Showing papers by "Medical University of South Carolina published in 2007"
University of Rhode Island1, Favaloro University2, Brigham and Women's Hospital3, University of Colorado Denver4, Icahn School of Medicine at Mount Sinai5, University of Sydney6, University Hospital of Wales7, University of Paris8, University of Pennsylvania9, University of Southern California10, Medical University of South Carolina11
TL;DR: Practice guidelines are presented for diagnosis and treatment of patients with thyroid-related medical issues just before and during pregnancy and in the postpartum interval, including evidence-based approaches to assessing the cause of the condition, treating it, and managing hypothyroidism.
Abstract: Objective: The aim was to update the guidelines for the management of thyroid dysfunction during pregnancy and postpartum published previously in 2007. A summary of changes between the 2007 and 2012 version is identified in the Supplemental Data (published on The Endocrine Society's Journals Online web site at http://jcem.endojournals.org). Evidence: This evidence-based guideline was developed according to the U.S. Preventive Service Task Force, grading items level A, B, C, D, or I, on the basis of the strength of evidence and magnitude of net benefit (benefits minus harms) as well as the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence. Consensus Process: The guideline was developed through a series of e-mails, conference calls, and one face-to-face meeting. An initial draft was prepared by the Task Force, with the help of a medical writer, and reviewed and commented on by members of The Endocri...
1,707 citations
TL;DR: The term mitophagy is used to refer to mitochondrial degradation by autophagy, and the possible role of the mitochondrial permeability transition in mitophagic delivery to lysosomes is the major degradative pathway in mitochondrial turnover.
1,492 citations
TL;DR: Transcranial magnetic stimulation was effective in treating major depression with minimal side effects reported and offers clinicians a novel alternative for the treatment of this disorder.
1,426 citations
Rush University Medical Center1, Columbia University2, Carlos III Health Institute3, Innsbruck Medical University4, University of Pennsylvania5, Medical University of South Carolina6, University of Bonn7, University of Rochester8, Baylor College of Medicine9, University of Toronto10, University College London11, Wayne State University12, University of Illinois at Chicago13, Icahn School of Medicine at Mount Sinai14, University of Toulouse15, Leiden University16, University of Massachusetts Medical School17
TL;DR: The MDS‐UPDRS retains the UPDRS structure of four parts with a total summed score, but the parts have been modified to provide a section that integrates nonmotor elements of PD: I, Nonmotor Experiences of Daily Living; II, Motor Exper experiences of daily Living; III, Motor Examination; and IV, Motor Complications.
Abstract: This article presents the revision process, major innovations, and clinimetric testing program for the Movement Disorder Society (MDS)-sponsored revision of the Unified Parkinson's Disease Rating Scale (UPDRS), known as the MDS-UPDRS. The UPDRS is the most widely used scale for the clinical study of Parkinson's disease (PD). The MDS previously organized a critique of the UPDRS, which cited many strengths, but recommended revision of the scale to accommodate new advances and to resolve problematic areas. An MDS-UPDRS committee prepared the revision using the recommendations of the published critique of the scale. Subcommittees developed new material that was reviewed by the entire committee. A 1-day face-to-face committee meeting was organized to resolve areas of debate and to arrive at a working draft ready for clinimetric testing. The MDS-UPDRS retains the UPDRS structure of four parts with a total summed score, but the parts have been modified to provide a section that integrates nonmotor elements of PD: I, Nonmotor Experiences of Daily Living; II, Motor Experiences of Daily Living; III, Motor Examination; and IV, Motor Complications. All items have five response options with uniform anchors of 0 = normal, 1 = slight, 2 = mild, 3 = moderate, and 4 = severe. Several questions in Part I and all of Part II are written as a patient/caregiver questionnaire, so that the total rater time should remain approximately 30 minutes. Detailed instructions for testing and data acquisition accompany the MDS-UPDRS in order to increase uniform usage. Multiple language editions are planned. A three-part clinimetric program will provide testing of reliability, validity, and responsiveness to interventions. Although the MDS-UPDRS will not be published until it has successfully passed clinimetric testing, explanation of the process, key changes, and clinimetric programs allow clinicians and researchers to understand and participate in the revision process.
