76 results on '"Szymonifka, Jackie"'
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2. Factors Associated With Diagnostic Error: An Analysis of Closed Medical Malpractice Claims
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Grenon, Véronique, Szymonifka, Jackie, Adler-Milstein, Julia, Ross, Jacqueline, and Sarkar, Urmimala
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- 2023
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3. Factors Associated with Malpractice Claim Payout: An Analysis of Closed Emergency Department Claims.
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Gupta, Kiran, Szymonifka, Jackie, Rivadeneira, Natalie A., Khoong, Elaine C., Adler-Milstein, Julia, Ross, Jacqueline, and Sarkar, Urmimala
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- 2022
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4. Is Traditional Chinese Medicine Use Associated with Worse Patient-reported Outcomes among Chinese American Rheumatology Patients?
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Kai Sun, Szymonifka, Jackie, Henghe Tian, Yaju Chang, Leng, Jennifer C., and Mandl, Lisa A.
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- 2019
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5. Association of Traditional Chinese Medicine Use With Adherence to Prescribed Western Rheumatic Medications Among Chinese American Patients: A Cross‐Sectional Survey
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Sun, Kai, Szymonifka, Jackie, Tian, Henghe, Chang, Yaju, Leng, Jennifer C., and Mandl, Lisa A.
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Chinese Americans are a fast‐growing immigrant group with worse rheumatic disease outcomes compared to white populations and frequently use traditional Chinese medicine (TCM). Whether TCM use is associated with lower adherence to Western rheumatic medications is unknown. The present study was undertaken to examine adherence to Western medications for systemic rheumatic diseases in the Chinese American immigrant population and its association with TCM use. Chinese Americans actively treated for a systemic rheumatic disease were recruited from 2 Chinatown clinics. Sociodemographic, TCM use, and clinical data were gathered. Self‐reported health status was assessed using Patient‐Reported Outcome Measurement Information System short forms. Adherence was stratified using the 8‐item Morisky Medication Adherence Scale. Factors independently associated with high adherence were identified using multivariable logistic regression. Of 230 subjects, the median age was 55 years (range 20–97 years), 65% were female, 71% had a high school education or less, 70% were enrolled in Medicaid, and 22% reported fluency in English. The most common rheumatic diagnoses were rheumatoid arthritis (41%), systemic lupus erythematosus (17%), and seronegative spondyloarthropathies (15%). One‐half reported TCM use in the past year, and 28% reported high adherence to Western rheumatic medications. In multivariable analysis, high adherence was associated with TCM use (odds ratio [OR] 3.96, P< 0.001), being married (OR 3.69, P= 0.004), medication regimen complexity (OR 1.13, P= 0.004), and older age (OR 1.06, P< 0.001), and was negatively associated with anxiety (OR 0.94, P= 0.001). While adherence to Western rheumatic medications was low in this cohort, interestingly, it was higher among TCM users compared to nonusers. TCM use appears to represent a complementary rather than an alternate approach to disease management for these patients. Future studies should evaluate whether TCM use is associated with better disease outcomes.
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- 2020
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6. Responsiveness of the Patient‐Reported Outcomes Measurement Information System Global Health Short Form in Outpatients With Systemic Lupus Erythematosus
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Kasturi, Shanthini, Szymonifka, Jackie, Berman, Jessica R., Kirou, Kyriakos A., Levine, Alana B., Sammaritano, Lisa R., and Mandl, Lisa A.
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To evaluate the longitudinal responsiveness (sensitivity to change) of the Patient‐Reported Outcomes Measurement Information System (PROMIS) Global Health Short Form (PROMIS10) in outpatients with systemic lupus erythematosus (SLE). Outpatients with SLE who were receiving care at an academic medical center completed the PROMIS10 at 2 visits that were a minimum of 1 month apart. Responsiveness of the PROMIS10 global physical and mental health domains to Patient‐Reported improvement or deterioration of health status was evaluated, as measured by standard validated instruments. Effect sizes of changes in PROMIS10 scores between visits were evaluated using Kruskal‐Wallis testing. A total of 223 SLE patients enrolled and completed baseline surveys, with 186 (83.4%) completing a second set of questionnaires. The PROMIS10 demonstrated mild‐to‐moderate responsiveness to Patient‐Reported improvement (effect size 0.29) and worsening (effect sizes –0.27 and –0.54) of health status for both global physical health and global mental health. Changes in the PROMIS10 correlated poorly with changes in physician‐reported measures of disease activity. The PROMIS10 showed responsiveness over time to Patient‐Reported changes in SLE health status, but not physician‐assessed changes. These data suggest that the PROMIS10 can be used to efficiently measure and monitor important aspects of the SLE patient experience that are not captured by standard physician‐derived metrics. Further studies are needed to evaluate the role of the PROMIS10 in optimizing longitudinal disease management in SLE and to determine its responsiveness in other chronic health conditions.
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- 2020
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7. Racial Disparities in Total Knee Replacement Failure As Related to Poverty
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Bass, Anne R., Mehta, Bella, Szymonifka, Jackie, Finik, Jackie, Lyman, Stephen, Lai, Emily Ying, Parks, Michael, Figgie, Mark, Mandl, Lisa A., and Goodman, Susan M.
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To determine whether racial disparities in total knee replacement (TKR) failure are explained by poverty. Black and white New York state residents, enrolled in a prospective single‐institution TKRregistry January 1, 2008 to February 6, 2012, who underwent primary unilateral TKR(n = 4,062) were linked to the New York Statewide Planning and Research Cooperative System database (January 1, 2008 to December 31, 2014) to capture revisions performed at outside institutions. Patients were linked by geocoded addresses to residential census tracts. Multivariable Cox regression was used to assess predictors of TKRrevision. Multivariable logistic regression was used to analyze predictors of TKRfailure, defined as TKRrevision in New York state ≤2 years after surgery, or as Hospital for Special Surgery (HSS) TKRquality of life score “not improved” or “worsened” 2 years after surgery. The mean ± SDage was 68.4 ± 10 years, 64% of patients were female, 8% lived in census tracts with >20% of the population under the poverty line, and 9% were black. Median follow‐up time was 5.3 years. A total of 3% of patients (122 of 4,062) required revision a median 454 days (interquartile range 215–829) after surgery. TKRrevision risk was higher in blacks than whites, with a hazard ratio of 1.69 (95% confidence interval 1.01–2.81), but in multivariable analysis, only younger age, male sex, and constrained prosthesis were predictors of TKRrevision. TKRfailure occurred in 200 of 2,832 cases (7%) with 2‐year surveys. Risk factors for TKRfailure were non‐osteoarthritis TKRindication, low surgeon volume, and low HSSExpectations Survey score, but not black race. Community poverty was not associated with TKRrevision or failure. There was a trend toward higher TKRrevision risk in blacks, but poverty did not modify the relationship between race and TKRrevision or failure.
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- 2019
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8. Cardiorenal status using amino-terminal pro-brain natriuretic peptide and cystatin C on cardiac resynchronization therapy outcomes: From the BIOCRT Study.
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Truong, Quynh A., Szymonifka, Jackie, Januzzi, James L., Contractor, Jigar H., Deaño, Roderick C., Chatterjee, Neal A., and Singh, Jagmeet P.
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Background: Cardiorenal syndrome comprises a heterogeneous group of disorders characterized by acute or chronic cardiac and renal dysfunction.Objective: The purpose of this study was to determine the effect of cardiorenal status using a dual-marker strategy with amino-terminal pro-brain natriuretic peptide (NT-proBNP) and cystatin C on cardiac resynchronization therapy (CRT) outcomes.Methods: In 92 patients (age 66 ± 13 years; 80% male; left ventricular ejection fraction 26% ± 7%), NT-proBNP and cystatin C levels were measured at CRT implantation and at 1 month. NT-proBNP >1000 pg/mL and cystatin C >1 mg/L were considered high. Baseline cardiorenal patients were defined as having high NT-proBNP and cystatin C. At 1 month, CRT patients were categorized as (1) irreversible cardiorenal if cystatin C was persistently high; (2) progressive cardiorenal with transition from low to high cystatin C; (3) reversible cardiorenal with transition from high to low cystatin C; and (4) "normal" with stable low cystatin C. Outcomes were 6-month clinical and echocardiographic CRT response and 2 -year major adverse cardiovascular event (MACE).Results: Compared to patients with low NT-proBNP and cystatin C, cardiorenal patients had >9-fold increase risk of CRT nonresponse (odds ratio uncompensated 9.0; compensated 36.4; both P ≤.004) and >6-fold risk of MACE (hazard ratio uncompensated 8.5; P = .005). Compared to "normal" and reversible patients (referent), irreversible patients had a 9-fold increase for CRT nonresponse (odds ratio 9.1; P <.001) and had >4-fold risk of MACE (adjusted hazard ratio 5.1; P <.001). Irreversible patients were most likely echocardiographic CRT nonresponders.Conclusion: Cardiorenal status by NT-proBNP and cystatin C can identify high-risk CRT patients, and those with both elevated concentrations have worse prognosis. [ABSTRACT FROM AUTHOR]- Published
- 2019
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9. Utility of dual-source computed tomography in cardiac resynchronization therapy-DIRECT study.
