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1.
Zhonghua Yi Xue Za Zhi ; 104(4): 276-281, 2024 Jan 23.
Article in Chinese | MEDLINE | ID: mdl-38246772

ABSTRACT

Objective: To explore the feasibility and application value of arterial spin labeling (ASL) in evaluating the degree of renal fibrosis after kidney transplantation. Methods: This is a cross-sectional study. Renal transplant recipients who received treatment at the First Affiliated Hospital of Soochow University from December 2021 to December 2022 were enrolled. All participants underwent ASL scan, and the values of renal cortical renal blood flow (RBF) were measured through post-processing software. The participants were divided into different groups according to the Banff interstitial fibrosis score (ci score) of the transplanted kidneys, and then relevant indicators were compared. One-way analysis of variance was conducted to compare the differences in renal cortical RBF among the groups. Spearman correlation analysis was employed to investigate the association between renal cortical RBF and ci score of the transplanted kidney. Receiver operating characteristic curve was used to analyze the diagnostic effectiveness of renal cortical RBF and laboratory indicators for distinguishing varying degrees of fibrosis in transplanted kidneys. The Delong test was utilized to compare the area under the curve (AUC). Results: A total of 60 patients (42 males and 18 females) were included in the study, with a mean age of (44.6±10.8) years. All patients were divided into 4 groups: ci0 group (ci score=0, 11 cases), ci1 group (ci score=1, 21 cases), ci2 group (ci score=2, 20 cases), and ci3 group (ci score=3, 8 cases). With an increase in the degree of fibrosis in the transplanted kidney, there was a corresponding decrease in the renal cortical RBF value. The differences in renal cortical RBF values among the 4 groups were statistically significant[ci0 group: (214.9±28.5) ml·(100 g)-1·min-1; ci1 group: (181.7±29.3) ml·(100 g)-1·min-1; ci2 group: (158.8±39.2) ml·(100 g)-1·min-1; ci3 group: (123.1±27.2) ml·(100 g)-1·min-1; F=14.02, P<0.001]. The renal cortical RBF was moderately negatively correlated with the ci score (r=-0.644, P<0.001). The AUC for discriminating between ci0 and ci1-3 of renal cortical RBF and 24-hour urine protein was 0.881 (95%CI: 0.772-0.950) and 0.680 (95%CI: 0.547-0.795), respectively. The AUC for renal cortical RBF was significantly higher than that for 24-hour urine protein (P=0.047). The renal cortical RBF can distinguish between ci0-1 and ci2-3, as well as ci0-2 and ci3, with the corresponding AUC value of 0.796 (95%CI: 0.673-0.889) and 0.900 (95%CI: 0.795-0.963), respectively. Conclusion: ASL can quantitatively assess renal blood perfusion in transplanted kidneys and demonstrates high operational efficacy in distinguishing varying degrees of fibrosis in the transplanted kidneys.


Subject(s)
Kidney Transplantation , Female , Male , Humans , Adult , Middle Aged , Cross-Sectional Studies , Kidney , Fibrosis , Allografts
2.
Eur Rev Med Pharmacol Sci ; 24(12): 6818-6824, 2020 06.
Article in English | MEDLINE | ID: mdl-32633374

ABSTRACT

OBJECTIVE: To explore the expression of linc00324 in papillary thyroid cancer (PTC) and its effect on the biological function of PTC cells. PATIENTS AND METHODS: A total of 60 pairs of PTC and para-carcinoma normal tissues surgically excised were collected. The expression of linc00324 in PTC tissues and cells was detected via quantitative Reverse Transcription-Polymerase Chain Reaction (qRT-PCR), and the expression of linc00324 in PTC cells was silenced using the small-interfering RNA (siRNA). Then, the effects of linc00324 on the PTC cell proliferation, apoptosis, and cycle and the downstream Notch signaling pathway were determined via methyl thiazolyl tetrazolium (MTT) assay, colony formation assay, flow cytometry, and Western blotting, respectively. RESULTS: The expression of linc00324 was upregulated in 48 out of 60 cases of PTC tissues, and it was increased in PTC cells compared with that in human thyroid follicular epithelial cells Nthy-ori 3-1. The results of MTT assay and colony formation assay showed that the proliferation of PTC cells declined after interference in linc00324 expression. The findings of flow cytometry revealed that the cell cycle was arrested in G1/G0 phase with a higher apoptosis rate in si-linc00324 group compared with that in the si-NC group. According to the data of Western blotting, the molecular markers for the downstream Notch signaling pathway were altered after interference in linc00324 expression. CONCLUSIONS: The expression of linc00324 is significantly increased in PTC tissues and cells. Silencing linc00324 may inhibit the proliferation of PTC cells, arrest the cell cycle in G1/G0 phase, and promote the apoptosis by inhibiting the Notch signaling pathway.


