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- 2019
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Tidskriftsartikel (refereegranskat)
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| 3. |
- Han, Hedong, et al.
(författare)
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Temporary Trend, Characteristics and Clinical Outcomes of Acute Pancreatitis Patients Infected with Human Immunodeficiency Virus
- 2021
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Ingår i: Digestive Diseases and Sciences. - : Kluwer Academic/Plenum Publishers. - 0163-2116 .- 1573-2568. ; 66, s. 1683-1692
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Compared to general population, human immunodeficiency virus (HIV) infection may increase frequency of acute pancreatitis (AP); however, evidence regarding effects of HIV infection on AP-related outcomes is limited and controversial.AIMS: We aim to investigate the temporary trend, characteristics and clinical outcomes of AP infected with HIV.METHODS: We reviewed data from the 2003-2014 National Inpatient Sample to identify patients with a primary diagnosis of AP. The primary outcomes (in-hospital mortality, acute respiratory failure, acute kidney injury, and prolonged length of stay [LOS]) and secondary outcomes (gastrointestinal hemorrhage, sepsis and total cost) were compared between patients with and without HIV infection using univariate, multivariable and propensity score matching analyses.RESULTS: Of 594,106 patients diagnosed with AP, 6775 (1.14%) had HIV infection. Patients with HIV were more likely to be younger, black, male, less likely to be gallstone-related and had lower rate of interventions. Multivariable analyses based on multiple imputation revealed that HIV infection was associated with higher risk of mortality (odds ratio [OR]: 1.74; 95% confidence interval [CI] 1.34-2.25), acute kidney injury (OR: 1.13; 95% CI 1.19-1.44), prolonged LOS (OR: 1.26; 95% CI 1.15-1.37) and 6% higher cost. There were no differences in sepsis, gastrointestinal bleeding, and respiratory failure between groups.CONCLUSIONS: HIV infection is associated with adverse outcomes including increased mortality, acute kidney injury and more healthcare utilization in AP patients. More assertive management strategies like early intravenous fluid resuscitation in HIV patients hospitalized with AP to prevent acute kidney injury may be helpful to improve clinical outcomes.
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| 4. |
- Han, Hedong, et al.
(författare)
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Atrial fibrillation in hospitalized patients with end-stage liver disease : temporal trends in prevalence and outcomes
- 2020
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Ingår i: Liver international (Print). - : Wiley-Blackwell Publishing Inc.. - 1478-3223 .- 1478-3231. ; 40:3, s. 674-684
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND & AIMS: End-stage liver disease (ESLD) happens due to the development and progression of chronic liver disease. This study aims to investigate the temporal trend, patient characteristics, and outcomes of atrial fibrillation (AF) in hospitalized ESLD patients across the United States.METHODS: Nationwide Inpatient Sample from 2003 to 2014 was utilized to retrospectively study the weighted prevalence of AF in hospitalized ESLD patients. Multivariable regression models were used to assess the association between AF with clinical factors, in-hospital mortality, length of stay (LOS), and cost.RESULTS: 639,345 hospitalizations associated with ESLD were identified, of which 47,710 (7.48%) were diagnosed with AF. The prevalence of AF increased from 5.73% in 2003 to 9.75% in 2014 in ESLD and varied by age, race, income, insurance type, and hospital characteristics. Factors associated with AF included advancing age, male, white race, high income, and urban teaching hospital. AF presence was associated with significant higher in-hospital mortality (odds ratio, 1.40; 95% confidence interval, 1.35-1.45), 21% longer LOS and 22% higher cost. In addition, a significant decreasing trend in in-hospital mortality was observed (from 16.70% to 10.63% in patients with AF and from 10.74% to 7.50% in patients without AF).CONCLUSIONS: The prevalence of AF in hospitalized ESLD patients has continued to increase from 2003 through 2014. AF is associated with poor prognosis and higher health resource utilization. Innovative anticoagulation strategies through improved collaboration between cardiologists and hepatologists are required for better management of hospitalized ESLD patients comorbid with AF.
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| 5. |
- Han, Hedong, et al.
