2025
Salerno & Li
Arabian Journal of Mathematics
Arabian Journal of Mathematics
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While mortality is often the main focus of cancer studies, non-fatal events, such as disease progression, can vitally impact patient outcomes. For example, recurrence after curative treatment is a crucial endpoint in lung cancer, affecting available second-line treatments and personalized care. Estimating the de-confounded effect of interventions on disease recurrence is a key aspect of assessing cancer treatments. However, semi-competing risks complicate causal inference when death prevents disease recurrence. Existing approaches for estimating causal quantities in semi-competing survival functions rely on complex objective functions with strong assumptions and are challenging to estimate accurately. To address these challenges, we propose a deep learning approach for estimating the causal effect of treatment on non-fatal outcomes in the presence of dependent censoring and complex covariate relationships. Our three-stage approach involves estimating the marginal survival function using an Archimedean copula representation, and a jackknife pseudo-value approach that estimates pseudo-survival probabilities at fixed time points. These pseudo-survival probabilities serve as target values for developing causal estimators that are consistent and do not rely on assumptions like proportional hazards across all time points. In the final stage, we employ a deep neural network to link pseudo-outcomes, the causal variable, and additional confounders. This enables us to estimate survival average causal effects through direct standardization. We evaluate our approach through numerical studies and apply it to the Boston Lung Cancer Study, specifically examining the effect of surgical tumor resection in patients with early-stage non-small cell lung cancer.
@article{salerno2025pseudo,
title = {A Pseudo-Value Approach to Causal Deep Learning of Semi-Competing Risks},
author = {Stephen Salerno and Yi Li},
year = {2025},
journal = {Arabian Journal of Mathematics},
pages = {1--20},
publisher = {Springer},
doi = {10.1007/s40065-025-00501-7}
}
Salerno, Yang, Dahlerus, Hirth, Xu, Eckard, Agbenyikey, Horton, Clark, Messana & Li
Medical Care
Medical Care
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Objectives: This study illustrates how the statistical reliability of an individual measure relates to the overall reliability of a composite metric, as understanding this relationship provides additional information when evaluating measures for endorsement. Background: National quality measure endorsement processes typically evaluate individual metrics on criteria such as importance and scientific acceptability (eg, reliability). In practice, quality measures may be used in composite rating systems, which aid in the interpretation of overall quality differences. Methods: We define an individual measure's reliability by its intraclass correlation and analytically establish the relationship between a composite's reliability and the reliability of its components. We use real data to confirm this relationship under various scenarios. We are motivated by 8 quality measures, which comprise the Quality of Patient Care Star Ratings on Dialysis Facility Care Compare. These measure 4 primary outcomes (mortality, hospitalizations, readmissions, and blood transfusions), vascular access (2 measures), and facility processes (2 measures). Results: Depending on the reliability of the individual measures, their respective weights in the composite, and their pairwise correlations, there are circumstances when adding a new measure, even if it is less reliable, increases the composite's reliability. For the dialysis facility Star Ratings, we find that the combined reliability of measures grouped within certain domains of care exceeded the reliability of the individual measures within those domains. Conclusions: New quality measures may add utility to a composite rating system under certain circumstances-a consideration that should, in part, factor into quality measure endorsement processes.
@article{salerno2025adding,
title = {Adding New Components to a Composite Quality Metric: How Good is Good Enough?},
author = {Stephen Salerno and Eileen Yang and Claudia Dahlerus and Richard A Hirth and Tao Xu and Ashley Eckard and Wilfred Agbenyikey and Golden M Horton and Stephanie Clark and Joseph M Messana and Yi Li},
year = {2025},
journal = {Medical Care},
volume = {63},
number = {4},
pages = {293--299},
publisher = {LWW},
doi = {10.1097/MLR.0000000000002116}
}
Yang, Salerno, Dahlerus, Hirth, Xu, Eckard, Agbenyikey, Horton, Clark, Messana & others
Health Services Research
Health Services Research
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Objective: To evaluate how adding kidney transplantation waitlisting measures-the Standardized First Kidney Transplant Waitlist Ratio for Incident Dialysis Patients (SWR) and Percentage of Prevalent Patients Waitlisted (PPPW)-affects Dialysis Facility Care Compare Star Ratings. Study setting and design: In this observational, cross-sectional study, we calculated the difference between facilities' published (with waitlisting measures) and counterfactual (without waitlisting measures) Star Ratings. We used multinomial regression to examine associations between Star Rating changes after waitlisting measure inclusion and facility characteristics and calculated corresponding average risk differences. Data sources and analytic sample: We used comprehensive clinical and administrative data from the Centers for Medicare/Medicaid Services from 2021 to investigate the impact of waitlisting measure addition on Star Ratings. Facility characteristics included demographic and patient mix, area deprivation index (ADI), dialysis organization affiliation, and urbanicity. Principal findings: 36.5% of facilities' ratings changed after waitlisting measures were added. Facility characteristics associated with a higher average risk of Star increase included location in low-ADI (0.091; 95% CI: 0.072, 0.109) or urban areas (0.061; 95% CI: 0.034, 0.087), independent/small dialysis organization affiliation (0.062; 95% CI: 0.041, 0.083), and having more PD patients (0.115; 95% CI: 0.093, 0.138). Characteristics associated with a higher average risk of Star decrease included high-ADI (0.075; 95% CI: 0.054, 0.095) or rural (0.056; 95% CI: 0.028, 0.083) location, large dialysis organization affiliation (0.058; 95% CI: 0.039, 0.078), having more patients with dual Medicare/Medicaid eligibility (0.052; 95% CI: 0.032, 0.071), and having fewer peritoneal dialysis patients (0.100; 95% CI: 0.081, 0.120). Conclusions: Including waitlisting measures significantly impacts the Star Ratings and captures a new dimension of care quality. Worse socioeconomic status-related facility characteristics were strongly associated with worse Star Rating outcomes. These findings can inform future discussions about risk adjustment among the developers of the SWR and PPPW measures.
@article{yang2025impact,
title = {The Impact of Transplant Waitlisting Measures on Dialysis Facilities' Star Ratings},
author = {Eileen Yang and Stephen Salerno and Claudia Dahlerus and Richard A Hirth and Tao Xu and Ashley Eckard and Wilfred Agbenyikey and Golden M Horton and Stephanie Clark and Joseph M Messana and {others}},
year = {2025},
journal = {Health Services Research},
pages = {e70071},
publisher = {Wiley Online Library},
doi = {10.1111/1475-6773.70071}
}
Salerno, Roberts, Needham, McCormick, Li, Mukherjee & Shi
Statistics in Medicine
Statistics in Medicine
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In this work, we are motivated by the problem of estimating racial disparities in health outcomes, specifically the average controlled difference (ACD) in telomere length between Black and White individuals, using data from the National Health and Nutrition Examination Survey (NHANES). To do so, we build a propensity for race to properly adjust for other social determinants while characterizing the controlled effect of race on telomere length. Propensity score methods are broadly employed with observational data as a tool to achieve covariate balance, but how to implement them in complex surveys is less studied-in particular, when the survey weights depend on the group variable under comparison (as the NHANES sampling scheme depends on self-reported race). We propose identification formulas to properly estimate the ACD in outcomes between Black and White individuals, with appropriate weighting for both covariate imbalance across the two racial groups and generalizability. Via extensive simulation, we show that our proposed methods outperform traditional analytic approaches in terms of bias, mean squared error, and coverage when estimating the ACD for our setting of interest. In our data, we find that evidence of racial differences in telomere length between Black and White individuals attenuates after accounting for confounding by socioeconomic factors and utilizing appropriate propensity score and survey weighting techniques. Software to implement these methods and code to reproduce our results can be found in the R package svycdiff, available through the Comprehensive R Archive Network (CRAN) at cran.r-project.org/web/packages/svycdiff/, or in a development version on GitHub at github.com/salernos/svycdiff.
@article{salerno2025whats,
title = {What's the Weight? Estimating Controlled Outcome Differences in Complex Surveys for Health Disparities Research},
author = {Stephen Salerno and Emily K Roberts and Belinda L Needham and Tyler H McCormick and Fan Li and Bhramar Mukherjee and Xu Shi},
year = {2025},
journal = {Statistics in Medicine},
volume = {44},
number = {23-24},
pages = {e70289},
publisher = {Wiley Online Library},
doi = {10.1002/sim.70289}
}
Salerno, Miao, Afiaz, Hoffman, Neufeld, Lu, McCormick & Leek
Bioinformatics
Bioinformatics
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ipd is an open-source R software package for the downstream modeling of an outcome and its associated features where a potentially sizable portion of the outcome data has been imputed by an artificial intelligence or machine learning prediction algorithm. The package implements several recent proposed methods for inference on predicted data with a single, user-friendly wrapper function, ipd. The package also provides custom print, summary, tidy, glance, and augment methods to facilitate easy model inspection. This document introduces the ipd software package and provides a demonstration of its basic usage.
