- Matthieu Legrand
- Division of Critical Care Medicine, Department of Anesthesia and Perioperative Care, UCSF, 521 Parnassus Avenue, San Francisco, CA, 94143, USA.
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Canada
| | - Pavan K Bhatraju
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, USA
- Kidney Research Institute, University of Washington, Seattle, USA
| | - Azra Bihorac
- Department of Medicine, University of Florida, Gainesville, FL, USA
- Intelligent Critical Care Center (IC3), University of Florida, Gainesville, FL, USA
| | - Ellen Caniglia
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Ashish K Khanna
- Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Outcomes Research Consortium, Cleveland, OH, USA
- Perioperative Outcomes and Informatics Collaborative, Winston-Salem, NC, USA
| | - John A Kellum
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jay Koyner
- University Section of Nephrology, Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Michael O Harhay
- Clinical Trials Methods and Outcomes Lab, Department of Biostatistics, Epidemiology, and Informatics, PAIR (Palliative and Advanced Illness Research) Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Fernando G Zampieri
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Canada
| | | | | | - Kathleen Liu
- Divisions of Nephrology and Critical Care Medicine, Departments of Medicine and Anesthesia, University of California San Francisco, San Francisco, CA, USA
| | - Ravindra Mehta
- Department of Medicine, University of California, San Diego, USA
| | - Peter Pickkers
- Intensive Care Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Abigail Ryan
- Chronic Care Policy Group, Division of Chronic Care Management, Center for Medicare and Medicaid Services, Center for Medicare, Baltimore, MD, USA
| | | | - Laura Dember
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Department of Biostatistics, Epidemiology and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Martin Gallagher
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Patrick Rossignol
- FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
- INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, Université de Lorraine, Nancy, France
- Medicine and Nephrology-Hemodialysis Departments, Monaco Private Hemodialysis Centre, Princess Grace Hospital, Monaco, Monaco
| | - Marlies Ostermann
- Department of Critical Care, King's College London, Guy's & St Thomas' Hospital, London, UK
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Chung K, Dean D, Olson J. Diagnostic Complexities of Oral Squamous Cell Carcinoma. Compend Contin Educ Dent 2024; 45:e1-e4. [PMID: 38460142] [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] [Subscribe] [Scholar Register] [Indexed: 03/11/2024]
Abstract
Prompt diagnosis of oral cancers is critical to increase survival rates. Treatment for oral squamous cell carcinoma (OSCC) and oropharyngeal squamous cell carcinoma (OPSCC) is mainly driven by cancer stage and may include surgery alone or surgery with adjuvant or neoadjuvant radiation, chemotherapy, and/or targeted therapy. This article describes a case of a patient who was referred by his general dentist to an oral medicine clinic for assessment of an exophytic lesion on the left lateral tongue. The case report discusses the differential diagnosis and treatment, examining critical elements in lesion assessment in the patient, who had a significant oral lesion history and who was ultimately diagnosed with OSCC. Highlighting various complexities that may arise in the diagnosis of OSCC, the article underscores the importance of surveillance, informed biopsy technique, and accurate interpretation of pathology reports to appropriately manage patients with potential oral malignancy.
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Affiliation(s)
- Kevin Chung
- Dental Oncology Fellow, Memorial Sloan Kettering Cancer Center, New York, New York; Affiliate Faculty, Department of Oral Medicine, University of Washington School of Dentistry, Seattle, Washingtonx
| | - David Dean
- Clinical Associate Professor, Department of Oral Medicine, University of Washington School of Dentistry, Seattle, Washington; Faculty of Dental Surgery, Royal College of Surgeons of Edinburgh; Diplomate, American Board of Oral Medicine
| | - Jasmine Olson
- Clinical Instructor, Department of Oral Medicine, University of Washington School of Dentistry, Seattle, Washington; Diplomate, American Board of Oral Medicine
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Lo B, Shin HD, Kemp J, Munnery M, Chen S, Ma C, Jankowicz D, Mehta R, Harris A, Sakal M, Pundit R, Chung K, Kuziemsky C, Rossetti S, Strudwick G. Shifting Mindsets: The Impact of a Patient Portal on Functioning and Recovery in a Mental Health Setting. Can J Psychiatry 2024; 69:217-227. [PMID: 37644885 PMCID: PMC10874602 DOI: 10.1177/07067437231197060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVE This study aims to understand whether higher use of a patient portal can have an impact on mental health functioning and recovery. METHOD A mixed methods approach was used for this study. In 2019-2021, patients with mental health diagnoses at outpatient clinics in an academic centre were invited to complete World Health Organization Disability Assessment Scale 12 (WHODAS-12) and Mental Health Recovery Measure surveys at baseline, 3 months, and 6 months after signing up for the portal. At the 3-month time point, patients were invited to a semistructured interview with a member of the team to contextualize the findings obtained from the surveys. Analytics data was also collected from the platform to understand usage patterns on the portal. RESULTS Overall, 113 participants were included in the analysis. There was no significant change in mental health functioning and recovery scores over the 6-month period. However, suboptimal usage was observed as 46% of participants did not complete any tasks within the portal. Thirty-five participants had low use of the portal (1-9 interactions) and 18 participants had high usage (10+ interactions). There were also no differences in mental health functioning and recovery scores between low and high users of the portal. Qualitative interviews highlighted many opportunities where the portal can support overall functioning and mental health recovery. CONCLUSIONS Collectively, this study suggests that higher use of a portal had no impact, either positive or negative, on mental health outcomes. While it may offer convenience and improved patient satisfaction, adequate support is needed to fully enable these opportunities for patient care. As the type of interaction with the portal was not specifically addressed, future work should focus on looking at ways to support patient engagement and portal usage throughout their care journey.
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Affiliation(s)
- Brian Lo
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Information Management & Technology, The Hospital for Sick Children (SickKids), Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Hwayeon Danielle Shin
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jessica Kemp
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Mikayla Munnery
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sheng Chen
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Clement Ma
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Damian Jankowicz
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rohan Mehta
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alexandra Harris
- Interprofessional Practice, Unity Health Toronto, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Moshe Sakal
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Ryan Pundit
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Craig Kuziemsky
- Office of Research, MacEwan University, Edmonton, AB, Canada
| | - Sarah Rossetti
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Gillian Strudwick
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Staplin N, Haynes R, Judge PK, Wanner C, Green JB, Emberson J, Preiss D, Mayne KJ, Ng SYA, Sammons E, Zhu D, Hill M, Stevens W, Wallendszus K, Brenner S, Cheung AK, Liu ZH, Li J, Hooi LS, Liu WJ, Kadowaki T, Nangaku M, Levin A, Cherney D, Maggioni AP, Pontremoli R, Deo R, Goto S, Rossello X, Tuttle KR, Steubl D, Petrini M, Seidi S, Landray MJ, Baigent C, Herrington WG, Abat S, Abd Rahman R, Abdul Cader R, Abdul Hafidz MI, Abdul Wahab MZ, Abdullah NK, Abdul-Samad T, Abe M, Abraham N, Acheampong S, Achiri P, Acosta JA, Adeleke A, Adell V, Adewuyi-Dalton R, Adnan N, Africano A, Agharazii M, Aguilar F, Aguilera A, Ahmad M, Ahmad MK, Ahmad NA, Ahmad NH, Ahmad NI, Ahmad Miswan N, Ahmad Rosdi H, Ahmed I, Ahmed S, Ahmed S, Aiello J, Aitken A, AitSadi R, Aker S, Akimoto S, Akinfolarin A, Akram S, Alberici F, Albert C, Aldrich L, Alegata M, Alexander L, Alfaress S, Alhadj Ali M, Ali A, Ali A, Alicic R, Aliu A, Almaraz R, Almasarwah R, Almeida J, Aloisi A, Al-Rabadi L, Alscher D, Alvarez P, Al-Zeer B, Amat M, Ambrose C, Ammar H, An Y, Andriaccio L, Ansu K, Apostolidi A, Arai N, Araki H, Araki S, Arbi A, Arechiga O, Armstrong S, Arnold T, Aronoff S, Arriaga W, Arroyo J, Arteaga D, Asahara S, Asai A, Asai N, Asano S, Asawa M, Asmee MF, Aucella F, Augustin M, Avery A, Awad A, Awang IY, Awazawa M, Axler A, Ayub W, Azhari Z, Baccaro R, Badin C, Bagwell B, Bahlmann-Kroll E, Bahtar AZ, Baigent C, Bains D, Bajaj H, Baker R, Baldini E, Banas B, Banerjee D, Banno S, Bansal S, Barberi S, Barnes S, Barnini C, Barot C, Barrett