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Truong, Quynh A., Szymonifka, Jackie, Picard, Michael H., Thai, Wai-ee, Wai, Bryan, Cheung, Jim W., Heist, E. Kevin, Hoffmann, Udo, and Singh, Jagmeet P.
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Background: Dual-source computed tomography (CT) can evaluate left ventricular (LV) dyssynchrony, myocardial scar, and coronary venous anatomy in patients undergoing cardiac resynchronization therapy (CRT).Objective: We aimed to determine whether dual-source CT predicts clinical CRT outcomes and reduces intraprocedural time.Methods: In this prospective study, 54 patients scheduled for CRT (mean age 63 ± 11 years; 74% men) underwent preprocedural CT to assess their venous anatomy as well as CT-derived dyssynchrony metrics and myocardial scar. Based on 1:1 randomization, the implanting physician had preimplant knowledge of the venous anatomy in half the patients. In blinded analyses, we measured time to maximal wall thickness and inward wall motion to determine (1) CT global and segmental dyssynchrony and (2) concordance of lead location to regional LV mechanical contraction. End points were 6-month CRT response measured using heart failure clinical composite score and 2-year major adverse cardiac events (MACE).Results: There were 72% CRT responders and 17% with MACE. Two wall motion dyssynchrony indices-global wall motion and opposing anteroseptal-inferolateral wall motion-predicted MACE (P < .01). Lead location concordant to regions of maximal wall thickness was associated with less MACE (P < .01). No CT dyssynchrony metrics predicted 6-month CRT response (P = NS for all). Myocardial scar (43%), posterolateral wall scar (28%), and total scar burden did not predict outcomes (P = NS for all). Preknowledge of coronary venous anatomy by CT did not reduce implant or fluoroscopy time (P = NS for both).Conclusion: Two CT dyssynchrony metrics predicted 2-year MACE, and LV lead location concordant to regions of maximal wall thickness was associated with less MACE. Other CT factors had little utility in CRT. [ABSTRACT FROM AUTHOR]- Published
- 2018
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10. Flares in Patients with Rheumatoid Arthritis after Total Hip and Total Knee Arthroplasty: Rates, Characteristics, and Risk Factors.
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Goodman, Susan M., Bykerk, Vivian P., DiCarlo, Edward, Cummings, Ryan W., Donlin, Laura T., Orange, Dana E., Hoang, Annie, Mirza, Serene, McNamara, Michael, Andersen, Kayte, Bartlett, Susan J., Szymonifka, Jackie, and Figgie, Mark P.
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- 2018
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11. Diagnostic Performance of Hybrid Cardiac Imaging Methods for Assessment of Obstructive Coronary Artery Disease Compared With Stand-Alone Coronary Computed Tomography Angiography: A Meta-Analysis.
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Rizvi, Asim, Han, Donghee, Danad, Ibrahim, Ó Hartaigh, Bríain, Lee, Ji Hyun, Gransar, Heidi, Stuijfzand, Wijnand J., Roudsari, Hadi Mirhedayati, Park, Mahn Won, Szymonifka, Jackie, Chang, Hyuk-Jae, Jones, Erica C., Knaapen, Paul, Lin, Fay Y., Min, James K., and Peña, Jessica M.
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Objectives The current meta-analysis aimed to evaluate the diagnostic performance of hybrid cardiac imaging techniques compared with stand-alone coronary computed tomography angiography (CTA) for assessment of obstructive coronary artery disease (CAD). Background The usefulness of coronary CTA for detecting obstructive CAD remains suboptimal at present. Myocardial perfusion imaging encompasses positron emission tomography, single-photon emission computed tomography, and cardiac magnetic resonance, which permit the identification of myocardial perfusion defects to detect significant CAD. A hybrid approach comprising myocardial perfusion imaging and coronary CTA may improve diagnostic performance for detecting obstructive CAD. Methods PubMed and Web of Knowledge were searched for relevant publications between January 1, 2000 and December 31, 2015. Studies using coronary CTA and hybrid imaging for diagnosis of obstructive CAD (a luminal diameter reduction of >50% or >70% by invasive coronary angiography) were included. In total, 12 articles comprising 951 patients and 1,973 vessels were identified, and a meta-analysis was performed to determine pooled sensitivity, specificity, and summary receiver-operating characteristic curves. Results On a per-patient basis, the pooled sensitivity of hybrid imaging was comparable to that of coronary CTA (91% vs. 90%; p = 0.28). However, specificity was higher for hybrid imaging versus coronary CTA (93% vs. 66%; p < 0.001). On a per-vessel basis, sensitivity for hybrid imaging against coronary CTA was comparable (84% vs. 89%; p = 0.29). Notably, hybrid imaging yielded a specificity of 95% versus 83% for coronary CTA (p < 0.001). Summary receiver-operating characteristic curves displayed improved discrimination for hybrid imaging beyond coronary CTA alone, on a per-vessel basis (area under the curve: 0.97 vs. 0.93; p = 0.047), although not on a per-patient level (area under the curve: 0.97 vs. 0.93; p = 0.132). Conclusions Hybrid cardiac imaging demonstrated improved diagnostic specificity for detection of obstructive CAD compared with stand-alone coronary CTA, yet improvement in overall diagnostic performance was relatively limited. [ABSTRACT FROM AUTHOR]
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- 2018
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12. Feasibility, Validity, and Reliability of the 10-item Patient Reported Outcomes Measurement Information System Global Health Short Form in Outpatients with Systemic Lupus Erythematosus.
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Kasturi, Shanthini, Szymonifka, Jackie, Burket, Jayme C., Berman, Jessica R., Kirou, Kyriakos A., Levine, Alana B., Sammaritano, Lisa R., and Mandl, Lisa A.
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- 2018
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13. A four-tier classification system of pulmonary artery metrics on computed tomography for the diagnosis and prognosis of pulmonary hypertension.
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Truong, Quynh A., Bhatia, Harpreet Singh, Szymonifka, Jackie, Zhou, Qing, Lavender, Zachary, Waxman, Aaron B., Semigran, Marc J., and Malhotra, Rajeev
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Background We aimed to develop a severity classification system of the main pulmonary artery diameter (mPA) and its ratio to the ascending aorta diameter (ratio PA) for the diagnosis and prognosis of pulmonary hypertension (PH) on computed tomography (CT) scans. Methods In 228 patients (136 with PH) undergoing right heart catheterization (RHC) and CT for dyspnea, we measured mPA and ratio PA. In a derivation cohort (n = 114), we determined cutpoints for a four-tier severity grading system that would maximize sensitivity and specificity, and validated it in a separate cohort (n = 114). Cutpoints for mPA were defined with ≤27 mm(F) and ≤29 mm(M) as the normal reference range; mild as >27 to <31 mm(F) and >29 to <31 mm(M); moderate≥31–34 mm; and severe>34 mm. Cutpoints for ratio PA were defined as normal ≤0.9; mild>0.9 to 1.0; moderate>1.0 to 1.1; and severe>1.1. Results Sensitivities for normal tier were 99% for mPA and 93% for ratio PA; while specificities for severe tier were 98% for mPA>34 mm and 100% for ratio PA>1.1. C-statistics for four-tier mPA and ratio PA were both 0.90 (derivation) and both 0.85 (validation). Severity of mPA and ratio PA corresponded to hemodynamics by RHC and echocardiography (both p < 0.001). Moderate-severe mPA values of ≥31 mm and ratio PA>1.1 had worse survival than normal values (all p ≤ 0.01). Conclusion A CT-based four-tier severity classification system of PA diameter and its ratio to the aortic diameter has high accuracy for PH diagnosis with increased mortality in patients with moderate-severe severity grades. These results may support clinical utilization on chest and cardiac CT reports. [ABSTRACT FROM AUTHOR]
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- 2018
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14. Is Traditional Chinese Medicine Use Associated with Worse Patient-reported Outcomes among Chinese American Rheumatology Patients?