@article{salerno2025ipd,
title = {ipd: An {R} Package for Conducting Inference on Predicted Data},
author = {Stephen Salerno and Jiacheng Miao and Awan Afiaz and Kentaro Hoffman and Anna Neufeld and Qiongshi Lu and Tyler H. McCormick and Jeffrey T. Leek},
year = {2025},
journal = {Bioinformatics},
volume = {41},
number = {2},
pages = {btaf055},
publisher = {Oxford University Press},
doi = {10.1093/bioinformatics/btaf055}
}
2024
Sun*, Salerno*, Pan, Yang, Sujimongkol, Song, Wang, Han, Zeng, Kang, Christiani & Li
Harvard Data Science Review
Harvard Data Science Review
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Severe cases of COVID-19 often necessitate escalation to the Intensive Care Unit (ICU), where patients may face grave outcomes, including mortality. Chest X-rays play a crucial role in the diagnostic process for evaluating COVID-19 patients. Our collaborative efforts with Michigan Medicine in monitoring patient outcomes within the ICU have motivated us to investigate the potential advantages of incorporating clinical information and chest X-ray images for predicting patient outcomes. We propose an analytical workflow to address challenges such as the absence of standardized approaches for image pre-processing and data utilization. We then propose an ensemble learning approach designed to maximize the information derived from multiple prediction algorithms. This entails optimizing the weights within the ensemble and considering the common variability present in individual risk scores. Our simulations demonstrate the superior performance of this weighted ensemble averaging approach across various scenarios. We apply this refined ensemble methodology to analyze post-ICU COVID-19 mortality, an occurrence observed in 21% of COVID-19 patients admitted to the ICU at Michigan Medicine. Our findings reveal substantial performance improvement when incorporating imaging data compared to models trained solely on clinical risk factors. Furthermore, the addition of radiomic features yields even larger enhancements, particularly among older and more medically compromised patients. These results may carry implications for enhancing patient outcomes in similar clinical contexts.
@article{sun2024hdsr,
title = {{Assessing} the {Prognostic} {Utility} of {Clinical} and {Radiomic} {Features} for {COVID}-19 {Patients} {Admitted} to {ICU}: Challenges and {Lessons} {Learned}},
author = {Yuming Sun* and Stephen Salerno* and Ziyang Pan and Eileen Yang and Chinakorn Sujimongkol and Jiyeon Song and Xinan Wang and Peisong Han and Donglin Zeng and Jian Kang and David C. Christiani and Yi Li},
year = {2024},
journal = {Harvard Data Science Review},
volume = {6},
number = {1},
doi = {10.1162/99608f92.9d86a749}
}
2023
Salerno & Li
Annual Review of Statistics and Its Application
Annual Review of Statistics and Its Application
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In the era of precision medicine, time-to-event outcomes such as time to death or progression are routinely collected, along with high-throughput covariates. These high-dimensional data defy classical survival regression models, which are either infeasible to fit or likely to incur low predictability due to over-fitting. To overcome this, recent emphasis has been placed on developing novel approaches for feature selection and survival prognostication. We will review various cutting-edge methods that handle survival outcome data with high-dimensional predictors, highlighting recent innovations in machine learning approaches for survival prediction. We will cover the statistical intuitions and principles behind these methods and conclude with extensions to more complex settings, where competing events are observed. We exemplify these methods with applications to the Boston Lung Cancer Survival Cohort study, one of the largest cancer epidemiology cohorts investigating the complex mechanisms of lung cancer.
@article{salerno2023high,
title = {High-Dimensional Survival Analysis: Methods and Applications},
author = {Stephen Salerno and Yi Li},
year = {2023},
journal = {Annual Review of Statistics and Its Application},
volume = {10},
pages = {25--49},
publisher = {Annual Reviews},
doi = {10.1146/annurev-statistics-032921-022127}
}
Sun*, Salerno*, He, Pan, Yang, Sujimongkol, Song, Wang, Han, Kang & others
Scientific Reports
Scientific Reports
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As portable chest X-rays are an efficient means of triaging emergent cases, their use has raised the question as to whether imaging carries additional prognostic utility for survival among patients with COVID-19. This study assessed the importance of known risk factors on in-hospital mortality and investigated the predictive utility of radiomic texture features using various machine learning approaches. We detected incremental improvements in survival prognostication utilizing texture features derived from emergent chest X-rays, particularly among older patients or those with a higher comorbidity burden. Important features included age, oxygen saturation, blood pressure, and certain comorbid conditions, as well as image features related to the intensity and variability of pixel distribution. Thus, widely available chest X-rays, in conjunction with clinical information, may be predictive of survival outcomes of patients with COVID-19, especially older, sicker patients, and can aid in disease management by providing additional information.
@article{sun2023use,
title = {Use of Machine Learning to Assess the Prognostic Utility of Radiomic Features for In-Hospital {COVID-19} Mortality},
author = {Yuming Sun* and Stephen Salerno* and Xinwei He and Ziyang Pan and Eileen Yang and Chinakorn Sujimongkol and Jiyeon Song and Xinan Wang and Peisong Han and Jian Kang and {others}},
year = {2023},
journal = {Scientific Reports},
volume = {13},
number = {1},
pages = {7318},
publisher = {Nature Publishing Group},
doi = {10.1038/s41598-023-34559-0}
}
2022
Roberts, Boss, Mukherjee, Salerno, Zota & Needham
Scientific Reports
Scientific Reports
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Despite racial disparities in diseases of aging and premature mortality, non-Hispanic Black Americans tend to have longer leukocyte telomere length (LTL), a biomarker of cellular aging, than non-Hispanic White Americans. Previous findings suggest that exposure to certain persistent organic pollutants (POPs) is both racially-patterned and associated with longer LTL. We examine whether Black/White differences in LTL are explained by differences in exposure to 15 POPs by estimating the indirect effect (IE) of self-reported race on LTL that is mediated through nine polychlorinated biphenyls (PCBs), three furans, and three dioxins, as well as their mixtures. Our study population includes 1,251 adults from the 1999-2000 and 2001-2002 cycles of the cross-sectional National Health and Nutrition Examination Survey. We characterized single-pollutant mediation effects by constructing survey-weighted linear regression models. We also implemented various approaches to quantify a global mediation effect of all POPs, including unpenalized linear regression, ridge regression, and examination of three summary exposure scores. We found support for the hypothesis that exposure to PCBs partially mediates Black/White differences in LTL. In single-pollutant models, there were significant IEs of race on LTL through six individual PCBs (118, 138, 153, 170, 180, and 187). Ridge regression (0.013, CI 0.001, 0.023; 26.0% mediated) and models examining summative exposure scores with linear combinations derived from principal components analysis (0.019, CI 0.009, 0.029; 34.8% mediated) and Toxic Equivalency Quotient (TEQ) scores (0.016, CI 0.005, 0.026; 28.8% mediated) showed significant IEs when incorporating survey weights. Exposures to individual POPs and their mixtures, which may arise from residential and occupational segregation, may help explain why Black Americans have longer LTL than their White counterparts, providing an environmental explanation for counterintuitive race differences in cellular aging.
@article{roberts2022persistent,
title = {Persistent Organic Pollutant Exposure Contributes to {Black/White} Differences in Leukocyte Telomere Length in the {National Health and Nutrition Examination Survey}},
author = {Emily K Roberts and Jonathan Boss and Bhramar Mukherjee and Stephen Salerno and Ami Zota and Belinda L Needham},
year = {2022},
journal = {Scientific Reports},
volume = {12},
number = {1},
pages = {1--15},
publisher = {Nature Publishing Group},
doi = {10.1038/s41598-022-24316-0}
}
Zhang, Chen, Salerno, Li, Zhou, Zeng & Li
Medicine in Novel Technology and Devices
Medicine in Novel Technology and Devices
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This study aimed to find out the blood data characteristics of patients and explore the correlation between severe preeclampsia and blood index value. Provide assistance for the early attention direction of severe preeclampsia diagnosis and treatment. 19,653 pregnant women presenting to the West China Second University Hospital, Sichuan University from January 2017 to April 2019. After screening, a total of 248 patients, 124 severe preeclampsia cases, and 124 controls were selected for this study. Forty-three blood examination variables were obtained from routine blood work, hepatic, renal and coagulation function examination. Light gradient boosting machine (light GBM), decision tree and random forest were used for date diving. We randomly divided 35% of the original data as a testing set to conduct internal validation of the performance of the prediction model. The area under receiver operating characteristic curve (AUC) was used as the main score to compare the three methods. Finally, a binary classification light GBM model based on aspartate aminotransferase, direct bilirubin and activated partial thromboplastin time ratio can predict severe preeclampsia with sensitivity of 88.37%, specificity of 77.27%, AUC of 89.74% and positive predictive value of 65.96%. We believe relevant quantifiable indicators can establish an effective prediction model, which can provide guidance for early detection and prevention of severe preeclampsia.
