Browsing by Author "Zhang, Jun"

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Open Access
Clinical and pathological characteristics of HIV- and HHV-8-negative Castleman disease.
(Blood, 2017-03) Yu, Li; Tu, Meifeng; Cortes, Jorge; Xu-Monette, Zijun Y; Miranda, Roberto N; Zhang, Jun; Zhang, Jun; Orlowski, Robert Z; Neelapu, Sattva; Boddu, Prajwal C; Akosile, Mary A; Uldrick, Thomas S; Yarchoan, Robert; Medeiros, L Jeffrey; Li, Yong; Fajgenbaum, David C; Young, Ken H
Castleman disease (CD) comprises 3 poorly understood lymphoproliferative variants sharing several common histopathological features. Unicentric CD (UCD) is localized to a single region of lymph nodes. Multicentric CD (MCD) manifests with systemic inflammatory symptoms and organ dysfunction due to cytokine dysregulation and involves multiple lymph node regions. Human herpesvirus 8 (HHV-8) causes MCD (HHV-8-associated MCD) in immunocompromised individuals, such as HIV-infected patients. However, >50% of MCD cases are HIV and HHV-8 negative (defined as idiopathic [iMCD]). The clinical and biological behavior of CD remains poorly elucidated. Here, we analyzed the clinicopathologic features of 74 patients (43 with UCD and 31 with iMCD) and therapeutic response of 96 patients (43 with UCD and 53 with iMCD) with HIV-/HHV-8-negative CD compared with 51 HIV-/HHV-8-positive patients. Systemic inflammatory symptoms and elevated inflammatory factors were more common in iMCD patients than UCD patients. Abnormal bone marrow features were more frequent in iMCD (77.0%) than UCD (45%); the most frequent was plasmacytosis, which was seen in 3% to 30.4% of marrow cells. In the lymph nodes, higher numbers of CD3+ lymphocytes (median, 58.88 ± 20.57) and lower frequency of CD19+/CD5+ (median, 5.88 ± 6.52) were observed in iMCD patients compared with UCD patients (median CD3+ cells, 43.19 ± 17.37; median CD19+/CD5+ cells, 17.37 ± 15.80). Complete surgical resection is a better option for patients with UCD. Siltuximab had a greater proportion of complete responses and longer progression-free survival (PFS) for iMCD than rituximab. Centricity, histopathological type, and anemia significantly impacted PFS. This study reveals that CD represents a heterogeneous group of diseases with differential immunophenotypic profiling and treatment response.
Open Access
Evaluation of CRUSADE and ACUITY-HORIZONS Scores for Predicting Long-term Out-of-Hospital Bleeding after Percutaneous Coronary Interventions.
(Chinese medical journal, 2018-02) Zhao, Xue-Yan; Li, Jian-Xin; Tang, Xiao-Fang; Xian, Ying; Xu, Jing-Jing; Song, Ying; Jiang, Lin; Xu, Lian-Jun; Chen, Jue; Zhang, Yin; Song, Lei; Gao, Li-Jian; Gao, Zhan; Zhang, Jun; Wu, Yuan; Qiao, Shu-Bin; Yang, Yue-Jin; Gao, Run-Lin; Xu, Bo; Yuan, Jin-Qing
BACKGROUND:There is scanty evidence concerning the ability of Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE) and Acute Catheterization and Urgent Intervention Triage Strategy and Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (ACUITY-HORIZONS) scores to predict out-of-hospital bleeding risk after percutaneous coronary interventions (PCIs) with drug-eluting stents (DES) in patients receiving dual antiplatelet therapy. We aimed to assess and compare the long-term prognostic value of these scores regarding out-of-hospital bleeding risk in such patients. METHODS:We performed a prospective observational study of 10,724 patients undergoing PCI between January and December 2013 in Fuwai Hospital, China. All patients were followed up for 2 years and evaluated through the Fuwai Hospital Follow-up Center. Major bleeding was defined as Types 2, 3, and 5 according to Bleeding Academic Research Consortium Definition criteria. RESULTS:During a 2-year follow-up, 245 of 9782 patients (2.5%) had major bleeding (MB). CRUSADE (21.00 [12.00, 29.75] vs. 18.00 [11.00, 26.00], P < 0.001) and ACUITY-HORIZONS (9.00 [3.00, 14.00] vs. 6.00 [3.00, 12.00], P < 0.001) risk scores were both significantly higher in the MB than non-MB groups. Both scores showed a moderate predictive value for MB in the whole study cohort (area under the receiver-operating characteristics curve [AUROC], 0.565; 95% confidence interval [CI], 0.529-0.601, P = 0.001; AUROC, 0.566; 95% CI, 0.529-0.603, P < 0.001, respectively) and in the acute coronary syndrome (ACS) subgroup (AUROC: 0.579, 95% CI: 0.531-0.627, P = 0.001; AUROC, 0.591; 95% CI, 0.544-0.638, P < 0.001, respectively). However, neither score was a significant predictor in the non-ACS subgroup (P > 0.05). The value of CRUSADE and ACUITY-HORIZONS scores did not differ significantly (P > 0.05) in the whole cohort, ACS subgroup, or non-ACS subgroup. CONCLUSIONS:CRUSADE and ACUITY-HORIZONS scores showed statistically significant but relatively limited long-term prognostic value for out-of-hospital MB after PCI with DES in a cohort of Chinese patients. The value of CRUSADE and ACUITY-HORIZONS scores did not differ significantly (P > 0.05) in the whole cohort, ACS subgroup, or non-ACS subgroup.