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Sun, Kai, Szymonifka, Jackie, Tian, Henghe, Chang, Yaju, Leng, Jennifer C., and Mandl, Lisa A.
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Objective.Chinese Americans are a fast-growing immigrant group with more severe rheumatic disease manifestations than whites and often a strong cultural preference for traditional Chinese medicine (TCM). We aimed to examine TCM use patterns and association with patient-reported outcomes (PRO) among Chinese American rheumatology patients.Methods.Chinese Americans actively treated for systemic rheumatic diseases were recruited from urban Chinatown rheumatology clinics. Data on sociodemographics, acculturation, clinical factors, and TCM use (11 modalities) were gathered. Self-reported health status was assessed using Patient Reported Outcomes Measurement Information System (PROMIS) short forms. TCM users and nonusers were compared. Factors independently associated with TCM use were identified using multivariable logistic regression.Results.Among 230 participants, median age was 57 years (range 20–97), 65% were women, 71% had ≤ high school education, 70% were on Medicaid insurance, 47% lived in the United States for ≥ 20 years, and 22% spoke English fluently. Half used TCM in the past year; these participants had worse self-reported anxiety, depression, fatigue, and ability to participate in social roles and activities compared with nonusers. In multivariable analysis, TCM use was associated with belief in TCM, female sex, ≥ 20 years of US residency, reporting Western medicine as ineffective, and shorter rheumatic disease duration.Conclusion.Among these Chinese American rheumatology patients, TCM users had worse PRO in many physical and mental health domains. TCM use may be a proxy for unmet therapeutic needs. Asking about TCM use could help providers identify patients with suboptimal health-related quality of life who may benefit from targeted interventions.
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- 2019
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15. Validity and Reliability of Patient Reported Outcomes Measurement Information System Computerized Adaptive Tests in Systemic Lupus Erythematosus.
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Kasturi, Shanthini, Szymonifka, Jackie, Burket, Jayme C., Berman, Jessica R., Kirou, Kyriakos A., Levine, Alana B., Sammaritano, Lisa R., and Mandl, Lisa A.
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- 2017
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16. Blood-induced bone loss in murine hemophilic arthropathy is prevented by blocking the iRhom2/ADAM17/TNF-α pathway
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Haxaire, Coline, Hakobyan, Narine, Pannellini, Tania, Carballo, Camila, McIlwain, David, Mak, Tak W., Rodeo, Scott, Acharya, Suchitra, Li, Daniel, Szymonifka, Jackie, Song, Xiangqian, Monette, Sébastien, Srivastava, Alok, Salmon, Jane E., and Blobel, Carl P.
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Hemophilic arthropathy (HA) is a debilitating degenerative joint disease that is a major manifestation of the bleeding disorder hemophilia A. HA typically begins with hemophilic synovitis that resembles inflammatory arthritides, such as rheumatoid arthritis, and frequently results in bone loss in patients. A major cause of rheumatoid arthritis is inappropriate release of the proinflammatory cytokine tumor necrosis factor-α (TNF-α) by the TNF-α convertase (TACE; also referred to as ADAM17) and its regulator, iRhom2. Therefore, we hypothesized that iRhom2/ADAM17-dependent shedding of TNF-α also has a pivotal role in mediating HA. Here, we show that addition of blood or its components to macrophages activates iRhom2/ADAM17-dependent TNF-α shedding, providing the premise to study the activation of this pathway by blood in the joint in vivo. For this, we turned to hemophilic FVIII-deficient mice (F8−/− mice), which develop a hemarthrosis following needle puncture injury with synovial inflammation and significant osteopenia adjacent to the affected joint. We found that needle puncture–induced bleeding leads to increased TNF-α levels in the affected joint of F8−/− mice. Moreover, inactivation of TNF-α or iRhom2 in F8−/− mice reduced the osteopenia and synovial inflammation that develops in this mouse model for HA. Taken together, our results suggest that blood entering the joint activates the iRhom2/ADAM17/TNF-α pathway, thereby contributing to osteopenia and synovitis in mice. Therefore, this proinflammatory signaling pathway could emerge as an attractive new target to prevent osteoporosis and joint damage in HA patients.
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- 2018
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17. Blood-induced bone loss in murine hemophilic arthropathy is prevented by blocking the iRhom2/ADAM17/TNF-α pathway
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Haxaire, Coline, Hakobyan, Narine, Pannellini, Tania, Carballo, Camila, McIlwain, David, Mak, Tak W., Rodeo, Scott, Acharya, Suchitra, Li, Daniel, Szymonifka, Jackie, Song, Xiangqian, Monette, Sébastien, Srivastava, Alok, Salmon, Jane E., and Blobel, Carl P.
- Abstract
Hemophilic arthropathy (HA) is a debilitating degenerative joint disease that is a major manifestation of the bleeding disorder hemophilia A. HA typically begins with hemophilic synovitis that resembles inflammatory arthritides, such as rheumatoid arthritis, and frequently results in bone loss in patients. A major cause of rheumatoid arthritis is inappropriate release of the proinflammatory cytokine tumor necrosis factor-α (TNF-α) by the TNF-α convertase (TACE; also referred to as ADAM17) and its regulator, iRhom2. Therefore, we hypothesized that iRhom2/ADAM17-dependent shedding of TNF-α also has a pivotal role in mediating HA. Here, we show that addition of blood or its components to macrophages activates iRhom2/ADAM17-dependent TNF-α shedding, providing the premise to study the activation of this pathway by blood in the joint in vivo. For this, we turned to hemophilic FVIII-deficient mice (F8−/−mice), which develop a hemarthrosis following needle puncture injury with synovial inflammation and significant osteopenia adjacent to the affected joint. We found that needle puncture–induced bleeding leads to increased TNF-α levels in the affected joint of F8−/−mice. Moreover, inactivation of TNF-α or iRhom2 in F8−/−mice reduced the osteopenia and synovial inflammation that develops in this mouse model for HA. Taken together, our results suggest that blood entering the joint activates the iRhom2/ADAM17/TNF-α pathway, thereby contributing to osteopenia and synovitis in mice. Therefore, this proinflammatory signaling pathway could emerge as an attractive new target to prevent osteoporosis and joint damage in HA patients.
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- 2018
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18. Does Education Level Mitigate the Effect of Poverty on Total Knee Arthroplasty Outcomes?
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Goodman, Susan M., Mandl, Lisa A., Mehta, Bella, Navarro‐Millan, Iris, Russell, Linda A., Parks, Michael L., Dey, Shirin A., Crego, Daisy, Figgie, Mark P., Nguyen, Joseph T., Szymonifka, Jackie, Zhang, Meng, and Bass, Anne R.
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Total knee arthroplasty (TKA) outcomes are worse for patients from poor neighborhoods, but whether education mitigates the effect of poverty is not known. We assessed the interaction between education and poverty on 2‐year Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function. Patient‐level variables from an institutional registry were linked to USCensus Bureau data (census tract [CT] level). Statistical models including patient and CT‐level variables were constructed within multilevel frameworks. Linear mixed‐effects models with separate random intercepts for each CTwere used to assess the interaction between education and poverty at the individual and community level on WOMACscores. Of 3,970 TKApatients, 2,438 (61%) had some college or more. Having no college was associated with worse pain and function at baseline and 2 years (P= 0.0001). Living in a poor neighborhood (>20% below poverty line) was associated with worse 2‐year pain (P= 0.02) and function (P= 0.006). There was a strong interaction between individual education and community poverty with WOMACscores at 2 years. Patients without college living in poor communities had pain scores that were ~10 points worse than those with some college (83.4% versus 75.7%; P< 0.0001); in wealthy communities, college was associated with a 1‐point difference in pain. Function was similar. In poor communities, those without college attain 2‐year WOMACscores that are 10 points worse than those with some college; education has no impact on TKAoutcomes in wealthy communities. How education protects those in impoverished communities warrants further study.
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- 2018
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19. Flares in Patients with Rheumatoid Arthritis after Total Hip and Total Knee Arthroplasty: Rates, Characteristics, and Risk Factors
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Goodman, Susan M., Bykerk, Vivian P., DiCarlo, Edward, Cummings, Ryan W., Donlin, Laura T., Orange, Dana E., Hoang, Annie, Mirza, Serene, McNamara, Michael, Andersen, Kayte, Bartlett, Susan J., Szymonifka, Jackie, and Figgie, Mark P.