Subject(s)
RNA, Long Noncoding/metabolism , Receptors, Notch/metabolism , Thyroid Cancer, Papillary/metabolism , Thyroid Neoplasms/metabolism , Apoptosis , Cell Proliferation , Cells, Cultured , Humans , RNA, Long Noncoding/genetics , Signal Transduction , Thyroid Cancer, Papillary/pathology , Thyroid Neoplasms/pathology
3.
Clin Transl Oncol ; 22(7): 1013-1022, 2020 Jul.
Article in English | MEDLINE | ID: mdl-31650468

ABSTRACT

OBJECTIVE: Chronic inflammation is recognized as a risk factor for colorectal cancer (CRC) development. Baicalin (BI), a major constituent in an anti-inflammatory herb Scutellaria baicalensis, can be biotransformed into baicalein (BE) by the intestinal microbiota. We evaluated the anti-inflammation and anti-CRC effects of the metabolite BE. METHODS: The in vitro biotransformation by human intestinal microbiota from BI into BE has been determined with HPLC. Using a gut-specific ApcMin/+ mouse model, the effects of oral BE on the life span, organ index, and tumor multiplicity were evaluated. The expressions of inflammatory cytokines were determined using ELISA. To verify the in vivo data, the anti-inflammatory and antiproliferative effects of BE were determined with an in vitro cell model. RESULTS: HPLC analysis showed that BI was quickly transformed into BE by the intestinal microbiota. Oral BE (30 mg/kg/day) significantly increased the life span, from 125.2 to 218.4 days (P < 0.01%). BE treatment also decreased intestine index and increased spleen index. Compared with the model group, following BE treatment, tumor numbers were significantly reduced in the small intestine and colon (P < 0.01, P < 0.05, respectively). In the gut tissues, BE treatment significantly reduced inflammatory cytokine levels such as IL-1ß, IL-2, IL-6, IL-10, G-CSF, and GM-CSF. In vitro data supported our in vivo results that the anti-CRC effects of BE were via the inhibition of gut inflammation and induction of cancer cell death. CONCLUSION: Our results suggest that the parent compound BI can be quickly converted into its microbial metabolite BE, which has stronger bioactive effects than BI. Baicalein is an active chemopreventive metabolite for inflammatory associated CRC.


Subject(s)
Antioxidants/pharmacology , Colon/drug effects , Colorectal Neoplasms/pathology , Cytokines/drug effects , Flavanones/pharmacology , Intestine, Small/drug effects , Adenomatous Polyposis Coli Protein/genetics , Animals , Colon/immunology , Colon/pathology , Colorectal Neoplasms/genetics , Cytokines/metabolism , Disease Models, Animal , Flavanones/metabolism , Flavonoids/metabolism , Gastrointestinal Microbiome , HT29 Cells , Humans , Inflammation/metabolism , Intestinal Neoplasms/genetics , Intestinal Neoplasms/pathology , Intestine, Small/immunology , Intestine, Small/pathology , Longevity , Mice , Tumor Burden
4.
Neuropsychol Rehabil ; 29(1): 144-159, 2019 Jan.
Article in English | MEDLINE | ID: mdl-28051902