K, Barrios R, Bartolomei Mecatti B, Barton I, Barton J, Basily W, Bavanandan S, Baxter A, Becker L, Beddhu S, Beige J, Beigh S, Bell S, Benck U, Beneat A, Bennett A, Bennett D, Benyon S, Berdeprado J, Bergler T, Bergner A, Berry M, Bevilacqua M, Bhairoo J, Bhandari S, Bhandary N, Bhatt A, Bhattarai M, Bhavsar M, Bian W, Bianchini F, Bianco S, Bilous R, Bilton J, Bilucaglia D, Bird C, Birudaraju D, Biscoveanu M, Blake C, Bleakley N, Bocchicchia K, Bodine S, Bodington R, Boedecker S, Bolduc M, Bolton S, Bond C, Boreky F, Boren K, Bouchi R, Bough L, Bovan D, Bowler C, Bowman L, Brar N, Braun C, Breach A, Breitenfeldt M, Brenner S, Brettschneider B, Brewer A, Brewer G, Brindle V, Brioni E, Brown C, Brown H, Brown L, Brown R, Brown S, Browne D, Bruce K, Brueckmann M, Brunskill N, Bryant M, Brzoska M, Bu Y, Buckman C, Budoff M, Bullen M, Burke A, Burnette S, Burston C, Busch M, Bushnell J, Butler S, Büttner C, Byrne C, Caamano A, Cadorna J, Cafiero C, Cagle M, Cai J, Calabrese K, Calvi C, Camilleri B, Camp S, Campbell D, Campbell R, Cao H, Capelli I, Caple M, Caplin B, Cardone A, Carle J, Carnall V, Caroppo M, Carr S, Carraro G, Carson M, Casares P, Castillo C, Castro C, Caudill B, Cejka V, Ceseri M, Cham L, Chamberlain A, Chambers J, Chan CBT, Chan JYM, Chan YC, Chang E, Chang E, Chant T, Chavagnon T, Chellamuthu P, Chen F, Chen J, Chen P, Chen TM, Chen Y, Chen Y, Cheng C, Cheng H, Cheng MC, Cherney D, Cheung AK, Ching CH, Chitalia N, Choksi R, Chukwu C, Chung K, Cianciolo G, Cipressa L, Clark S, Clarke H, Clarke R, Clarke S, Cleveland B, Cole E, Coles H, Condurache L, Connor A, Convery K, Cooper A, Cooper N, Cooper Z, Cooperman L, Cosgrove L, Coutts P, Cowley A, Craik R, Cui G, Cummins T, Dahl N, Dai H, Dajani L, D'Amelio A, Damian E, Damianik K, Danel L, Daniels C, Daniels T, Darbeau S, Darius H, Dasgupta T, Davies J, Davies L, Davis A, Davis J, Davis L, Dayanandan R, Dayi S, Dayrell R, De Nicola L, Debnath S, Deeb W, Degenhardt S, DeGoursey K, Delaney M, Deo R, DeRaad R, Derebail V, Dev D, Devaux M, Dhall P, Dhillon G, Dienes J, Dobre M, Doctolero E, Dodds V, Domingo D, Donaldson D, Donaldson P, Donhauser C, Donley V, Dorestin S, Dorey S, Doulton T, Draganova D, Draxlbauer K, Driver F, Du H, Dube F, Duck T, Dugal T, Dugas J, Dukka H, Dumann H, Durham W, Dursch M, Dykas R, Easow R, Eckrich E, Eden G, Edmerson E, Edwards H, Ee LW, Eguchi J, Ehrl Y, Eichstadt K, Eid W, Eilerman B, Ejima Y, Eldon H, Ellam T, Elliott L, Ellison R, Emberson J, Epp R, Er A, Espino-Obrero M, Estcourt S, Estienne L, Evans G, Evans J, Evans S, Fabbri G, Fajardo-Moser M, Falcone C, Fani F, Faria-Shayler P, Farnia F, Farrugia D, Fechter M, Fellowes D, Feng F, Fernandez J, Ferraro P, Field A, Fikry S, Finch J, Finn H, Fioretto P, Fish R, Fleischer A, Fleming-Brown D, Fletcher L, Flora R, Foellinger C, Foligno N, Forest S, Forghani Z, Forsyth K, Fottrell-Gould D, Fox P, Frankel A, Fraser D, Frazier R, Frederick K, Freking N, French H, Froment A, Fuchs B, Fuessl L, Fujii H, Fujimoto A, Fujita A, Fujita K, Fujita Y, Fukagawa M, Fukao Y, Fukasawa A, Fuller T, Funayama T, Fung E, Furukawa M, Furukawa Y, Furusho M, Gabel S, Gaidu J, Gaiser S, Gallo K, Galloway C, Gambaro G, Gan CC, Gangemi C, Gao M, Garcia K, Garcia M, Garofalo C, Garrity M, Garza A, Gasko S, Gavrila M, Gebeyehu B, Geddes A, Gentile G, George A, George J, Gesualdo L, Ghalli F, Ghanem A, Ghate T, Ghavampour S, Ghazi A, Gherman A, Giebeln-Hudnell U, Gill B, Gillham S, Girakossyan I, Girndt M, Giuffrida A, Glenwright M, Glider T, Gloria R, Glowski D, Goh BL, Goh CB, Gohda T, Goldenberg R, Goldfaden R, Goldsmith C, Golson B, Gonce V, Gong Q, Goodenough B, Goodwin N, Goonasekera M, Gordon A, Gordon J, Gore A, Goto H, Goto S, Goto S, Gowen D, Grace A, Graham J, Grandaliano G, Gray M, Green JB, Greene T, Greenwood G, Grewal B, Grifa R, Griffin D, Griffin S, Grimmer P, Grobovaite E, Grotjahn S, Guerini A, Guest C, Gunda S, Guo B, Guo Q, Haack S, Haase M, Haaser K, Habuki K, Hadley A, Hagan S, Hagge S, Haller H, Ham S, Hamal S, Hamamoto Y, Hamano N, Hamm M, Hanburry A, Haneda M, Hanf C, Hanif W, Hansen J, Hanson L, Hantel S, Haraguchi T, Harding E, Harding T, Hardy C, Hartner C, Harun Z, Harvill L, Hasan A, Hase H, Hasegawa F, Hasegawa T, Hashimoto A, Hashimoto C, Hashimoto M, Hashimoto S, Haskett S, Hauske SJ, Hawfield A, Hayami T, Hayashi M, Hayashi S, Haynes R, Hazara A, Healy C, Hecktman J, Heine G, Henderson H, Henschel R, Hepditch A, Herfurth K, Hernandez G, Hernandez Pena A, Hernandez-Cassis C, Herrington WG, Herzog C, Hewins S, Hewitt D, Hichkad L, Higashi S, Higuchi C, Hill C, Hill L, Hill M, Himeno T, Hing A, Hirakawa Y, Hirata K, Hirota Y, Hisatake T, Hitchcock S, Hodakowski A, Hodge W, Hogan R, Hohenstatt U, Hohenstein B, Hooi L, Hope S, Hopley M, Horikawa S, Hosein D, Hosooka T, Hou L, Hou W, Howie L, Howson A, Hozak M, Htet Z, Hu X, Hu Y, Huang J, Huda N, Hudig L, Hudson A, Hugo C, Hull R, Hume L, Hundei W, Hunt N, Hunter A, Hurley S, Hurst A, Hutchinson C, Hyo T, Ibrahim FH, Ibrahim S, Ihana N, Ikeda T, Imai A, Imamine R, Inamori A, Inazawa H, Ingell J, Inomata K, Inukai Y, Ioka M, Irtiza-Ali A, Isakova T, Isari W, Iselt M, Ishiguro A, Ishihara K, Ishikawa T, Ishimoto T, Ishizuka K, Ismail R, Itano S, Ito H, Ito K, Ito M, Ito Y, Iwagaitsu S, Iwaita Y, Iwakura T, Iwamoto M, Iwasa M, Iwasaki H, Iwasaki S, Izumi K, Izumi K, Izumi T, Jaafar SM, Jackson C, Jackson Y, Jafari G, Jahangiriesmaili M, Jain N, Jansson K, Jasim H, Jeffers L, Jenkins A, Jesky M, Jesus-Silva J, Jeyarajah D, Jiang Y, Jiao X, Jimenez G, Jin B, Jin Q, Jochims J, Johns B, Johnson C, Johnson T, Jolly S, Jones L, Jones L, Jones S, Jones T, Jones V, Joseph M, Joshi S, Judge P, Junejo N, Junus S, Kachele M, Kadowaki T, Kadoya H, Kaga H, Kai H, Kajio H, Kaluza-Schilling W, Kamaruzaman L, Kamarzarian A, Kamimura Y, Kamiya H, Kamundi C, Kan T, Kanaguchi Y, Kanazawa A, Kanda E, Kanegae S, Kaneko K, Kaneko K, Kang HY, Kano T, Karim M, Karounos D, Karsan W, Kasagi R, Kashihara N, Katagiri H, Katanosaka A, Katayama A, Katayama M, Katiman E, Kato K, Kato M, Kato N, Kato S, Kato T, Kato Y, Katsuda Y, Katsuno T, Kaufeld J, Kavak Y, Kawai I, Kawai M, Kawai M, Kawase A, Kawashima S, Kazory A, Kearney J, Keith B, Kellett J, Kelley S, Kershaw M, Ketteler M, Khai Q, Khairullah Q, Khandwala H, Khoo KKL, Khwaja A, Kidokoro K, Kielstein J, Kihara M, Kimber C, Kimura S, Kinashi H, Kingston H, Kinomura M, Kinsella-Perks E, Kitagawa M, Kitajima M, Kitamura S, Kiyosue A, Kiyota M, Klauser F, Klausmann G, Kmietschak W, Knapp K, Knight C, Knoppe A, Knott C, Kobayashi M, Kobayashi R, Kobayashi T, Koch M, Kodama S, Kodani N, Kogure E, Koizumi M, Kojima H, Kojo T, Kolhe N, Komaba H, Komiya T, Komori H, Kon SP, Kondo M, Kondo M, Kong W, Konishi M, Kono K, Koshino M, Kosugi T, Kothapalli B, Kozlowski T, Kraemer B, Kraemer-Guth A, Krappe J, Kraus D, Kriatselis C, Krieger C, Krish P, Kruger B, Ku Md Razi KR, Kuan Y, Kubota S, Kuhn S, Kumar P, Kume S, Kummer I, Kumuji R, Küpper A, Kuramae T, Kurian L, Kuribayashi C, Kurien R, Kuroda E, Kurose T, Kutschat A, Kuwabara N, Kuwata H, La Manna G, Lacey M, Lafferty K, LaFleur P, Lai V, Laity E, Lambert A, Landray MJ, Langlois M, Latif F, Latore E, Laundy E, Laurienti D, Lawson A, Lay M, Leal I, Leal I, Lee AK, Lee J, Lee KQ, Lee R, Lee SA, Lee YY, Lee-Barkey Y, Leonard N, Leoncini G, Leong CM, Lerario S, Leslie A, Levin A, Lewington A, Li J, Li N, Li X, Li Y, Liberti L, Liberti ME, Liew A, Liew YF, Lilavivat U, Lim SK, Lim YS, Limon E, Lin H, Lioudaki E, Liu H, Liu J, Liu L, Liu Q, Liu WJ, Liu X, Liu Z, Loader D, Lochhead H, Loh CL, Lorimer A, Loudermilk L, Loutan J, Low CK, Low CL, Low YM, Lozon Z, Lu Y, Lucci D, Ludwig U, Luker N, Lund D, Lustig R, Lyle S, Macdonald C, MacDougall I, Machicado R, MacLean D, Macleod P, Madera A, Madore F, Maeda K, Maegawa H, Maeno S, Mafham M, Magee J, Maggioni AP, Mah DY, Mahabadi V, Maiguma M, Makita Y, Makos G, Manco L, Mangiacapra R, Manley J, Mann P, Mano S, Marcotte G, Maris J, Mark P, Markau S, Markovic M, Marshall C, Martin M, Martinez C, Martinez S, Martins G, Maruyama K, Maruyama S, Marx K, Maselli A, Masengu A, Maskill A, Masumoto S, Masutani K, Matsumoto M, Matsunaga T, Matsuoka N, Matsushita M, Matthews M, Matthias S, Matvienko E, Maurer M, Maxwell P, Mayne KJ, Mazlan N, Mazlan SA, Mbuyisa A, McCafferty K, McCarroll F, McCarthy T, McClary-Wright C, McCray K, McDermott P, McDonald C, McDougall R, McHaffie E, McIntosh K, McKinley T, McLaughlin S, McLean N, McNeil L, Measor A, Meek J, Mehta A, Mehta R, Melandri M, Mené P, Meng T, Menne J, Merritt K, Merscher S, Meshykhi C, Messa P, Messinger L, Miftari N, Miller R, Miller Y, Miller-Hodges E, Minatoguchi M, Miners M, Minutolo R, Mita T, Miura Y, Miyaji M, Miyamoto S, Miyatsuka T, Miyazaki M, Miyazawa I, Mizumachi R, Mizuno M, Moffat S, Mohamad Nor FS, Mohamad Zaini SN, Mohamed Affandi FA, Mohandas C, Mohd R, Mohd Fauzi NA, Mohd Sharif NH, Mohd Yusoff Y, Moist L, Moncada A, Montasser M, Moon A, Moran C, Morgan N, Moriarty J, Morig G, Morinaga H, Morino K, Morisaki T, Morishita Y, Morlok S, Morris A, Morris F, Mostafa S, Mostefai Y, Motegi M, Motherwell N, Motta D, Mottl A, Moys R, Mozaffari S, Muir J, Mulhern J, Mulligan S, Munakata Y, Murakami C, Murakoshi M, Murawska A, Murphy K, Murphy L, Murray S, Murtagh H, Musa MA, Mushahar L, Mustafa R, Mustafar R, Muto M, Nadar E, Nagano R, Nagasawa T, Nagashima E, Nagasu H, Nagelberg S, Nair H, Nakagawa Y, Nakahara M, Nakamura J, Nakamura R, Nakamura T, Nakaoka M, Nakashima E, Nakata J, Nakata M, Nakatani S, Nakatsuka A, Nakayama Y, Nakhoul G, Nangaku M, Naverrete G, Navivala