Biomedical subjects

Sarmad Sadeghi

Publications and source records attributed to Sarmad Sadeghi.

6 recordsLinked to original sources

PubMed2026

Integrating NECTIN4 Amplification With Membranous Nectin-4 Expression to Develop a Scoring System for Predicting Enfortumab Vedotin Response in Urothelial Carcinoma.

PURPOSE: Enfortumab vedotin (EV) is standard therapy for metastatic urothelial carcinoma (mUC), yet the predictive relevance of NECTIN4 expression-especially membranous versus cytoplasmic-remains unclear. Here, we sought to extend previous findings on NECTIN4 gene amplification in parallel with a systematic subcellular evaluation of NECTIN4 expression. EXPERIMENTAL DESIGN: We retrospectively analyzed 179 EV-treated mUC patients. NECTIN4 amplification was assessed by FISH and NECTIN4 protein levels by IHC. A four-tier membranous scoring algorithm (0,1+,2+,3+) adapted from CAP HER2 gastric guidelines was benchmarked against H-score. We integrated amplification status with membranous staining to refine predictive stratification and compared associations with objective response rate (ORR) to EV-301 data. RESULTS: Combining membranous and cytoplasmic compartments resulted in a median composite H-score of 260 (78.2% ≥150), closely matching NECTIN4 expression prevalence reported in EV-301 (median 250; 82.6% ≥ 150). A ≥150 cut-off enriched for EV responders in both cohorts; in EV-301 with ORR of 45.8% vs. 20% (P = 0.001). High membranous expression based on the scoring (2+/3+) predicted response (ORR 55.1% vs. 25.5%; P < 0.001), with longer PFS (7.1 vs. 2.9 months; HR 0.45) and OS (12.3 vs. 6.9 months; HR 0.57), whereas cytoplasmic expression lacked predictive value. NECTIN4-amplified tumors showed particularly favorable outcomes (PFS 12.2 months; OS 30.1 months). An integrated three-tier model-amplified, non-amplified/high-membranous, and non-amplified/low-membranous-yielded ORRs of 77.2%, 42.9%, and 26.1% and separated survival outcomes. CONCLUSIONS: Our NECTIN4 scoring system integrating NECTIN4 amplification with membranous NECTIN4 expression accurately predicts outcomes, supporting combined genomic and membranous assessment as complementary biomarkers for optimizing EV selection.

Journal Article↗

PubMed2005

A Bayesian model for triage decision support.

OBJECTIVE: To compare triage decisions of an automated emergency department triage system with decisions made by an emergency specialist. METHODS: In a retrospective setting, data extracted from charts of 90 patients with chief complaint of non-traumatic abdominal pain were used as input for triage system and emergency medicine specialist. The final disposition and diagnoses of the physicians who visited the patient in Emergency Department (ED) as reflected in the medical records were considered as control. Results were compared by chi(2)-test and a binary logistic regression model. RESULTS: Compared to emergency medicine specialist, triage system had higher sensitivity (90% versus 64%) and lower specificity (25% versus 48%) for patients who required hospitalization. The triage system successfully predicted the Admit decisions made in the ED whereas the emergency medicine specialist decisions could not predict the ED disposition. Both triage system and emergency medicine specialist properly disposed 56% of cases, however, the emergency medicine specialist in this study under-disposed more patients than the triage system considering Admit disposition (p=0.004) while he appropriately discharged more patients compared to the triage system (p=0.017). CONCLUSION: The triage system studied here shows promise as a triage decision support tool to be used for telephone triage and triage in the emergency departments. This technology may also be useful to the patients as a self-triage tool. However, the efficiency of this particular application of this technology is unclear.

Abdominal Pain↗

PubMed2005

Ontology Driven Construction of a Knowledgebase for Bayesian Decision Models Based on UMLS.