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Objective.Rates of total knee arthroplasty (TKA) and total hip arthroplasty (THA) remain high for patients with rheumatoid arthritis (RA), who are at risk of flaring after surgery. We aimed to describe rates, characteristics, and risk factors of RA flare within 6 weeks of THA and TKA.Methods.Patients with RA were recruited prior to elective THA and TKA surgery and prospectively followed. Clinicians evaluated RA clinical characteristics 0–2 weeks before and 6 weeks after surgery. Patients answered questions regarding disease activity including self-reported joint counts and flare status weekly for 6 weeks. Per standard of care, biologics were stopped before surgery, while glucocorticoids and methotrexate (MTX) were typically continued. Multivariable logistic regression was used to identify baseline characteristics associated with postsurgical RA flares.Results.Of 120 patients, the mean age was 62 years and the median RA duration 14.8 years. Ninety-eight (82%) met 2010/1987 American College of Rheumatology/European League Against Rheumatism criteria, 53 (44%) underwent THA (and the rest TKA), and 61 (51%) were taking biologics. By 6 weeks, 75 (63%) had flared. At baseline, flarers had significantly higher disease activity (as measured by the 28-joint Disease Activity Score), erythrocyte sedimentation rate, C-reactive protein, and pain. Numerically more flarers used biologics, but stopping biologics did not predict flares, and continuing MTX was not protective. A higher baseline disease activity predicted flaring by 6 weeks (OR 2.12, p = 0.02).Conclusion.Flares are frequent in patients with RA undergoing arthroplasty. Higher baseline disease activity significantly increases the risk. Although more patients stopping biologics flared, this did not independently predict flaring. The effect of early postsurgery flares requires further study.
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- 2018
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20. Achieving target SBP for lowering the risk of major adverse cardiovascular events in persons with diabetes mellitus
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Ó Hartaigh, Bríain, Szymonifka, Jackie, and Okin, Peter M.
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Supplemental Digital Content is available in the text
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- 2018
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21. Feasibility, Validity, and Reliability of the 10-item Patient Reported Outcomes Measurement Information System Global Health Short Form in Outpatients with Systemic Lupus Erythematosus
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Kasturi, Shanthini, Szymonifka, Jackie, Burket, Jayme C., Berman, Jessica R., Kirou, Kyriakos A., Levine, Alana B., Sammaritano, Lisa R., and Mandl, Lisa A.
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Objective.To assess the feasibility, validity, and reliability of the Patient Reported Outcomes Measurement Information System Global Health Short Form (PROMIS10) in outpatients with systemic lupus erythematosus (SLE).Methods.SLE outpatients completed PROMIS10, Medical Outcomes Study Short Form-36 (SF-36), LupusQoL-US, and selected PROMIS computerized adaptive tests (CAT) at routine visits at an SLE Center of Excellence. Construct validity was evaluated by correlating PROMIS10 physical and mental health scores with PROMIS CAT, legacy instruments, and physician-derived measures of disease activity and damage. Test-retest reliability was determined among subjects reporting stable SLE activity at 2 assessments 1 week apart using intraclass correlation coefficients (ICC).Results.A diverse cohort of 204 out of 238 patients with SLE (86%) completed survey instruments. PROMIS10 physical health scores strongly correlated with physical function, pain, and social health domains in PROMIS CAT, SF-36, and LupusQoL, while mental health scores strongly correlated with PROMIS depression CAT, SF-36, and LupusQoL mental health domains (Spearman correlations ≥ 0.70). Active arthritis, comorbid fibromyalgia (FM), and anxiety were associated with worse PROMIS10 scores, but sociodemographic factors and physician-assessed flare status were not. Test-retest reliability for PROMIS10 physical and mental health scores was high (ICC ≥ 0.85). PROMIS10 required < 2 minutes to complete.Conclusion.PROMIS10 is valid and reliable, and can efficiently screen for impaired physical function, pain, and emotional distress in outpatients with SLE. With strong correlations to LupusQoL and SF-36 but significantly reduced responder burden, PROMIS10 is a promising tool for measuring patient-reported outcomes in routine SLE clinical care and value-based healthcare initiatives.
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- 2018
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22. Validity and Reliability of Patient Reported Outcomes Measurement Information System Computerized Adaptive Tests in Systemic Lupus Erythematosus
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Kasturi, Shanthini, Szymonifka, Jackie, Burket, Jayme C., Berman, Jessica R., Kirou, Kyriakos A., Levine, Alana B., Sammaritano, Lisa R., and Mandl, Lisa A.
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Objective.The aims of this study were to assess the construct validity and the test-retest reliability of Patient Reported Outcomes Measurement Information System (PROMIS) computerized adaptive tests (CAT) in patients with systemic lupus erythematosus (SLE).Methods.Adults with SLE completed the Medical Outcomes Study Short Form-36, LupusQoL-US version (“legacy instruments”), and 14 selected PROMIS CAT. Using Spearman correlations, PROMIS CAT were compared with similar domains measured with legacy instruments. CAT were also correlated with the Safety of Estrogens in Lupus Erythematosus National Assessment–Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) disease activity and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) scores. Test-retest reliability was evaluated using ICC.Results.There were 204 outpatients with SLE enrolled in the study and 162 completed a retest. PROMIS CAT showed good performance characteristics and moderate to strong correlations with similar domains in the 2 legacy instruments (r = −0.49 to 0.86, p < 0.001). However, correlations between PROMIS CAT and the SELENA-SLEDAI disease activity and SDI were generally weak and statistically insignificant. PROMIS CAT test-retest ICC were good to excellent, ranging from 0.72 to 0.88.Conclusion.To our knowledge, these data are the first to show that PROMIS CAT are valid and reliable for many SLE-relevant domains. Importantly, PROMIS scores did not correlate well with physician-derived measures. This disconnect between objective signs and symptoms and the subjective patient disease experience underscores the crucial need to integrate patient-reported outcomes into clinical care to ensure optimal disease management.
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- 2017
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23. Novel Heart Failure Biomarkers Predict Improvement of Mitral Regurgitation in Patients Receiving Cardiac Resynchronization Therapy—The BIOCRT Study
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Beaudoin, Jonathan, Singh, Jagmeet P., Szymonifka, Jackie, Zhou, Qing, Levine, Robert A., Januzzi, James L., and Truong, Quynh A.
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Cardiac resynchronization therapy (CRT) improves mitral regurgitation (MR) in a subset of patients. We hypothesized that biomarkers (amino-terminal pro-B type natriuretic peptide, high-sensitivity troponin I, galectin-3 [gal-3], and soluble ST2) might predict MR response after CRT.
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- 2016
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24. Computed Tomography−Guided Assessment of Response to Cardiac Resynchronization Therapy
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Galand, Vincent, Ghoshhajra, Brian, Szymonifka, Jackie, Leclercq, Christophe, Truong, Quynh A., and Singh, Jagmeet P.
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- 2019
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25. Characterization and Prediction of Adverse Events From Intensive Chronic Heart Failure Management and Effect on Quality of Life: Results From the Pro-B-Type Natriuretic Peptide Outpatient-Tailored Chronic Heart Failure Therapy (PROTECT) Study.
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Gandhi, Parul U., Szymonifka, Jackie, Motiwala, Shweta R., Belcher, Arianna M., JrJanuzzi, James L., and Gaggin, Hanna K.
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Background Serious adverse events (SAEs) from heart failure (HF) therapy are frequent; however, techniques to identify at-risk patients are inadequate. Furthermore, the relationship between SAEs, quality of life (QOL), and cardiac structure are unknown. Methods and Results 151 symptomatic patients with systolic HF were followed for a mean of 10 months. In this post hoc analysis, treatment-related SAEs included acute renal failure, dizziness, hypo/hyperkalemia, hypotension, and syncope. At 1 year, 21 treatment-related SAEs occurred. No difference in SAEs existed between the N-terminal pro-B-type natriuretic peptide (NT-proBNP)–guided arm and the standard of care arm ( P = .20). At baseline, patients who suffered SAEs were less likely to be receiving beta-blockers (85.7% vs 97.7%; P = .009) and had worse functional class and lower chloride levels. Patients who experienced SAEs had less improvement in their Minnesota Living With Heart Failure Questionnaire scores and had a trend toward reduced echocardiographic reverse remodeling over the follow-up period. Univariable and multivariable analyses were conducted to develop a risk score for SAE prediction; patients in the highest risk quartile had the shortest time to first cardiovascular event ( P = 0.01). Conclusions NT-proBNP–guided HF care is safe. Experiencing treatment-related SAEs is associated with worse QOL and potentially reduced reverse remodeling. A risk score to prospectively predict SAEs in aggressive HF management was developed. [ABSTRACT FROM AUTHOR]
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- 2015
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26. Coronary sinus biomarker sampling compared to peripheral venous blood for predicting outcomes in patients with severe heart failure undergoing cardiac resynchronization therapy: The BIOCRT study.