@article{zhang2022prediction,
title = {Prediction of Severe Preeclampsia in Machine Learning},
author = {Xinyuan Zhang and Yu Chen and Stephen Salerno and Yi Li and Libin Zhou and Xiaoxi Zeng and Huafeng Li},
year = {2022},
journal = {Medicine in Novel Technology and Devices},
volume = {15},
pages = {100158},
publisher = {Elsevier},
doi = {10.1016/j.medntd.2022.100158}
}
Shen, Zhao, Salerno & Cui
Asian Journal of Surgery
Asian Journal of Surgery
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N/A
@article{shen2022sharp,
title = {Sharp Recanalization with Transseptal Needle for Superior Vena Cava Occlusion: A Retrospective Single-Center Analysis},
author = {Xi Shen and Qiuyan Zhao and Stephen Salerno and Tianlei Cui},
year = {2022},
journal = {Asian Journal of Surgery},
volume = {45},
number = {2},
pages = {816--817},
publisher = {Elsevier {BV}},
doi = {10.1016/j.asjsur.2021.12.013},
month = {feb}
}
Li, Zhou, Ma, Salerno, Qi, Diao, Chen, Zhong, Xiao, Wang & others
Nursing Open
Nursing Open
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Aim: To investigate the extent of post-traumatic growth, and the correlation between post-traumatic growth and self-perceived stress, post-traumatic growth and self-perceived burden among CAPD patients. Design: A cross-sectional study. Methods: This was a multi-centre study including 752 patients from 44 hospitals. Self-perceived stress, self-perceived burden and post-traumatic growth were measured using the post-traumatic growth inventory (PTGI), the Chinese version of the perceived stress questionnaire (CPSQ) and the self-perceived burden scale (SPBS). A multiple stepwise regression analysis was fit with the total PTGI score as the outcome of interest. Results: Patients concurrently experienced post-traumatic growth and stress following peritoneal dialysis. The initiation of patients' education level, employment status and self-perceived stress were all found to relate to growth among Chinese CAPD patients. There was not sufficient evidence to suggest that self-perceived burden was related to experiencing growth.
@article{li2022status,
title = {Status and Factors Related to Post-Traumatic Growth in Continuous Ambulatory Peritoneal Dialysis: A Multi-Centre Study},
author = {Xing Li and Xueli Zhou and Dengyan Ma and Stephen Salerno and Min Qi and Yongshu Diao and Chongcheng Chen and Hui Zhong and Shuxin Xiao and Yan Wang and {others}},
year = {2022},
journal = {Nursing Open},
volume = {9},
number = {1},
pages = {550--558},
publisher = {Wiley Online Library},
doi = {10.1002/nop2.1096}
}
Sun, Zhao, Salerno, Shen, Li, Fu & Cui
Annals of Translational Medicine
Annals of Translational Medicine
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Background: Central vein occlusion (CVO) is a serious problem in hemodialysis patients. There is an unsatisfactory result for refractory CVO by sharp recanalization alone. This study evaluated the efficacy and safety of blunt impingement followed by sharp recanalization for the treatment of CVO in hemodialysis patients. Methods: This study retrospectively examined hemodialysis patients with CVO who failed to recanalize using standard guidewire and catheter techniques in our department. In the first instance, all CVOs were recanalized using blunt impingement techniques, including a 6-Fr long sheath (Cook Incorporated, Bloomington, IN USA) and an 8-Fr sheath of Rosch-Uchida Transjugular Liver Access Set (RUPS-100; Cook Incorporated, Bloomington, IN, USA). If this was not successful, sharp recanalization devices were applied, including the stiff tip of a guidewire (Terumo, Tokyo, Japan), the RUPS-100, and the percutaneous transhepatic cholangial drainage (PTCD) needle (Cook Incorporated, USA). All patients were followed up at least 4 months postoperatively. The technical success rate, arteriovenous access patency rates, and operation-related complications were analyzed. Results: The procedural success rate was 100.0% (30 of 30). Thirty patients with CVO underwent blunt impingement with a technique success rate of 70.0% (21 of 30), and 9 patients received sharp recanalization after failed blunt impingement, with a technique success rate of 100.0% (9 of 9). The primary patency rates at 6 and 12 months postoperatively were 86.7% and 53.3%, respectively. The primary assisted patency rates were 93.3% and 63.3%, and the secondary patency rates were 93.3% and 70.0% at 6 and 12 months, respectively. One major procedure-related complication was detected, namely, a small injury of the superior vena cava (SVC) wall in a patient receiving recanalization via the stiff end of a guidewire, but this did not require further treatment. Conclusions: It is potentially effective and safe for interventionalists to use blunt impingement followed by sharp recanalization techniques to treat chronic CVO that is refractory to traversal using traditional catheter and guidewire techniques.
@article{sun2022efficacy,
title = {The Efficacy and Safety of Blunt Impingement Followed by a Sharp Recanalization Technique in Hemodialysis Patients with Refractory Central Vein Occlusion: A Single-Center Experience},
author = {Ji-Bo Sun and Qiu-Yan Zhao and Stephen Salerno and Xi Shen and Yi Li and Ping Fu and Tian-Lei Cui},
year = {2022},
journal = {Annals of Translational Medicine},
volume = {10},
number = {14},
doi = {10.21037/atm-22-3131}
}
Salerno, Gremel, Dahlerus, Han, Affholter, Tong, Wisniewski, Roach, Li & Hirth
Medical Care
Medical Care
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Background: Renal dialysis is a lifesaving but demanding therapy, requiring 3 weekly treatments of multiple-hour durations. Though travel times and quality of care vary across facilities, the extent to which patients are willing and able to engage in weighing tradeoffs is not known. Since 2015, Medicare has summarized and reported quality data for dialysis facilities using a star rating system. We estimate choice models to assess the relative roles of travel distance and quality of care in explaining patient choice of facility. Research design: Using national data on 2 million patient-years from 7198 dialysis facilities and 4-star rating releases, we estimated travel distance to patients' closest facilities, incremental travel distance to the next closest facility with a higher star rating, and the difference in ratings between these 2 facilities. We fit mixed effects logistic regression models predicting whether patients dialyzed at their closest facilities. Results: Median travel distance was 4 times that in rural (10.9 miles) versus urban areas (2.6 miles). Higher differences in rating [odds ratios (OR): 0.56; 95% confidence interval (CI): 0.50-0.62] and greater area deprivation (OR: 0.50; 95% CI: 0.48-0.53) were associated with lower odds of attending one's closest facility. Stratified models were also fit based on urbanicity. For rural patients, excess travel was associated with higher odds of attending the closer facility (per 10 miles; OR: 1.05; 95% CI: 1.04-1.06). Star rating differences were associated with lower odds of receiving care from the closest facility among urban (OR: 0.57; 95% CI: 0.51-0.63) and rural patients (OR: 0.18; 95% CI: 0.08-0.44). Conclusions: Most dialysis patients have higher rated facilities located not much further than their closest facility, suggesting many patients could evaluate tradeoffs between distance and quality of care in where they receive dialysis. Our results show that such tradeoffs likely occur. Therefore, quality ratings such as the Dialysis Facility Compare (DFC) Star Rating may provide actionable information to patients and caregivers. However, we were not able to assess whether these associations reflect a causal effect of the Star Ratings on patient choice, as the Star Ratings served only as a marker of quality of care.
@article{salerno2022understanding,
title = {Understanding the Tradeoffs Between Travel Burden and Quality of Care for In-center Hemodialysis Patients},
author = {Stephen Salerno and Garrett Gremel and Claudia Dahlerus and Peisong Han and Jordan Affholter and Lan Tong and Karen Wisniewski and Jesse Roach and Yi Li and Richard A Hirth},
year = {2022},
journal = {Medical Care},
volume = {60},
number = {3},
pages = {240--247},
publisher = {Wolters Kluwer},
doi = {10.1097/MLR.0000000000001684}
}
2021
Li, Jiang, Salerno, Li, Chen, Xu & Wang
Journal of Vascular Research
Journal of Vascular Research
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Objective: To study the hemodynamic response to lower leg heating intervention (LLHI) inside the abdominal and iliac arterial segments (AIAS) of young sedentary individuals. Methods: A Doppler measurement of blood flow was conducted for 5 young sedentary adults with LLHI. Heating durations of 0, 20, and 40 min were considered. A lumped parameter model (LPM) was used to ascertain the hemodynamic mechanism. The hemodynamics were determined via numerical approaches. Results: Ultrasonography revealed that the blood flow waveform shifted upwards under LLHI; in particular, the mean flow increased significantly (p < 0.05) with increasing heating duration. The LPM showed that its mechanism depends on the reduction in afterload resistance, not on the inertia of blood flow and arterial compliance. The time-averaged wall shear stress, time-averaged production rate of nitric oxide, and helicity in the external iliac arteries increased more significantly than in other segments as the heating duration increased, while the oscillation shear index (OSI) and relative residence time (RRT) in the AIAS declined with increasing heating duration. There was a more obvious helicity response in the bilateral external iliac arteries than the OSI and RRT responses. Conclusion: LLHI can effectively induce a positive hemodynamic environment in the AIAS of young sedentary individuals.
