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Challenges and improvements in testosterone and estradiol testing

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Asian Journal of Andrology 2014年第2期16卷 178-184,I0006,I0007页

作者： Hubert W Vesper Julianne C Botelho Yuesong Wang clinical Chemistry Branch Division of Laboratory Sciences Centers for Disease Control and Prevention Atlanta Georgia USA.

Assays that measure steroid hormones in patient care, public health, and research need to be both accurate and precise, as these criteria help to ensure comparability across all clinical and research applications. This review addresses major issues relevant to assay variability and describes recent activities by the US Centers for Disease Control and Prevention （CDC） to improve assay performance. Currently, high degrees of accuracy and precision are not always met for testosterone and estradiol measurements; although technologies for steroid hormone measurement have advanced significantly, measurement variability within and across laboratories has not improved accordingly. Differences in calibration and specificity are discussed as sources of variability in measurement accuracy. Ultimately, a combination of factors appears to cause inaccuracy of steroid hormone measurements, with nonuniform assay calibration and lack of specificity being two major contributors to assay variability. Within-assay variability for current assays is generally high, especially at low analyte concentrations. The CDC Hormone Standardization （HoSt） Program is improving clinical assays, as evidenced by a 50% decline in mean absolute bias between mass spectrometry assays and the CDC reference method from 2007 to 2011. This program provides the measurement traceability to CDC reference methods and helps to minimize factors affecting measurement variability.

关键词： CDC hormone standardization CDC HoSt estradiol steroid hormone testing testosterone

Targeted therapy in gastroesophageal cancers:past,present and future

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Gastroenterology Report 2015年第4期3卷 316-329,I0002页

作者： Janghee Woo Stacey A.Cohen Jonathan E.Grim clinical research Division Fred Hutchinson Cancer Research CenterSeattleWAUSA Division of Medical Oncology University of WashingtonSeattleWAUSA Hospital and specialty Medicine VA Puget Sound Health Care SystemSeattleWAUSA

Gastroesophageal cancer is a significant global problem that frequently presents at an incurable stage and has very poor survival with standard chemotherapy *** review will examine the epidemiology and molecular biology of gastroesophageal cancer and will focus on the key deregulated signaling pathways that have been targeted in the clinic.A comprehensive overview of clinical data highlighting successes and failures with targeted agents will be *** notably,HER2-targeted therapy with the monoclonal antibody trastuzumab has proven beneficial in first-line therapy and has been incorporated into standard *** the VEGF pathway has also proven beneficial,and the VEGFR-targeted monoclonal antibody ramucirumab is now approved for second-line *** contrast to these positive results,agents targeting the EGFR and MET pathways have been evaluated extensively in gastroesophageal cancer but have repeatedly failed to show *** increased understanding of the molecular predictors of response to targeted therapies is sorely *** the future,improved molecular pathology approaches should subdivide this heterogeneous disease entity to allow individualization of cancer therapy based on integrated and global identification of deregulated signaling *** patient selection,rational combinations of targeted therapies and incorporation of emerging immunotherapeutic approaches should further improve the treatment of this deadly disease.

关键词： esophageal cancer gastric cancer targeted therapy molecular oncology

The immunological underpinnings of vaccinations to prevent cvtomegalovirus disease

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Cellular & Molecular Immunology 2015年第2期12卷 170-179页

作者： A. Louise McCormick Edward S. Mocarski Laboratory of Biochemical Pharmacology Department of Pediatrics Emery University Atlanta GA USA Department of Microbiology and Immunology and Emery Vaccine Center Emery University Atlanta GA USA