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Truong, Quynh A., Januzzi, James L., Szymonifka, Jackie, Thai, Wai-ee, Wai, Bryan, Lavender, Zachary, Sharma, Umesh, Sandoval, Ryan M., Grunau, Zachary S., Basnet, Sandeep, Babatunde, Adefolakemi, Ajijola, Olujimi A., Min, James K., and Singh, Jagmeet P.
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Background A significant minority of patients receiving cardiac resynchronization therapy (CRT) remain nonresponsive to this intervention. Objective This study aimed to determine whether coronary sinus (CS) or baseline peripheral venous (PV) levels of established and emerging heart failure (HF) biomarkers are predictive of CRT outcomes. Methods In 73 patients (aged 68 ± 12 years; 83% men; ejection fraction 27% ± 7%) with CS and PV blood samples drawn simultaneously at the time of CRT device implantation, we measured amino-terminal pro-B–type natriuretic peptide (NT-proBNP), galectin-3 (gal-3), and soluble ST2 (sST2) levels. NT-proBNP concentrations >2000 pg/mL, gal-3 concentrations >25.9 ng/mL, and sST2 concentrations >35 ng/mL were considered positive on the basis of established PV cut points for identifying “high-risk” individuals with HF. CRT response was adjudicated by the HF Clinical Composite Score. A major adverse cardiovascular event (MACE) was defined as the composite end point of death, cardiac transplant, left ventricular assist device, and HF hospitalization at 2 years. Results NT-proBNP concentrations were 20% higher in the CS than in the periphery, while gal-3 and sST2 concentrations were 10% higher in the periphery than in the CS (all P < .001). There were 45% CRT nonresponders at 6 months and 16 (22%) patients with MACE. Triple-positive CS values yielded the highest specificity of 95% for predicting CRT nonresponse. Consistently, CS strategies identified patients at higher risk of developing MACE, with >11-fold adjusted increase for triple-positive CS patients compared to triple-negative patients (all P ≤ .04). PV strategies were not predictive of MACE. Conclusion Our findings suggest that CS sampling of HF biomarkers may be better than PV sampling for predicting CRT outcomes. Larger studies are needed to confirm our findings. [ABSTRACT FROM AUTHOR]
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- 2014
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27. Preliminary Results of a Phase II Trial of Proton Radiotherapy for Pediatric Rhabdomyosarcoma.
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Ladra, Matthew M., Szymonifka, Jackie D., Mahajan, Anita, Friedmann, Alison M., Beow Yong Yeap, Goebel, Claire P., MacDonald, Shannon M., Grosshans, David R., Rodriguez-Galindo, Carlos, Marcus, Karen J., Tarbell, Nancy J., and Yock, Torunn I.
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- 2014
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28. Outcomes of Breast Cancer in Brazil Related to Health Care Coverage: A Retrospective Cohort Study.
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Liedke, Pedro E. R., Finkelstein, Dianne M., Szymonifka, Jackie, Barrios, Carlos H., Chavarri-Guerra, Yanin, Bines, José, Vasconcelos, Cláudia, Simon, Sérgio D., and Goss, Paul E.
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The article provides information on a study which evaluated differences in breast cancer outcomes according to type of healthcare coverage, public or private. Topics addressed include patient characteristics, role of funding sources and comparisons of demographics, disease characteristics and treatment regimens between those with public and private coverage.
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- 2014
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29. Analysis of start-up, retention, and adherence in ALS clinical trials.
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Atassi, Nazem, Yerramilli-Rao, Padmaja, Szymonifka, Jackie, Yu, Hong, Kearney, Marianne, Grasso, Daniela, Deng, Jing, Levine-Weinberg, Mark, Shapiro, Jordan, Lee, Alexandra, Joseph, Lucia, Macklin, Eric A, and Cudkowicz, Merit E
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- 2013
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30. Analysis of start-up, retention, and adherence in ALS clinical trials.
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Atassi, Nazem, Yerramilli-Rao, Padmaja, Szymonifka, Jackie, Hong Yu, Kearney, Marianne, Grasso, Daniela, Jing Deng, Levine-Weinberg, Mark, Shapiro, Jordan, Lee, Alexandra, Joseph, Lucia, Macklin, Eric A., and Cudkowicz, Merit E.
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- 2013
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31. Head-to-Head Comparison of Serial Soluble ST2, Growth Differentiation Factor-15, and Highly-Sensitive Troponin T Measurements in Patients With Chronic Heart Failure
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Gaggin, Hanna K., Szymonifka, Jackie, Bhardwaj, Anju, Belcher, Arianna, De Berardinis, Benedetta, Motiwala, Shweta, Wang, Thomas J., and Januzzi, James L.
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This analysis aimed to perform a head-to-head comparison of 3 of the promising biomarkers of cardiovascular (CV) outcomes in heart failure (HF)—soluble ST2 (sST2), growth differentiation factor (GDF)-15, and highly-sensitive troponin T (hsTnT)—and to evaluate the role of serial measurement of these biomarkers in patients with chronic HF.
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- 2014
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32. Analysis of start-up, retention, and adherence in ALS clinical trials
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Atassi, Nazem, Yerramilli-Rao, Padmaja, Szymonifka, Jackie, Yu, Hong, Kearney, Marianne, Grasso, Daniela, Deng, Jing, Levine-Weinberg, Mark, Shapiro, Jordan, Lee, Alexandra, Joseph, Lucia, Macklin, Eric A., and Cudkowicz, Merit E.
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To investigate predictors of trial start-up times, high attrition, and poor protocol adherence in amyotrophic lateral sclerosis (ALS) trials.
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- 2013
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33. Implications of Incidentally Discovered, Nonfunctioning Pancreatic Endocrine Tumors: Short-term and Long-term Patient OutcomesPancreatic Endocrine Tumors
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Haynes, Alex B., Deshpande, Vikram, Ingkakul, Thun, Vagefi, Parsia A., Szymonifka, Jackie, Thayer, Sarah P., Ferrone, Cristina R., Wargo, Jennifer A., and Warshaw, Andrew L.
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OBJECTIVES To describe the characteristics and outcomes after resection of incidentally discovered, nonfunctioning pancreatic endocrine tumors (PETs). DESIGN Case series. SETTING Academic hospital. PATIENTS Consecutive patients with an incidentally identified, nonfunctioning PET resected from May 1, 1977, through July 31, 2009. MAIN OUTCOME MEASURES Operative morbidity and survival after resection. RESULTS A total of 139 patients with median age of 56 years (range, 21-85 years) underwent resection; tumor size ranged from 0.4 to 17.0 cm, with median size of 3.0 cm. No perioperative deaths were reported. Sixty-one patients (43.9%) experienced a perioperative complication. Twenty-six tumors (18.7%) were classified as benign, 39 (28.1%) as malignant, and 72 (51.8%) as uncertain. We were unable to confidently classify 2 tumors due to lack of information regarding mitotic rate in the pathology report. Complete follow-up was available for 112 patients (80.6%) (median, 34.2 months). Five-year actuarial survival rates were 88.8% for patients with benign disease, 92.5% for patients with tumors of uncertain biology, and 49.8% for those with malignant tumors (P = .01). Late metastasis, tumor recurrence, or disease progression were seen in 1 patient (3.8%) with tumors initially classified as benign, 8 patients (11.1%) with uncertain tumors, and 15 patients (38.5%) with tumors classified as malignant (P < .001). Of the 39 patients with tumors 2 cm or smaller, 3 (7.7%) had late metastases or recurrence. When compared with patients with symptomatic, nonfunctioning PETs, no large difference was observed in tumor size, patient age, disease, or survival. CONCLUSIONS Incidentally detected, nonfunctioning PETs can display aggressive behavior, even when small. Although patients with malignant disease had diminished survival and increased rates of recurrence, benign histologic findings did not eliminate the possibility of progression. Patients with incidentally discovered, nonfunctioning PETs should undergo tumor resection and careful postoperative surveillance, even if surgical pathologic findings suggest benign disease.Arch Surg. 2011;146(5):534-538--
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- 2011
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34. Total Therapy 3 for multiple myeloma: prognostic implications of cumulative dosing and premature discontinuation of VTD maintenance components, bortezomib, thalidomide, and dexamethasone, relevant to all phases of therapy
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van Rhee, Frits, Szymonifka, Jackie, Anaissie, Elias, Nair, Bijay, Waheed, Sarah, Alsayed, Yazan, Petty, Nathan, Shaughnessy, John D., Hoering, Antje, Crowley, John, and Barlogie, Bart
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The impact of cumulative dosing and premature drug discontinuation (PMDD) of bortezomib (V), thalidomide (T), and dexamethasone (D) on overall survival (OS), event-free survival (EFS), time to next therapy, and post-relapse survival in Total Therapy 3 were examined, using time-dependent methodology, relevant to induction, peritransplantation, consolidation, and maintenance phases. Univariately, OS and EFS were longer in case higher doses were used of all agents during induction, consolidation (except T), and maintenance (except V and T). The favorable OS and EFS impact of D induction dosing provided the rationale for examining the expression of glucocorticoid receptor NR3C1, top-tertile levels of which significantly prolonged OS and EFS and rendered outcomes independent of D and T dosing, whereas T and D, but not V, dosing was critical to outcome improvement in the bottom-tertile NR3C1 setting. PMDD of V was an independent highly adverse feature for OS (hazard ratio = 6.44; P < .001), whereas PMDD of both T and D independently imparted shorter time to next therapy. The absence of adverse effects on postrelapse survival of dosing of any VTD components and indeed a benefit from V supports the use up-front of all active agents in a dose-dense and dose-intense fashion, as practiced in Total Therapy 3, toward maximizing myeloma survival.
