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Cleveland, OH, United States

Muller M.,North Carolina State University | Ait-Belkacem D.,ESPCI ParisTech | Hessabi M.,University of Paris Descartes | Gennisson J.-L.,ESPCI ParisTech | And 7 more authors.
Ultrasound in Medicine and Biology

The quantitative assessment of the cervix is crucial for the estimation of pre-term delivery risk and the prediction of the success of labor induction. We conducted a cross-sectional study using shear wave elastography based on the supersonic shear imaging technique. The shear wave speed (SWS) of the lower anterior part of the cervix was quantified over an 8-mm region of interest in 157 pregnant women. Cervical SWS is slightly but significantly reduced in patients diagnosed with pre-term labor and in patients who actually delivered pre-term. © 2015 World Federation for Ultrasound in Medicine and Biology. Source

Davis E.M.,University of Pittsburgh | Appel L.J.,Johns Hopkins University | Wang X.,Center for Clinical Investigation | Greene T.,University of Utah | And 6 more authors.

Blood pressure (BP) guidelines that set target BP levels often rely on analyses of achieved BP from hypertension treatment trials. The objective of this article was to compare the results of analyses of achieved BP to intention-to-treat analyses on renal disease progression. Participants (n=1094) in the African-American Study of Kidney Disease and Hypertension Trial were randomly assigned to either usual BP goal defined by a mean arterial pressure goal of 102 to 107 mm Hg or lower BP goal defined by a mean arterial pressure goal of ≤92 mm Hg. Median follow-up was 3.7 years. Primary outcomes were rate of decline in measured glomerular filtration rate and a composite of a decrease in glomerular filtration rate by >50% or >25 mL/min per 1.73 m 2, requirement for dialysis, transplantation, or death. Intention-to-treat analyses showed no evidence of a BP effect on either the rate of decline in glomerular filtration rate or the clinical composite outcome. In contrast, the achieved BP analyses showed that each 10-mm Hg increment in mean follow-up achieved mean arterial pressure was associated with a 0.35 mL/min per 1.73 m2 (95% CI: 0.08 to 0.62 mL/min per 1.73 m; P=0.01) faster mean glomerular filtration rate decline and a 17% (95% CI: 5% to 32%; P=0.006) increased risk of the clinical composite outcome. Analyses based on achieved BP lead to markedly different inferences than traditional intention-to-treat analyses, attributed in part to confounding of achieved BP with comorbidities, disease severity, and adherence. Clinicians and policy makers should exercise caution when making treatment recommendations based on analyses relating outcomes to achieved BP. © 2011 American Heart Association, Inc. Source

Li A.,Harvard Medical SchoolBoston | Makar R.S.,Harvard Medical SchoolBoston | Hurwitz S.,Center for Clinical Investigation | Uhl L.,Harvard Medical SchoolBoston | And 4 more authors.

BACKGROUND: Therapeutic plasma exchange (TPE) is a proven treatment for thrombotic thrombocytopenic purpura (TTP) characterized by severe ADAMTS13 deficiency, but the efficacy of TPE in suspected TTP with an ADAMTS13 activity level of more than 10% remains controversial. STUDY DESIGN AND METHODS: We conducted a propensity score (PS)-matched study of 186 adult patients included in the Harvard Thrombotic Microangiopathy (TMA) Research Collaborative registry who presented with TMA suggestive of TTP but an ADAMTS13 activity level of more than 10%. RESULTS: Before matching, patients treated with TPE (n=71) differed from untreated patients (n=115) by several clinical measures. PS matching was performed to address clinical disparities between the two groups and resulted in a well-balanced cohort of 59 TPE-treated patients paired with 59 untreated controls, all of whom had TMA. After matching, we observed no significant difference in the primary outcome of 90-day survival between the treated and untreated groups (hazard ratio, 0.88; 95% confidence interval [CI], 0.44-1.77; p=0.72). In-hospital mortality (odds ratio [OR], 0.77; 95% CI, 0.34-1.75; p=0.53) and the percentage of patients with platelet count recovery (OR, 1.58; 95% CI, 0.77-3.26; p=0.21) also did not differ significantly between the two matched groups. CONCLUSION: Our data suggest that routine use of TPE in the diverse group of TMA patients without severe ADAMTS13 deficiency may not significantly improve outcomes. © 2016 AABB. Source

Billings M.E.,Health Services Research and Development | Billings M.E.,University of Washington | Auckley D.,Center for Sleep Medicine | Auckley D.,Case Western Reserve University | And 9 more authors.

Study Objectives: There are few established predictors of CPAP adherence; poor adherence limits its effectiveness. We investigated whether race, education level, and residential economic status predict CPAP adherence in participants enrolled in a trial with standard access to treatment. Design: A multi-center randomized trial of home vs. lab-based evaluation and treatment of OSA assessing adherence to CPAP at 1 and 3 months. Setting: Seven AASM-accredited sleep centers in 5 U.S. cities. Participants: Subjects with moderate to severe OSA (AHI ≥ 15 and Epworth Sleepiness Scale score > 12) who completed follow-up at 1 and/or 3 months (n = 135). Measurements and Results: Subjects' demographic data were collected upon enrollment; CPAP use at 1 and 3 months was assessed at clinic follow-up. In unadjusted analyses, CPAP adherence (average minutes per night of CPAP use) at 3 months was lower in black subjects and in subjects from lower socioeconomic status ZIP codes. In adjusted analyses using multivariate linear regression, black race was predictive of CPAP adherence at one month (P = 0.03). At 3 months, black race was predictive in analyses only when ZIP code SES was not adjusted for. Conclusion: Black race and lower socioeconomic residential areas are associated with poorer adherence to CPAP in subjects with standardized access to care and treatment. Disparities remain despite provision of standardized care in a clinical trial setting. Future research is needed to identify barriers to adherence and to develop interventions tailored to improve CPAP adherence in at risk populations. Portable Monitoring for Diagnosis and Management of Sleep Apnea (HomePAP) Clinical Trial Information: NIH clinical trials registry number: NCT00642486. URL: http://clinicaltrials.gov/show/ NCT00642486. Source

Chen Y.,Center for Clinical Investigation | Chen Y.,Case Western Reserve University | Xu R.,Center for Clinical Investigation
Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics)

We propose a phenome-based strategy to identify novel disease associated genes for PD, and investigated the translational potential of the predicted genes in drug discovery. Different from previous studies, we incorporated multiple disease phenotypic similarity networks, and integrated them with a genetic network to infer novel candidate genes. We validated the approach in two experiments: the 15 known PD genes from OMIM were averagely ranked within the top 0.8%, and the top-ranked genes were enriched for 669 PD genes from GWAS. In addition, our approach prioritized the target genes for both FDA-approved PD drugs and candidate PD drugs in clinical trials. The result provides empirical evidence that our computational gene prediction approach has the translational potential in PD drug discovery. © Springer International Publishing Switzerland 2015. Source

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