A universal cytomegalovirus （CMV） vaccination promises to reduce the burden of the developmental damage that afflicts up to 0.5% of live births worldwide. An effective vaccination that prevents transplacental transmission would reduce CMV congenital disease and CMV-associated still births and leave populations less susceptible to opportunistic CMV disease. Thus, a vaccination against this virus has long been recognized for the potential of enormous health-care savings because congenital damage is life-long and existing anti-viral options are limited. Vaccine researchers, industry leaders, and regulatory representatives have discussed the challenges posed by clinical efficacy trials that would lead to a universal CMV vaccine, reviewing the links between infection and disease, and identifying settings where disrupting viral transmission might provide a surrogate endpoint for disease prevention. Reducing the complexity of such trials would facilitate vaccine development. Children and adolescents are the targets for universal vaccination, with the expectation of protecting the offspring of immunized women. Given that a majority of females worldwide experience CMV infection during childhood, a universal vaccine must boost natural immunity and reduce transmission due to reactivation and re-infection as well as primary infection during pregnancy. Although current vaccine strategies recognize the value of humoral and cellular immunity, the precise mechanisms that act at the placental interface remain elusive. Immunity resulting from natural infection appears to limit rather than prevent reactivation of latent viruses and susceptibility to re-infection, leaving a challenge for universal vaccination to improve upon natural immunity levels. Despite these hurdles, early phase clinical trials have achieved primary end points in CMV seronegative subjects. Efficacy studies must be expanded to mixed populations of CMV-naive and naturally infected subjects to understand the overall

关键词： congenital disease prevention re-infection vaccine

Major histocompatibility complex I upregulation in clear cell renal cell carcinoma is associated with increased survival

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Asian Journal of Urology 2016年第2期3卷 75-81页

作者： Rishi R.Sekar Claire M.De La Calle Dattatraya Patil Sarah A.Holzman Yoram Baum Umer Sheikh Jonathan H.Huang Adeboye O.Osunkoya Brian P.Pollack Haydn T.Kissick Kenneth Ogan Viraj A.Master Department of Urology Emory University School of MedicineAtlantaGAUSA Department of Pathology Emory University School of MedicineAtlantaGAUSA Department of Dermatology Emory University School of MedicineAtlantaGAUSA The atlanta VA Medical Center DecaturGAUSA

Objective:To examine the prognostic value of tumor major histocompatibility complex I(MHCI)expression on survival and recurrence in patients with clear cell renal cell carcinoma(RCC).Methods:Fifty-three patients that underwent nephrectomy at our institution for clear cell RCC(T1eT3)with4 years of follow-up were queried from our nephrectomy *** staining for MHCI was performed on tumor specimens and MHCI expression was quantified with an automated image analysis *** were divided into high and low MHCI expression groups in order to study the relationship between MHCI expression and prognosis using the KaplaneMeier method and log-rank ***:Overall survival and recurrence free survival were increased in the high MHCI expression group compared to the low MHCI expression group(log-rank,p=0.036 and p=0.028,respectively).Patients alive at the end of the study had higher MHCI expression(mean positivity score 0.82)than those that died of disease(mean positivity score 0.76,t test,p=0.030).Patients that did not develop recurrence during the study period had higher MHCI expression(mean positivity score 0.83)than those that did develop recurrence(mean positivity score 0.78),but this difference was not significant(t test,p =0.079).

关键词： Renal cell carcinoma Prognosis MHCI Biomarker

Hypogonadism is independently associated with varicocele repair-in a contemporary cohort of men in the USA

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Asian Journal of Andrology 2019年第1期21卷 45-49页

作者： Cailey Guercio Dattatraya Patil Akanksha Mehta Department of Urology Emory University School of MedicineAtlantaGA 30322USA.

We aimed to identify demographic and clinical predictors of varicocele repair in a contemporary cohort of men in the *** queried the 2009-2015 MarketScan Database using relevant ICD9,ICD10,and CPT codes to identify all 18-45 year olds with *** in age,area of residence,clinical characteristics,and medical management between men who did and did not undergo varicocelectomy (open,laparoscopic,or microsurgical)during the study period were compared using unpaired t-tests and Chi-squared tests for continuous and categorical variables,*** logistic regression analysis was used to evaluate age,semen analyses,and serum hormone assessment as predictors of varicocele *** version 9.4 was used for all statistical *** was set at P clinical management of varicoceles in the USA.