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- 2010
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35. Superior results of Total Therapy 3 (2003-33) in gene expression profiling–defined low-risk multiple myeloma confirmed in subsequent trial 2006-66 with VRD maintenance
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Nair, Bijay, van Rhee, Frits, Shaughnessy, John D., Anaissie, Elias, Szymonifka, Jackie, Hoering, Antje, Alsayed, Yazan, Waheed, Sarah, Crowley, John, and Barlogie, Bart
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The Total Therapy 3 trial 2003-33 enrolled 303 newly diagnosed multiple myeloma patients and was noted to provide superior clinical outcomes compared with predecessor trial Total Therapy 2, especially in gene expression profiling (GEP)–defined low-risk disease. We report here on the results of successor trial 2006-66 with 177 patients, using bortezomib, lenalidomide, and dexamethasone maintenance for 3 years versus bortezomib, thalidomide, and dexamethasone in year 1 and thalidomide/dexamethasone in years 2 and 3 in the 2003-33 protocol. Overall survival (OS) and event-free survival (EFS) plots were super-imposable for the 2 trials, as were onset of complete response and complete response duration (CRD), regardless of GEP risk. GEP-defined high-risk designation, pertinent to 17% of patients, imparted inferior OS, EFS, and CRD in both protocols and, on multivariate analysis, was the sole adverse feature affecting OS, EFS, and CRD. Mathematical modeling of CRD in low-risk myeloma predicted a 55% cure fraction (P< .001). Despite more rapid onset and higher rate of CR than in other molecular subgroups, CRD was inferior in CCND1 without CD20 myeloma, resembling outcomes in MAF/MAFB and proliferation entities. The robustness of the GEP risk model should be exploited in clinical trials aimed at improving the notoriously poor outcome in high-risk disease.
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- 2010
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36. Superior results of Total Therapy 3 (2003-33) in gene expression profiling–defined low-risk multiple myeloma confirmed in subsequent trial 2006-66 with VRD maintenance
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Nair, Bijay, van Rhee, Frits, Shaughnessy, John D., Anaissie, Elias, Szymonifka, Jackie, Hoering, Antje, Alsayed, Yazan, Waheed, Sarah, Crowley, John, and Barlogie, Bart
- Abstract
The Total Therapy 3 trial 2003-33 enrolled 303 newly diagnosed multiple myeloma patients and was noted to provide superior clinical outcomes compared with predecessor trial Total Therapy 2, especially in gene expression profiling (GEP)–defined low-risk disease. We report here on the results of successor trial 2006-66 with 177 patients, using bortezomib, lenalidomide, and dexamethasone maintenance for 3 years versus bortezomib, thalidomide, and dexamethasone in year 1 and thalidomide/dexamethasone in years 2 and 3 in the 2003-33 protocol. Overall survival (OS) and event-free survival (EFS) plots were super-imposable for the 2 trials, as were onset of complete response and complete response duration (CRD), regardless of GEP risk. GEP-defined high-risk designation, pertinent to 17% of patients, imparted inferior OS, EFS, and CRD in both protocols and, on multivariate analysis, was the sole adverse feature affecting OS, EFS, and CRD. Mathematical modeling of CRD in low-risk myeloma predicted a 55% cure fraction (P < .001). Despite more rapid onset and higher rate of CR than in other molecular subgroups, CRD was inferior in CCND1 without CD20 myeloma, resembling outcomes in MAF/MAFB and proliferation entities. The robustness of the GEP risk model should be exploited in clinical trials aimed at improving the notoriously poor outcome in high-risk disease.
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- 2010
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37. Complete remission in multiple myeloma examined as time-dependent variable in terms of both onset and duration in Total Therapy protocols
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Hoering, Antje, Crowley, John, Shaughnessy, John D, Hollmig, Klaus, Alsayed, Yazan, Szymonifka, Jackie, Waheed, Sarah, Nair, Bijay, van Rhee, Frits, Anaissie, Elias, and Barlogie, Bart
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Landmark analyses are used to investigate the importance for survival of achieving complete response (CR), an important initial goal of myeloma therapy. With median times to CR in Total Therapy (TT) trials of approximately 1 year, this approach excludes a sizeable fraction of patients dying before such a landmark. To permit inclusion of all trial participants, we investigated the prognostic implications of both onset and duration of CR as time-dependent variables. Superseding the adverse effects of cytogenetic abnormalities and other standard prognostic parameters, both failure to achieve CR (non-CR) and, especially, loss of CR (los-CR) were independently associated with inferior survival in TT1, TT2, and TT3 protocols. In the context of gene array–defined risk, available in TT2 and TT3 subsets, both los-CR and non-CR terms were retained in the survival model as dominant adverse variables, stressing the prognostic importance of sustaining CR status, especially in high-risk disease.
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- 2009
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38. Complete remission in multiple myeloma examined as time-dependent variable in terms of both onset and duration in Total Therapy protocols
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Hoering, Antje, Crowley, John, Shaughnessy, John D, Hollmig, Klaus, Alsayed, Yazan, Szymonifka, Jackie, Waheed, Sarah, Nair, Bijay, van Rhee, Frits, Anaissie, Elias, and Barlogie, Bart
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Landmark analyses are used to investigate the importance for survival of achieving complete response (CR), an important initial goal of myeloma therapy. With median times to CR in Total Therapy (TT) trials of approximately 1 year, this approach excludes a sizeable fraction of patients dying before such a landmark. To permit inclusion of all trial participants, we investigated the prognostic implications of both onset and duration of CR as time-dependent variables. Superseding the adverse effects of cytogenetic abnormalities and other standard prognostic parameters, both failure to achieve CR (non-CR) and, especially, loss of CR (los-CR) were independently associated with inferior survival in TT1, TT2, and TT3 protocols. In the context of gene array–defined risk, available in TT2 and TT3 subsets, both los-CR and non-CR terms were retained in the survival model as dominant adverse variables, stressing the prognostic importance of sustaining CR status, especially in high-risk disease.
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- 2009
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39. Gene expression profiling of plasma cells at myeloma relapse from tandem transplantation trial Total Therapy 2 predicts subsequent survival
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Nair, Bijay, Shaughnessy, John D., Zhou, Yiming, Astrid-Cartron, Marie, Qu, Pingping, van Rhee, Frits, Anaissie, Elias, Alsayed, Yazan, Waheed, Sarah, Hollmig, Klaus, Szymonifka, Jackie, Petty, Nathan, Hoering, Antje, and Barlogie, Bart
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We report on prognostic implications for postrelapse survival (PRS) of a gene expression profiling (GEP)–defined risk score at relapse available in 120 myeloma patients previously enrolled in tandem transplantation trial Total Therapy 2. Among the 71 patients with additional GEP baseline information, 3-year PRS was 71% in 40 patients with low risk present both at baseline and relapse contrasting with only 17% in 28 patients with high risk at relapse, 12 of whom with baseline low-risk status fared better than the remainder (P = .08). On multivariate analysis of relapse parameters available in 104 patients, high risk conferred short PRS (hazard ratio = 4.00, P < .001, R2 = 33%), whereas relapse hyperdiploidy predicted long PRS (hazard ratio = 0.37, P = .022, cumulative R2 = 41%). In case the initial partial response lasted less than 2 years, relapse low-risk identified 26 patients with superior 3-year PRS of 61% versus 9% among 32 with relapse high-risk (P < .001). Based on its PRS predictive power, GEP analysis should be an integral part of new agent trials in search of better therapy for high-risk myeloma.
