Cutaneous T-cell lymphoma (CTCL) is defined by infiltration of activated and malignant T cells in the skin. The clinical manifestations and prognosis in CTCL are highly variable. In this study, we hypothesized that gene expression analysis in lesional skin biopsies can improve understanding of the disease and its management. Based on 63 skin samples, we performed consensus clustering, revealing 3 patient clusters. Of these, 2 clusters tended to differentiate limited CTCL (stages IA and IB) from more extensive CTCL (stages IB and III). Stage IB patients appeared in both clusters, but those in the limited CTCL cluster were more responsive to treatment than those in the more extensive CTCL cluster. The third cluster was enriched in lymphocyte activation genes and was associated with a high proportion of tumor (stage IIB) lesions. Survival analysis revealed significant differences in event-free survival between clusters, with poorest survival seen in the activated lymphocyte cluster. Using supervised analysis, we further characterized genes significantly associated with lower-stage/treatment-responsive CTCL versus higher-stage/treatmentresistant CTCL. We conclude that transcriptional profiling of CTCL skin lesions reveals clinically relevant signatures, correlating with differences in survival and response to treatment. Additional prospective long-term studies to validate and refine these findings appear warranted.
ObjectiveTo examine the relationship between body mass index and metabolic syndrome for Asian Americans and non-Hispanic Whites, given that evidence shows racial/ethnic heterogeneity exists in how body mass index predicts metabolic syndrome.Research Design and MethodsElectronic health records of 43 507 primary care patients aged 35 years and older with self-identified race/ethnicity of interest (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, or non-Hispanic White) were analyzed in a mixed-payer, outpatient-focused healthcare organization in the San Francisco Bay Area.ResultsMetabolic syndrome prevalence is significantly higher in Asians compared to non-Hispanic Whites for every body mass index category. For women at the mean age of 55 and body mass index of 25 kg/m2, the predicted prevalence of metabolic syndrome is 12% for non-Hispanic White women compared to 30% for Asians; similarly for men, the predicted prevalence of metabolic syndrome is 22% for non-Hispanic Whites compared to 43% of Asians. Compared to non-Hispanic White women and men with a body mass index of 25 kg/m2, comparable prevalence of metabolic syndrome was seen at body mass index of 19.6 kg/m2 for Asian women and 19.9 kg/m2 for Asian men. A similar pattern was seen in disaggregated Asian subgroups.ConclusionsDespite lower body mass index values and lower prevalence of overweight/obesity than non-Hispanic Whites, Asian Americans have higher rates of metabolic syndrome over the range of body mass index. Our results indicate that body mass index ranges for defining overweight/obesity in Asian populations should be lower than for non-Hispanic Whites.
Background. Lipoprotein (a) [Lp(a)] is an independent risk factor for cardiovascular disease (CVD) in Non-Hispanic Whites (NHW). There are known racial/ethnic differences in Lp(a) levels, and the association of Lp(a) with CVD outcomes has not been examined in Asian Americans in the USA. Objective. We hypothesized that Lp(a) levels would differ in Asian Indians and Chinese Americans when compared to NHW and that the relationship between Lp(a) and CVD outcomes would be different in these Asian racial/ethnic subgroups when compared to NHW. Methods. We studied the outpatient electronic health records of 2022 NHW, 295 Asian Indians, and 151 Chinese adults age ≥18 y in Northern California in whom Lp(a) levels were assessed during routine clinical care from 2001 to 2008, excluding those who had received prescriptions for niacin (14.6%). Nonparametric methods were used to compare median Lp(a) levels. Significance was assessed at the P < .0001 level to account for multiple comparisons. CVD outcomes were defined as ischemic heart disease (IHD) (265 events), stroke (122), or peripheral vascular disease (PVD) (87). We used logistic regression to determine the relationship between Lp(a) and CVD outcomes. Results. Both Asian Indians (36 nmol/L) and NHW (29 nmol/L) had higher median Lp(a) levels than Chinese (22 nmol/L, P ≤ .0001 and P = .0032). When stratified by sex, the differences in median Lp(a) between these groups persisted in the 1761 men (AI v CH: P = .001, NHW v CH: P = .0018) but were not statistically significant in the 1130 women (AI v CH: P = .0402, NHW v CH: P = .0761). Asian Indians (OR = 2.0) and Chinese (OR = 4.8) exhibited a trend towards greater risk of IHD with high Lp(a) levels than NHW (OR = 1.4), but no relationship was statistically significant. Conclusion. Asian Indian and NHW men have higher Lp(a) values than Chinese men, with a trend toward, similar associations in women. High Lp(a) may be more strongly associated with IHD in Asian Indians and Chinese, although we did not have a sufficient number of outcomes to confirm this. Further studies should strive to elucidate the relationship between Lp(a) levels, CVD, and race/ethnicity among Asian subgroups in the USA.
Objective. To describe data collection methods and to audit staff data entry of patient self-reported race/ethnicity/ancestry and preferred spoken language (R/E/A/ L) information. Data Source/Study Setting. Large mixed payer outpatient health care organization in Northern California, June 2009. Study Design. Secondary analysis of an audit planned and executed by the Department of Clinical Services. Data Collection/Extraction Methods. We analyzed concordance between patient written responses and staff data entry. Principal Findings. The data entry accuracy rate across questions was high, ranging from 92 to 97 percent. Inaccuracies were due to human error (62 percent), flaws in system design (2 percent), or some combination of both (35 percent). Conclusions. This study highlights the high accuracy of patient self-reported R/E/ A/L data entry and identifies some areas for improvement in staff training and technical system design to facilitate further progress. Key Words. Racial/ethnic differences in health and health care, health care organizations and systems, demography, survey research and questionnaire design, quality of care/patient safety (measurement) BACKGROUND
Objective To collect patient race/ethnicity and language (r/e/l) in an ambulatory care setting. Data Sources/Study Setting The Palo Alto Medical Foundation (PAMF), December 2006–May 2008. Study Design Three pilot studies: (1) Comparing mail versus telephone versus clinic visit questionnaire distribution; (2) comparing the front desk method (FDM) versus exam room method (ERM) in the clinic visit; and (3) determining resource allocation necessary for data entry. Data Collection/Extraction Methods Studies were planned and executed by PAMF’s Quality and Planning division. Principal Findings Collecting r/e/l data during clinic visits elicited the highest response rate. The FDM yielded higher response rate than the ERM. One full-time equivalent is initially necessary for data entry. Conclusions Conducting sequential studies can help guide r/e/l collection in a short time frame.
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