@article{li2021acute,
title = {Acute Hemodynamic Improvement by Thermal Vasodilation inside the Abdominal and Iliac Arterial Segments of Young Sedentary Individuals},
author = {Zhongyou Li and Wentao Jiang and Stephen Salerno and Yi Li and Yu Chen and Zhi Xu and Guanshi Wang},
year = {2021},
journal = {Journal of Vascular Research},
volume = {58},
number = {3},
pages = {191--206},
publisher = {Karger Publishers},
doi = {10.1159/000514588}
}
Zhao, Yang, Yu, Salerno, Li, Cui, Zhang & Fu
Kidney Diseases
Kidney Diseases
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Background: The prognostic value of blood pressure variability (BPV) in patients receiving hemodialysis is inconclusive. In this study, we aimed to assess the association between BPV and clinical outcomes in the hemodialysis population. Methods: Pubmed/Medline, EMBASE, Ovid, the Cochrane Library, and the Web of Science databases were searched for relevant articles published until April 1, 2020. Studies on the association between BPV and prognosis in patients receiving hemodialysis were included. Results: A total of 14 studies (37,976 patients) were included in the analysis. In patients receiving hemodialysis, systolic BPV was associated with higher all-cause (hazard ratio [HR]: 1.13; 95% confidence interval [CI]: 1.07-1.19; p < 0.001) and cardiovascular (HR: 1.16; 95% CI: 1.10-1.22; p < 0.001) mortality. In the stratified analysis of systolic BPV, interdialytic systolic BPV, rather than 44-h ambulatory systolic BPV or intradialytic systolic BPV, was identified to be related to both all-cause (HR: 1.11; 95% CI: 1.05-1.17; p = 0.001) and cardiovascular (HR: 1.14; 95% CI: 1.06-1.22; p < 0.001) mortality. Among the different BPV metrics, the coefficient of variation of systolic blood pressure was a predictor of both all-cause (p = 0.01) and cardiovascular (p = 0.002) mortality. Although diastolic BPV was associated with all-cause mortality (HR: 1.09; 95% CI: 1.01-1.17; p = 0.02) in patients receiving hemodialysis, it failed to predict cardiovascular mortality (HR: 0.86; 95% CI: 0.52-1.42; p = 0.56). Conclusions: This meta-analysis revealed that, in patients receiving hemodialysis, interdialytic systolic BPV was associated with both increased all-cause and cardiovascular mortality. Furthermore, the coefficient of variation of systolic blood pressure was identified as a potentially promising metric of BPV in predicting all-cause and cardiovascular mortality. The use of 44-h ambulatory systolic BPV, intradialytic systolic BPV, and metrics of diastolic BPV in the prognosis of the hemodialysis population require further investigation (PROSPERO registry number: CRD42019139215).
@article{zhao2021blood,
title = {Blood Pressure Variability and Prognosis in Hemodialysis Patients: A Systematic Review and Meta-Analysis},
author = {Yuliang Zhao and Letian Yang and Shaobin Yu and Stephen Salerno and Yi Li and Tianlei Cui and Ling Zhang and Ping Fu},
year = {2021},
journal = {Kidney Diseases},
volume = {7},
number = {5},
pages = {411--424},
publisher = {Karger Publishers},
doi = {10.1159/000511295}
}
Salerno, Messana, Gremel, Dahlerus, Hirth, Han, Segal, Xu, Shaffer, Jiao, Simon, Tong, Wisniewski, Nahra, Padilla, Sleeman, Shearon, Callard, Yaldo, Borowicz, Agbenyikey, Horton, Roach & Li
JAMA Network Open
JAMA Network Open
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Importance: There is a need for studies to evaluate the risk factors for COVID-19 and mortality among the entire Medicare long-term dialysis population using Medicare claims data. Objective: To identify risk factors associated with COVID-19 and mortality in Medicare patients undergoing long-term dialysis. Design, setting, and participants: This retrospective, claims-based cohort study compared mortality trends of patients receiving long-term dialysis in 2020 with previous years (2013-2019) and fit Cox regression models to identify risk factors for contracting COVID-19 and postdiagnosis mortality. The cohort included the national population of Medicare patients receiving long-term dialysis in 2020, derived from clinical and administrative databases. COVID-19 was identified through Medicare claims sources. Data were analyzed on May 17, 2021. Main outcomes and measures: The 2 main outcomes were COVID-19 and all-cause mortality. Associations of claims-based risk factors with COVID-19 and mortality were investigated prediagnosis and postdiagnosis. Results: Among a total of 498 169 Medicare patients undergoing dialysis (median [IQR] age, 66 [56-74] years; 215 935 [43.1%] women and 283 227 [56.9%] men), 60 090 (12.1%) had COVID-19, among whom 15 612 patients (26.0%) died. COVID-19 rates were significantly higher among Black (21 787 of 165 830 patients [13.1%]) and Hispanic (13 530 of 86 871 patients [15.6%]) patients compared with non-Black patients (38 303 of 332 339 [11.5%]), as well as patients with short (ie, 1-89 days; 7738 of 55 184 patients [14.0%]) and extended (ie, ≥90 days; 10 737 of 30 196 patients [35.6%]) nursing home stays in the prior year. Adjusting for all other risk factors, residing in a nursing home 1 to 89 days in the prior year was associated with a higher hazard for COVID-19 (hazard ratio [HR] vs 0 days, 1.60; 95% CI 1.56-1.65) and for postdiagnosis mortality (HR, 1.31; 95% CI, 1.25-1.37), as was residing in a nursing home for an extended stay (COVID-19: HR, 4.48; 95% CI, 4.37-4.59; mortality: HR, 1.12; 95% CI, 1.07-1.16). Black race (HR vs non-Black: HR, 1.25; 95% CI, 1.23-1.28) and Hispanic ethnicity (HR vs non-Hispanic: HR, 1.68; 95% CI, 1.64-1.72) were associated with significantly higher hazards of COVID-19. Although home dialysis was associated with lower COVID-19 rates (HR, 0.77; 95% CI, 0.75-0.80), it was associated with higher mortality (HR, 1.18; 95% CI, 1.11-1.25). Conclusions and relevance: These results shed light on COVID-19 risk factors and outcomes among Medicare patients receiving long-term chronic dialysis and could inform policy decisions to mitigate the significant extra burden of COVID-19 and death in this population.
@article{salerno2021covid,
title = {{COVID-19} Risk Factors and Mortality Outcomes Among Medicare Patients Receiving Long-term Dialysis},
author = {Stephen Salerno and Joseph M. Messana and Garrett W. Gremel and Claudia Dahlerus and Richard A. Hirth and Peisong Han and Jonathan H. Segal and Tao Xu and Dan Shaffer and Amy Jiao and Jeremiah Simon and Lan Tong and Karen Wisniewski and Tammie Nahra and Robin Padilla and Kathryn Sleeman and Tempie Shearon and Sandra Callard and Alexander Yaldo and Lisa Borowicz and Wilfred Agbenyikey and Golden M. Horton and Jesse Roach and Yi Li},
year = {2021},
journal = {{JAMA} Network Open},
volume = {4},
number = {11},
pages = {e2135379-e2135379},
doi = {10.1001/jamanetworkopen.2021.35379},
month = {11}
}
Li, Chen, Zeng, Salerno, Li, Li, Dong, He, Zhang, Yang & others
Journal of Biomechanics
Journal of Biomechanics
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Recently, the effectiveness of internal iliac artery balloon occlusion (IIABO) for treating postpartum hemorrhage caused by pernicious placenta previa (PPP) has been questioned. We conducted a retrospective analysis and hemodynamic simulation to assess the IIABO's effectiveness. The retrospective analysis involved 480 patients with PPP, among which 288 underwent IIABO treatment and the remaining 192 were used as controls. Blood loss and preoperative indicators were recorded, and multiple regression analysis was applied to test the effect of preoperative indicators on blood loss. Hemorrhage mechanisms were simulated using a numerical model. Results suggested that no significant difference in blood loss (1836 ± 1440 ml vs. 1784 ± 1647 ml, p = 0.22) was observed between the two groups. In addition, preoperative indicators, including age, weight, gestational age, gravidity, parity, blood type, anemia, or diabetes, were not associated with blood loss. In the simulation, after the intra-iliac artery was blocked, blood loss was caused by a reversed flow in the intrapelvic arteries, uterine veins, and uterine venules. The ratio of the time-averaged hemorrhage velocity (TAHV) in the balloon group to that in the control group was lower than that obtained in a clinical study (13.0% vs. 88.9%); in the presence of collateral circulation, blood loss occurred from collateral circulation and uterine venules after IIABO intervention, and the TAHV was 60%-90% that of the control group, which was closer to the clinical results (88.9%). These results suggest that IIABO cannot effectively treat postpartum hemorrhage because of the collateral circulation and reversed flow in the uterine venules.
@article{li2021clinical,
title = {Clinical and Hemodynamic Insights into the Use of Internal Iliac Artery Balloon Occlusion as a Prophylactic Technique for Treating Postpartum Hemorrhage},
author = {Zhongyou Li and Yu Chen and Xiaoxi Zeng and Stephen Salerno and Yi Li and Huafeng Li and Lihua Dong and Teng He and Shihong Zhang and Pei Yang and {others}},
year = {2021},
journal = {Journal of Biomechanics},
volume = {129},
pages = {110827},
publisher = {Elsevier},
doi = {10.1016/j.jbiomech.2021.110827}
}
Salerno, Sun, Morris, He, Li, Pan, Han, Kang, Sjoding & Li
PloS ONE
PloS ONE
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Background: Understanding risk factors for short- and long-term COVID-19 outcomes have implications for current guidelines and practice. We study whether early identified risk factors for COVID-19 persist one year later and through varying disease progression trajectories. Methods: This was a retrospective study of 6,731 COVID-19 patients presenting to Michigan Medicine between March 10, 2020 and March 10, 2021. We describe disease progression trajectories from diagnosis to potential hospital admission, discharge, readmission, or death. Outcomes pertained to all patients: rate of medical encounters, hospitalization-free survival, and overall survival, and hospitalized patients: discharge versus in-hospital death and readmission. Risk factors included patient age, sex, race, body mass index, and 29 comorbidity conditions. Results: Younger, non-Black patients utilized healthcare resources at higher rates, while older, male, and Black patients had higher rates of hospitalization and mortality. Diabetes with complications, coagulopathy, fluid and electrolyte disorders, and blood loss anemia were risk factors for these outcomes. Diabetes with complications, coagulopathy, fluid and electrolyte disorders, and blood loss were associated with lower discharge and higher inpatient mortality rates. Conclusions: This study found differences in healthcare utilization and adverse COVID-19 outcomes, as well as differing risk factors for short- and long-term outcomes throughout disease progression. These findings may inform providers in emergency departments or critical care settings of treatment priorities, empower healthcare stakeholders with effective disease management strategies, and aid health policy makers in optimizing allocations of medical resources.