关键词： decision-making hypogonadism male infertility varicocele varicocelectomy

Clinician Utilization of Best Practices for HIV care and Status Disclosure: A Cross-Sectional Study

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Open Journal of Preventive Medicine 2014年第8期4卷 649-658页

作者： Victor N. Ede Elleen Yancey Harold Stringer Robina Josiah Willock Gregory Strayhorn Department of Community Health and Preventive Medicine Morehouse School of Medicine Atlanta GA USA Department of Medicine Morehouse School of Medicine Atlanta GA USA Department of Psychiatry and Behavioral Sciences Morehouse School of Medicine Atlanta GA USA Department of Community Health and Preventive Medicine Morehouse School of Medicine Atlanta GA USA Master of Science in clinical research Program Morehouse School of Medicine Atlanta GA USA Master of Science in clinical research Program Morehouse School of Medicine Atlanta GA USA Department of Family Medicine Morehouse School of Medicine Atlanta GA USA

Determining the baseline utilization of best practices among clinicians, with regard to HIV care and disclosure of status to at-risk partners, is critical to addressing HIV prevention issues and disease transmission. In this study, we examined clinicians' utilization of best practices for HIV/AIDS care and the disclosure of HIV status to sexual and needle-sharing partners (HSSNSP). We conducted a cross-sectional survey of 100 clinicians to assess knowledge, attitude, and behavior towards best practices for HIV care and disclosure of HSSNSP. Multiple logistic regression analysis was used to determine factors associated with the utilization of clinical best practices for HIV care and disclosure of HSSNSP. Forty eight percent of the participants revealed poor behaviors. Fifty six percent showed less positive attitudes towards clinical best practices for HIV care and disclosure of status. Less than half (32%) of the participants had earned at least 1 HIV/AIDS CME credit in the past two years. Our study showed strong associations between the utilization of best practices for HIV care and the disclosure of status, and clinician attitudes and knowledge levels. Further research that aims to improve knowledge and attitudes on clinical best practices for providing HIV/AIDS care and the disclosure of status is needed. This improvement may lead to increase in the utilization of best practices for HIV care and disclosure of status, and contribute to decreases in disease transmission rates.

关键词： HIV/AIDS care Status Disclosure Best Practice Clinician Sexual and Needle-Sharing Partners

Advances in the diagnosis and management of acute retinal necrosis

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Annals of Eye Science 2020年第3期5卷 69-76页

作者： Casey L.Anthony J.Clay Bavinger Steven Yeh Department of Ophthalmology Emory Eye CenterAtlantaGAUSA

Acute retinal necrosis(ARN)is a devastating syndrome characterized by panuveitis,retinal necrosis,and a high rate of retinal detachment that may result in poor visual outcomes if not promptly diagnosed and *** is most commonly caused by viruses within the herpesvirus *** include varicella-zoster virus,herpes simplex virus,and cytomegalovirus,and may be promptly diagnosed by polymerase chain reaction testing of aqueous or vitreous *** true incidence of ARN is not known due to its rarity;as a result,clinical treatment is often guided by retrospective case series,case reports,and expert *** of care has evolved over time but currently includes a combination of systemic and intravitreal antiviral in conjunction with topical or oral steroids and surgical therapy as *** therapy may reduce the rate of severe vision loss and increase the rate of visual acuity gain,although further studies are needed in this *** particular for patients with mild to moderate disease,combination therapy may reduce the rate of retinal *** therapies including oral corticosteroid and prophylactic laser barricade are incompletely studied,but corticosteroid in particular,may reduce inflammation,which also is involved in the severe disease pathogenesis observed in *** review discusses the advances in diagnosis and treatment of ARN,including management with combination antiviral medication and surgical interventions.