ABSTRACT

This study examined the use of the Hong Kong version of the Rivermead Behavioral Memory Test-Third Edition (RBMT-3) for older adults, and by presenting the optimal cut-off scores for patients with cognitive impairments, and for a group of peers who have functional everyday cognition. Hundred older adults residing in community dwellings were recruited from three non-government organisations and completed the RBMT-3: 29 patients with mild to moderate dementia, 34 persons at risk for MCI, and 37 matched older adults with everyday functional cognition for a healthy control group (NC). The test has excellent inter-rater (ICC [2, 1] = 0.997), intra-rater (ICC [3, 1] = 0), and parallel version (ICC [3, 1] = 0.990) reliabilities, as well as satisfactory internal consistency (Cronbach's alpha: 0.643-0.832). The scores of the MCI group were significantly lower than those of NC group in four subtests. The optimal cut-off scaled scores of ≤ 41.5, ≤ 102.5, and ≤ 131.5 are suggested for the RBMT-3 to discriminate between patients with mild and moderate dementia, mild dementia and MCI, and MCI and NC, with sensitivities 73%, 100% and 94.1%, respectively. This version is useful to differentiate those with or without risk of cognitive impairments.


Subject(s)
Cognition Disorders/psychology , Cognition Disorders/rehabilitation , Memory and Learning Tests/standards , Occupational Therapy/methods , Outcome Assessment, Health Care/methods , Aged , Aged, 80 and over , Analysis of Variance , Female , Hong Kong , Humans , Male , Middle Aged , Photic Stimulation/methods , Psychometrics , Reproducibility of Results
5.
Clin Transl Oncol ; 20(3): 302-312, 2018 03.
Article in English | MEDLINE | ID: mdl-28808878

ABSTRACT

OBJECTIVE: Chronic intestinal inflammation is a risk factor for colorectal cancer (CRC) initiation and development. Diets that are rich in Western style fats have been shown to promote CRC. This study was conducted to investigate the role of intestinal microbiome in American ginseng-mediated CRC chemoprevention in a mouse model. The population and diversity of enteric microbiome were evaluated after the ginseng treatment. METHODS: Using an azoxymethane (AOM)/dextran sulfate sodium (DSS)-induced gut inflammation and tumorigenesis mouse model, the effects of oral American ginseng on high fat diet-associated enteric pathology were determined. After establishment of a 16S rRNA illumina library from fecal samples, MiSeq sequencing was carried out to reveal the microbial population. The alpha and beta diversities of microbiome were analyzed. RESULTS: American ginseng significantly attenuated AOM/DSS-induced colon inflammation and tumorigenesis by reducing the colitis score and colon tumor multiplicity. The MiSeq results showed that the majority of sequences fell into three phyla: Firmicutes, Bacteroidetes and Verrucomicrobia. Further, two significant abundance shifts at the family level, Bacteroidaceae and Porphyromonadaceae, were identified to support ginseng's anti-colitis and anti-tumor effects. In addition, alpha and beta diversity data demonstrated that ginseng led to a profound recovery from the AOM/DSS-induced dysbiosis in the microbial community. CONCLUSION: Our results suggest that the CRC chemopreventive effects of American ginseng are mediated through enteric microbiome population-shift recovery and dysbiosis restoration. Ginseng's regulation of the microbiome balance contributes to the maintenance of enteric homeostasis.


Subject(s)
Carcinogenesis/drug effects , Colonic Neoplasms/pathology , Gastrointestinal Microbiome/drug effects , Panax , Plant Extracts/pharmacology , Animals , Azoxymethane/toxicity , Carcinogenesis/chemically induced , Carcinogenesis/pathology , Colitis/etiology , Colitis/microbiology , Colitis/pathology , Colonic Neoplasms/etiology , Colonic Neoplasms/microbiology , Dextran Sulfate/toxicity , Diet, High-Fat/adverse effects , Male , Mice , Plant Roots
7.
Oncogene ; 36(4): 491-500, 2017 01 26.
Article in English | MEDLINE | ID: mdl-27321183