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- 2009
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40. Gene expression profiling of plasma cells at myeloma relapse from tandem transplantation trial Total Therapy 2 predicts subsequent survival
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Nair, Bijay, Shaughnessy, John D., Zhou, Yiming, Astrid-Cartron, Marie, Qu, Pingping, van Rhee, Frits, Anaissie, Elias, Alsayed, Yazan, Waheed, Sarah, Hollmig, Klaus, Szymonifka, Jackie, Petty, Nathan, Hoering, Antje, and Barlogie, Bart
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We report on prognostic implications for postrelapse survival (PRS) of a gene expression profiling (GEP)–defined risk score at relapse available in 120 myeloma patients previously enrolled in tandem transplantation trial Total Therapy 2. Among the 71 patients with additional GEP baseline information, 3-year PRS was 71% in 40 patients with low risk present both at baseline and relapse contrasting with only 17% in 28 patients with high risk at relapse, 12 of whom with baseline low-risk status fared better than the remainder (P= .08). On multivariate analysis of relapse parameters available in 104 patients, high risk conferred short PRS (hazard ratio = 4.00, P< .001, R2= 33%), whereas relapse hyperdiploidy predicted long PRS (hazard ratio = 0.37, P= .022, cumulative R2= 41%). In case the initial partial response lasted less than 2 years, relapse low-risk identified 26 patients with superior 3-year PRS of 61% versus 9% among 32 with relapse high-risk (P< .001). Based on its PRS predictive power, GEP analysis should be an integral part of new agent trials in search of better therapy for high-risk myeloma.
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- 2009
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41. Factors associated with malpractice claim payout: an analysis of closed emergency department claims
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Gupta, Kiran, Szymonifka, Jackie, Rivadeneira, Natalie A., Khoong, Elaine C., Adler-Milstein, Julia, Ross, Jacqueline, and Sarkar, Urmimala
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- 2022
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42. Long-term survival in Waldenstrom macroglobulinemia: 10-year follow-up of Southwest Oncology Group–directed intergroup trial S9003
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Dhodapkar, Madhav V., Hoering, Antje, Gertz, Morie A., Rivkin, Saul, Szymonifka, Jackie, Crowley, John, and Barlogie, Bart
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The survival of patients with Waldenstrom macroglobulinemia (WM) varies enormously. The development of prognostic models in WM has been fraught by limited follow-up in current studies. Here, we update the outcome of a prospective WM trial with a median follow-up of 10 years for live patients. Of the 59 previously untreated patients who initially were observed, only 12 patients (21%) required therapy at a median follow-up of 100 months. Multivariate analysis among the 183 patients requiring therapy reaffirmed age 70 years or greater, previous nonprotocol therapy, and β-2 microglobulin (B2M) of 3 mg/dL or greater as prognostic factors. Importantly, increased serum lactate dehydrogenase (LDH) was identified as an additional independent variable, which improved risk assessment beyond the recent WM international prognostic scoring system (ISSWM). By using age, previous therapy, B2M, and LDH, we identified 3 risk groups with 8-year survival estimates of 55%, 33%, and 5% (P < .001). These data provide novel insights into factors predicting long-term outcome in WM. This trial has been registered with www.cancer.gov under ID 4852904.
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- 2009
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43. Long-term survival in Waldenstrom macroglobulinemia: 10-year follow-up of Southwest Oncology Group–directed intergroup trial S9003
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Dhodapkar, Madhav V., Hoering, Antje, Gertz, Morie A., Rivkin, Saul, Szymonifka, Jackie, Crowley, John, and Barlogie, Bart
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The survival of patients with Waldenstrom macroglobulinemia (WM) varies enormously. The development of prognostic models in WM has been fraught by limited follow-up in current studies. Here, we update the outcome of a prospective WM trial with a median follow-up of 10 years for live patients. Of the 59 previously untreated patients who initially were observed, only 12 patients (21%) required therapy at a median follow-up of 100 months. Multivariate analysis among the 183 patients requiring therapy reaffirmed age 70 years or greater, previous nonprotocol therapy, and β-2 microglobulin (B2M) of 3 mg/dL or greater as prognostic factors. Importantly, increased serum lactate dehydrogenase (LDH) was identified as an additional independent variable, which improved risk assessment beyond the recent WM international prognostic scoring system (ISSWM). By using age, previous therapy, B2M, and LDH, we identified 3 risk groups with 8-year survival estimates of 55%, 33%, and 5% (P< .001). These data provide novel insights into factors predicting long-term outcome in WM. This trial has been registered with www.cancer.govunder ID 4852904.
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- 2009
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44. Seven-year median time to progression with thalidomide for smoldering myeloma: partial response identifies subset requiring earlier salvage therapy for symptomatic disease
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Barlogie, Bart, van Rhee, Frits, Shaughnessy, John D., Epstein, Joshua, Yaccoby, Shmuel, Pineda-Roman, Mauricio, Hollmig, Klaus, Alsayed, Yazan, Hoering, Antje, Szymonifka, Jackie, Anaissie, Elias, Petty, Nathan, Kumar, Naveen S., Srivastava, Geetika, Jenkins, Bonnie, Crowley, John, and Zeldis, Jerome B.
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Smoldering multiple myeloma (SMM) is usually followed expectantly without therapy. We conducted a phase 2 trial in 76 eligible patients with SMM, combining thalidomide (THAL, 200 mg/d) with monthly pamidronate. In the first 2 years, THAL dose reduction was required in 86% and drug was discontinued in 50%. Within 4 years, 63% improved, including 25% qualifying for partial response (PR); by then, 34 patients had progressed and 17 required salvage therapy. Unexpectedly, attaining PR status was associated with a shorter time to salvage therapy for disease progression (P < .001), perhaps reflecting greater drug sensitivity of more aggressive disease. Low beta-2-microglobulin levels less than 2 mg/L were independently associated with superior overall and event-free survival. Four-year survival and event-free survival estimates of 91% and 60%, respectively, together with a median postsalvage therapy survival of more than 5 years justify the conduct of a prospective randomized clinical trial to determine the clinical value of preemptive therapy in SMM. Trial registered at http://www.clinicaltrials.gov under identifier NCT00083382.
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- 2008
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45. Seven-year median time to progression with thalidomide for smoldering myeloma: partial response identifies subset requiring earlier salvage therapy for symptomatic disease
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Barlogie, Bart, van Rhee, Frits, Shaughnessy, John D., Epstein, Joshua, Yaccoby, Shmuel, Pineda-Roman, Mauricio, Hollmig, Klaus, Alsayed, Yazan, Hoering, Antje, Szymonifka, Jackie, Anaissie, Elias, Petty, Nathan, Kumar, Naveen S., Srivastava, Geetika, Jenkins, Bonnie, Crowley, John, and Zeldis, Jerome B.
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Smoldering multiple myeloma (SMM) is usually followed expectantly without therapy. We conducted a phase 2 trial in 76 eligible patients with SMM, combining thalidomide (THAL, 200 mg/d) with monthly pamidronate. In the first 2 years, THAL dose reduction was required in 86% and drug was discontinued in 50%. Within 4 years, 63% improved, including 25% qualifying for partial response (PR); by then, 34 patients had progressed and 17 required salvage therapy. Unexpectedly, attaining PR status was associated with a shorter time to salvage therapy for disease progression (P< .001), perhaps reflecting greater drug sensitivity of more aggressive disease. Low beta-2-microglobulin levels less than 2 mg/L were independently associated with superior overall and event-free survival. Four-year survival and event-free survival estimates of 91% and 60%, respectively, together with a median postsalvage therapy survival of more than 5 years justify the conduct of a prospective randomized clinical trial to determine the clinical value of preemptive therapy in SMM. Trial registered at http://www.clinicaltrials.govunder identifier NCT00083382.
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- 2008
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46. Validation of the Hip Disability and Osteoarthritis Outcome Score and Knee Injury and Osteoarthritis Outcome Score Pain and Function Subscales for Use in Total Hip Replacement and Total Knee Replacement Clinical Trials.