1,086 citations
TL;DR: Given the importance of the physical and social contexts of individual behavior and the limited success of individual-based interventions in long-term obesity prevention, more research on the impact of the built environment on obesity is needed.
Abstract: Obesity results from a complex interaction between diet, physical activity, and the environment. The built environment encompasses a range of physical and social elements that make up the structure of a community and may influence obesity. This review summarizes existing empirical research relating the built environment to obesity. The Medline, PsychInfo, and Web of Science databases were searched using the keywords ‘‘obesity’’ or ‘‘overweight’’ and ‘‘neighborhood’’ or ‘‘built environment’’ or ‘‘environment.’’ The search was restricted to Englishlanguage articles conducted in human populations between 1966 and 2007. To meet inclusion criteria, articles had to 1) have a direct measure of body weight and 2) have an objective measure of the built environment. A total of 1,506 abstracts were obtained, and 20 articles met the inclusion criteria. Most articles (84%) reported a statistically significant positive association between some aspect of the built environment and obesity. Several methodological issues were of concern, including the inconsistency of measurements of the built environment across studies, the cross-sectional design of most investigations, and the focus on aspects of either diet or physical activity but not both. Given the importance of the physical and social contexts of individual behavior and the limited success of individual-based interventions in long-term obesity prevention, more research on the impact of the built environment on obesity is needed.
1,068 citations
TL;DR: MRI is better than CT for detection of acute ischaemia, and can detect acute and chronic haemorrhage; therefore it should be the preferred test for accurate diagnosis of patients with suspected acute stroke.
1,054 citations
TL;DR: The purpose of this review is to examine and redefine the myocardial matrix as a critical and dynamic entity with respect to the remodeling process encountered with MI, hypertension, or cardiomyopathic disease, and to dispel the historical belief that the myCardial matrix is a passive structure.
Abstract: It is now becoming apparent that dynamic changes occur within the interstitium that directly contribute to adverse myocardial remodeling following myocardial infarction (MI), with hypertensive hear...
1,042 citations
Medical University of South Carolina1, University of Massachusetts Medical School2, Johns Hopkins University3, University of Washington4, University of Texas Health Science Center at San Antonio5, Baylor College of Medicine6, University of Pittsburgh7, Columbia University8, University of Texas Southwestern Medical Center9, Pennsylvania State University10, Cystic Fibrosis Foundation11, Dartmouth College12
TL;DR: New guidelines are provided for the appropriate application of drug therapies used in the maintenance of pulmonary function to improve and extend the lives of all individuals with cystic fibrosis.
Abstract: The natural history of cystic fibrosis lung disease is one of chronic progression with intermittent episodes of acute worsening of symptoms frequently called acute pulmonary exacerbations These exacerbations typically warrant medical intervention. It is important that appropriate therapies are recommended on the basis of available evidence of efficacy and safety. The Cystic Fibrosis Foundation therefore established a committee to define the key questions related to pulmonary exacerbations, review the clinical evidence using an evidence-based methodology, and provide recommendations to clinicians. It is hoped that these guidelines will be helpful to clinicians in the treatment of individuals with cystic fibrosis.
1,016 citations
TL;DR: NSS for small, easily resectable, incidentally discovered RCC in the presence of a normal contralateral kidney can be performed safely with slightly higher complication rates than after RN.
955 citations
TL;DR: This poster presents a poster presented at the American Society of Echocardiography’s annual meeting in Los Angeles, California, on Wednesday, 3 March 2016, featuring presentations by Scott T. Reeves, MD, FASE and Kathryn E. Reeves.