ABSTRACT

Although MUC13, a transmembrane mucin, is aberrantly expressed in pancreatic ductal adenocarcinoma (PDAC) and generally correlates with increased expression of HER2, the underlying mechanism remains poorly understood. Herein, we found that MUC13 co-localizes and interacts with HER2 in PDAC cells (reciprocal co-immunoprecipitation, immunofluorescence, proximity ligation, co-capping assays) and tissues (immunohistofluorescence). The results from this study demonstrate that MUC13 functionally interacts and activates HER2 at p1248 in PDAC cells, leading to stimulation of HER2 signaling cascade, including ERK1/2, FAK, AKT and PAK1 as well as regulation of the growth, cytoskeleton remodeling and motility, invasion of PDAC cells-all collectively contributing to PDAC progression. Interestingly, all of these phenotypic effects of MUC13-HER2 co-localization could be effectively compromised by depleting MUC13 and mediated by the first and second EGF-like domains of MUC13. Further, MUC13-HER2 co-localization also holds true in PDAC tissues with a strong functional correlation with events contributing to increased degree of disorder and cancer aggressiveness. In brief, findings presented here provide compelling evidence of a functional ramification of MUC13-HER2: this interaction could be potentially exploited for targeted therapeutics in a subset of patients harboring an aggressive form of PDAC.


Subject(s)
Carcinoma, Pancreatic Ductal/metabolism , Mucins/metabolism , Pancreatic Neoplasms/metabolism , Receptor, ErbB-2/metabolism , Carcinoma, Pancreatic Ductal/genetics , Carcinoma, Pancreatic Ductal/pathology , Cell Line, Tumor , Disease Progression , Gene Knockdown Techniques , Humans , Mucins/genetics , Pancreatic Neoplasms/genetics , Pancreatic Neoplasms/pathology , Receptor, ErbB-2/genetics , Signal Transduction , Transfection
10.
Int J Immunopathol Pharmacol ; 25(4): 923-34, 2012.
Article in English | MEDLINE | ID: mdl-23298483

ABSTRACT

Fulminant hepatic failure (FHF) is a devastating clinical syndrome with extremely poor prognosis and high mortality. Therefore, better treatment is urgently needed. Polydatin (PD), a traditional anti-inflammatory drug, has been described to protect against liver injury induced by certain hepatotoxins. The present study investigated the protective effect of PD against lipopolysaccharide (LPS)/D-galactosamine (D-GalN)-induced FHF in mice and the underlying mechanism. Mice were pretreated with an increasing dose of PD (10, 30, and 100 mg/kg), following LPS/D-GalN challenge. The liver injury was assessed biochemically and histologically. We found that PD exerted a protective effect on LPS/D-GalN-induced FHF as evidenced by reducing sera alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities, diminishing liver histopathological injury, and lowering mortality in a dose-dependent manner. In addition, pretreatment mice with PD dose-dependently suppressed tumor necrosis factor-alpha (TNF-alpha) production, myeloperoxidase (MPO) activity, intercellular adhesion molecule-1 (ICAM-1) and endothelial cell adhesion molecule-1 (ECAM-1) expression, caspase-3 activation, and transcription factor nuclear factor-kappa B(NF-kB) activity induced by LPS. These results suggested that PD could effectively protect from LPS/D-GalN-induced FHF and the protective effect afforded by PD probably contributed to reduce TNF-alpha production via inhibiting NF-kB activation.


Subject(s)
Galactosamine/toxicity , Glucosides/pharmacology , Lipopolysaccharides/toxicity , Liver Failure, Acute/prevention & control , Stilbenes/pharmacology , Animals , Caspase 3/metabolism , Cell Adhesion Molecules/analysis , Intercellular Adhesion Molecule-1/analysis , Liver Failure, Acute/chemically induced , Mice , Mice, Inbred BALB C , NF-kappa B/metabolism , Neutrophil Infiltration/drug effects , Tumor Necrosis Factor-alpha/biosynthesis
11.
Inflamm Res ; 60(4): 357-66, 2011 Apr.
Article in English | MEDLINE | ID: mdl-21063746