A, Nazeer I, Negrea L, Nethaji C, Newman E, Ng SYA, Ng TJ, Ngu LLS, Nimbkar T, Nishi H, Nishi M, Nishi S, Nishida Y, Nishiyama A, Niu J, Niu P, Nobili G, Nohara N, Nojima I, Nolan J, Nosseir H, Nozawa M, Nunn M, Nunokawa S, Oda M, Oe M, Oe Y, Ogane K, Ogawa W, Ogihara T, Oguchi G, Ohsugi M, Oishi K, Okada Y, Okajyo J, Okamoto S, Okamura K, Olufuwa O, Oluyombo R, Omata A, Omori Y, Ong LM, Ong YC, Onyema J, Oomatia A, Oommen A, Oremus R, Orimo Y, Ortalda V, Osaki Y, Osawa Y, Osmond Foster J, O'Sullivan A, Otani T, Othman N, Otomo S, O'Toole J, Owen L, Ozawa T, Padiyar A, Page N, Pajak S, Paliege A, Pandey A, Pandey R, Pariani H, Park J, Parrigon M, Passauer J, Patecki M, Patel M, Patel R, Patel T, Patel Z, Paul R, Paul R, Paulsen L, Pavone L, Peixoto A, Peji J, Peng BC, Peng K, Pennino L, Pereira E, Perez E, Pergola P, Pesce F, 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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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Liew A, Liew YF, Lilavivat U, Lim SK, Lim YS, Limon E, Lin H, Lioudaki E, Liu H, Liu J, Liu L, Liu Q, Liu WJ, Liu X, Liu Z, Loader D, Lochhead H, Loh CL, Lorimer A, Loudermilk L, Loutan J, Low CK, Low CL, Low YM, Lozon Z, Lu Y, Lucci D, Ludwig U, Luker N, Lund D, Lustig R, Lyle S, Macdonald C, MacDougall I, Machicado R, MacLean D, Macleod P, Madera A, Madore F, Maeda K, Maegawa H, Maeno S, Mafham M, Magee J, Maggioni AP, Mah DY, Mahabadi V, Maiguma M, Makita Y, Makos G, Manco L, Mangiacapra R, Manley J, Mann P, Mano S, Marcotte G, Maris J, Mark P, Markau S, Markovic M, Marshall C, Martin M, Martinez C, Martinez S, Martins G, Maruyama K, Maruyama S, Marx K, Maselli A, Masengu A, Maskill A, Masumoto S, Masutani K, Matsumoto M, Matsunaga T, Matsuoka N, Matsushita M, Matthews M, Matthias S, Matvienko E, Maurer M, Maxwell P, Mayne KJ, Mazlan N, Mazlan SA, Mbuyisa A, McCafferty K, McCarroll F, McCarthy T, McClary-Wright C, McCray K, McDermott P, McDonald C, McDougall R, McHaffie E, McIntosh K, McKinley T, McLaughlin S, McLean N, McNeil L, Measor A, Meek J, Mehta A, Mehta R, Melandri M, Mené P, Meng T, Menne J, Merritt K, Merscher S, Meshykhi C, Messa P, Messinger L, Miftari N, Miller R, Miller Y, Miller-Hodges E, Minatoguchi M, Miners M, Minutolo R, Mita T, Miura Y, Miyaji M, Miyamoto S, Miyatsuka T, Miyazaki M, Miyazawa I, Mizumachi R, Mizuno M, Moffat S, Mohamad Nor FS, Mohamad Zaini SN, Mohamed Affandi FA, Mohandas C, Mohd R, Mohd Fauzi NA, Mohd Sharif NH, Mohd Yusoff Y, Moist L, Moncada A, Montasser M, Moon A, Moran C, Morgan N, Moriarty J, Morig G, Morinaga H, Morino K, Morisaki T, Morishita Y, Morlok S, Morris A, Morris F, Mostafa S, Mostefai Y, Motegi M, Motherwell N, Motta D, Mottl A, Moys R, Mozaffari S, Muir J, Mulhern J, Mulligan S, Munakata Y, Murakami C, Murakoshi M, Murawska A, Murphy K, Murphy L, Murray S, Murtagh H, Musa MA, Mushahar L, Mustafa R, Mustafar R, Muto M, Nadar E, Nagano R, Nagasawa T, Nagashima E, Nagasu H, Nagelberg S, Nair H, Nakagawa Y, Nakahara M, Nakamura J, Nakamura R, Nakamura T, Nakaoka M, Nakashima E, Nakata J, Nakata M, Nakatani S, Nakatsuka A, Nakayama Y, Nakhoul G, Nangaku M, Naverrete G, Navivala A, Nazeer I, Negrea L, Nethaji C, Newman E, Ng SYA, Ng TJ, Ngu LLS, Nimbkar T, Nishi H, Nishi M, Nishi S, Nishida Y, Nishiyama A, Niu J, Niu P, Nobili G, Nohara N, Nojima I, Nolan J, Nosseir H, Nozawa M, Nunn M, Nunokawa S, Oda M, Oe M, Oe Y, Ogane K, Ogawa W, Ogihara T, Oguchi G, Ohsugi M, Oishi K, Okada Y, Okajyo J, Okamoto S, Okamura K, Olufuwa O, Oluyombo R, Omata A, Omori Y, Ong LM, Ong YC, Onyema J, Oomatia A, Oommen A, Oremus R, Orimo Y, Ortalda V, Osaki Y, Osawa Y, Osmond Foster J, O'Sullivan A, Otani T, Othman N, Otomo S, O'Toole J, Owen L, Ozawa T, Padiyar A, Page N, Pajak S, Paliege A, Pandey A, Pandey R, Pariani H, Park J, Parrigon M, Passauer J, Patecki M, Patel M, Patel R, Patel T, Patel Z, Paul R, Paul R, Paulsen L, Pavone L, Peixoto A, Peji J, Peng BC, Peng K, Pennino L, Pereira E, Perez E, Pergola P, Pesce F, Pessolano G, Petchey W, Petr EJ, Pfab T, Phelan P, Phillips R, Phillips T, Phipps M, Piccinni G, Pickett T, Pickworth S, Piemontese M, Pinto D, Piper J, Plummer-Morgan J, Poehler D, Polese L, Poma V, Pontremoli R, Postal A, Pötz C, Power A, Pradhan N, Pradhan R, Preiss D, Preiss E, Preston K, Prib N, Price L, Provenzano C, Pugay C, Pulido R, Putz F, Qiao Y, Quartagno R, Quashie-Akponeware M, Rabara R, Rabasa-Lhoret R, Radhakrishnan D, Radley M, Raff R, Raguwaran S, Rahbari-Oskoui F, Rahman M, Rahmat K, Ramadoss S, Ramanaidu S, Ramasamy S, Ramli R, Ramli S, Ramsey T, Rankin A, Rashidi A, Raymond L, Razali WAFA, Read K, Reiner H, Reisler A, Reith C, Renner J, Rettenmaier B, Richmond L, Rijos D, Rivera R, Rivers V, Robinson H, Rocco M, Rodriguez-Bachiller I, Rodriquez R, Roesch C, Roesch J, Rogers J, Rohnstock M, Rolfsmeier S, Roman M, Romo A, Rosati A, Rosenberg S, Ross T, Rossello X, Roura M, Roussel M, Rovner S, Roy S, Rucker S, Rump L, Ruocco M, Ruse S, Russo F, Russo M, Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, 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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Xu L, Liu T, Chung K, Pyle AM. Structural insights into intron catalysis and dynamics during splicing. Nature 2023; 624:682-688. [PMID: 37993708 PMCID: PMC10733145 DOI: 10.1038/s41586-023-06746-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/13/2023] [Indexed: 11/24/2023]
Abstract
The group II intron ribonucleoprotein is an archetypal splicing system with numerous mechanistic parallels to the spliceosome, including excision of lariat introns1,2. Despite the importance of branching in RNA metabolism, structural understanding of this process has remained elusive. Here we present a comprehensive analysis of three single-particle cryogenic electron microscopy structures captured along the splicing pathway. They reveal the network of molecular interactions that specifies the branchpoint adenosine and positions key functional groups to catalyse lariat formation and coordinate exon ligation. The structures also reveal conformational rearrangements of the branch helix and the mechanism of splice site exchange that facilitate the transition from branching to ligation. These findings shed light on the evolution of splicing and highlight the conservation of structural components, catalytic mechanism and dynamical strategies retained through time in premessenger RNA splicing machines.
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Affiliation(s)
- Ling Xu
- Howard Hughes Medical Institute, Chevy Chase, MD, USA.
- Department of Molecular, Cellular and Developmental Biology, Yale University, New Haven, CT, USA.
| | - Tianshuo Liu
- Department of Molecular, Cellular and Developmental Biology, Yale University, New Haven, CT, USA
| | - Kevin Chung
- Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, CT, USA
| | - Anna Marie Pyle
- Howard Hughes Medical Institute, Chevy Chase, MD, USA.
- Department of Molecular, Cellular and Developmental Biology, Yale University, New Haven, CT, USA.
- Department of Chemistry, Yale University, New Haven, CT, USA.
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Shanholtz CB, Terrin ML, Harrington T, Chan C, Warren W, Walter R, Armstrong F, Marshall J, Scheraga R, Duggal A, Formanek P, Baram M, Afshar M, Marchetti N, Singla S, Reilly J, Knox D, Puri N, Chung K, Brown CH, Hasday JD. Design and rationale of the CHILL phase II trial of hypothermia and neuromuscular blockade for acute respiratory distress syndrome. Contemp Clin Trials Commun 2023; 33:101155. [PMID: 37228902 PMCID: PMC10191700 DOI: 10.1016/j.conctc.2023.101155] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 05/08/2023] [Accepted: 05/14/2023] [Indexed: 05/27/2023] Open
Abstract
The Cooling to Help Injured Lungs (CHILL) trial is an open label, two group, parallel design multicenter, randomized phase IIB clinical trial assessing the efficacy and safety of targeted temperature management with combined external cooling and neuromuscular blockade to block shivering in patients with early moderate-severe acute respiratory distress syndrome (ARDS). This report provides the background and rationale for the clinical trial and outlines the methods using the Consolidated Standards of Reporting Trials guidelines. Key design challenges include: [1] protocolizing important co-interventions; [2] incorporation of patients with COVID-19 as the cause of ARDS; [3] inability to blind the investigators; and [4] ability to obtain timely informed consent from patients or legally authorized representatives early in the disease process. Results of the Reevaluation of Systemic Early Neuromuscular Blockade (ROSE) trial informed the decision to mandate sedation and neuromuscular blockade only in the group assigned to therapeutic hypothermia and proceed without this mandate in the control group assigned to a usual temperature management protocol. Previous trials conducted in National Heart, Lung, and Blood Institute ARDS Clinical Trials (ARDSNet) and Prevention and Early Treatment of Acute Lung Injury (PETAL) Networks informed ventilator management, ventilation liberation and fluid management protocols. Since ARDS due to COVID-19 is a common cause of ARDS during pandemic surges and shares many features with ARDS from other causes, patients with ARDS due to COVID-19 are included. Finally, a stepwise approach to obtaining informed consent prior to documenting critical hypoxemia was adopted to facilitate enrollment and reduce the number of candidates excluded because eligibility time window expiration.