Abstract: Scott T. Reeves, MD, FASE, Kathryn E. Glas, MD, FASE, Holger Eltzschig, MD, Joseph P. Mathew, MD, FASE, David S. Rubenson, MD, FASE, Gregg S. Hartman, MD, and Stanton K. Shernan, MD, FASE, for the Council for Intraoperative Echocardiography of the American Society of Echocardiography, Charleston, South Carolina; Atlanta, Georgia; Tubingen, Germany; Durham, North Carolina; La Jolla, California; and Lebanon, New Hampshire
886 citations
Book•
19 Oct 2007TL;DR: The definition of ADHD in Adults was made in the UMASS and Milwaukee Studies using criteria from the DSM-5 and the issue of Age of Onset was considered.
Abstract: Introduction. History and Prevalence of ADHD in Adults. Diagnostic Criteria for ADHD in Adults. Defining ADHD in Adults: Making the Diagnosis in the UMASS and Milwaukee Studies. DSM Symptom Utility and the Issue of Age of Onset. Impairment in Major Life Activities. Identifying New Symptoms of ADHD in Adulthood. Comorbid Psychiatric Disorders and Psychological Maladjustment. Educational and Occupational Functioning. Drug Use and Antisocial Behavior. Health, Lifestyle, Money Management, and Driving. Sex, Dating and Marriage, Parenting, and Psychological Adjustment of Offspring. Neuropsychological Functioning. Summary, Conclusions, and Treatment Implications.
University of Toronto1, University of Zurich2, Harvard University3, Queen Mary University of London4, Tufts University5, University of California, San Diego6, Boston University7, Medical University of South Carolina8, University of Helsinki9, University of Queensland10, Queensland Health11, University of California, Riverside12, University of Auckland13, University of Saskatchewan14, Ruhr University Bochum15
TL;DR: There is now strong evidence that increasing vitamin D intake will lower risk of falling and lower fracture risk in older men and women and regulatory agencies in the United States and abroad should review the evidence and reassess their dietary recommendations.
TL;DR: In patients with extensive mediastinal infiltration, invasive staging is not needed and patients with a peripheral clinical stage I NSCLC do not usually need invasive confirmation of mediastsinal nodes unless a PET scan finding is positive in the nodes.
TL;DR: In this paper, the authors show that PET scanning is more accurate than CT scanning for detecting mediastinal lymph node metastasis than chest CT scanning, with a pooled sensitivity and specificity of 51% (95% confidence interval [CI], 47 to 54%) and 85%(95% CI, 84 to 88%), respectively.
TL;DR: The reductions in smoking prevalence in men that occurred in the late 1960s through the 1980s will continue to drive lung cancer mortality rates downward in men during the first portion of this century, but rates in women have not yet begun to decrease.
TL;DR: Functional biomechanical properties of periostin null skin specimens and atrioventricular valve explant experiments provided direct evidence of the role that periastin plays in regulating the viscoelastic properties of connective tissues.
Abstract: Periostin is predominantly expressed in collagen-rich fibrous connective tissues that are subjected to constant mechanical stresses including: heart valves, tendons, perichondrium, cornea, and the periodontal ligament (PDL) Based on these data we hypothesize that periostin can regulate collagen I fibrillogenesis and thereby affect the biomechanical properties of connective tissues Immunoprecipitation and immunogold transmission electron microscopy experiments demonstrate that periostin is capable of directly interacting with collagen I To analyze the potential role of periostin in collagen I fibrillogenesis, gene targeted mice were generated Transmission electron microscopy and morphometric analyses demonstrated reduced collagen fibril diameters in skin dermis of periostin knockout mice, an indication of aberrant collagen I fibrillogenesis In addition, differential scanning calorimetry (DSC) demonstrated a lower collagen denaturing temperature in periostin knockout mice, reflecting a reduced level of collagen cross-linking Functional biomechanical properties of periostin null skin specimens and atrioventricular (AV) valve explant experiments provided direct evidence of the role that periostin plays in regulating the viscoelastic properties of connective tissues Collectively, these data demonstrate for the first time that periostin can regulate collagen I fibrillogenesis and thereby serves as an important mediator of the biomechanical properties of fibrous connective tissues
TL;DR: An increase in serum GGT predicts onset of metabolic syndrome, incident CVD, and death suggesting that GGT is a marker of metabolic and cardiovascular risk.