Open Access
Increasing the Electricity Generation Capacity from Solar Resources at Duke University
(2018-04-27) Zhang, Jun; Zaragoza Castillo, Ricardo
Duke University has set the goal of achieving carbon neutrality by 2024. This study explores the alternative of contributing to this target through the installation of solar photovoltaic systems (PV) from environmental, technical, regulatory, economic, and financial perspectives. It estimates the technical potential of on-site PV on the main Duke Campus and assesses the opportunities and challenges posed by federal and state regulations. We found out that the maximum technical potential of solar PV systems is 51.5 MWdc when being installed on rooftops and 35.6 MWdc when being installed atop parking lots. Together, Duke University owns 87.1 MWdc on-site PV technical potential. Our power system operation analysis illustrates that the on-site solar capacity addition at Duke University would incrementally reduce the system cost and emissions, while the 300-MWdc solar farm would negatively impact the power system economics and grid reliability. The costs of installation on parking lots are lower than on rooftops, but due to economies of scale, the most economical option to reduce emissions is to install off-site solar farms. For the cost-effectiveness of sustainability, this study also estimates the carbon abatement costs (COA) of carbon-abating strategies including PV, carbon offset, and Renewable Energy Credits (RECs) that Duke University could apply at this stage under business-as-usual (BAU) and carbon-tax scenarios. We also find that state regulations severely limit the benefits of on-campus PV development given a) the lack of programs allowing the participation of third-party energy providers, b) the limitation of standard Power Purchase Agreements for solar energy facilities to less than 1 MWdc, and c) the lack of certainty on the value of RECs.
Open Access
Pulmonary Catherization Data Correlate Poorly with Renal Function in Heart Failure.
(Cardiorenal medicine, 2018-01) Masha, Luke; Stone, James; Stone, Danielle; Zhang, Jun; Sheng, Luo
BACKGROUND:The mechanisms of renal dysfunction in heart failure are poorly understood. We chose to explore the relationship of cardiac filling pressures and cardiac index (CI) in relation to renal dysfunction in advanced heart failure. OBJECTIVES:To determine the relationship between renal function and cardiac filling pressures using the United Network of Organ Sharing (UNOS) pulmonary artery catherization registry. METHODS:Patients over the age of 18 years who were listed for single-organ heart transplantation were included. Exclusion criteria included a history of mechanical circulatory support, previous transplantation, any use of renal replacement therapy, prior history of malignancy, and cardiac surgery, amongst others. Correlations between serum creatinine (SCr) and CI, pulmonary capillary wedge pressure (PCWP), pulmonary artery systolic pressure (PASP), and pulmonary artery diastolic pressure (PADP) were assessed by Pearson correlation coefficients and simple linear regression coefficients. RESULTS:Pearson correlation coefficients between SCr and PCWP, PASP, and PADP were near zero with values of 0.1, 0.07, and 0.08, respectively (p < 0.0001). A weak negative correlation coefficient between SCr and CI was found (correlation coefficient, -0.045, p = 0.027). In a subgroup of young patients unlikely to have noncardiac etiologies, no significant correlations between these values were identified. CONCLUSION:These findings suggest that, as assessed by pulmonary artery catherization, none of the factors - PCWP, PASP, PADP, or CI - play a prominent role in cardiorenal syndromes.