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Affiliation(s)
- Carl B. Shanholtz
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael L. Terrin
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Thelma Harrington
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Caleb Chan
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Whittney Warren
- Department of Pulmonary and Critical Care Medicine, Brooke Army Medical Center, San Antonio, TX, USA
| | - Robert Walter
- Department of Pulmonary and Critical Care Medicine, Brooke Army Medical Center, San Antonio, TX, USA
| | | | | | | | - Abjihit Duggal
- Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Perry Formanek
- Department of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Michael Baram
- Department of Medicine, Sidney Kimmel College of Medicine USA, Philadelphia, PA, USA
| | - Majid Afshar
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Nathaniel Marchetti
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Sunit Singla
- Division of Pulmonary, Critical Care, Sleep, and Allergy Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - John Reilly
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Dan Knox
- Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT, USA
| | - Nitin Puri
- Division of Critical Care, Cooper University Health Care, USA
| | - Kevin Chung
- Department of Medicine, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Clayton H. Brown
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jeffrey D. Hasday
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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Avram R, Barrios JP, Abreau S, Goh CY, Ahmed Z, Chung K, So DY, Olgin JE, Tison GH. Automated Assessment of Cardiac Systolic Function From Coronary Angiograms With Video-Based Artificial Intelligence Algorithms. JAMA Cardiol 2023; 8:586-594. [PMID: 37163297 PMCID: PMC10267763 DOI: 10.1001/jamacardio.2023.0968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 03/20/2023] [Indexed: 05/11/2023]
Abstract
Importance Understanding left ventricular ejection fraction (LVEF) during coronary angiography can assist in disease management. Objective To develop an automated approach to predict LVEF from left coronary angiograms. Design, Setting, and Participants This was a cross-sectional study with external validation using patient data from December 12, 2012, to December 31, 2019, from the University of California, San Francisco (UCSF). Data were randomly split into training, development, and test data sets. External validation data were obtained from the University of Ottawa Heart Institute. Included in the analysis were all patients 18 years or older who received a coronary angiogram and transthoracic echocardiogram (TTE) within 3 months before or 1 month after the angiogram. Exposure A video-based deep neural network (DNN) called CathEF was used to discriminate (binary) reduced LVEF (≤40%) and to predict (continuous) LVEF percentage from standard angiogram videos of the left coronary artery. Guided class-discriminative gradient class activation mapping (GradCAM) was applied to visualize pixels in angiograms that contributed most to DNN LVEF prediction. Results A total of 4042 adult angiograms with corresponding TTE LVEF from 3679 UCSF patients were included in the analysis. Mean (SD) patient age was 64.3 (13.3) years, and 2212 patients were male (65%). In the UCSF test data set (n = 813), the video-based DNN discriminated (binary) reduced LVEF (≤40%) with an area under the receiver operating characteristic curve (AUROC) of 0.911 (95% CI, 0.887-0.934); diagnostic odds ratio for reduced LVEF was 22.7 (95% CI, 14.0-37.0). DNN-predicted continuous LVEF had a mean absolute error (MAE) of 8.5% (95% CI, 8.1%-9.0%) compared with TTE LVEF. Although DNN-predicted continuous LVEF differed 5% or less compared with TTE LVEF in 38.0% (309 of 813) of test data set studies, differences greater than 15% were observed in 15.2% (124 of 813). In external validation (n = 776), video-based DNN discriminated (binary) reduced LVEF (≤40%) with an AUROC of 0.906 (95% CI, 0.881-0.931), and DNN-predicted continuous LVEF had an MAE of 7.0% (95% CI, 6.6%-7.4%). Video-based DNN tended to overestimate low LVEFs and underestimate high LVEFs. Video-based DNN performance was consistent across sex, body mass index, low estimated glomerular filtration rate (≤45), presence of acute coronary syndromes, obstructive coronary artery disease, and left ventricular hypertrophy. Conclusion and relevance This cross-sectional study represents an early demonstration of estimating LVEF from standard angiogram videos of the left coronary artery using video-based DNNs. Further research can improve accuracy and reduce the variability of DNNs to maximize their clinical utility.
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Affiliation(s)
- Robert Avram
- Division of Cardiology, Department of Medicine, University of California, San Francisco, Cardiology, San Francisco
- Division of Cardiology, Department of Medicine, Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
- Division of Cardiology, Department of Medicine, Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Joshua P. Barrios
- Division of Cardiology, Department of Medicine, University of California, San Francisco, Cardiology, San Francisco
- Cardiovascular Research Institute, University of California, San Francisco
| | - Sean Abreau
- Division of Cardiology, Department of Medicine, University of California, San Francisco, Cardiology, San Francisco
- Cardiovascular Research Institute, University of California, San Francisco
| | - Cheng Yee Goh
- Division of Cardiology, Department of Medicine, Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Zeeshan Ahmed
- Division of Cardiology, Department of Medicine, Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin Chung
- Division of Cardiology, Department of Medicine, Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Derek Y. So
- Division of Cardiology, Department of Medicine, Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey E. Olgin
- Division of Cardiology, Department of Medicine, University of California, San Francisco, Cardiology, San Francisco
- Cardiovascular Research Institute, University of California, San Francisco
| | - Geoffrey H. Tison
- Division of Cardiology, Department of Medicine, University of California, San Francisco, Cardiology, San Francisco
- Cardiovascular Research Institute, University of California, San Francisco
- Bakar Computational Health Sciences Institute, University of California, San Francisco
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9
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Chung K, Parker WF. A bridge to nowhere: The durable left ventricular assist device dilemma in the new heart allocation system. J Heart Lung Transplant 2023; 42:87-88. [PMID: 36437169 PMCID: PMC10792764 DOI: 10.1016/j.healun.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 10/12/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Kevin Chung
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - William F Parker
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois; Department of Public Health Sciences, University of Chicago, Chicago, Illinois; Department of Medicine, University of Chicago, Chicago, Illinois.
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10
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Roh M, Seo J, Kim J, Chung K. 459 Weight-bearing activity impairs nuclear membrane and genome integrity via YAP activation in plantar melanoma. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.473] [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: 11/19/2022]
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11
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Kim J, Chung K, Lee J, Kim J. 611 Transcriptomic differences between surgical and non-surgical keloids. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.628] [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: 11/19/2022]
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12
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Merks P, Kowalczuk A, Wong A, Chung K, Religioni U, Świetlik D, Rotmans-Plagens K, Cameron J, Sola KF, Kazmierczak J, Blicharska E, Vaillancourt R, Neumann-Podczaska A. Patient satisfaction with pharmacist-administered COVID-19 vaccines in Poland: a survey study in the vaccination centres context. BMC Health Serv Res 2022; 22:1339. [DOI: 10.1186/s12913-022-08720-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 10/23/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Since 2021, pharmacists in Poland have been authorised to administer vaccinations against COVID-19, which is of particular significance in the efforts towards preventing the spread of the pandemic. The primary objective of this study was to evaluate the patients’ satisfaction with delivering vaccinations through national vaccination centres.
Methods
This study was conducted in 2021. The research tool was an anonymous questionnaire distributed to patients after vaccination. The questionnaire was developed specifically for the purpose of the study. Ultimately, 628 patients participated in this study.
Results
Nearly 97% of the respondents agreed that the administration of vaccinations by pharmacists had been convenient, and pharmacists possessed the relevant skills to provide this service. Almost 90% of the respondents expressed their readiness to be vaccinated by pharmacists again. Nearly all the respondents indicated that pharmacists should also provide other vaccinations.
Conclusions
Patients in Poland have a positive attitude toward vaccinations administered by pharmacists in national vaccination centres.
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13
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Abstract
Group II introns are ribozymes that catalyze their self-excision and function as retroelements that invade DNA. As retrotransposons, group II introns form ribonucleoprotein (RNP) complexes that roam the genome, integrating by reversal of forward splicing. Here we show that retrotransposition is achieved by a tertiary complex between a structurally elaborate ribozyme, its protein mobility factor, and a structured DNA substrate. We solved cryo-electron microscopy structures of an intact group IIC intron-maturase retroelement that was poised for integration into a DNA stem-loop motif. By visualizing the RNP before and after DNA targeting, we show that it is primed for attack and fits perfectly with its DNA target. This study reveals design principles of a prototypical retroelement and reinforces the hypothesis that group II introns are ancient elements of genetic diversification.
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Affiliation(s)
- Kevin Chung
- Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, CT 06511, USA
| | - Ling Xu
- Department of Molecular, Cellular and Developmental Biology, Yale University, New Haven, CT 06511, USA.,Howard Hughes Medical Institute, Chevy Chase, MD 20815, USA
| | - Pengxin Chai
- Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, CT 06511, USA
| | - Junhui Peng
- Laboratory of Evolutionary Genetics and Genomics, The Rockefeller University, New York, NY 10065, USA
| | - Swapnil C Devarkar
- Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, CT 06511, USA
| | - Anna Marie Pyle
- Department of Molecular, Cellular and Developmental Biology, Yale University, New Haven, CT 06511, USA.,Howard Hughes Medical Institute, Chevy Chase, MD 20815, USA
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14
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Gillmore T, Jung RG, Moreland R, Di Santo P, Stotts C, Makwana D, Abdel-Razek O, Ahmed Z, Chung K, Parlow S, Simard T, Froeschl M, Labinaz M, Hibbert B. Impact of intracoronary assessments on revascularization decisions: A contemporary evaluation. Catheter Cardiovasc Interv 2022; 100:955-963. [PMID: 36259740 DOI: 10.1002/ccd.30417] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 09/06/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To investigate the real-world implementation of intracoronary assessment (ICA) techniques and evaluate their impact on clinical decisions regarding the management of coronary artery disease (CAD) in contemporary practice. BACKGROUND Coronary angiogram is the gold standard used to diagnose vessel stenosis and guide percutaneous coronary intervention (PCI); however, it is limited by its two-dimensional imaging capabilities. ICA techniques like intravascular ultrasound and optical coherence tomography capture the vessel in three-dimensional images. Comparatively, fractional flow reserve provides information on the physiologic significance of coronary stenosis. Both techniques may improve PCI outcomes if they routinely change physician behavior. METHODS Patients who underwent ICA between August 2015 and March 2020 were included in the study. The primary outcome was the clinical impact of ICA on physician clinical decision making of a stenotic vessel. The secondary outcome was the clinical changes that occurred following ICA. RESULTS A total of 1135 patients were included in the study. Physiologic assessment (PA) and image assessment (IA) were performed in 61.4% and 38.6% respectively. Management plans were changed in 38.1% and 23.9% of patients who received PA and IA. Over half of the management change resulted in physicians deciding to not intervene on the stenotic vessel. One-year outcome of these decisions showed no significant increase in major adverse cardiac events (hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.40-1.15; p = 0.15) or unplanned revascularization (HR, 0.78; 95% CI, 0.35-1.74; p = 0.55) suggesting reliance on PA/IA data did not increase risk. CONCLUSION Selected ICA alters physician management of CAD in one-third of patients being evaluated for revascularization-typically leading to fewer interventions. All cause death is numerally lower in patients that received a change in management. However, the 1-year outcome of these altered decisions does not appear to be significantly different.
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Affiliation(s)
- Taylor Gillmore
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Richard G Jung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Robert Moreland
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Pietro Di Santo
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Cameron Stotts
- Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Dwipen Makwana
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Omar Abdel-Razek
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Zeeshan Ahmed
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kevin Chung
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Simon Parlow
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Trevor Simard
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Michael Froeschl
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marino Labinaz
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Vascular Biology and Experimental Medicine Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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15
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Flynn K, Chung K, Brooke T, Keung J. Ectopic variceal bleeding from chronic superior mesenteric vein thrombosis after hemorrhagic pancreatitis. Clin Case Rep 2022; 10:e05731. [PMID: 35474995 PMCID: PMC9019875 DOI: 10.1002/ccr3.5731] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/16/2022] [Accepted: 03/07/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kathryn Flynn
- Internal Medicine Walter Reed National Military Medical Center Bethesda Maryland USA
| | - Kevin Chung
- Pulmonary and Critical Care Medicine Walter Reed National Military Medical Center Bethesda Maryland USA
| | - Thomas Brooke
- Internal Medicine Walter Reed National Military Medical Center Bethesda Maryland USA
| | - Jonathan Keung
- Interventional Radiology Walter Reed National Military Medical Center Bethesda Maryland USA
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16
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Drelich E, Religioni U, Chung K, Kaźmierczak J, Blicharska E, Neumann-Podczaska A, Krysiński J, Merks P. The Quality and Reliability of Information in the Summaries of Product Characteristics. Int J Environ Res Public Health 2022; 19:ijerph19042185. [PMID: 35206371 PMCID: PMC8872284 DOI: 10.3390/ijerph19042185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 02/04/2023]
Abstract
The Summary of Product Characteristics (SmPC) is an obligatory document concerning a medicine required (among other things) for the authorization of a medicinal product. The purpose of the SmPC is to provide product information to healthcare professionals. A necessary condition for this is to ensure that the SmPC is clear and precise. However, neither European nor national legislation obliges marketing authorization holders to review the SmPC in terms of its readability and understandability prior to the registration of a medicine. To date, research on SmPCs has focused on accuracy and completeness; however, the literature lacks information on the extent to which SmPCs meet the needs of healthcare professionals concerning the readability of the information they contain. The main objective of this article is to point out the lack of precision in the legal provisions for the preparation of SmPCs concerning the comprehensibility of the provisions. The article points to the lack of testing of the SmPC in terms of accessibility and transparency for healthcare professionals, highlighting that the document does not meet the needs of healthcare professionals in providing adequate information about medicines. It shows that the current rules and guidelines for the preparation of the registration dossier for a medicinal product are not entirely precise and contain numerous shortcomings.