Abstract: Objective— To determine whether serum γ-glutamyl transferase (GGT) predicts cardiovascular disease (CVD) morbidity and mortality, accounting for temporal changes in known CVD risk factors and C-reactive protein (CRP).
Methods and Results— In 3451 Framingham Study participants (mean age 44 years, 52% women) we examined the relations of GGT with CVD risk factors, and prospectively determined the risk of new-onset metabolic syndrome, incident CVD, and death. GGT was positively associated with body mass index, blood pressure, LDL cholesterol, triglycerides, and blood glucose in cross-sectional analysis ( P <0.005). On follow-up (mean 19 years), 968 participants developed metabolic syndrome, 535 developed incident CVD, and 362 died. The risk of metabolic syndrome increased with higher GGT (multivariable-adjusted hazard ratio [HR] per SD increment log-GGT, 1.26 [95%CI; 1.18 to 1.35]). Adjusting for established CVD risk factors (as time-dependent covariates updated quadriennially) and baseline CRP, a 1-SD increase in log-GGT conferred a 13% increase in CVD risk ( P =0.007) and 26% increased risk of death ( P <0.001). Individuals in the highest GGT quartile experienced a 67% increase in CVD incidence (multivariable-adjusted HR 1.67, 95%CI; 1.25 to 2.22).
Conclusion— An increase in serum GGT predicts onset of metabolic syndrome, incident CVD, and death suggesting that GGT is a marker of metabolic and cardiovascular risk.
TL;DR: This research suggests that networks of highly conserved hypothalamic-midbrain-limbic-paralimbic-cortical circuits act in concert to support aspects of parent response to infants, including the emotion, attention, motivation, empathy, decision-making and other thinking that are required to navigate the complexities of parenting.
Abstract: Parenting behavior critically shapes human infants' current and future behavior. The parent-infant relationship provides infants with their first social experiences, forming templates of what they can expect from others and how to best meet others' expectations. In this review, we focus on the neurobiology of parenting behavior, including our own functional magnetic resonance imaging (fMRI) brain imaging experiments of parents. We begin with a discussion of background, perspectives and caveats for considering the neurobiology of parent-infant relationships. Then, we discuss aspects of the psychology of parenting that are significantly motivating some of the more basic neuroscience research. Following that, we discuss some of the neurohormones that are important for the regulation of social bonding, and the dysregulation of parenting with cocaine abuse. Then, we review the brain circuitry underlying parenting, proceeding from relevant rodent and nonhuman primate research to human work. Finally, we focus on a study-by-study review of functional neuroimaging studies in humans. Taken together, this research suggests that networks of highly conserved hypothalamic-midbrain-limbic-paralimbic-cortical circuits act in concert to support aspects of parent response to infants, including the emotion, attention, motivation, empathy, decision-making and other thinking that are required to navigate the complexities of parenting. Specifically, infant stimuli activate basal forebrain regions, which regulate brain circuits that handle specific nurturing and caregiving responses and activate the brain's more general circuitry for handling emotions, motivation, attention, and empathy--all of which are crucial for effective parenting. We argue that an integrated understanding of the brain basis of parenting has profound implications for mental health.
TL;DR: Endoscopic submucosal esophageal myotomy is feasible, safe, and effective in the short term, and has the potential for being useful in patients with achalasia.