(författare)
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Prevalence, trends, and outcomes of atrial fibrillation in hospitalized patients with metastatic cancer : findings from a national sample
- 2021
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Ingår i: Cancer Medicine. - : John Wiley & Sons. - 2045-7634. ; 10:16, s. 5661-5670
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Tidskriftsartikel (refereegranskat)abstract
- Background: Epidemiological evidence regarding the link between cancer and atrial fibrillation (AF) are limited and outcomes of metastatic cancer comorbid with AF need to be elucidated.Objective: This study aims to evaluate the prevalence, temporal trends, and outcomes of AF in hospitalized metastatic cancer patients.Methods: The National Inpatient Sample (NIS) database was used to identify adult patients with metastatic tumors from 2003 to 2014. We analyzed the trends in AF prevalence, in-hospital mortality, total cost, length of stay (LOS), and comorbidities pertaining to metastatic cancer. Multivariable-adjusted models were used to evaluate the association of AF with clinical factors, in-hospital mortality, total cost, and LOS.Results: Among 2,478,598 patients with metastatic cancer, 8.74% (216,737) were diagnosed with AF. The proportion of comorbid AF increased from 8.28% in 2003 to 10.06% in 2014 (p < 0.0001). Older age, white race, male, Medicare, higher income, larger hospital bed size, and urban teaching hospital were associated with higher AF occurrence. Among primary tumor sites, lung cancer experienced the highest odds of AF compared to other cancers. Patients with metastasis to lymph node and respiratory organ had higher odds of AF. In metastatic cancer, AF was associated with higher in-hospital mortality (odds ratio: 1.48; 95% confidence interval: 1.43-1.54), 18% longer LOS, and 19% higher cost.Conclusions: AF prevalence in metastatic cancer continues to increase from 2003 to 2014. AF is linked to poorer prognosis and higher healthcare resource utilization. As the population ages, optimal preventive and treatment management strategies are needed for metastatic cancer comorbid with AF.
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- Jiang, Guo-Xin
(författare)
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Guillain-Barre syndrome in Sweden : from clinical epidemiology to public-health surveillance
- 1996
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The Guillain-Barre syndrome (GBS) is an acute inflammatory demyelinating polyradiculoneuropathy of unknown etiology. A suspected diagnosis of GBS usually leads to immediate hospitalization of the patient for early detection and treatment of respiratory failure or cardiac arrhythmia. Antecedent events, usually an infection, occur in around two thirds of GBS patients during weeks before onset. The presumed pathogenesis for GBS is that diverse agents trigger an immune response directed against myelin or axonal antigens, and the immunopathological mechanisms may be predominantly cell-mediated or humoral, or a combination of the two. This thesis consists of a set of sequential studies on: 1) the descriptive epidemiology of GBS in the populations of South-West Stockholm (SWS), Stockholm County (SC) and Sweden; 2) the clinical epidemiology of GBS in SWS; and 3) the relationship between risk of GBS and pregnancy or postpartum using a cohort design. In addition, a study aimed to assess the requirement of public health surveillance (PHS) of GBS was undertaken. The mean annual incidence rates of GBS per 100,000 population, age-adjusted to the European population, were 1.81 and 1.84 in SWS and in SC during 1973-1991, and 1.77 in Sweden during 1978-1993. In general, the incidence was higher in men (male/female ratio 1.31), and increased with age, presenting a bimodal shape with peaks at 20-24 and 70-74 years in Sweden. Neither clear time trend nor spatial clustering was observed. Moderate seasonality for GBS among the young population, with a peak in late summer or early autumn, was suggested in the aforementioned three populations. The study of annual incidences in SC and Sweden disclosed statistically significant higher rates in 1978 and 1983 for certain age-groups in both populations. Based on the results from clinicoepidemiological analysis of incident cases in SWS, three major clinicoepidemiological subgroups of GBS in SWS were identified by a hierarchical ascending procedure using complete linkage. One subgroup, with a rapidly progressive course and benign outcome, consisted of young patients and a high proportion of cases with respiratory infection as preceding events, and with normal motor conduction velocity (CV) and less affected biological parameters. A second subgroup, severely affected clinically and functionally, consisted predominantly of young individuals with a high incidence in autumn. A third subgroup was older and, in general, also severely affected. Forecasts from time series using autoregressive integrated moving average (ARIMA) models fitted to hospital discharge data in SC during 1973-1992 and in Sweden during 1978- 1992, respectively, detected significant variations of GBS incidences in 1993 and displayed a seasonal pattern. When compared with data in retrospect, certain monthly incidences in Sweden and two-monthly numbers of incident cases in SC in 1978 and 1983, located at time-periods when significantly high risks or the outbreak of zimeldine-induced GBS had been identified, exceeded the upper 95 % confidence interval (CI) of the corresponding predicted values. PHS of GBS in Sweden is feasible for populations over 1.5 million and may be worthwhile. We propose a nation-wide GBS surveillance system based on notification by a sentinel network of neurologists in Sweden. From the results of this study, it is concluded that: 1) the quality of the register data of GBS diagnoses in Sweden is good for epidemiological research and surveillance; 2) the incidence of GBS in Sweden during the last two decades was in magnitude similar to those reported from other populations; 3) in general, rates were stable over the time with occasional significant variation, and no geographical clustering was found; 4) small epidemics of GBS in 1978 and 1983 might have been overlooked; 5) three clinicoepidemiological subgroups were identified; 6) PHS of GBS in Sweden is feasible and may be worthwhile if supported by a clinical network of neurologists; and 7) risk of GBS seems to be lower during pregnancy and increases after delivery.