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Affiliation(s)
- Ewelina Drelich
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, 85-067 Bydgoszcz, Poland; (E.D.); (J.K.)
| | - Urszula Religioni
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, 01-826 Warsaw, Poland
- Correspondence:
| | - Kevin Chung
- Children’s Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada;
| | - Justyna Kaźmierczak
- Zdrowit sp. z o.o., Pharmacy Chain, ul. Diamentowa 3, 41-940 Piekary Śląskie, Poland;
| | - Eliza Blicharska
- Department of Analytical Chemistry, Medical University of Lublin, Chodźki 4a, 20-093 Lublin, Poland;
| | | | - Jerzy Krysiński
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, 85-067 Bydgoszcz, Poland; (E.D.); (J.K.)
| | - Piotr Merks
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University in Warsaw, 01-938 Warsaw, Poland;
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17
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Chung K, Wong J, Cunha-Cruz J, Carsten D. Teledentistry: An Adjunct for Delivering Dental Care in Crises and Beyond. Compend Contin Educ Dent 2022; 43:108-112. [PMID: 35077192] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Teledentistry can play a viable role both during a public health emergency and in everyday practice, contributing to sustaining, building, and improving dental practices as well as addressing health inequities. In light of the COVID-19 pandemic, which has caused widespread disruptions in the delivery of dental care, Oregon Health and Science University (OHSU) and the University of Washington (UW) implemented virtual care programs to help mitigate challenges associated with access to care. This article outlines a practical workflow for dentists to embark on teledentistry.
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Affiliation(s)
- Kevin Chung
- Former General Practice Resident, Oregon Health and Science University, Portland, Oregon; Oral Medicine Fellow, University of Washington, Seattle, Washington
| | - Jacqueline Wong
- Clinical Instructor, Department of Oral Medicine, University of Washington School of Dentistry, Seattle, Washington; appointed Director for Teledentistry at the beginning of the pandemic
| | - Joana Cunha-Cruz
- Professor and Director of Practice-based and Community-based Research, Division of Behavioral and Population Sciences, School of Dentistry, University of Alabama at Birmingham
| | - David Carsten
- Assistant Professor in Hospital Dentistry, Oregon Health and Science University, Portland, Oregon; Fellow, Academy of Dentistry International; Fellow, American College of Dentists
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18
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Ran G, Chung K, Anderson AS, Gibbons RD, Narang N, Churpek MM, Parker WF. Between-center variation in high-priority listing status under the new heart allocation policy. Am J Transplant 2021; 21:3684-3693. [PMID: 33864733 PMCID: PMC8729112 DOI: 10.1111/ajt.16614] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/24/2021] [Accepted: 04/11/2021] [Indexed: 01/25/2023]
Abstract
Under the new US heart allocation policy, transplant centers listed significantly more candidates at high priority statuses (Status 1 and 2) with mechanical circulatory support devices than expected. We determined whether the practice change was widespread or concentrated among certain transplant centers. Using data from the Scientific Registry of Transplant Recipients, we used mixed-effect logistic regression to compare the observed listings of adult, heart-alone transplant candidates post-policy (December 2018 to February 2020) to seasonally matched pre-policy cohort (December 2016 to February 2018). US transplant centers (N = 96) listed similar number of candidates in each policy period (4472 vs. 4498) but listed significantly more at high priority status (25.5% vs. 7.0%, p < .001) than expected. Adjusted for candidate characteristics, 91 of 96 (94.8%) centers listed significantly more candidates at high-priority status than expected, with the unexpected increase varying from 4.8% to 50.4% (interquartile range [IQR]: 14.0%-23.3%). Centers in OPOs with highest Status 1A transplant rate pre-policy were significantly more likely to utilize high-priority status under the new policy (OR: 9.73, p = .01). The new heart allocation policy was associated with widespread and significantly variable changes in transplant center practice that may undermine the effectiveness of the new system.
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Affiliation(s)
- Gege Ran
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Kevin Chung
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | | | - Robert D. Gibbons
- Department of Medicine, University of Chicago, Chicago, Illinois,Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Nikhil Narang
- Department of Medicine, University of Illinois-Chicago, Chicago, Illinois, USA,Advocate Heart Institute, Advocate Christ Medical Center, Oak Lawn, Illinois
| | | | - William F. Parker
- Department of Medicine, University of Chicago, Chicago, Illinois,Department of Public Health Sciences, University of Chicago, Chicago, Illinois,MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois
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19
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Keller T, Wilson M, Chung K, Andrilla CHA, Evans DV, Cawse-Lucas J. Gender Differences in Authorship of Family Medicine Publications, 2002-2017. Fam Med 2021; 53:416-422. [PMID: 34077960 DOI: 10.22454/fammed.2021.866524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Representation of women in medicine is increasing, including in academic family medicine. Despite this, women continue to hold a minority of senior faculty and leadership roles. This study examines the trends of women first and senior authorship between 2002 and 2017 in five family medicine journals: Family Medicine, Journal of Family Practice, Journal of the American Board of Family Medicine, Annals of Family Medicine, and American Family Physician. The study also examines gender congruence between first and senior authors and women's membership on editorial boards. METHODS We collected and analyzed data on a total of 1,671 original articles published in the five family medicine journals in 2002, 2007, 2012, and 2017. We also examined the gender composition of the journals' editorial boards. RESULTS Overall, women first authorship increased significantly from 32.6% in 2002 to 47.7% in 2017. There was no significant difference in women senior authorship or editorial board representation from 2002 to 2017. Both men and women senior authors partnered with women first authors significantly more over the 15 years. CONCLUSIONS While there was a statistically significant increase in women first authors between 2002 and 2017, there is still a gap between women's authorship and editorial board representation and their representation within academic family medicine. These gaps could help to explain the continued lack of women represented within senior faculty positions.
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20
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Ahn DJ, Garg N, Naik AG, Fan J, Wei H, Song BB, Chung K, Vela MB, Kim KE. Where Do I Fit In? A Perspective on Challenges Faced by Asian American Medical Students. Health Equity 2021; 5:324-328. [PMID: 34036216 PMCID: PMC8140354 DOI: 10.1089/heq.2020.0158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 11/20/2022] Open
Abstract
Asian American medical students (AAMSs) face significant bias in the medical learning environment and are more likely than White students to perceive their school climate negatively. Little is known about the factors that contribute to AAMSs' negative experiences. This perspective aims to describe AAMSs' experiences with diversity and inclusion efforts using survey data from a midwest regional conference, Asians in Medicine: A Conference on Advocacy and Allyship. AAMS respondents reported feeling excluded from diversity and inclusion efforts and conference participants advocated for institutional culture and climate assessments stratified by race and disaggregated into Asian subgroups.
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Affiliation(s)
- Daniel J Ahn
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Namrata Garg
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Aaditi G Naik
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - James Fan
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Helen Wei
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Bonnie B Song
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Kevin Chung
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Monica B Vela
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Karen E Kim
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
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21
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Park S, Chung K, Cho H, Kim Y, Jhung K. Differential risk factors for prenatal and postpartum depression in South Korea. Eur Psychiatry 2021. [PMCID: PMC9480344 DOI: 10.1192/j.eurpsy.2021.1599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Incidence for depression increases during the perinatal period. Risk factors for depression may differentially affect each time period. Objectives To assess demographic, psychological and obstetric risk factors that differentially affect prenatal and postpartum depression Methods A total of 169 subjects participated. Assessment was conducted during the first trimester, second trimester, third trimester, within a month after childbirth, and a month after childbirth. Demographic and obstetric measures, as well as psychological measures, including the Edinburgh Postnatal Depression Scale were conducted. Multiple regression and the Mann-Whitney U test were performed to examine the association between variables and depression scores. Results Depression score was higher during the postpartum period than the prenatal period. Younger age was associated with depression during the first trimester. In the second trimester, less education, a history of depression and having stress within a year significantly affected depression scores. Smoking, artificial abortion and lack of support from family and parents correlated with depression during the third trimester. Within a month after childbirth, psychiatric and depression history, smoking, stress level within a year and lack of family support were associated with depression. At a month after childbirth, those who were primiparous and not breastfeeding had significantly higher depression scores. Conclusions This study identifies various risk factors for each gestational and postpartum period and suggests differential interventions for different perinatal periods.
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22
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Parker WF, Chung K, Anderson AS, Siegler M, Huang ES, Churpek MM. Practice Changes at U.S. Transplant Centers After the New Adult Heart Allocation Policy. J Am Coll Cardiol 2021; 75:2906-2916. [PMID: 32527399 DOI: 10.1016/j.jacc.2020.01.066] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND In October 2018, the U.S. heart allocation system expanded the number of priority "status" tiers from 3 to 6 and added cardiogenic shock requirements for some heart transplant candidates listed with specific types of treatments. OBJECTIVES This study sought to determine the impact of the new policy on the treatment practices of transplant centers. METHODS Initial listing data on all adult heart candidates listed from December 1, 2017 to April 30, 2019 were collected from the Scientific Registry of Transplant Recipients. The status-qualifying treatments (or exception requests) and hemodynamic values at listing of a post-policy cohort (December 2018 to April 2019) were compared with a seasonally matched pre-policy cohort (December 2017 to April 2018). Candidates in the pre-policy cohort were reclassified into the new priority system statuses by using treatment, diagnosis, and hemodynamics. RESULTS Comparing the post-policy cohort (N = 1,567) with the pre-policy cohort (N = 1,606), there were significant increases in listings with extracorporeal membrane oxygenation (+1.2%), intra-aortic balloon pumps (+ 4 %), and exceptions (+ 12%). Listings with low-dose inotropes (-18%) and high-dose inotropes (-3%) significantly decreased. The new priority status distribution had more status 2 (+14%) candidates than expected and fewer status 3 (-5%), status 4 (- 4%) and status 6 (-8%) candidates than expected (p values <0.01 for all comparisons). CONCLUSIONS After implementation of the new heart allocation policy, transplant centers listed more candidates with extracorporeal membrane oxygenation, intra-aortic balloon pumps, and exception requests and fewer candidates with inotrope therapy than expected, thus leading to significantly more high-priority status listings than anticipated. If these early trends persist, the new allocation system may not function as intended.