ABSTRACT

OBJECTIVE: Protein kinase D (PKD) is a newly described serine/threonine protein kinase that plays a pivotal role in inflammatory response. In the present study, we examined the protective effect of Gö6976, a PKD inhibitor, on lipopolysaccharide (LPS) and D: -galactosamine (D: -GalN)-induced acute liver injury in mice. MATERIALS AND METHODS: Mice were pretreated intraperitoneally with Gö6976 30 min before LPS/D: -GalN administration . The mortality and degree of hepatic injury was subsequently assessed. RESULTS: The results indicated that LPS/D: -GalN administration markedly induced hepatic PKD activation, lethality and liver injury, while pretreatment of the PKD inhibitor Gö6976 significantly inhibited LPS-induced PKD activation, improved the survival of LPS/D: -GalN-administered mice and attenuated LPS/D: -GalN-induced liver injury, as evidenced by reduced levels of serum aminotransferases as well as reduced histopathological changes. In addition, the protective effects of Gö6976 were paralleled by suppressed activation of mitogen-activated protein kinases (MAPKs), decreased expression of tumor necrosis factor-α (TNF-α) and adhesion molecules, and reduced apoptosis and myeloperoxidase (MPO) activity in liver. CONCLUSIONS: Our experimental data indicated that Gö6976, a PKD inhibitor, could effectively prevent LPS/D: -GalN-induced acute liver injury by inhibition of MAPKs activation to reduce TNF-α production. This suggests the potential pharmacological value of PKD inhibitors in the intervention of inflammation-based liver diseases.


Subject(s)
Carbazoles/therapeutic use , Chemical and Drug Induced Liver Injury/drug therapy , Chemical and Drug Induced Liver Injury/pathology , Enzyme Inhibitors/therapeutic use , Galactosamine/adverse effects , Lipopolysaccharides/adverse effects , Protein Kinase C/antagonists & inhibitors , Animals , Apoptosis/drug effects , Carbazoles/pharmacology , Caspases/metabolism , Enzyme Activation/drug effects , Liver/drug effects , Liver/metabolism , Liver/pathology , MAP Kinase Signaling System/drug effects , Mice , Mice, Inbred BALB C , Peroxidase/metabolism , Tumor Necrosis Factor-alpha/metabolism
12.
Genes Immun ; 12(2): 116-25, 2011 Mar.
Article in English | MEDLINE | ID: mdl-21179116

ABSTRACT

The IL-2/IL-2R signaling pathway has an important role in autoimmunity. Several genes identified in genome-wide association (GWA) studies encode proteins in the IL-2/IL-2R signaling cascade that are associated with autoimmune diseases. One of these, PTPN2, encodes a protein tyrosine phosphatase that is highly expressed in T cells and regulates cytokine signaling. An intronic risk allele in PTPN2, rs1893217(C), correlated with decreased IL-2R signaling in CD4(+) T cells as measured by phosphorylation of STAT5 (phosphorylated STAT5 (pSTAT5)). We modeled an additive single nucleotide polymorphism (SNP) genotype, in which each copy of the risk allele conferred a decrease in IL-2R signaling (P=4.4 × 10(-8)). Decreased pSTAT5 impacted IL-2Rß chain signaling resulting in reduced FOXP3 expression in activated cells. This phenotype was not due to overt differences in expression of the IL-2R, molecules in the IL-2R signaling cascade or defects in STAT5. However, the rs1893217(C) risk variant did correlate with decreased PTPN2 expression in CD4(+)CD45RO T cells (P=0.0002). Thus, the PTPN2rs1893217(C) risk allele associated with reduced pSTAT5 in response to IL-2 and reduced PTPN2 expression. Together, these data suggest that decreased expression of PTPN2 may indirectly modulate IL-2 responsiveness. These findings, identified through genotype/phenotype relationships, may lead to identification of novel mechanisms underlying dysregulation of cytokine signaling in autoimmunity.