Abstract: BACKGROUND AND STUDY AIMS: The most permanent method of treating achalasia is a surgical myotomy. Because of the requirement for a mucosal incision and the risk of perforation, this procedure has not generally been approached endoscopically. We hypothesized that we could perform a safe and robust myotomy by working in the submucosal space, accessed from the esophageal lumen. MATERIALS AND METHODS: Four pigs were used for this experiment. Baseline lower esophageal sphincter (LES) pressures were recorded and the pigs underwent upper endoscopy using a standard endoscope. A submucosal saline lift was created approximately 5 cm above the LES and a small nick was made in the mucosa in order to facilitate the introduction of a dilating balloon. After dilation, the scope was introduced over the balloon into the submucosal space and advanced toward the now visible fibers of the LES. The circular layer of muscle was then cleanly incised using an electrocautery knife in a distal-to-proximal fashion, without complications. The scope was then withdrawn back into the lumen and the mucosal defect was closed with endoscopically applied clips. The entire procedure took less than 15 minutes. Manometry was repeated on day 5 after the procedure and the animals were euthanized on day 7. RESULTS: LES pressures fell significantly from an average of 16.4 mm Hg to an average of 6.7 mm Hg after the myotomy. The necropsy examinations revealed no evidence of mediastinitis or peritonitis. CONCLUSIONS: Endoscopic submucosal esophageal myotomy is feasible, safe, and effective in the short term. It has the potential for being useful in patients with achalasia. The submucosal space is a novel and potentially important field of operation for endoscopic procedures.
TL;DR: Data suggest that variable responsiveness to UVB radiation is evident among individuals, causing some to have low vitamin D status despite abundant sun exposure, and it seems prudent to use this value as an upper limit when prescribing vitamin D supplementation.
Abstract: Context: Lack of sun exposure is widely accepted as the primary cause of epidemic low vitamin D status worldwide. However, some individuals with seemingly adequate UV exposure have been reported to have low serum 25-hydroxyvitamin D [25(OH)D] concentration, results that might have been confounded by imprecision of the assays used. Objective: The aim was to document the 25(OH)D status of healthy individuals with habitually high sun exposure. Setting: This study was conducted in a convenience sample of adults in Honolulu, Hawaii (latitude 21°). Participants: The study population consisted of 93 adults (30 women and 63 men) with a mean (sem) age and body mass index of 24.0 yr (0.7) and 23.6 kg/m2 (0.4), respectively. Their self-reported sun exposure was 28.9 (1.5) h/wk, yielding a calculated sun exposure index of 11.1 (0.7). Main Outcome Measures: Serum 25(OH)D concentration was measured using a precise HPLC assay. Low vitamin D status was defined as a circulating 25(OH)D concentration less than 30 ng/ml. Re...
TL;DR: In this article, the authors reviewed studies published in the past 10 years that examine the prevalence and trends in the prevalence of gestational diabetes mellitus (GDM) and reported an increase in prevalence of GDM across most racial/ethnic groups studied.
TL;DR: Although the MICs of all agents appeared to be associated with increasing oxacillin MICs, the strongest associations were noted for vancomycin and linezolid.
Abstract: lin. MICs increased for vancomycin, linezolid and oxacillin (P < 0.0001); however, daptomycin MICs decreased slightly (P 5 0.0386). For vancomycin, linezolid and oxacillin, there were significant increases (P < 0.0001) in the percentage of isolates with MICs that were higher than the respective 2001 median MIC, but not for daptomycin (P 5 0.1361). Oxacillin MICs were associated with MICs of linezolid (r 5 0.364, P < 0.0001), vancomycin (r 5 0.353, P < 0.0001) and daptomycin (r 5 0.106, P 5 0.0063). Conclusions: Oxacillin, vancomycin and linezolid MICs increased over time. For vancomycin and linezolid, these MIC increases were not reliably detected by percentage susceptibility as they occurred below the susceptibility breakpoint. Although the MICs of all agents appeared to be associated with increasing oxacillin MICs, the strongest associations were noted for vancomycin and linezolid.