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Affiliation(s)
- William F Parker
- Department of Medicine, University of Chicago, Chicago, Illinois; MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois.
| | - Kevin Chung
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Allen S Anderson
- Department of Medicine, Northwestern University, Chicago Illinois
| | - Mark Siegler
- MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois
| | - Elbert S Huang
- Department of Medicine, University of Chicago, Chicago, Illinois; MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois
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23
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Laing E, Sterling S, Richard S, Epsi N, Phogat S, Samuels E, Yan L, Moreno N, Coles C, Drew M, Mehalko J, English C, Merritt S, Mende K, Chung K, Clifton G, Munster V, de Wit E, Tribble D, Agan B, Esposito D, Lanteri C, Mitre E, Burgess T, Broder C. A betacoronavirus multiplex microsphere immunoassay detects early SARS-CoV-2 seroconversion and antibody cross reactions. Res Sq 2020:rs.3.rs-105768. [PMID: 33269345 PMCID: PMC7709164 DOI: 10.21203/rs.3.rs-105768/v1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Sensitive and specific SARS-CoV-2 antibody assays remain critical for community and hospital-based SARS-CoV-2 surveillance. Here, we developed and applied a multiplex microsphere-based immunoassay (MMIA) for COVD-19 antibody studies that incorporates spike protein trimers of SARS-CoV-2, SARS-CoV-1, MERS-CoV, and the seasonal human betacoronaviruses, HCoV-HKU1 and HCoV-OC43, that enables measurement of off-target pre-existing cross-reactive antibodies. The MMIA performances characteristics are: 98% sensitive and 100% specific for human subject samples collected as early as 10 days from symptom onset. The MMIA permitted the simultaneous identification of SARS-CoV-2 seroconversion and the induction of SARS-CoV-2 IgG antibody cross reactions to SARS-CoV-1 and MERS-CoV. Further, synchronous increases of HCoV-OC43 IgG antibody levels was detected with SARS-CoV-2 seroconversion in a subset of subjects for whom early infection sera were available prior to their SARS-CoV-2 seroconversion, suggestive of an HCoV-OC43 memory response triggered by SARS-CoV-2 infection.
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Affiliation(s)
| | | | | | - Nusrat Epsi
- Uniformed Services University/Henry M. Jackson Foundation
| | | | - Emily Samuels
- Uniformed Services University/Henry M. Jackson Foundation
| | - Lianying Yan
- Uniformed Services University of the Health Sciences
| | - Nicole Moreno
- Uniformed Services University/Henry M. Jackson Foundation
| | | | - Matthew Drew
- Frederick National Laboratory for Cancer Research
| | | | | | - Scott Merritt
- Uniformed Services University/Henry M. Jackson Foundation/Brooke Army Medical Center
| | - Katrin Mende
- Uniformed Services University/Henry M. Jackson Foundation/Brooke Army Medical Center
| | | | | | | | - Emmie de Wit
- National Institute of Allergy and Infectious Diseases
| | | | - Brian Agan
- Uniformed Services University/Henry M. Jackson Foundation
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Hightower S, Ellis H, Collen J, Ellis J, Grasso I, Roswarski J, Cap AP, Chung K, Prescher L, Kavanaugh M, Brown T, Nau M, Clark P. Correlation of indirect markers of hypercoagulability with thromboelastography in severe coronavirus 2019. Thromb Res 2020; 195:69-71. [PMID: 32659463 PMCID: PMC7346789 DOI: 10.1016/j.thromres.2020.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/11/2020] [Accepted: 07/06/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Stephanie Hightower
- Department of Pulmonary, Critical Care and Sleep Medicine, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA
| | - Harvey Ellis
- Department of Cardiothoracic Surgery, Walter Reed National Military Medical Center, USA
| | - Jacob Collen
- Department of Pulmonary, Critical Care and Sleep Medicine, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA; Department of Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - John Ellis
- Department of Pulmonary, Critical Care and Sleep Medicine, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA
| | - Ian Grasso
- Department of Pulmonary, Critical Care and Sleep Medicine, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA
| | - Joseph Roswarski
- Department of Hematology and Oncology, Walter Reed National Military Medical Center, USA
| | - Andrew P Cap
- US Army Institute of Surgical Research and Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA-Fort Sam Houston, TX 78234, USA
| | - Kevin Chung
- Department of Pulmonary, Critical Care and Sleep Medicine, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA; Department of Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Lindsey Prescher
- Department of Cardiothoracic Surgery, Walter Reed National Military Medical Center, USA
| | - Michael Kavanaugh
- Department of Infectious Disease, Walter Reed National Military Medical Center, USA
| | - Tara Brown
- Department of Pulmonary, Critical Care and Sleep Medicine, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA
| | - Mark Nau
- Department of Pulmonary, Critical Care and Sleep Medicine, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA
| | - Paul Clark
- Department of Pulmonary, Critical Care and Sleep Medicine, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA
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Thakur A, Mallory H, Chung K, Vallabhaneni D, Dharmasiri U, Legmann R. Oncolytic virus scalability affinity chromatography process. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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26
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Xiang L, Calderon A, Hinojosa-Laborde C, Ryan K, Hudson I, Klemcke H, Chung K. Extremity trauma impairs renal tolerance to hemorrhage. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.04463] [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: 11/11/2022]
Affiliation(s)
| | | | | | - Kathy Ryan
- U.S. Army Institute of Surgical Research
| | - Ian Hudson
- U.S. Army Institute of Surgical Research
| | | | - Kevin Chung
- Uniformed Services University of the Health Sciences
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27
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Affiliation(s)
- Eric Elster
- Department of Surgery, Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, MD.
| | - Benjamin K Potter
- Department of Surgery, Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, MD
| | - Kevin Chung
- Department of Medicine, Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, MD
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28
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Dado D, Basel A, Ainsworth C, Chung K, Thomas S, Batchinsky A, Morrow B, Sams V, Piper L. 1397: OUTCOMES AMONG PATIENTS TREATED WITH RENAL REPLACEMENT THERAPY DURING ECMO. Crit Care Med 2020. [DOI: 10.1097/01.ccm.0000645504.46781.dc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Thomas S, Woo I, Ho J, Jones T, Paulson R, Chung K, Bendikson K. Ovulation rates in a stair-step protocol with Letrozole vs clomiphene citrate in patients with polycystic ovarian syndrome. Contracept Reprod Med 2019; 4:20. [PMID: 31867117 PMCID: PMC6900839 DOI: 10.1186/s40834-019-0102-4] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 10/22/2019] [Indexed: 01/20/2023] Open
Abstract
Purpose To compare ovulation rates between Letrozole and Clomiphene Citrate (CC) using a stair-step protocol to achieve ovulation induction in women with Polycystic Ovarian Syndrome (PCOS). Methods This is a retrospective cohort of predominantly Hispanic PCOS women of reproductive age who completed ovulation induction (OI) comparing women who underwent Letrozole stair-step protocol to those who underwent OI with CC stair-step. All women had a diagnosis of PCOS based on the 2003 Rotterdam criteria. For both protocols, sequentially higher doses of Letrozole or CC were given 7 days after the last dose if no dominant follicles were seen on ultrasonography. The primary outcome was ovulation rate (determined by presence of a dominant follicle) between the two treatment groups. Secondary outcomes included time to ovulation, clinical pregnancy rates and side effects. Results 49 PCOS patients completed a Letrozole stair-step cycle and 43 completed a CC stair-step cycle for OI. Overall, demographics were comparable between both groups. Ovulation rates with the Letrozole stair-step protocol were equivalent to CC stair-step protocol (96% vs 88%, p = 0.17). Although the mean time (days) to ovulation was shorter in the Letrozole group (19.5 vs 23.1, p = 0.027), the pregnancy rates were similar for both groups. Conclusions This is the first study to date that has compared the efficacy of the stair-step protocol in PCOS patients using Letrozole and CC. Both Letrozole and CC can be prescribed in a stair-step fashion. Letrozole stair-step was as efficacious as CC stair-step; patients achieved comparable rates of ovulation and clinical pregnancy. Time to ovulation was shorter in the Letrozole protocol.
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Affiliation(s)
- S Thomas
- University of Southern California, 2020 Zonal Avenue, IRD 534, California, Los Angeles 90033 USA
| | - I Woo
- University of Southern California, 2020 Zonal Avenue, IRD 534, California, Los Angeles 90033 USA
| | - J Ho
- University of Southern California, 2020 Zonal Avenue, IRD 534, California, Los Angeles 90033 USA
| | - T Jones
- University of Southern California, 2020 Zonal Avenue, IRD 534, California, Los Angeles 90033 USA
| | - R Paulson
- University of Southern California, 2020 Zonal Avenue, IRD 534, California, Los Angeles 90033 USA
| | - K Chung
- University of Southern California, 2020 Zonal Avenue, IRD 534, California, Los Angeles 90033 USA
| | - K Bendikson
- University of Southern California, 2020 Zonal Avenue, IRD 534, California, Los Angeles 90033 USA
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30
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Luke J, Fong L, Chung K, Tolcher A, Kelly K, Hollebecque A, Le Tourneau C, Subbiah V, Tsai F, Kao S, Cassier P, Khasraw M, Allaire K, Fan F, Fang H, Patel M, Henner W, Hayflick J, McDevitt M, Barlesi F. Phase I study evaluating safety, pharmacokinetics (PK), pharmacodynamics, and preliminary efficacy of ABBV-428, first-in-class mesothelin (MSLN)-CD40 bispecific, in patients (pts) with advanced solid tumours. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz253.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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31
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Elzinga K, Chung K. Evolution of the Ring Concept for the Forearm and Its Implication on Treatment: From Galeazzi, Monteggia, Essex-Lopresti, and Darrach to the Current Era. J Hand Surg Asian Pac Vol 2019; 24:251-257. [PMID: 31438785 DOI: 10.1142/s2424835519300019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Geometrically, rings distribute their stress along their arc instead of concentrating at any one point. The forearm ring is composed of the radius, ulna, proximal radioulnar joint, and distal radioulnar joint. The annular ligament, interosseous membrane, and triangular fibrocartilage complex link and stabilize the ring. Injuries to the forearm occur along a continuum with recognized patterns of ring disruption, including Galeazzi, Monteggia, and Essex-Lopresti injuries. The Darrach procedure causes a disruption to the forearm ring and can lead to painful convergence between the radius and distal ulnar stump. Injuries to the forearm ring are unstable. Management of forearm injuries is centered on the restoration of the anatomy and stability of the forearm ring. Forearm ring injuries and their treatment are discussed in this article.