@article{salerno2021comprehensive,
title = {Comprehensive Evaluation of {COVID-19} Patient Short-and Long-Term Outcomes: Disparities in healthcare utilization and post-hospitalization outcomes},
author = {Stephen Salerno and Yuming Sun and Emily L Morris and Xinwei He and Yajing Li and Ziyang Pan and Peisong Han and Jian Kang and Michael W Sjoding and Yi Li},
year = {2021},
journal = {PloS ONE},
volume = {16},
number = {10},
pages = {e0258278},
publisher = {Public Library of Science},
doi = {10.1371/journal.pone.0258278}
}
Salerno, Dahlerus, Messana, Wisniewski, Tong, Hirth, Affholter, Gremel, Wu, Zhu & others
Health Services Research
Health Services Research
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Objective: To examine which factors are driving improvement in the Dialysis Facility Compare (DFC) star ratings and to test whether nonclinical facility characteristics are associated with observed longitudinal changes in the star ratings. Data sources: Data were collected from eligible patients in over 6,000 Medicare-certified dialysis facilities from three annual star rating and individual measure updates, publicly released on DFC in October 2015, October 2016, and April 2018. Study design: Changes in the star rating and individual quality measures were investigated across three public data releases. Year-to-year changes in the star ratings were linked to facility characteristics, adjusting for baseline differences in quality measure performance. Data collection: Data from publicly reported quality measures, including standardized mortality, hospitalization, and transfusion ratios, dialysis adequacy, type of vascular access for dialysis, and management of mineral and bone disease, were extracted from annual DFC data releases. Principal findings: The proportion of four- and five-star facilities increased from 30.0% to 53.4% between October 2015 and April 2018. Quality improvement was driven by the domain of care containing the dialysis adequacy and hypercalcemia measures. Additionally, independently owned facilities and facilities belonging to smaller dialysis organizations had significantly lower odds of year-to-year improvement than facilities belonging to either of the two large dialysis organizations (Odds Ratio [OR]: 0.736, 95% Confidence Interval [CI]: 0.631-0.856 and OR: 0.797, 95% CI: 0.723-0.879, respectively). Conclusions: The percentage of four- and five-star facilities has increased markedly over a three-year time period. These changes were driven by improvement in the specific quality measures that may be most directly under the control of the dialysis facility.
@article{salerno2021evaluating,
title = {Evaluating National Trends in Outcomes after Implementation of a Star Rating System: Results from {Dialysis Facility Compare}},
author = {Stephen Salerno and Claudia Dahlerus and Joseph Messana and Karen Wisniewski and Lan Tong and Richard A Hirth and Jordan Affholter and Garrett Gremel and YiFan Wu and Ji Zhu and {others}},
year = {2021},
journal = {Health Services Research},
volume = {56},
number = {1},
pages = {123--131},
publisher = {Wiley Online Library},
doi = {10.1111/1475-6773.13600}
}
Salerno*, Zhao*, Prabhu Sankar, Salvatore, Gu, Fritsche, Lee, Lisabeth, Valley & Mukherjee
Journal of Internal Medicine
Journal of Internal Medicine
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Background: Whilst the COVID-19 diagnostic test has a high false-negative rate, not everyone initially negative is re-tested. Michigan Medicine, a primary regional centre, provided an ideal setting for studying testing patterns during the first wave of the pandemic. Objectives: To identify the characteristics of patients who underwent repeated testing for COVID-19 and determine if repeated testing was associated with downstream outcomes amongst positive cases. Methods: Characteristics, test results, and health outcomes for patients presenting for a COVID-19 diagnostic test were collected. We examined whether patient characteristics differed with repeated testing and estimated a false-negative rate for the test. We then studied repeated testing patterns in patients with severe COVID-19-related outcomes. Results: Patient age, sex, body mass index, neighbourhood poverty levels, pre-existing type 2 diabetes, circulatory, kidney, and liver diseases, and cough, fever/chills, and pain symptoms 14 days prior to a first test were associated with repeated testing. Amongst patients with a positive result, age (OR: 1.17; 95% CI: (1.05, 1.34)) and pre-existing kidney diseases (OR: 2.26; 95% CI: (1.41, 3.68)) remained significant. Hospitalization (OR: 7.88; 95% CI: (5.15, 12.26)) and ICU-level care (OR: 6.93; 95% CI: (4.44, 10.92)) were associated with repeated testing. The estimated false-negative rate was 23.8% (95% CI: (19.5%, 28.5%)). Conclusions: Whilst most patients were tested once and received a negative result, a meaningful subset underwent multiple rounds of testing. These results shed light on testing patterns and have important implications for understanding the variation of repeated testing results within and between patients.
@article{salerno2021patterns,
title = {Patterns of Repeated Diagnostic Testing for {COVID-19} in Relation to Patient Characteristics and Outcomes},
author = {Stephen Salerno* and Zhangchen Zhao* and Swaraaj {Prabhu Sankar} and Maxwell Salvatore and Tian Gu and Lars G Fritsche and Seunggeun Lee and Lynda D Lisabeth and Thomas S Valley and Bhramar Mukherjee},
year = {2021},
journal = {Journal of Internal Medicine},
volume = {289},
number = {5},
pages = {726--737},
publisher = {Wiley Online Library},
doi = {10.1111/joim.13213}
}
Zhang, Chen, Salerno, Li, Zhou, Zeng & Li
The Journal of Maternal-Fetal \& Neonatal Medicine
The Journal of Maternal-Fetal \& Neonatal Medicine
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Aim: Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disease associated with a significant risk of fetal complications including pre-term delivery and fetal death. Typically, it was diagnosed in the third trimester of pregnancy. This study utilized characteristics from routine maternal examinations in the first 20 weeks' gestation to predict ICP in pregnant women. Methods: This is a retrospective case-control study. 13,329 medical records were collected on pregnant women presenting to the West China Second University Hospital between December 2017 and December 2018. After screening according to strict criteria, a total of 487 patients, 250 intrahepatic cholestasis of pregnancy cases, and 237 controls were selected for this study. We collected seven maternal characteristics indices for analysis and forty-three routine blood examination indices were obtained from routine hepatic, renal, and coagulation function examinations. The least absolute shrinkage and selection operator regression was applied for variable selection. Classification and regression trees, logistic regression, random forests, and light gradient boosting machines were fit for predictive modeling. We randomly divided 25% of the original data as testing set to conduct internal validation of the performance of the prediction model. The area under the receiver operating characteristic curves (AUC) was used to compare methods. Results: Eight variables were selected out as potentially significant predictors that could reliably predict ICP. The sensitivity, specificity, accuracy, and AUC of the final prediction model obtained by light gradient boosting machines were 72.41, 79.69, 76.23, and 79.77%, respectively. Significantly higher platelet large cell ratio, alanine aminotransferase, glutamyl transpeptidase, and fibrinogen levels were found in cases as compared to healthy controls, while activated partial thromboplastin time and mean corpuscular hemoglobin concentration levels were significantly lower (p < .001). Conclusions: The combination of alanine aminotransferase, glutamyl transpeptidase, fibrinogen, platelet large cell ratio, activated partial thromboplastin time, lactate dehydrogenase, creatinine, and mean corpuscular hemoglobin concentration levels can effectively predict ICP in the first 20 weeks of gestation. These could help provide direction for earlier detection and prevention of ICP.
@article{zhang2021prediction,
title = {Prediction of Intrahepatic Cholestasis of Pregnancy in the First 20 Weeks of Pregnancy},
author = {Xinyuan Zhang and Yu Chen and Stephen Salerno and Yi Li and Libin Zhou and Xiaoxi Zeng and Huafeng Li},
year = {2021},
journal = {The Journal of Maternal-Fetal \& Neonatal Medicine},
pages = {1--7},
publisher = {Taylor \& Francis},
doi = {10.1080/14767058.2021.1911996}
}
Wang, Ma, Salerno, Chen, Liu, Luo, Diao, Chen, Fu & Li
Nursing Open
Nursing Open
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Aim: The study aimed to investigate the current status of reproductive concerns and explore the associated factors among young female chronic kidney disease (CKD) patients. Design: A multi-center cross-sectional study was designed. Methods: The study was conducted in six representative tertiary hospitals across southwest China. A total of 295 female Chronic kidney disease patients between 18-45 years of age completed a 20 min, web-based survey, which included demographics and disease-related information questionnaire, Reproductive Concerns Scale, Generalized Anxiety Disorder 7 (GAD-7) instrument and Patient Health Questionnaire 9 (PHQ-9) instrument. Result: The survey total collected 270 valid questionnaires. The mean reproductive concern score was 54.39 ± 10.90 (out of a maximum of 90), with the mean scores for sub-scales ranging from 7.80 ± 1.69 to 10.44 ± 1.85. Multiple regression analysis showed that those with higher reproductive concerns were more likely to have pregnancy intentions, to be in Chronic kidney disease stages 1-3, and to have a higher GAD-7 score. This study offered further evidence of the need for improved education and emotional support surrounding reproductive concerns among young Chinese women with Chronic kidney disease.