TL;DR: Measurement of adenosine deaminase and interferon-gamma in the pleural fluid and polymerase chain reaction for M tuberculosis has gained wide acceptance in the diagnosis of TB pleural effusions, and although promising, these tests require further evaluation before their routine use can be recommended.
TL;DR: In this article, the authors further validated the Mindful attention and awareness scale (MAAS) in a large university sample and found that no gender differences in MAAS performance were evident, but the factor structure was not confirmed in the subsample of men.
Abstract: Mindfulness is an increasingly prominent construct in health research but its study has been impeded by a lack of well-validated measures. The Mindful Attention and Awareness Scale (MAAS; Brown and Ryan, Journal of Personality and Social Psychology, 84:822–848, 2003) is a promising measure and the goal of the present study was to further validate the MAAS in a large university sample (n = 711). Confirmatory factor analysis supported the unidimensional factor structure of the MAAS in the overall sample. No gender differences in MAAS performance were evident, but the factor structure was not confirmed in the subsample of men, apparently due to power limitations. No categorical differences were evident based on experience with meditation, and MAAS performance was not significantly associated with experience with meditation. These findings are interpreted as broadly supporting the MAAS as a valid measure of mindfulness, but suggesting that novice-level experience with meditation should not be presumed to be associated with greater mindfulness.
TL;DR: CN PJI treated at the authors' institution is associated with a rate of favorable outcome that is comparable to that associated with PJI due to known bacterial pathogens.
Abstract: Background. Culture-negative (CN) prosthetic joint infection (PJI) has not been well studied. We performed a retrospective cohort study to define the demographic characteristics and determine the outcome of patients with CN PJI. Methods. All cases of CN total hip arthroplasty and total knee arthroplasty infections (using a strict case definition) treated at our institution from January 1990 through December 1999 were analyzed. Kaplan-Meier survival methods were used to determine the cumulative probability of success. Results. Of 897 episodes of PJI during the study period, 60 (7%) occurred in patients for whom this was the initial episode of CN PJI. The median age of the cohort was 69 years (range, 36‐87 years). Patients had received a prior course of antimicrobial therapy in 32 (53%) of 60 episodes. Of the 60 episodes, 34 (57%), 12 (20%), and 8 (13%) were treated with 2-stage exchange, debridement and retention, and permanent resection arthroplasty, respectively. The median duration of parenteral antimicrobial therapy was 28 days (range, 0‐88 days). Forty-nine (82%) of 60 episodes were treated with a cephalosporin. The 5-year estimate of survival free of treatment failure was 94% (95% confidence interval, 85%‐100%) for patients treated with 2-stage exchange and 71% (95% confidence interval, 44%‐100%) for patients treated with debridement and retention. Conclusions. CN PJI occurs infrequently at our institution. Prior use of antimicrobial therapy is common among patients with CN PJI. CN PJI treated at our institution is associated with a rate of favorable outcome that is comparable to that associated with PJI due to known bacterial pathogens. Prosthetic joint infection ( PJI) involving a total hip athroplasty or total knee arthroplasty can occur in up to 5% of patients undergoing total joint replacement. Staphylococcus aureus and coagulase-negative Staphylococcus species account for close to 65% of PJIs [1‐9]. We have observed a significant number of patients with PJI for whom aerobic and anaerobic cultures of periprosthetic tissue samples did not reveal the growth of any microorganisms. These patients received a diagnosis of PJI on the basis of the presence of periprosthetic purulence, acute pathology revealed by histopathologic examination of periprosthetic tissue samples, or a sinus tract communicating with the prosthesis. Although the outcome of microbiologically confirmed PJI
TL;DR: Three-dimensional tissue structures are formed through the postprinting fusion of the bio-ink particles, in analogy with early structure-forming processes in the embryo that utilize the apparent liquid-like behavior of tissues composed of motile and adhesive cells.