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Goodman, Susan M., Mehta, Bella Y., Mandl, Lisa A., Szymonifka, Jackie D., Finik, Jackie, Figgie, Mark P., Navarro-Millán, Iris Y., Bostrom, Mathias P., Parks, Michael L., Padgett, Douglas E., McLawhorn, Alexander S., Antao, Vinicius C., Yates, Adolph J., Springer, Bryan D., Lyman, Stephen L., and Singh, Jasvinder A.
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Background: Total hip replacement (THR)/total knee replacement (TKR) studies do not uniformly measure patient centered domains, pain, and function. We aim to validate existing measures of pain and function within subscales of standard instruments to facilitate measurement.Methods: We evaluated baseline and 2-year pain and function for THR and TKR using Hip disability and Osteoarthritis Outcome Score (HOOS)/Knee Injury and Osteoarthritis Outcome Score (KOOS), with primary unilateral TKR (4796) and THR (4801). Construct validity was assessed by correlating HOOS/KOOS pain and activities of daily living (ADL), function quality of life (QOL), and satisfaction using Spearman correlation coefficients. Patient relevant thresholds for change in pain and function were anchored to improvement in QOL; minimally clinically important difference (MCID) corresponded to "a little improvement" and a really important difference (RID) to a "moderate improvement." Pain and ADL function scores were compared by quartiles using Kruskal-Wallis.Results: Two-year HOOS/KOOS pain and ADL function correlated with health-related QOL (KOOS pain and Short Form 12 Physical Component Scale ρ = 0.54; function ρ = 0.63). Comparing QOL by pain and function quartiles, the highest levels of pain relief and function were associated with the most improved QOL. MCID for pain was estimated at ≥20, and the RID ≥29; MCID for function ≥14, and the RID ≥23. The measures were responsive to change with large effect sizes (≥1.8).Conclusion: We confirm that HOOS/KOOS pain and ADL function subscales are valid measures of critical patient centered domains after THR/TKR, and achievable thresholds anchored to improved QOL. Cost-free availability and brevity makes them feasible, to be used in a core measurement set in total joint replacement trials. [ABSTRACT FROM AUTHOR]- Published
- 2020
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47. Impact of Aortomitral Continuity Calcification on Need for Permanent Pacemaker After Transcatheter Aortic Valve Replacement.
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Katchi, Farhan, Bhatt, Deep, Markowitz, Steven M., Szymonifka, Jackie, Cheng, Edward P., Minutello, Robert M., Bergman, Geoffrey W., Wong, S. Chiu, Salemi, Arash, and Truong, Quynh A.
- Abstract
Supplemental Digital Content is available in the text. Background: By virtue of its proximity to structures vital to cardiac conduction, aortomitral continuity calcification (AMCC) may help identify patients at highest risk for developing atrioventricular conduction disease requiring permanent pacemaker implantation (PPMI). We aim to determine the association of AMCC and need for PPMI after transcatheter aortic valve replacement. Methods: Of 614 patients who underwent transcatheter aortic valve replacement (11.8% PPMI rate), we included 136 patients (age 85±8 years, 47% male) without a preexisting intracardiac device or prior valve surgery who underwent preprocedural computed tomography. We analyzed for the presence of AMCC, aortic valve calcification, and mitral annular calcification as well as quantified AMCC and aortic valve calcification score using the Agatston method. We further stratified AMCC score into 3 categories: 0, 1 to 300, and >300. End point was PPMI at 1 month after transcatheter aortic valve replacement. Results: There were 51 (38%) new PPMIs (median time to PPMI, 5 days). Patients who underwent PPMI had a higher prevalence of AMCC than patients without PPMI (69% versus 32%; P <0.0001), as well as higher median AMCC score (263 versus 0; P <0.0001). There was no difference in aortic valve calcification and mitral annular calcification between patients with and without PPMI (all P ≥0.09). Patients with AMCC had a 4-fold increase in odds for PPMI compared with those without (adjusted odds ratio, 4.0; P =0.0026). Compared with patients with an AMCC score of 0, patients with an AMCC score >300 had greater than a 5-fold increased odds for PPMI (adjusted odds ratio, 5.7; P =0.0016). Conclusions: Presence of AMCC, particularly with AMCC score >300, is associated with the need for PPMI after transcatheter aortic valve replacement. [ABSTRACT FROM AUTHOR]
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- 2019
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48. Impact of Aortomitral Continuity Calcification on Need for Permanent Pacemaker After Transcatheter Aortic Valve Replacement
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Katchi, Farhan, Bhatt, Deep, Markowitz, Steven M., Szymonifka, Jackie, Cheng, Edward P., Minutello, Robert M., Bergman, Geoffrey W., Wong, S. Chiu, Salemi, Arash, and Truong, Quynh A.
- Abstract
Supplemental Digital Content is available in the text.
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- 2019
- Full Text
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49. Abstract 13476: Spatial Risk Factors Impact Cardiovascular Mortality: Analysis From the Golestan Cohort Study
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Hadley, Michael, Nalini, Mahdi, Adhikari, Samrachana, Szymonifka, Jackie, Etemadi, Arash, Kamangar, Farin, Khoshnia, Masoud, McChane, Jesse, Pourshams, Akram, Poustchi, Hossein, Sepanlou, Sadaf G, Boffetta, Paolo, Malekzadeh, Reza, and Vedanthan, Rajesh
- Abstract
Introduction:Spatial risk factors are increasingly recognized to predict cardiovascular events independently of traditional risk factors. However, these spatial risk factors have been studied only individually and primarily in high-income countries.Hypothesis:We hypothesize that spatial risk factors independently predict all-cause and cardiovascular mortality.Methods:We developed exposure models for the following spatial risk factors in Golestan Provence, Iran: outdoor air pollution, proximity to traffic, proximity to health facilities, population density, land cover, socioeconomic environment, and light-at-night. Spatial exposures were assigned to 50,045 individuals in the Golestan Cohort Study, who have been followed-up for up to 12 years. Using a multivariable Cox proportional hazards spatial frailty model, we determined the impact of these exposures, as well as household fuel use and traditional risk factors, on cardiovascular mortality.Results:Spatial surfaces demonstrated spatial variability of the spatial risk factors (Figure), and outdoor air pollution also displayed temporal variability. Exposure to outdoor air pollution 5 years prior to enrollment, household kerosene and biomass fuel use, and proximity to advanced health facilities independently increased total and cardiovascular mortality (Table).Conclusions:Both outdoor air pollution and household fuel use independently predicted cardiovascular mortality in a middle-income country. Following this approach, future studies can better estimate the total impact of the environment on cardiovascular events.
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- 2019
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50. Diagnosing Prosthetic Joint Infections in Patients With Inflammatory Arthritis: A Systematic Literature Review.
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Mirza, Serene Z., Richardson, Shawn S., Kahlenberg, Cynthia A., Blevins, Jason L., Lautenbach, Charles, Demetres, Michelle, Martin, Lily, Szymonifka, Jackie, Sculco, Peter K., Figgie, Mark P., and Goodman, Susan M.
- Abstract
Background: Patients with inflammatory arthritis (IA) are at increased risk of prosthetic joint infections (PJI), yet differentiating between septic and aseptic failure is a challenge. The aim of our systematic review is to evaluate synovial biomarkers and their efficacy at diagnosing PJI in patients with IA.Methods: A comprehensive literature search was performed in the following databases from inception to January 2018: Ovid MEDLINE, Ovid EMBASE, and the Cochrane Library. Searches across the databases retrieved 367 results. Two of 5 reviewers independently screened a total of 298 citations. Discrepancies were resolved by a third reviewer. Twenty articles fit our criteria, but due to methodological differences findings could not be pooled for meta-analysis. For 5 studies, raw data were provided, pooled, and used to derive optimal diagnostic cut points.Results: Our final analysis included 1861 non-IA patients, including 426 patients with PJI, and 90 IA patients of whom 26 had PJI. There was a significant difference among the 4 groups for serum C-reactive protein (CRP), erythrocyte sedimentation rate, and synovial CRP, polymorphonuclear neutrophil percent, white blood cells, interleukin (IL)-6, IL-8, and IL-1b. Polymorphonuclear neutrophil percent had the highest sensitivity (95.2%) and specificity (85.0%) to detect infections with an optimum threshold of 78%.Conclusion: While levels of synovial white blood cells, IL-6, IL-8, and serum CRP appear higher in patients with IA, there is overlap with those who are not infected. Further studies are needed to explore diagnostic tests that will better detect PJI in patients with IA. [ABSTRACT FROM AUTHOR]- Published
- 2019
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