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| 7. |
- Loth, Daan W, et al.
(författare)
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Genome-wide association analysis identifies six new loci associated with forced vital capacity
- 2014
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Ingår i: Nature Genetics. - : Springer Science and Business Media LLC. - 1061-4036 .- 1546-1718. ; 46, s. 669-677
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Tidskriftsartikel (refereegranskat)abstract
- Forced vital capacity (FVC), a spirometric measure of pulmonary function, reflects lung volume and is used to diagnose and monitor lung diseases. We performed genome-wide association study meta-analysis of FVC in 52,253 individuals from 26 studies and followed up the top associations in 32,917 additional individuals of European ancestry. We found six new regions associated at genome-wide significance (P < 5 × 10(-8)) with FVC in or near EFEMP1, BMP6, MIR129-2-HSD17B12, PRDM11, WWOX and KCNJ2. Two loci previously associated with spirometric measures (GSTCD and PTCH1) were related to FVC. Newly implicated regions were followed up in samples from African-American, Korean, Chinese and Hispanic individuals. We detected transcripts for all six newly implicated genes in human lung tissue. The new loci may inform mechanisms involved in lung development and the pathogenesis of restrictive lung disease.
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| 8. |
- Lu, Yingchang, et al.
(författare)
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Identification of Novel Loci and New Risk Variant in Known Loci for Colorectal Cancer Risk in East Asians
- 2020
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Ingår i: Cancer Epidemiology, Biomarkers and Prevention. - : American Association for Cancer Research. - 1055-9965 .- 1538-7755. ; 29:2, s. 477-486
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Tidskriftsartikel (refereegranskat)abstract
- Background: Risk variants identified so far for colorectal cancer explain only a small proportion of milial risk of this cancer, particularly in Asians.Methods: We performed a genome-wide association study (GWAS) of colorectal cancer in East Asians, cluding 23,572 colorectal cancer cases and 48,700 controls. To identify novel risk loci, we selected 60 omising risk variants for replication using data from 58,131 colorectal cancer cases and 67,347 controls European descent. To identify additional risk variants in known colorectal cancer loci, we performed nditional analyses in East Asians.Results: An indel variant, rs67052019 at 1p13.3, was found to be associated with colorectal cancer risk P = 3.9 x 10(-8) in Asians (OR per allele deletion = 1.13, 95% confidence interval = 1.08-1.18). This sociation was replicated in European descendants using a variant (rs2938616) in complete linkage sequilibrium with rs67052019 (P = 7.7 x 10(-3)). Of the remaining 59 variants, 12 showed an association P < 0.05 in the European-ancestry study, including rs11108175 and rs9634162 at P < 5 x 10(-8) and o variants with an association near the genome-wide significance level (rs60911071, P = 5.8 x 10(-8); 62558833, P = 7.5 x 10(-8)) in the combined analyses of Asian- and European-ancestry data. In addition, ing data from East Asians, we identified 13 new risk variants at 11 loci reported from previous GWAS.Conclusions: In this large GWAS, we identified three novel risk loci and two highly suggestive loci for lorectal cancer risk and provided evidence for potential roles of multiple genes and pathways in the iology of colorectal cancer. In addition, we showed that additional risk variants exist in many colorectal ncer risk loci identified previously.Impact: Our study provides novel data to improve the understanding of the genetic basis for colorectal ncer risk.
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| 10. |
- Teslovich, Tanya M., et al.
(författare)
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Biological, clinical and population relevance of 95 loci for blood lipids
- 2010
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Ingår i: Nature. - : Springer Science and Business Media LLC. - 0028-0836 .- 1476-4687. ; 466:7307, s. 707-713
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Tidskriftsartikel (refereegranskat)abstract
- Plasma concentrations of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides are among the most important risk factors for coronary artery disease (CAD) and are targets for therapeutic intervention. We screened the genome for common variants associated with plasma lipids in >100,000 individuals of European ancestry. Here we report 95 significantly associated loci (P<5 x 10(-8)), with 59 showing genome-wide significant association with lipid traits for the first time. The newly reported associations include single nucleotide polymorphisms (SNPs) near known lipid regulators (for example, CYP7A1, NPC1L1 and SCARB1) as well as in scores of loci not previously implicated in lipoprotein metabolism. The 95 loci contribute not only to normal variation in lipid traits but also to extreme lipid phenotypes and have an impact on lipid traits in three non-European populations (East Asians, South Asians and African Americans). Our results identify several novel loci associated with plasma lipids that are also associated with CAD. Finally, we validated three of the novel genes-GALNT2, PPP1R3B and TTC39B-with experiments in mouse models. Taken together, our findings provide the foundation to develop a broader biological understanding of lipoprotein metabolism and to identify new therapeutic opportunities for the prevention of CAD.
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