Abstract: Understanding the principles of biological self-assembly is indispensable for developing efficient strategies to build living tissues and organs. We exploit the self-organizing capacity of cells an...
TL;DR: It is shown that human FAPP2 is a glucosylceramide-transfer protein that has a pivotal role in the synthesis of complex glycosphingolipids, key structural and signalling components of the plasma membrane.
Abstract: The molecular machinery responsible for the generation of transport carriers moving from the Golgi complex to the plasma membrane relies on a tight interplay between proteins and lipids. Among the lipid-binding proteins of this machinery, we previously identified the four-phosphate adaptor protein FAPP2, the pleckstrin homology domain of which binds phosphatidylinositol 4-phosphate and the small GTPase ARF1. FAPP2 also possesses a glycolipid-transfer-protein homology domain. Here we show that human FAPP2 is a glucosylceramide-transfer protein that has a pivotal role in the synthesis of complex glycosphingolipids, key structural and signalling components of the plasma membrane. The requirement for FAPP2 makes the whole glycosphingolipid synthetic pathway sensitive to regulation by phosphatidylinositol 4-phosphate and ARF1. Thus, by coupling the synthesis of glycosphingolipids with their export to the cell surface, FAPP2 emerges as crucial in determining the lipid identity and composition of the plasma membrane.
TL;DR: The low-expression variant of the 5-HTTLPR polymorphism modifies risk of postdisaster PTSD and major depression under conditions of high hurricane exposure and low social support, confirming and extending previous research.
Abstract: Objective: Disasters are associated with increased risk of posttraumatic stress disorder (PTSD) and major depression, but no study, to the authors’ knowledge, has determined whether genotype interacts with disaster exposure and social support to moderate risk of these phenotypes. The authors tested the hypothesis that a polymorphism in the serotonin transporter gene (locus, SLC6A4 ; variant, serotonin 5-HTTLPR) moderates risk of posthurricane PTSD and major depression given high hurricane exposure and low social support. Method: The authors interviewed a household probability sample of adults 6–9 months after the 2004 hurricanes about hurricane exposure, social support, and posthurricane PTSD and major depression. DNA was collected from a subset of participants. Participants were 589 adults ages 18 and older from 38 Florida counties who provided valid DNA samples. Outcome measures were DSM-IV diagnoses of posthurricane PTSD and major depression derived from structured interviews. Results: The low-expressi...
University of California, Los Angeles1, Medical University of South Carolina2, Rutgers University3, University of Illinois at Chicago4, Boston University5, Johns Hopkins University6, Georgetown University7, University of Texas Health Science Center at Houston8, Wayne State University9, University of California, San Francisco10, University of Alabama at Birmingham11, University of Connecticut12
TL;DR: One year of CYC improved lung function, skin scores, dyspnea, and health status/disability, effects which either persisted or increased further for several months after stopping therapy, but all of these effects waned and were no longer apparent at 24 months.
Abstract: Rationale: The Scleroderma Lung Study enrolled 158 patients with scleroderma-related interstitial lung disease in a placebo-controlled trial of oral cyclophosphamide (CYC). Although treatment-related benefits in pulmonary function, skin scores, and patient-centered outcomes were demonstrated after 1 year of therapy, the duration of benefit beyond 1 year was unclear.Objectives: A second year of follow-up was performed to determine if these effects persisted after stopping treatment.Methods: A detailed analysis of data obtained over the two years of the study was performed.Measurements and Main Results: Using a longitudinal joint model, we analyzed FVC, total lung capacity, transitional dyspnea index, Rodnan skin scores, and the Health Assessment Questionnaire–Disability Index during the second year, after adjusting for baseline values, baseline fibrosis score, and nonignorable missing data. Evaluable subjects (72 CYC; 73 placebo) included 93 who completed all visits plus 52 who completed at least 6 months ...