@article{wang2021reproductive,
title = {Reproductive Concerns and Associated Factors among Female Chronic Kidney Diseases Patients: A Multi-Center Cross-Sectional Study},
author = {Fang Wang and Dengyan Ma and Stephen Salerno and Yi Chen and Min Liu and Yan Luo and Yongshu Diao and Chongcheng Chen and Ping Fu and Yi Li},
year = {2021},
journal = {Nursing Open},
volume = {8},
number = {5},
pages = {2743--2749},
publisher = {Wiley Online Library},
doi = {10.1002/nop2.850}
}
Zhao, Salerno, Shi, Lee, Mukherjee & Fritsche
Journal of Clinical Medicine
Journal of Clinical Medicine
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Testing for SARS-CoV-2 antibodies is commonly used to determine prior COVID-19 infections and to gauge levels of infection- or vaccine-induced immunity. Michigan Medicine, a primary regional health center, provided an ideal setting to understand serologic testing patterns over time. Between 27 April 2020 and 3 May 2021, characteristics for 10,416 individuals presenting for SARS-CoV-2 antibody tests (10,932 tests in total) were collected. Relative to the COVID-19 vaccine roll-out date, 14 December 2020, the data were split into a pre- (8026 individuals) and post-vaccine launch (2587 individuals) period and contrasted with untested individuals to identify factors associated with tested individuals and seropositivity. Exploratory analysis of vaccine-mediated seropositivity was performed in 347 fully vaccinated individuals. Predictors of tested individuals included age, sex, smoking, neighborhood variables, and pre-existing conditions. Seropositivity in the pre-vaccine launch period was 9.2% and increased to 46.7% in the post-vaccine launch period. In the pre-vaccine launch period, seropositivity was significantly associated with age (10 year; OR = 0.80 (0.73, 0.89)), ever-smoker status (0.49 (0.35, 0.67)), respiratory disease (4.38 (3.13, 6.12)), circulatory disease (2.09 (1.48, 2.96)), liver disease (2.06 (1.11, 3.84)), non-Hispanic Black race/ethnicity (2.18 (1.33, 3.58)), and population density (1.10 (1.03, 1.18)). Except for the latter two, these associations remained statistically significant in the post-vaccine launch period. The positivity rate of fully vaccinated individual was 296/347(85.3% (81.0%, 88.8%)).
@article{zhao2021understanding,
title = {Understanding the Patterns of Serological Testing for {COVID-19} Pre- and Post-Vaccination Rollout in {Michigan}},
author = {Zhangchen Zhao and Stephen Salerno and Xu Shi and Seunggeun Lee and Bhramar Mukherjee and Lars G. Fritsche},
year = {2021},
journal = {Journal of Clinical Medicine},
volume = {10},
number = {19},
doi = {10.3390/jcm10194341}
}
2020
Needham*, Salerno*, Roberts, Boss, Allgood & Mukherjee
Biodemography and Social Biology
Biodemography and Social Biology
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Social and economic disadvantage are hypothesized to increase the risk of disease and death via accelerated biological aging. Given that US blacks are socially and economically disadvantaged relative to whites, health disparities scholars expected that blacks would have shorter telomere length-a biomarker of cell aging-than whites. Yet the majority of studies have found that blacks have longer telomere length than whites. Using data from the National Health and Nutrition Examination Survey (n = 3,761; 28.3% non-Hispanic black, 71.7% non-Hispanic white), we found that leukocyte telomere length was 4.00% (95% CI: 1.12%, 6.87%) longer among blacks compared to whites in the full sample, but differences were greatest among those with lower SES (5.66%; 95% CI: 0.10%, 10.32%), intermediate among those with middle SES (4.14%; 95% CI: 0.05%, 8.24%), and smallest among those with higher SES (2.33%; 95% CI: -3.02%, 7.67%). These results challenge purely genetic explanations for race differences in telomere length and point to a potential social-environmental cause of longer telomere length in US blacks.
@article{needham2020black,
title = {Do Black/White Differences in Telomere Length Depend on Socioeconomic Status?},
author = {Belinda Needham* and Stephen Salerno* and Emily Roberts and Jonathan Boss and Kristi L Allgood and Bhramar Mukherjee},
year = {2020},
journal = {Biodemography and Social Biology},
volume = {65},
number = {4},
pages = {287--312},
publisher = {Taylor \& Francis},
doi = {10.1080/19485565.2020.1765734}
}
Ma, Chen, Diao, Yang, Li, Salerno & Fu
Chinese Medical Journal
Chinese Medical Journal
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N/A
@article{ma2020efficacy,
title = {Efficacy of Exercises in Improving the Quality of Life for Chronic Kidney Disease Patients without Dialysis},
author = {Deng-Yan Ma and Chong-Cheng Chen and Yong-Shu Diao and Kun Yang and Yi Li and Stephen Salerno and Ping Fu},
year = {2020},
journal = {Chinese Medical Journal},
volume = {133},
number = {14},
pages = {1738--1740},
publisher = {LWW},
doi = {10.1097/CM9.0000000000000941}
}
Xiong, Lin, Chen, Salerno, Li, Zeng & Li
The Journal of Maternal-Fetal \& Neonatal Medicine
The Journal of Maternal-Fetal \& Neonatal Medicine
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Aim: Our objective was to develop a first 19 weeks risk prediction model with several potential gestational diabetes mellitus (GDM) predictors including hepatic and renal and coagulation function measures. Methods: A total of 490 pregnant women, 215 with GDM and 275 controls, participated in this case-control study. Forty-three blood examination indexes including blood routine, hepatic and renal function, and coagulation function were obtained. Support vector machine (SVM) and light gradient boosting machine (lightGBM) were applied to estimate possible associations with GDM and build the predict model. Cutoff points were estimated using receiver operating characteristic curve analysis. Results: It was observed that a cutoff of Prothrombin time (PAT-PT) and Activated partial thromboplastin time (PAT-APTT) could reliably predict GDM with sensitivity of 88.3% and specificity of 99.47% (AUC of 94.2%). If we only use hepatic and renal function examination, a cutoff of DBIL and FPG with sensitivity of 82.6% and specificity of 90.0% (AUC of 91.0%) was obvious and a negative correlation with PAT-PT (r=-0.430549) and patient activated partial thromboplastin time (PAT-APTT) (r=-0.725638). A negative correlation with direct bilirubin (DBIL) (r=-0.379882) and positive correlation with fasting plasma glucose (FPG) (r = 0.458332) neglect coagulation function examination. Conclusion: The results of this study point out the possible roles of PAT-PT and PAT-APTT as potential novel biomarkers for the prediction and earlier diagnosis of GDM. A first 19 weeks risk prediction model, which incorporates novel biomarkers, accurately identifies women at high risk of GDM, and relevant measures can be applied early to achieve the prevention and control effects.
@article{xiong2020prediction,
title = {Prediction of Gestational Diabetes Mellitus in the First 19 Weeks of Pregnancy Using Machine Learning Techniques},
author = {Yan Xiong and Lu Lin and Yu Chen and Stephen Salerno and Yi Li and Xiaoxi Zeng and Huafeng Li},
year = {2020},
journal = {The Journal of Maternal-Fetal \& Neonatal Medicine},
pages = {1--7},
publisher = {Taylor \& Francis},
doi = {10.1080/14767058.2020.1786517}
}
Yu, Yuan, Salerno, Gou, Chen, Yang, Li & Fu
Chinese Medical Journal
Chinese Medical Journal
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N/A
@article{yu2020risk,
title = {Risk Factors for Mortality at Beginning of Maintenance Hemodialysis},
author = {Shao-Bin Yu and Huai-Hong Yuan and Stephen Salerno and Shen-Ju Gou and Wen-Wen Chen and Hong-Liu Yang and Yi Li and Ping Fu},
year = {2020},
journal = {Chinese Medical Journal},
volume = {133},
number = {07},
pages = {868--870},
publisher = {Wolters Kluwer--Medknow Publications},
doi = {10.1097/CM9.0000000000000719}
}
Yang, Yang, Zhao, Wang, Yu, Salerno, Li, Fu & Cui
Hemodialysis International
Hemodialysis International
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Introduction: Hemodialysis catheter-related superior vena cava (SVC) occlusions can cause considerable morbidity for patients and be challenging to treat if refractory to conventional guide wire transversal. This pilot study assessed the feasibility and safety of sharp recanalization of SVC occlusion in hemodialysis patients. Methods: This study retrospectively enrolled hemodialysis patients treated in West China Hospital diagnosed with SVC occlusion who failed traditional guide wire transversal from January 2014 to November 2017. In brief, a guide wire from the femoral approach was advanced to the lower end of the obstructive lesion to act as a target, while the stiff end of hydrophilic wire was advanced though a jugular approach. Under fluoroscopic guidance in biplane imaging, the occlusive SVC lesion was penetrated with the stiff wire that was snared and pulled through. Graded dilation of the SVC and subsequent tunneled-cuffed catheter implantation were performed. Demographic information and clinical outcomes were recorded and evaluated. Findings: Sixteen patients with a mean age of 62 ± 13 years (13 females and 3 males) who received SVC sharp recanalization were included in this study. The sharp recanalization procedure was successfully performed in 14 patients (87.5%). Two patients were complicated with SVC laceration and hemopericardium but remained asymptomatic and required no surgical repair. One patient suffered ventricular fibrillation during procedure. Despite the return of spontaneous circulation, the patient unfortunately died of gastrointestinal tract bleeding after 3 days in ICU. Follow-up suggested the 6-month catheter patency to be 92.85% and 12-month catheter patency to be 58.33%. No long-term procedure-related complications were recorded. Discussion: Sharp recanalization might be a feasible strategy in managing SVC occlusion in hemodialysis patients. The potential life-threatening complications (cardiac arrhythmia and SVC laceration) necessitate strict eligibility screening, skillful operation, and avoidance of over-dilation of SVC.