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Affiliation(s)
- Kate Elzinga
- Section of Plastic Surgery, University of Calgary, South Health Campus, Calgary, AB, Canada
| | - Kevin Chung
- Section of Plastic Surgery, The University of Michigan Health System, Ann Arbor, MI, USA
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32
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Saelices L, Nguyen BA, Chung K, Wang Y, Ortega A, Lee JH, Eisenberg DS. P3-161: AMYLOID SEEDING OF TRANSTHYRETIN CAUSED BY ATTR EX-VIVO FIBRILS AND ITS INHIBITION. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3190] [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: 10/25/2022]
Affiliation(s)
| | | | | | | | | | | | - David S. Eisenberg
- University of California Los Angeles; Los Angeles CA USA
- Howard Hughes Medical Institute; Los Angeles CA USA
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33
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Radford J, Kahl B, Hamadani M, Carlo-Stella C, O'Connor O, Ardeshna K, Feingold J, He S, Reid E, Solh M, Chung K, Heffner L, Ungar D, Caimi P. ANALYSIS OF EFFICACY AND SAFETY OF LONCASTUXIMAB TESIRINE (ADCT-402) BY DEMOGRAPHIC AND CLINICAL CHARACTERISTICS IN RELAPSED/REFRACTORY DIFFUSE LARGE B-CELL LYMPHOMA. Hematol Oncol 2019. [DOI: 10.1002/hon.60_2629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- J. Radford
- Department of Medical Oncology; University of Manchester and The Christie NHS Foundation Trust; Manchester United Kingdom
| | - B. Kahl
- Department of Medicine; Oncology Division, Washington University in St. Louis; St. Louis MO United States
| | - M. Hamadani
- Division of Hematology and Oncology; Medical College of Wisconsin; Milwaukee WI United States
| | - C. Carlo-Stella
- Department of Oncology and Hematology; Humanitas Cancer Center, Humanitas University; Milan Italy
| | - O.A. O'Connor
- Center for Lymphoid Malignancies; NewYork-Presbyterian/Columbia University Irving Medical Center; New York United States
| | - K.M. Ardeshna
- Department of Haematology; University College London Hospitals NHS Foundation Trust; London United Kingdom
| | - J. Feingold
- Clinical Development; ADC Therapeutics; Murray Hill NJ United States
| | - S. He
- Clinical Development; ADC Therapeutics; Murray Hill NJ United States
| | - E. Reid
- Division of Hematology/Oncology; University of California San Diego Health Moores Cancer Center; La Jolla CA United States
| | - M. Solh
- Blood and Marrow Transplant Program; Northside Hospital; Atlanta GA United States
| | - K. Chung
- Department of Hematology and Oncology; Greenville Health System; Greenville SC United States
| | - L. Heffner
- Department of Haematology and Medical Oncology; Winship Cancer Institute, Emory University; Atlanta GA United States
| | - D. Ungar
- Clinical Development; ADC Therapeutics; Murray Hill NJ United States
| | - P. Caimi
- University Hospitals Cleveland Medical Center; Case Western Reserve University (CWRU); Cleveland OH United States
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34
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Cannon J, Pamplin J, Zonies D, Mason P, Sine C, Cancio L, McNeill J, Colombo C, Osborn E, Ricca R, Allan P, DellaVolpe J, Chung K, Stockinger Z. Acute Respiratory Failure. Mil Med 2019; 183:123-129. [PMID: 30189088 DOI: 10.1093/milmed/usy151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Indexed: 11/12/2022] Open
Abstract
Acute respiratory distress syndrome (ARDS) is a condition affecting critically ill patients, characterized by pulmonary inflammation and defects in oxygenation due to either direct or indirect injury to the lungs. These guidelines will define the diagnosis and management of ARDS, particularly among combat casualties and patients in the deployed environment. The cornerstone of management of ARDS involves maintaining adequate oxygenation while avoiding further pulmonary injury through lung-protective ventilation. Additional strategies for advanced respiratory failure, such as prone positioning, neuromuscular blockade, and extracorporeal membrane oxygenation will be reviewed here as well. Particularly important to the care of the patient with ARDS in the deployed environment is a familiarity with the challenges and indications for transport/aeromedical evacuation.
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Affiliation(s)
- Jeremy Cannon
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
| | - Jeremy Pamplin
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
| | - David Zonies
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
| | - Phillip Mason
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
| | - Christy Sine
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
| | - Leopoldo Cancio
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
| | - Jeffrey McNeill
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
| | - Christopher Colombo
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
| | - Erik Osborn
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
| | - Robert Ricca
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
| | - Patrick Allan
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
| | - Jeff DellaVolpe
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
| | - Kevin Chung
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
| | - Zsolt Stockinger
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
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35
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Mandelbaum R, Matsuo K, Awadalla M, Shoupe D, Chung K. Risk of ovarian torsion in patients with ovarian hyperstimulation syndrome. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.02.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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36
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Mandelbaum R, Adams C, Shoupe D, Chung K, Roman L, Matsuo K. Utilization and outcomes of ovarian conservation at the time of hysterectomy for cervical cancer. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.02.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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37
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Thomas S, Rhodes-Long K, Bendikson K, Chung K, Paulson R, McGinnis L, Ahmady A. Examining the effects of temperature on embryo growth. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.02.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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38
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Saelices L, Nguyen BA, Chung K, Wang Y, Ortega A, Lee JH, Coelho T, Bijzet J, Benson MD, Eisenberg DS. A pair of peptides inhibits seeding of the hormone transporter transthyretin into amyloid fibrils. J Biol Chem 2019; 294:6130-6141. [PMID: 30733338 DOI: 10.1074/jbc.ra118.005257] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 01/22/2019] [Indexed: 11/06/2022] Open
Abstract
The tetrameric protein transthyretin is a transporter of retinol and thyroxine in blood, cerebrospinal fluid, and the eye, and is secreted by the liver, choroid plexus, and retinal epithelium, respectively. Systemic amyloid deposition of aggregated transthyretin causes hereditary and sporadic amyloidoses. A common treatment of patients with hereditary transthyretin amyloidosis is liver transplantation. However, this procedure, which replaces the patient's variant transthyretin with the WT protein, can fail to stop subsequent cardiac deposition, ultimately requiring heart transplantation. We recently showed that preformed amyloid fibrils present in the heart at the time of surgery can template or seed further amyloid aggregation of native transthyretin. Here we assess possible interventions to halt this seeding, using biochemical and EM assays. We found that chemical or mutational stabilization of the transthyretin tetramer does not hinder amyloid seeding. In contrast, binding of the peptide inhibitor TabFH2 to ex vivo fibrils efficiently inhibits amyloid seeding by impeding self-association of the amyloid-driving strands F and H in a tissue-independent manner. Our findings point to inhibition of amyloid seeding by peptide inhibitors as a potential therapeutic approach.
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Affiliation(s)
- Lorena Saelices
- From the Departments of Biological Chemistry and Chemistry and Biochemistry, Howard Hughes Medical Institute, UCLA-DOE Institute, Molecular Biology Institute, UCLA, Los Angeles, California 90095-1570
| | - Binh A Nguyen
- From the Departments of Biological Chemistry and Chemistry and Biochemistry, Howard Hughes Medical Institute, UCLA-DOE Institute, Molecular Biology Institute, UCLA, Los Angeles, California 90095-1570
| | - Kevin Chung
- From the Departments of Biological Chemistry and Chemistry and Biochemistry, Howard Hughes Medical Institute, UCLA-DOE Institute, Molecular Biology Institute, UCLA, Los Angeles, California 90095-1570
| | - Yifei Wang
- From the Departments of Biological Chemistry and Chemistry and Biochemistry, Howard Hughes Medical Institute, UCLA-DOE Institute, Molecular Biology Institute, UCLA, Los Angeles, California 90095-1570
| | - Alfredo Ortega
- From the Departments of Biological Chemistry and Chemistry and Biochemistry, Howard Hughes Medical Institute, UCLA-DOE Institute, Molecular Biology Institute, UCLA, Los Angeles, California 90095-1570
| | - Ji H Lee
- From the Departments of Biological Chemistry and Chemistry and Biochemistry, Howard Hughes Medical Institute, UCLA-DOE Institute, Molecular Biology Institute, UCLA, Los Angeles, California 90095-1570
| | - Teresa Coelho
- the Neurophysiology Department and Corino de Andrade Unit, Hospital Santo António, Centro Hospitalar do Porto, Porto 4099-001, Portugal
| | - Johan Bijzet
- the Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, 9713 GZ, The Netherlands
| | - Merrill D Benson
- the Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202
| | - David S Eisenberg
- From the Departments of Biological Chemistry and Chemistry and Biochemistry, Howard Hughes Medical Institute, UCLA-DOE Institute, Molecular Biology Institute, UCLA, Los Angeles, California 90095-1570.
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39
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Qiu W, Kuang H, Nair J, Assis Z, Najm M, McDougall C, McDougall B, Chung K, Wilson AT, Goyal M, Hill MD, Demchuk AM, Menon BK. Radiomics-Based Intracranial Thrombus Features on CT and CTA Predict Recanalization with Intravenous Alteplase in Patients with Acute Ischemic Stroke. AJNR Am J Neuroradiol 2018; 40:39-44. [PMID: 30573458 DOI: 10.3174/ajnr.a5918] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/21/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Thrombus characteristics identified on non-contrast CT (NCCT) are potentially associated with recanalization with intravenous (IV) alteplase in patients with acute ischemic stroke (AIS). Our aim was to determine the best radiomics-based features of thrombus on NCCT and CT angiography associated with recanalization with IV alteplase in AIS patients and proximal intracranial thrombi. MATERIALS AND METHODS With a nested case-control design, 67 patients with ICA/M1 MCA segment thrombus treated with IV alteplase were included in this analysis. Three hundred twenty-six radiomics features were extracted from each thrombus on both NCCT and CTA images. Linear discriminative analysis was applied to select features most strongly associated with early recanalization with IV alteplase. These features were then used to train a linear support vector machine classifier. Ten times 5-fold cross-validation was used to evaluate the accuracy of the trained classifier and the stability of the selected features. RESULTS Receiver operating characteristic curves showed that thrombus radiomics features are predictive of early recanalization with IV alteplase. The combination of radiomics features from NCCT, CTA, and radiomics changes is best associated with early recanalization with IV alteplase (area under the curve = 0.85) and was significantly better than any single feature such as thrombus length (P < .001), volume (P < .001), and permeability as measured by mean attenuation increase (P < .001), maximum attenuation in CTA (P < .001), maximum attenuation increase (P < .001), and assessment of residual flow grade (P < .001). CONCLUSIONS Thrombus radiomics features derived from NCCT and CTA are more predictive of recanalization with IV alteplase in patients with acute ischemic stroke with proximal occlusion than previously known thrombus imaging features such as length, volume, and permeability.
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Affiliation(s)
- W Qiu
- From the Departments of Clinical Neurosciences (W.Q., H.K., J.N., Z.A. M.N., C.M., A.T.W., B.M., M.G., M.D.H., A.M.D., B.K.M.)
| | - H Kuang
- From the Departments of Clinical Neurosciences (W.Q., H.K., J.N., Z.A. M.N., C.M., A.T.W., B.M., M.G., M.D.H., A.M.D., B.K.M.)
| | - J Nair
- From the Departments of Clinical Neurosciences (W.Q., H.K., J.N., Z.A. M.N., C.M., A.T.W., B.M., M.G., M.D.H., A.M.D., B.K.M.).,Department of Radiology (J.N.), McMaster University, Hamilton, Ontario, Canada
| | - Z Assis
- From the Departments of Clinical Neurosciences (W.Q., H.K., J.N., Z.A. M.N., C.M., A.T.W., B.M., M.G., M.D.H., A.M.D., B.K.M.)
| | - M Najm
- From the Departments of Clinical Neurosciences (W.Q., H.K., J.N., Z.A. M.N., C.M., A.T.W., B.M., M.G., M.D.H., A.M.D., B.K.M.)
| | - C McDougall
- From the Departments of Clinical Neurosciences (W.Q., H.K., J.N., Z.A. M.N., C.M., A.T.W., B.M., M.G., M.D.H., A.M.D., B.K.M.)
| | - B McDougall
- From the Departments of Clinical Neurosciences (W.Q., H.K., J.N., Z.A. M.N., C.M., A.T.W., B.M., M.G., M.D.H., A.M.D., B.K.M.)
| | - K Chung
- Calgary Stroke Program, Mechanical and Manufacturing Engineering (K.C.)
| | - A T Wilson
- From the Departments of Clinical Neurosciences (W.Q., H.K., J.N., Z.A. M.N., C.M., A.T.W., B.M., M.G., M.D.H., A.M.D., B.K.M.)