关键词： Acute retinal necrosis(ARN) herpetic retinitis herpesvirus retinal detachment

Severe Pulmonary Embolism,Thrombosis of Lower Extremity,Unexpected Mild Renal Disorder in MPO-ANCA Associated Vasculitis:A Case Report

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Chinese Medical Sciences Journal 2021年第4期36卷 342-345页

作者： Zhonghua Liao Juntao Feng Jiale Tang Liying Luo Xiaozhao Li Department of Nephrology National Key Clinical SpecialtyBranch of National Clinical Research Center for Respiratory DiseaseXiangya HospitalCentral South UniversityChangsha 410008China Department of Respiratory and Critical care Medicine National Key Clinical SpecialtyBranch of National Clinical Research Center for Respiratory DiseaseXiangya HospitalCentral South UniversityChangsha 410008China

Myeloperoxidase antineutrophil cytoplasmic antibody(MPO-ANCA)associated vasculitis is an autoimmune disease usually with severe multiple dysfunction syndrome,especially prominent acute renal failure.A 65-year-old woman was admitted with progressive dyspnoea for six months and fever,sputum with blood,pain of the lower extremities and intermittent claudication for two days,indicating multiple organ involvement(respiratory system,blood vessels).The renal involvement was relatively mild,presenting with microscopic *** chest computed tomography demonstrated multiple pulmonary *** and computed tomography angiography for the lower extremity vessels showed venous and arterial *** of other diseases that can cause multiple organ damage and thrombosis,the positive perinuclear ANCA and MPO-ANCA strongly support the diagnosis of MPO-ANAC-associated *** patient’s physical condition has been greatly improved by treatment with corticosteroids and anticoagulation.

关键词： antineutrophil cytoplasmic antibody-associated vasculitis myeloperoxidase pulmonary embolism arterial embolism

Intensive care unit hospitalizations and outcomes in patients with severe COVID-19 during summer and fall surges in Georgia

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World Journal of Critical care Medicine 2021年第6期10卷 369-376页

作者： Titilope Olanipekun Temidayo Ayotomiwa Abe Valery Sammah Effoe Joffi E Musonge-Effoe Agusiegbe Chuks Esther Kwara Alexandra Caldwell Samed Obeng Nicolas Bakinde Gloria Westney Richard Snyder Department of Hospital Medicine Covenant Health SystemKnoxvilleTNCovenant Health SystemKnoxvilleTX 37922United States Department of Medicine Morehouse School of MedicineAtlantaGA 30310United States Department of Cardiology Morehouse School of MedicineAtlantaGA 30310United States Department of clinical research Morehouse School of MedicineAtlantaGA 30310United States Department of Medicine Pulmonary and Critical Care SectionMorehouse School of MedicineAtlantaGA 30310United States

BACKGROUND There is limited data on the difference in the clinical characteristics and outcomes of patients with severe coronavirus disease 2019(COVID-19)infection in the summer compared to the fall *** To compare the sociodemographic,clinical characteristics,and outcomes among mechanically ventilated patients with severe COVID-19 infection admitted to the intensive care unit(ICU)during the summer and fall surges in the year *** We included patients admitted to the ICU and treated with invasive mechanical ventilation for COVID-19 associated respiratory failure between April 1 and December 31,*** were categorized into summer surge for ICU admissions between June 15,2020,and August 15,2020,and fall surge between October 15,2020,and December 31,*** compared patients'characteristics and outcomes using descriptive and inferential *** A total of 220 patients were admitted to the Grady Memorial Hospital ICU and mechanically ventilated for COVID-19 associated hypoxemic respiratory failure during the period considered(125 during the summer surge and 95 during the fall surge).More women were admitted in the fall compared to summer(41.1%vs 36.8%,difference,4.3%;95%CI:1.2,7.5).Patients admitted in the fall had fewer comorbidities(chronic obstructive pulmonary disease,stroke,diabetes mellitus,obstructive sleep apnea and body mass index≥35 kg/m2).Overall,patients in the fall had a lower ICU mortality rate(27.4%vs 38.4%,difference,-11.0;95%CI:-6.4,-18.2),shorter length of stay on the mechanical ventilator(7 d vs 11 d,difference,4 d;95% CI:2.1,6.6)and shorter ICU length of stay(9 d vs 14 d,difference,5 d;95% CI:2.7,9.4).CONCLUSION Patients admitted with severe COVID-19 infection requiring mechanical ventilation had better outcomes in the fall than *** difference observed is likely attributable to a better understanding of the condition and advances in treatment strategies.

关键词： COVID-19 COVID-19 surge Georgia Intensive care unit Mechanical ventilation