Subject(s)
CD4-Positive T-Lymphocytes/immunology , CD4-Positive T-Lymphocytes/metabolism , Protein Tyrosine Phosphatase, Non-Receptor Type 2/genetics , Protein Tyrosine Phosphatase, Non-Receptor Type 2/metabolism , Receptors, Interleukin-2/immunology , Receptors, Interleukin-2/metabolism , Adult , Alleles , Autoimmunity/immunology , Female , Forkhead Transcription Factors/genetics , Forkhead Transcription Factors/metabolism , Genome-Wide Association Study , Genotype , Humans , Interleukin-2/genetics , Interleukin-2/immunology , Interleukin-2/metabolism , Male , Phenotype , Phosphorylation , Polymorphism, Single Nucleotide , STAT5 Transcription Factor/metabolism , Signal Transduction
13.
Mol Biol ; 44(1): 37-44, 2010.
Article in English | MEDLINE | ID: mdl-32214469

ABSTRACT

The frequent disease outbreaks caused by avian influenza virus (AIV) not only affect the poultry industry but also pose a threat to human safety. To address the problem, RNA interference (RNAi) has recently been widely used as a potential antiviral approach. Transgenesis, in combination with RNAi to specifically inhibit AIV gene expression, has been proposed to make chickens resistant to avian influenza. For the transgenic breeding, screening the efficient siRNAs in vitro as the candidate genes is one of the most important tasks. Here, we combined an online search tool and a series of bioinformatics programs with a set of rules for designing the siRNAs targeting different mRNA regions of AIV H5N1 subtype. By this method we chose five rational siRNAs, constructed five U6 promoter-driven shRNA expression plasmids contained the siRNA genes, and used these to produce stably transfected Madin-Darby canine kidney (MDCK) cells. Data from virus titration, IFA, PUI-stained flow cytometry, real-time quantitative RT-PCR and DAS-ELISA analyses showed that all five stably transfected cell lines were effectively resistant to viral replication when exposed to 100 CCID50 of AIV, and we finally chose the most effective plasmids (pSi-604i and pSi-1597i) as the candidates for making the transgenic chickens. These findings provide baseline information for breeding transgenic chickens resistant to AIV in combination with RNAi.

14.
Arch Virol ; 153(7): 1281-9, 2008.
Article in English | MEDLINE | ID: mdl-18521536

ABSTRACT

Newcastle disease virus (NDV) has been thought to infect only domestic avian species, with waterfowl such as geese either not being infected, even by virulent strains, or developing only in apparent infection. In 1997, a new infectious disease producing high morbidity and mortality among geese broke out in many provinces of China, which was caused by a serotype I avian paramyxovirus (APMV-1)--NDV. To investigate how NDV spreads between chickens and geese, the complete genome of one NDV strain isolated from a goose was cloned and analyzed. The results indicate that there is conservation in NDV structural genetic evolution but that there are also considerable differences between goose and chicken NDV strains. Separate patterns of NDV evolution exist among wild bird species. Meanwhile, there is evidence indicating that the goose NDV may have evolved from chicken NDV strain Herts/33. In addition, the possibility was investigated that this new strain of NDV may bind to different sialic acid receptor binding sites than the normal NDV strains that have been investigated so far. This might provide clues to the evolution of the goose NDV.


Subject(s)
Bird Diseases/virology , Geese/virology , Genome, Viral , Newcastle disease virus/genetics , RNA, Viral/genetics , Amino Acid Sequence , Animals , Base Sequence , China , Conserved Sequence , Evolution, Molecular , Molecular Sequence Data , Newcastle disease virus/isolation & purification , Phylogeny , Receptors, Cell Surface/physiology , Sequence Alignment , Sequence Analysis, DNA , Sequence Homology , Virus Attachment
15.
J Thromb Haemost ; 4(6): 1279-87, 2006 06.
Article in English | MEDLINE | ID: mdl-16706972