| | - M Goyal
- From the Departments of Clinical Neurosciences (W.Q., H.K., J.N., Z.A. M.N., C.M., A.T.W., B.M., M.G., M.D.H., A.M.D., B.K.M.).,Radiology (M.D.H., A.M.D., M.G., B.K.M.).,Hotchkiss Brain Institute (M.D.H., A.M.D., M.G., B.K.M.), Calgary, Alberta, Canada
| | - M D Hill
- From the Departments of Clinical Neurosciences (W.Q., H.K., J.N., Z.A. M.N., C.M., A.T.W., B.M., M.G., M.D.H., A.M.D., B.K.M.).,Radiology (M.D.H., A.M.D., M.G., B.K.M.).,Community Health Sciences (M.D.H., B.K.M.), University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute (M.D.H., A.M.D., M.G., B.K.M.), Calgary, Alberta, Canada
| | - A M Demchuk
- From the Departments of Clinical Neurosciences (W.Q., H.K., J.N., Z.A. M.N., C.M., A.T.W., B.M., M.G., M.D.H., A.M.D., B.K.M.).,Radiology (M.D.H., A.M.D., M.G., B.K.M.).,Hotchkiss Brain Institute (M.D.H., A.M.D., M.G., B.K.M.), Calgary, Alberta, Canada
| | - B K Menon
- From the Departments of Clinical Neurosciences (W.Q., H.K., J.N., Z.A. M.N., C.M., A.T.W., B.M., M.G., M.D.H., A.M.D., B.K.M.) .,Radiology (M.D.H., A.M.D., M.G., B.K.M.).,Community Health Sciences (M.D.H., B.K.M.), University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute (M.D.H., A.M.D., M.G., B.K.M.), Calgary, Alberta, Canada
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Joo Y, Lee H, Lee S, Parahipta D, Kang D, Chung K, Kim D, Kim S. PSXIII-42 Effects of alkaloid rich potato by-product on in vitro rumen digestibility and fermentation characteristics. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Y Joo
- Gyeongsang National University,Jinju, South Korea
| | - H Lee
- Gyeongsang National University,Jinju, South Korea
| | - S Lee
- Gyeongsang National University,Jinju, South Korea
| | - D Parahipta
- Gyeongsang National University,Jinju, South Korea
| | - D Kang
- Hanwoo Research Institute,Pyeongchang, South Korea
| | - K Chung
- Hanwoo Research Institute,Pyeongchang, South Korea
| | - D Kim
- University of Florida,Gainesville, FL, United States
| | - S Kim
- Gyeongsang National University,Jinju, South Korea
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Chung K, Chang S, Yang S, Hwang S, Kang D, Park B, Kwon E. PSXV-28 α-solanine induces myogenesis of bovine satellite cells but does not affect adipogenesis of adipocytes. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.526] [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: 11/14/2022] Open
Affiliation(s)
- K Chung
- Hanwoo Research Institute,Pyeongchang, South Korea
| | - S Chang
- Hanwoo Research Institute,Pyeongchang, South Korea
| | - S Yang
- Hanwoo Research Institute,Pyeongchang, South Korea
| | - S Hwang
- Hanwoo Research Institute,Pyeongchang, South Korea
| | - D Kang
- Hanwoo Research Institute,Pyeongchang, South Korea
| | - B Park
- Hanwoo Research Institute,Pyeongchang, South Korea
| | - E Kwon
- Hanwoo Research Institute,Pyeongchang, South Korea
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Gajaweera C, Chung K, Cho S, Lee S. 346 Assessment of carcass and meat quality of Longissimus dorsi and semimembranosus muscle with Korean meat quality grading standards. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Gajaweera
- Division of Animal and Dairy Science, Chungnam National University,Daejeon, Republic of Korea/ Department of Animal Science, Faculty of Agriculture, University of Ruhuna,Sri Lanka, Mapalana, Kamburupitiya, Sri Lanka
| | - K Chung
- Hanwoo Experiment Station, National Institute of Animal Science, RDA,Pyeong-Chang, Republic of Korea, Mapalana, Kamburupitiya, Sri Lanka
| | - S Cho
- Division of Animal Production, National Institute of animal Science, RDA,Wanju, Republic of Korea, Mapalana, Kamburupitiya, Sri Lanka
| | - S Lee
- Division of Animal and Dairy Science, Chungnam National University,Daejeon, Republic of Korea, Mapalana, Kamburupitiya, Sri Lanka
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Rahmanian S, Chung K, Kokozian C, Knighten M, Flores J, Alcantara M. EDUCATING LATINO TERMINALLY-ILL PATIENTS USING SPANISH-LANGUAGE HOSPICE VIDEO: INCREASING HOSPICE ENROLLMENT. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2436] [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: 11/12/2022] Open
Affiliation(s)
- S Rahmanian
- University of California, Los Angeles (UCLA)
| | - K Chung
- California State University, Northridge
| | | | | | - J Flores
- California State University, Northridge
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Spira A, Chung K, Patnaik A, Tolcher A, Blaney M, Parikh A, Reddy A, Henner W, McDevitt M, Afar D, Powderly J. Safety, tolerability, and pharmacokinetics of the OX40 agonist ABBV-368 in patients with advanced solid tumors. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy288.022] [Citation(s) in RCA: 2] [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: 11/14/2022] Open
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Plummer R, Cook N, Arkenau T, Melear J, Redfern C, Spira A, Chung K, Haddad T, Ramalingam S, Wesolowski R, Dean E, Goddemeier T, Falk M, Shapiro G. Phase I dose expansion data for M6620 (formerly VX-970), a first-in-class ATR inhibitor, combined with gemcitabine (Gem) in patients (pts) with advanced non-small cell lung cancer (NSCLC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy292.059] [Citation(s) in RCA: 2] [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: 11/13/2022] Open
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Thomas S, Kitapci T, Campo D, Woo I, Bendikson K, Chung K, Paulson R, Ahmady A, McGinnis L. miRNA from follicular extracellular vesicles target cell proliferation in young women with diminished ovarian reserve. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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47
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Maggiore P, Bellinge J, Chieng D, White D, Lan NSR, Jaltotage B, Ali U, Gordon M, Chung K, Stobie P, Ng J, Hankey GJ, McQuillan B. Ischaemic Stroke and the Echocardiographic "Bubble Study": Are We Screening the Right Patients? Heart Lung Circ 2018; 28:1183-1189. [PMID: 30131285 DOI: 10.1016/j.hlc.2018.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/08/2018] [Accepted: 07/18/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Patent foramen ovale (PFO) is a potential mechanism for paradoxical embolism in cryptogenic ischaemic stroke or transient ischaemic attack (TIA). PFO is typically demonstrated with agitated saline ("bubble study", BS) during echocardiography. We hypothesised that the BS is frequently requested in patients that have a readily identifiable cause of stroke, that any PFO detected is likely incidental, and its detection often does not alter management. METHODS This was a retrospective observational study of patients with recent ischaemic stroke/TIA referred for a BS. Patient demographics, stroke risk factors, vascular/cerebral imaging results and transoesophageal echocardiogram (TOE) reports were recorded. A "modified" Risk of Paradoxical Embolism (RoPE) score was calculated. Change in management was defined as antiplatelet/anticoagulant therapy alteration or referral for PFO closure. Bubble Study complications were recorded. RESULTS Among 715 patients with ischaemic stroke/TIA referred for a BS, 8.7% had atrial fibrillation and 9.2% had carotid stenosis ≥70%. At least three stroke risk factors were present in 39.3% and only 47.1% of patients screened had a "modified" RoPE score of >5. A PFO was detected in 248 patients of whom only 31% (77/248) had a subsequent change in management. Of BS performed, 1/924 patients (0.1%) suffered a TIA as a complication. CONCLUSIONS The echocardiographic BS is frequently performed in patients that have a readily identifiable cause of stroke and whose PFO unlikely relates to the stroke/TIA. Bubble Study findings resulted in a change in management in the minority. The procedure is safe but the complication rate warrants informed consent.
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Affiliation(s)
- Paul Maggiore
- Department of Cardiology, Sir Charles Gairdner Hospital, Perth, WA, Australia.
| | - Jamie Bellinge
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
| | - David Chieng
- Department of Cardiology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - David White
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
| | - Nick S R Lan
- Department of Cardiology, Fiona Stanley Hospital, Perth, WA, Australia
| | - Biyanka Jaltotage
- Department of Cardiology, Fiona Stanley Hospital, Perth, WA, Australia
| | - Umar Ali
- Department of Cardiology, Fiona Stanley Hospital, Perth, WA, Australia
| | - Madeleine Gordon
- Department of Cardiology, Fiona Stanley Hospital, Perth, WA, Australia
| | - Kevin Chung
- Department of Cardiology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Paul Stobie
- Department of Cardiology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Justin Ng
- Department of Cardiology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Graeme J Hankey
- Department of Neurology, Sir Charles Gairdner Hospital, Perth, WA, Australia; University of Western Australia School of Medicine, WA, Australia
| | - Brendan McQuillan
- Department of Cardiology, Sir Charles Gairdner Hospital, Perth, WA, Australia; University of Western Australia School of Medicine, WA, Australia
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Chung K, Strange G, Naing P, Codde J, Celermajer D, Scalia GM, Playford D. P4541Assessing the cause of pulmonary hypertension on echo in the absence of tricuspid regurgitation - A NEDA (National Echo Database of Australia) study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4541] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K Chung
- THE UNIVERSITY OF NOTRE DAME, SCHOOL OF MEDICINE, PERTH, Australia
| | - G Strange
- The University of Notre Dame, School of Medicine, Perth, Australia
| | - P Naing
- The University of Notre Dame, School of Medicine, Perth, Australia
| | - J Codde
- The University of Notre Dame, School of Medicine, Perth, Australia
| | | | - G M Scalia
- University of Queensland, Brisbane, Australia
| | - D Playford
- The University of Notre Dame, School of Medicine, Perth, Australia
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Worthy SE, Haynes L, Chambers M, Bethune D, Kan E, Chung K, Ota R, Taylor CJ, Glater EE. Identification of attractive odorants released by preferred bacterial food found in the natural habitats of C. elegans. PLoS One 2018; 13:e0201158. [PMID: 30036396 PMCID: PMC6056031 DOI: 10.1371/journal.pone.0201158] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 07/10/2018] [Indexed: 01/26/2023] Open
Abstract
Food choice is critical for survival because organisms must choose food that is edible and nutritious and avoid pathogenic food. Many organisms, including the nematode C. elegans, use olfaction to detect and distinguish among food sources. C. elegans exhibits innate preferences for the odors of different bacterial species. However, little is known about the preferences of C. elegans for bacterial strains isolated from their natural environment as well as the attractive volatile compounds released by preferred natural bacteria isolates. We tested food odor preferences of C. elegans for non-pathogenic bacteria found in their natural habitats. We found that C. elegans showed a preference for the odor of six of the eight tested bacterial isolates over its standard food source, E. coli HB101. Using solid-phase microextraction and gas chromatography coupled with mass spectrometry, we found that four of six attractive bacterial isolates (Alcaligenes sp. JUb4, Providenica sp. JUb5, Providencia sp. JUb39, and Flavobacteria sp. JUb43) released isoamyl alcohol, a well-studied C. elegans attractant, while both non-attractive isolates (Raoultella sp. JUb38 and Acinetobacter sp. JUb68) released very low or non-detectable amounts of isoamyl alcohol. In conclusion, we find that isoamyl alcohol is likely an ethologically relevant odor that is released by some attractive bacterial isolates in the natural environment of C. elegans.
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Affiliation(s)
- Soleil E. Worthy
- Department of Chemistry, Pomona College, Claremont, California, United States of America
| | - Lillian Haynes
- Department of Biology, Harvey Mudd College, Claremont, California, United States of America
| | - Melissa Chambers
- Department of Neuroscience, Pomona College, Claremont, California, United States of America
| | - Danika Bethune
- Department of Neuroscience, Pomona College, Claremont, California, United States of America
| | - Emily Kan
- Department of Neuroscience, Pomona College, Claremont, California, United States of America
| | - Kevin Chung
- Department of Neuroscience, Pomona College, Claremont, California, United States of America
| | - Ryan Ota
- Department of Neuroscience, Pomona College, Claremont, California, United States of America
| | - Charles J. Taylor
- Department of Chemistry, Pomona College, Claremont, California, United States of America
| | - Elizabeth E. Glater
- Department of Neuroscience, Pomona College, Claremont, California, United States of America
- * E-mail:
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Lee S, Oh Y, Nam K, Oh B, Roh M, Chung K. 575 Comparative single-institute analysis of slow Mohs micrographic surgery and frozen section Mohs micrographic surgery for dermatofibrosarcoma protuberans. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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