All decision models use some form of language to describe domain elements and their interactions. The terminology is often specific and even unique to the algorithm and is a choice of designers. Nevertheless the domain elements and concepts of any decision problem are almost never unique and are used and reused in many other decision problems. The same is true about the information about those elements in the context of different decision problems. Put together, the information about any given element forms our knowledge about the element and if stored properly in a knowledgebase, can be used and reused as necessary without the need for duplication.In this paper we discuss creation of an ontology using UMLS vocabulary and semantic network that provides an abstract understanding of elements (or objects) in the problem domain. Based on this ontology, a knowledgebase will be constructed that provides further information about the object in relation to another object or objects as described in the semantic links.A knowledgebase structured as such will have the benefit of problem-independence. It can be expanded as needed to include other objects that are used in a different series of problems and therefore, will have a one to many mapping between knowledgebase and decision models. Updating the knowledgebase will update the decision models seamlessly and maintenance will be less of an issue across decision models and within the knowledgebase. We are using this approach in building Bayesian decision models using Bayesian networks; however, this approach is not limited to Bayesian networks and has been and can be used for other decision making purposes.

Bayes Theorem↗

PubMed2002

Determinants of operative mortality following primary coronary artery bypass surgery.

BACKGROUND: The purpose of this study was to determine the factors which can help to predict operative mortality before performing the operation, and afterwards. METHODS: The study population consisted of 504 patients (91 women and 413 men) who underwent primary isolated coronary artery bypass surgery from December 1997 to September 1999 by the same surgeon in a referral center in Tehran, Iran. Perioperative data were gathered and analyzed both in a univariate and multivariate model. RESULTS: After the operation patients spent 7.3 +/- 4.0 days in hospital. The total operative morbidity was 20.5%. Arrhythmias were the most common complication, with atrial fibrillation as the predominant feature. Major complications of the operation were: low cardiac output (4.2%); prolonged ventilatory support (2.4%); hemorrhage and exploratory reoperation (2.0%); postoperative myocardial infarction (1.4%); postoperative renal failure in (1.4%); and postoperative cerebrovascular accident (0.8%). Operative mortality rate in this study was 2.98%. Factors associated with high operative mortality in univariate analysis were: recent myocardial infarction, low ejection fraction, non-elective operation, left main coronary artery disease and prolonged cardiopulmonary bypass time. CONCLUSION: Our data suggest that prior to operation, operative mortality can be best predicted by urgency of operation and left ventricle ejection fraction. After performing the operation, prognostic factors include preoperative LVEF < or = 35%, non-elective operation, and prolonged cardiopulmonary bypass time. Further study is required to assess the generalization of our findings to Iranian patients.

Adult↗

PubMed2002

Mitral valve recurrence of a left atrial myxoma.

Recurrence of intracardiac myxoma is unusual, and heart valves are extremely rare locations for this tumor to originate, either as the primary site or the site of recurrence. We present a case of non-familial cardiac myxoma, which after successful resection of the tumor mass from the left atrium, recurred in the atrial surface of anterior leaflet of the mitral valve, along with a review of similar cases in the literature. Myxoma was originally believed to recur due to inadequate resection, but recent data suggest the multicentric disease to be the reason. Mitral valve myxoma mainly presents with symptoms of embolization and appears to affect women more often. It involves both leaflets with the same frequency and usually originates from the atrial side. Transesophageal echocardiography is the gold standard for non-invasive diagnosis and localization. Operative resection of the tumor along with the underlying tissue followed by suture repair of the valve and annuloplasty is recommended as the most appropriate treatment option. Long-term follow-up of patients by echocardiography is advised for early detection of any recurrence.

Female↗

PubMed2002

Self-administered decision support tool for triage: results of a retrospective study.

BACKGROUND: This study was designed to evaluate the safety of a self-administered triage tool. MATERIALS: Ninety-five patients older than 14 years who presented to Memorial Hermann Hospital emergency room (ER) with chief complaint of abdominal pain were included in the study. Their ER disposition and final diagnoses were logged into a database. The assigned disposition and top three diagnoses by the triage tool for each patient were also logged into the database. An emergency physician blinded to the actual disposition reviewed all cases and provided a disposition for each patient. RESULTS: The system disposed 51.1% of cases appropriately and under-disposed 4.4% of cases. Comparison between the system and the emergency physician shows that all cases under-disposed by the system are also under-disposed by the physician.

Abdominal Pain↗