ABSTRACT

BACKGROUND: Previous genotype-phenotype association studies of fibrinogen have been limited by incomplete knowledge of genomic sequence variation within and between major ethnic groups in FGB, FGA, and FGG. METHODS: We characterized the linkage disequilibrium patterns and haplotype structure across the human fibrinogen gene locus in European- and African-American populations. We analyzed the association between common polymorphisms in the fibrinogen genes and circulating levels of both 'functional' fibrinogen (measured by the Clauss clotting rate method) and total fibrinogen (measured by immunonephelometry) in a large, multi-center, bi-racial cohort of young US adults. RESULTS: A common haplotype tagged by the A minor allele of the well-studied FGB-455 G/A promoter polymorphism (FGB 1437) was confirmed to be strongly associated with increased plasma fibrinogen levels. Two non-coding variants specific to African-American chromosomes, FGA 3845 A and FGG 5729 G, were each associated with lower plasma fibrinogen levels. In European-Americans, a common haplotype tagged by FGA Thr312Ala and several other variant alleles across the fibrinogen gene locus was strongly associated with decreased fibrinogen levels as measured by functional assay, but not by immunoassay. Overall, common polymorphisms within the three fibrinogen genes explain < 2% of the variability in plasma fibrinogen concentration. CONCLUSIONS: In young adults, fibrinogen multi-locus genotypes are associated with plasma fibrinogen levels. The specific single nucleotide polymorphism and haplotype patterns for these associations differ according to population and also according to phenotypic assay. It is likely that a substantial proportion of the heritable component of plasma fibrinogen concentration is due to genetic variation outside the three fibrinogen genes.


Subject(s)
Cardiovascular Diseases/genetics , Fibrinogen/genetics , Genetic Variation , Polymorphism, Single Nucleotide , Adolescent , Adult , Black or African American/genetics , Blood Coagulation Tests , Cardiovascular Diseases/blood , Fibrinogen/metabolism , Gene Frequency , Genetic Predisposition to Disease , Haplotypes , Humans , Immunoassay/methods , Linkage Disequilibrium , Phenotype , Reproducibility of Results , White People/genetics
16.
Am J Med Sci ; 331(3): 124-30, 2006 Mar.
Article in English | MEDLINE | ID: mdl-16538072

ABSTRACT

OBJECTIVE: Mitral annulus calcification (MAC) is an independent predictor of cardiovascular mortality in the general population. The purpose of the current historical cohort study is to assess risk factors for long-term mortality in end-stage renal disease (ESRD) patients with MAC (n = 30; age, 62 +/- 2 yr), as compared to ESRD patients without MAC (n = 30; age, 63 +/- 2 yr). Additional analysis compared ESRD patients with MAC to non-ESRD patients with MAC (n = 32; age, 66 +/- 2 yr). METHODS: The groups included age-matched male patients followed at a single center. Long-term survival was assessed by Kaplan-Meier analysis. Regular and stepwise Cox proportional hazards models were used to determine risk factors for mortality. RESULTS: There was a similarly high prevalence of cardiovascular complications, including hypertension, coronary artery disease, left ventricular hypertrophy, atrial fibrillation, and congestive heart failure, in all three groups. Median survival time was significantly longer in non-ESRD patients (90 months), compared with the ESRD with MAC (45 months) and ESRD without MAC (45 months) patients (log-rank test; P < 0.001). With stepwise Cox proportional hazards model, including ESRD patients with MAC and ESRD patients without MAC, increased calcium x phosphate product, decreased serum creatinine concentration, and the presence of coronary artery disease and lower extremity amputations were independent predictors of mortality for patients with ESRD. With stepwise Cox proportional hazards model, including ESRD patients with MAC and non-ESRD patients with MAC, the presence of ESRD, atrial fibrillation, diabetes, aortic valve calcification, coronary artery disease, and tricuspid regurgitation were independent predictors of mortality. CONCLUSION: The mortality rate was high in ESRD patients, approximately 15% per year. After accounting for baseline cardiovascular disease and traditional risk factors, the presence of MAC did not confer additional risk for mortality.


Subject(s)
Calcinosis/etiology , Heart Valve Diseases/etiology , Kidney Failure, Chronic/mortality , Mitral Valve/pathology , Calcinosis/epidemiology , Cohort Studies , Heart Valve Diseases/epidemiology , Humans , Kidney Failure, Chronic/complications , Male , Middle Aged , Risk Factors , Survival Analysis
18.
Cancer ; 92(6): 1349-53, 2001 Sep 15.
Article in English | MEDLINE | ID: mdl-11745210