@article{yang2020feasibility,
title = {The Feasibility and Safety of Sharp Recanalization for Superior Vena Cava Occlusion in Hemodialysis Patients: A Retrospective Cohort Study},
author = {Ling Yang and Letian Yang and Yuliang Zhao and Yating Wang and Yang Yu and Stephen Salerno and Yi Li and Ping Fu and Tianlei Cui},
year = {2020},
journal = {Hemodialysis International},
volume = {24},
number = {1},
pages = {52--60},
publisher = {Wiley Online Library},
doi = {10.1111/hdi.12804}
}
2019
Mai, Zhao, Salerno, Li, Feng, Ma & Fu
International Urology and Nephrology
International Urology and Nephrology
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Objective: To provide updated evidence, we conducted a systematic review and meta-analysis to compare citrate lock with heparin in the prevention of hemodialysis catheter-related complications. Methods: A systematic review and meta-analysis of randomized controlled trials were obtained by searching PubMed, EMBASE, Ovid, Cochrane library, and the Web of Science databases. Primary outcomes were catheter-related bloodstream infections (CRBI), exit-site infections, bleeding events, catheter removal for poor flow, and thrombolytic treatment. Secondary outcomes were thrombocytopenia, access-related admission, and all-cause mortality. Results: The meta-analysis showed that the citrate lock containing antimicrobials can reduce the risk of CRBI when compared with heparin lock (RR: 0.34, 95% CI 0.24-0.49; I2 = 0%; P < 0.00001), and a tunneled cuffed catheter (TCC) was more beneficial for the prevention of CRBI (RR: 0.42, 95% CI 0.25-0.69; I2 = 40%; P = 0.0007) when compared with non-tunneled cuffed catheters (NTCC). The microbiological correlation analysis suggests that the occurrence of CRBI is closely related to S. aureus in catheters locked by citrate (P = 0.015) rather than by heparin (P = 0.868). In the analysis of exit-site infection, citrate lock with NTCC was more effective in preventing exit-site infection than heparin (RR: 0.48, 95% CI 0.31-0.75; I2 = 0%; P = 0.001). In addition, the risk of bleeding episodes was reduced in hemodialysis patients using citrate lock with TCC (RR: 0.53, 95% CI 0.32-0.86; I2 = 0%; P = 0.01) and patients with citrate alone (RR: 0.51, 95% CI 0.30-0.85; I2 = 12%; P = 0.010). The risk of catheter removal for poor flow (P = 0.91), thrombolytic treatment (P = 0.76), thrombocytopenia (P = 0.37), access-related admission (P = 0.10), and all-cause mortality (P = 0.62) was not significantly different. Conclusions: Antimicrobial-containing citrate lock solutions could reduce the risk of CRBI in hemodialysis patients. The occurrence of CRBI is closely related to S. aureus in catheters locked by citrate rather than by heparin. Citrate lock was effective in reducing exit-site infection in NTCC and bleeding events in TCC.
@article{mai2019citrate,
title = {Citrate versus Heparin Lock for Prevention of Hemodialysis Catheter-Related Complications: Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials},
author = {Hongxia Mai and Yuliang Zhao and Stephen Salerno and Yi Li and Yanhuan Feng and Liang Ma and Ping Fu},
year = {2019},
journal = {International Urology and Nephrology},
volume = {51},
number = {6},
pages = {1019--1033},
publisher = {Springer},
doi = {10.1007/s11255-019-02150-0}
}
Li, Shi, Salerno, Tang, Guo, Liu, Feng, Fu, Huang, Ma & others
PLoS ONE
PLoS ONE
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Medicine-food homology is a long-standing concept in traditional Chinese medicine. YiNianKangBao (YNKB) tea is a medicine-food formulation based on Sichuan dark tea (Ya'an Tibetan tea), which is traditionally used for its lipid-lowering properties. In this study, we evaluated the effects of YNKB on dyslipidemia and investigated the mechanism underlying its correlation with gut microbiota and serum metabolite regulation. Wild-type mice were fed a normal diet as a control. Male ApoE-/- mice were randomly divided into three high-fat diet (HFD) groups, a model group, and two treated groups (100, 400 mg/kg/d for low, high-dose), and fed by gavage for 12 weeks. Serum lipid levels, composition of gut microbiota, and serum metabolites were then analyzed before treatment with YNKB. We extracted the ingredients of YNKB in boiled water for one hour. YNKB supplementation at a high dose of 400 mg/kg/day reduced bodyweight gains (relative epididymal fat pad and liver weight), and markedly attenuated serum lipid profiles and atherosclerosis index, with no significant differences present between the low-dose treatment and HFD groups. Gut microbiota and serum metabolic analysis indicated that significant differences were observed between normal, HFD, and YNKB treatment groups. These differences in gut microbiota exhibited strong correlations with dyslipidemia-related indexes and serum metabolite levels. Oral administration of high-dose YNKB also showed significant lipid-lowering activity against hyperlipidemia in apoE-deficient mice, which might be associated with composition alterations of the gut microbiota and changes in serum metabolite abundances. These findings highlight that YNKB as a medicine-food formulation derived from Sichuan dark tea could prevent dyslipidemia and improve the understanding of its mechanisms and the pharmacological rationale for preventive use.
@article{li2019microbial,
title = {Microbial and Metabolomic Remodeling by a Formula of {Sichuan} Dark Tea Improves Hyperlipidemia in {apoE}-Deficient Mice},
author = {Lingzhi Li and Min Shi and Stephen Salerno and Minghai Tang and Fan Guo and Jing Liu and Yanhuan Feng and Martina Fu and Qinwan Huang and Liang Ma and {others}},
year = {2019},
journal = {PLoS ONE},
volume = {14},
number = {7},
pages = {e0219010},
publisher = {Public Library of Science},
doi = {10.1371/journal.pone.0219010}
}
Mai, Zhao, Salerno, Li, Yang & Fu
Medicine
Medicine
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Rationale: Acute kidney injury (AKI) accounts for 8% to 16% of hospital admissions and can quadruple hospital mortality, placing a serious burden on the health economy. Acute kidney injury (AKI) is mainly caused by dehydration, shock, infection, sepsis, heart disease, or as a side-effect of nephrotoxic drugs. About 10% to 60% of patients with rhabdomyolysis develop AKI, and 10% of AKI is attributable to rhabdomyolysis. However, rhabdomyolysis-induced AKI secondary to undifferentiated connective tissue disease (UCTD) has rarely been reported before. Patient concerns: We report the case of a 50-year-old male of UCTD presented with dark brown urine, swelling and edema of the upper limbs, and decreased urine output. Diagnosis: The patient was diagnosed with rhabdomyolysis-induced AKI secondary to UCTD. Interventions: The patient was successfully treated with intravenous methylprednisolone with other supportive treatment. Outcomes: After 3 days of initiating treatment of medicinal charcoal tablets, sodium bicarbonate and intravenous fluids upon admission, the patient's serum creatinine changed mildly from 145.0 μmol/L to 156.0 μmol/L, but the urinary output increased from 1000 mL/24 h to 2400 mL/24 h, with his creatine kinase (CK) and myoglobin rose from 474 IU/L to 962 IU/L and from 641.5ng/mL to 1599 ng/mL, respectively. We then tried to empirically initiate UCTD therapy by giving corticosteroids. After the administration of the 40 mg of methylprednisolone daily, the serum creatinine level dropped to 97 μmol/L the second day, CK decreased to 85 IU/L within 1 week and myoglobin decreased to 65.05 ng/mL within 10 days. When maintenance dose of 4 mg daily was given, the patient showed no abnormalities in creatinine or CK levels. Lessons: There have been few reports on the association between rhabdomyolysis-induced AKI and UCTD and its mechanism remains unclear. Clinicians should be aware of UCTD as a possible cause to rhabdomyolysis-induced AKI.
@article{mai2019rhabdomyolysis,
title = {Rhabdomyolysis-Induced Acute Kidney Injury in a Patient with Undifferentiated Connective Tissue Disease: A Case Report and Literature Review},
author = {Hongxia Mai and Yuliang Zhao and Stephen Salerno and Yi Li and Letian Yang and Ping Fu},
year = {2019},
journal = {Medicine},
volume = {98},
number = {30},
pages = {e16492},
publisher = {LWW},
doi = {10.1097/MD.0000000000016492}
}
2018
Liu, Yu, Zeng, Yuan, Salerno & Fu
Chinese Medical Journal
Chinese Medical Journal
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N/A
@article{liu2018clinical,
title = {Clinical Characteristics of Pneumonia in Chinese Hemodialysis Patients},
author = {Jing Liu and Shao-Bin Yu and Xiao-Xi Zeng and Huai-Hong Yuan and Stephen Salerno and Ping Fu},
year = {2018},
journal = {Chinese Medical Journal},
volume = {131},
number = {4},
pages = {498},
publisher = {Wolters Kluwer--Medknow Publications},
doi = {10.4103/0366-6999.225046}
}
Isa, Collins, Lee, Decome, Dorvil, Joseph, Smith, Salerno, Wells, Fischer & others
EBioMedicine
EBioMedicine
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Background: Tuberculosis (TB) is the leading infectious cause of death worldwide. A major barrier to control of the pandemic is a lack of clinical biomarkers with the ability to distinguish active TB from healthy and sick controls and potential for development into point-of-care diagnostics. Methods: We conducted a prospective case control study to identify candidate urine-based diagnostic biomarkers of active pulmonary TB (discovery cohort) and obtained a separate blinded “validation” cohort of confirmed cases of active pulmonary TB and controls with non-tuberculous pulmonary disease for validation. Clean-catch urine samples were collected and analyzed using high performance liquid chromatography-coupled time-of-flight mass spectrometry. Results: We discovered ten molecules from the discovery cohort with receiver-operator characteristic (ROC) area-under-the-curve (AUC) values >85%. These 10 molecules also significantly decreased after 60 days of treatment in a subset of 20 participants followed over time. Of these, a specific combination of diacetylspermine, neopterin, sialic acid, and N-acetylhexosamine exhibited ROC AUCs >80% in a blinded validation cohort of participants with active TB and non-tuberculous pulmonary disease. Conclusion: Urinary levels of diacetylspermine, neopterin, sialic acid, and N-acetylhexosamine distinguished patients with tuberculosis from healthy controls and patients with non-tuberculous pulmonary diseases, providing a potential noninvasive biosignature of active TB.
@article{isa2018mass,
title = {Mass Spectrometric Identification of Urinary Biomarkers of Pulmonary Tuberculosis},
author = {Flonza Isa and Sean Collins and Myung Hee Lee and Diessy Decome and Nancy Dorvil and Patrice Joseph and Lauren Smith and Stephen Salerno and Martin T Wells and Steven Fischer and {others}},
year = {2018},
journal = {EBioMedicine},
volume = {31},
pages = {157--165},
publisher = {Elsevier},
doi = {10.1016/j.ebiom.2018.04.014}
}
2017
Liao, Huang, Lai, Liu, Ma, Xie, Salerno, Li & Fu
Chinese Medical Journal
Chinese Medical Journal
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Background: Cyclosporine A (CsA) is a commonly used clinical immunosuppressant. However, CsA exposure in rabbits during the gestation period was shown to cause a postnatal decrease in the number of nephrons, with the effects remaining unknown. In this study, we aimed to explore the effects of CsA on metanephros development in the pregnant BALB/c mice. Methods: Pregnant mice were randomly divided into two groups, and CsA (10 mg·kg-1·d-1) was subcutaneously injected from gestation day 10.5 to day 16.5 in the CsA group, whereas a comparable volume of normal saline was given to the control group. All of the mice were sacrificed on gestation day 17.5 and serum CsA concentration was measured. The fetuses were removed and weighed, and their kidneys were prepared for histological assessment and polymerase chain reaction assay. In an in vitro experiment, embryo kidneys of fetal mice on gestation day 12.5 were used, and CsA (10 μmol/L) was added in the culture of the CsA group. The growth pattern of the ureteric bud and nephrons was assessed by lectin staining. Results: No significant differences in the weight of embryo (4.54 ± 1.22 vs. 3.26 ± 1.09 mg) were observed between the CsA and control groups, the thickness of the cortical (510.0 ± 30.3 vs. 350.0 ± 29.7 μm, P < 0.05) and nephrogenic zone (272.5 ± 17.2 vs. 173.3 ± 24.0 μm, P < 0.05), and the number of glomeruli (36.5 ± 0.7 vs. 27.5 ± 2.1, P < 0.05) were reduced in the CsA group when compared to the control group. The cell proliferation of Ki-67 positive index between control and CsA group (307.0 ± 20.0 vs. 219.0 ± 25.0, P < 0.05) in the nephrogenic zone was decreased with the increase of apoptotic cells (17.0 ± 2.0 vs. 159.0 ± 33.0, P < 0.05). The mRNA expression of WT-1, Pax2, and Pax8 was downregulated by CsA treatment. As for the in vitro CsA group, the branch number of the ureteric bud was decreased in the CsA-treated group with the nephrons missing in contrast to control after the incubation for 24 h and 72 h (all P < 0.0001). Conclusion: Treatment of CsA suppressed metanephros development in the pregnant mice; however, the potential action of mechanism needs to be further investigated.
@article{liao2017effects,
title = {Effects of Cyclosporine A on the Development of Metanephros in the Pregnant {BALB/c} Mice},
author = {Yu-Jie Liao and Rong-Shuang Huang and Wei-Jing Lai and Fang Liu and Liang Ma and Yuan-Sheng Xie and Stephen Salerno and Yi Li and Ping Fu},
year = {2017},
journal = {Chinese Medical Journal},
volume = {130},
number = {18},
pages = {2156},
publisher = {Wolters Kluwer--Medknow Publications},
doi = {10.4103/0366-6999.213971}
}
Huang, Zhou, Feng, Shi, Guo, Gou, Salerno, Ma & Fu
Chinese Medical Journal
Chinese Medical Journal
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Background: Acute kidney injury (AKI) is the most common and life-threatening systemic complication of rhabdomyolysis. Inflammation plays an important role in the development of rhabdomyolysis-induced AKI. This study aimed to investigate the kidney model of AKI caused by rhabdomyolysis to verify the role of macrophage Toll-like receptor 4/nuclear factor-kappa B (TLR4/NF-κB) signaling pathway. Methods: C57BL/6 mice were injected with a 50% glycerin solution at bilateral back limbs to induce rhabdomyolysis, and CLI-095 or pyrrolidine dithiocarbamate (PDTC) was intraperitoneally injected at 0.5 h before molding. Serum creatinine levels, creatine kinase, the expression of tumor necrosis factor (TNF)-α, interleukin (IL)-1β and IL-6, and hematoxylin and eosin stainings of kidney tissues were tested. The infiltration of macrophage, mRNA levels, and protein expression of TLR4 and NF-κB were investigated by immunofluorescence double-staining techniques, reverse transcriptase-quantitative polymerase chain reaction, and Western blotting, respectively. In vitro, macrophage RAW264.7 was stimulated by ferrous myoglobin; the cytokines, TLR4 and NF-κB expressions were also detected. Results: In an in vivo study, using CLI-095 or PDTC to block TLR4/NF-κB, functional and histologic results showed that the inhibition of TLR4 or NF-κB alleviated glycerol-induced renal damages (P < 0.01). CLI-095 or PDTC administration suppressed proinflammatory cytokine (TNF-α, IL-6, and IL-1β) production and macrophage infiltration into the kidney (P < 0.01). Moreover, in an in vitro study, CLI-095 or PDTC suppressed myoglobin-induced expression of TLR4, NF-κB, and proinflammatory cytokine levels in macrophage RAW264.7 cells (P < 0.01). Conclusion: The pharmacological inhibition of TLR4/NF-κB exhibited protective effects on rhabdomyolysis-induced AKI by the regulation of proinflammatory cytokine production and macrophage infiltration.
@article{huang2017pharmacological,
title = {Pharmacological Inhibition of Macrophage Toll-Like Receptor 4/Nuclear Factor-kappa b Alleviates Rhabdomyolysis-Induced Acute Kidney Injury},
author = {Rong-Shuang Huang and Jiao-Jiao Zhou and Yu-Ying Feng and Min Shi and Fan Guo and Shen-Ju Gou and Stephen Salerno and Liang Ma and Ping Fu},
year = {2017},
journal = {Chinese Medical Journal},
volume = {130},
number = {18},
pages = {2163},
publisher = {Wolters Kluwer--Medknow Publications},
doi = {10.4103/0366-6999.213406}
}
Salerno*, Mehrmohamadi*, Liberti, Wan, Wells, Booth & Locasale
PloS ONE
PloS ONE
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With the surge of interest in metabolism and the appreciation of its diverse roles in numerous biomedical contexts, the number of metabolomics studies using liquid chromatography coupled to mass spectrometry (LC-MS) approaches has increased dramatically in recent years. However, variation that occurs independently of biological signal and noise (i.e. batch effects) in metabolomics data can be substantial. Standard protocols for data normalization that allow for cross-study comparisons are lacking. Here, we investigate a number of algorithms for batch effect correction and differential abundance analysis, and compare their performance. We show that linear mixed effects models, which account for latent (i.e. not directly measurable) factors, produce satisfactory results in the presence of batch effects without the need for internal controls or prior knowledge about the nature and sources of unwanted variation in metabolomics data. We further introduce an algorithm—RRmix—within the family of latent factor models and illustrate its suitability for differential abundance analysis in the presence of strong batch effects. Together this analysis provides a framework for systematically standardizing metabolomics data.
@article{salerno2017rrmix,
title = {{RRmix}: A Method for Simultaneous Batch Effect Correction and Analysis of Metabolomics Data in the Absence of Internal Standards},
author = {Stephen Salerno* and Mahya Mehrmohamadi* and Maria V Liberti and Muting Wan and Martin T Wells and James G Booth and Jason W Locasale},
year = {2017},
journal = {PloS ONE},
volume = {12},
number = {6},
pages = {e0179530},
publisher = {Public Library of Science},
doi = {10.1371/journal.pone.0179530}
}