ABSTRACT

BACKGROUND: Chronic disseminated candidiasis (CDC) is a serious complication of treatment in patients with acute leukemia. Although some general risk factors are known to predispose to systemic fungal infections, few studies have addressed the relevance of certain clinical and laboratory features in patients with CDC. PATIENTS AND METHODS: To define a subset of patients at high risk for CDC, the authors evaluated the demographics and clinical and laboratory characteristics of 423 patients with acute leukemia. Patients who had bone marrow transplant before the diagnosis of CDC were excluded from the analysis. The diagnosis of CDC was based on blood cultures, liver biopsy, and imaging studies. The authors conducted 2 separate regression analyses on 3 subsets of patients: patients without documented candidiasis (n = 374), patients with CDC (n = 23), and patients with candidemia (n = 26). RESULTS: According to multivariate analysis, younger age (P = 0.009; odds ratio [OR], 1.96; 95% confidence interval [CI], 1.72-2.99), duration of neutropenia of 15 days or longer (P = 0.0003; OR, 11.7; 95% CI, 3.04-45.1), and use of prophylactic quinolone antibiotics (P = 0.039; OR, 3.85; 95% CI, 1.11-13.4) emerged as independent factors related to the development of CDC in patients with acute leukemia. The presence of severe mucositis, colonization with Candida, and administration of high-dose ara-C were statistically significant parameters in univariate analysis only (P = 0.0001, P = 0.003, and P = 0.058, respectively). CONCLUSIONS: On the basis of the results of this investigation, it is possible to define a subset of patients with acute leukemia at very high risk for CDC. Because of the morbidity and mortality of this infection, a targeted prophylactic approach may be more effective and less costly than the random administration of antifungal agents.


Subject(s)
Candidiasis/etiology , Leukemia, Myeloid, Acute/complications , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Child , Chronic Disease , Female , Humans , Liver Diseases , Male , Middle Aged , Multivariate Analysis , Neutropenia/complications , Splenic Diseases , Time Factors
20.
Tenn Med ; 94(11): 425-30, 2001 Nov.
Article in English | MEDLINE | ID: mdl-11709896

ABSTRACT

OBJECTIVE: To determine the impact of managed care on effectiveness of diabetes management in Tennessee, where a statewide Medicaid program (TennCare) delivers services through capitated managed care organizations (MCOs). RESEARCH DESIGN AND METHODS: This retrospective cohort study documented the health care utilization experiences and clinical outcomes of a convenience sample of Tennessee Medicaid enrollees with chronic diabetes before and after the initiation of TennCare. Exposures to recommended diabetic services and outcomes were compared before and after TennCare for 171 enrollees with diabetes in the state's largest academic MCO who met age, continuous enrollment, insurance, and diagnostic criteria for two years before (1992 and 1993) and two years after TennCare (1995 and 1996). Claims data were used to assess baseline characteristics and chart review data were used to assess health services utilization for 71% of cohort members (n = 121) for whom complete medical records were available. The paired t-test was used to compare exposures and outcomes before and after TennCare. RESULTS: Participants had an average of 6.4 outpatient clinic visits per year before TennCare vs. 8.2 visits per year after TennCare (P = .0009), 0.6 vs. 1.0 diabetic eye examinations (P = .0042), 0.2 vs. 0.5 foot examinations (P = .0358), 0.4 vs. 0.6 cholesterol assessments (P < .0001), and 0.5 vs. 1.0 glycosylated hemoglobin assessments annually (P < .0001). Average glycosylated hemoglobin decreased from 10.3 to 8.2 (P < .0001). Although hospitalizations and hospital days increased overall, there was no increase in emergency visits, preventable emergency visits, or preventable hospitalizations. CONCLUSIONS: Enrollees with diabetes experienced increases in utilization of recommended health services and improved glucose control following the initiation of Medicaid managed care. These improvements may reflect improved chronic disease care in a primary care gatekeeper system.


Subject(s)
Diabetes Mellitus/therapy , Disease Management , Managed Care Programs , Medicaid , Outcome and Process Assessment, Health Care , Adult , Female , Health Services/statistics & numerical data , Humans , Male , Middle Aged , Retrospective Studies , Tennessee , United States
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