Publications

2023

1. Maternal Gut Microbiota in the Postpartum Period: A Systematic Review

   Wasana Weerasuriya, Julia E Saunders, Lilla Kis, Thao TB Ho, Ke Xu, Dominick J Lemas, Maureen W Groer, and Adetola F Louis-Jacques

   European Journal of Obstetrics & Gynecology and Reproductive Biology, 2023
2. Peripartum women’s perspectives on research study participation in the OneFlorida Clinical Research Consortium during COVID-19 pandemic

   Ke Xu, Chu J Hsiao, Hailey Ballard, Nisha Chachad, Callie Reeder, Elizabeth Shenkman, Elizabeth Flood-Grady, Adetola Louis-Jacques, Erica L Smith, Lindsay A Thompson, and  others

   Journal of Clinical and Translational Science, 2023

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   Introduction: The COVID-19 pandemic created an unprecedented need for population-level clinical trials focused on the discovery of life-saving therapies and treatments. However, there is limited information on perception of research participation among perinatal populations, a population of particular interest during the pandemic. Methods: Eligible respondents were 18 years or older, currently pregnant or had an infant (≤12 months old), and lived in Florida within 50 miles of sites participating in the OneFlorida Clinical Research Consortium. Respondents were recruited via Qualtrics panels between April and September 2020. Respondents completed survey items about barriers and facilitators to participation and answered sociodemographic questions. Results: Of 533 respondents, most were between 25-34 years of age (n=259, 49%) and identified as White (n=303, 47%) non-Hispanic (n=344, 65%). Facebook was the most popular social media platform among our respondents. The most common barriers to research participation included poor explanation of study goals, discomforts to the infant, and time commitment. Recruitment through healthcare providers was perceived as the best way to learn about clinical research studies. When considering research participation, ’myself’ had the greatest influence, followed by familial ties. Non-invasive biological samples were highly acceptable. Hispanics had higher positive perspectives on willingness to participate in a randomized study (p=0.009). Education (p=0.007) had significant effects on willingness to release personal health information. Conclusion: When recruiting women during the pregnancy and postpartum periods for perinatal studies, investigators should consider protocols that account for common barriers and preferred study information sources. Social media-based recruitment is worthy of adoption.

2022

1. Assessment of human milk in the era of precision health

   Farhad Dastmalchi, Ke Xu, Helen N Jones, and Dominick J Lemas

   Current Opinion in Clinical Nutrition & Metabolic Care, 2022

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   Purpose of review Precision health provides an unprecedented opportunity to improve the assessment of infant nutrition and health outcomes. Breastfeeding is positively associated with infant health outcomes, yet only 58.3% of children born in 2017 were still breastfeeding at 6 months. There is an urgent need to examine the application of precision health tools that support the development of public health interventions focused on improving breastfeeding outcomes. Recent findings In this review, we discussed the novel and highly sensitive techniques that can provide a vast amount of omics data and clinical information just by evaluating small volumes of milk samples, such as RNA sequencing, cytometry by time-of-flight, and human milk analyzer for clinical implementation. These advanced techniques can run multiple samples in a short period of time making them ideal for the routine clinical evaluation of milk samples.Summary Precision health tools are increasingly used in clinical research studies focused on infant nutrition. The integration of routinely collected multiomics human milk data within the electronic health records has the potential to identify molecular biomarkers associated with infant health outcomes.

2. Deep learning-based prognosis prediction among preeclamptic pregnancies using electronic health record data

   Xiaotong Yang, Hailey K Ballard, Aditya D Mahadevan, Ke Xu, David G Garmire, Elizabeth S Langen, Dominick J Lemas, and Lana X Garmire

   medRxiv, 2022

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   Background Preeclampsia (PE) is one of the leading factors in maternal and perinatal mortality and morbidity worldwide. The only cure for PE to date is to deliver the placenta and stop gestation. However, the timing of delivery among PE patients is essential to minimize the risk of severe maternal morbidities, and at the same time ensure the survival of the baby. Methods In this study, we constructed a series of deep learning-based models to predict the prognosis, or the time to delivery, since the initial diagnosis of PE using electronic health record (EHR) data. We extracted and processed 1578 pregnancies in Michigan Medicine at the University of Michigan in 2015-2021 as the discovery cohort. Using the Cox-nnet v2 algorithm, we built the baseline model with EHR information prior to diagnosis, as well as the full model including baseline information and lab testing results and vital signs at the time of diagnosis. We evaluated the models using the C-index and log-rank p-values in KM survival curves, using both 20% testing data of the Michigan cohort, as well as 1177 PE pregnancy EHR data from the Medical Center of the University of Florida. Results The baseline prognosis model for time to delivery since PE diagnosis achieved C-index values of 0.75 and 0.72 on the training and testing set respectively. While the full model reached C-indices of 0.77 and 0.74 in the same training and testing sets. Both models performed better than their Cox-PH model counterparts. The seven most important features in the baseline model in descending order were diagnosis gestational age, severe PE, past PE, age, parity, gravidity, and uncomplicated diabetes. Meanwhile, 14 most important features were selected and interpreted in the full model, including diagnosis gestational age, parity, severe PE, past PE, features in lab tests (white blood cell, platelet, and red blood cell counts, AST value), min respiratory rate, and features measuring blood pressure (minimum, mean and standard deviation of systolic blood pressure, and maximum and standard deviation of diastolic blood pressure). Conclusion The time to delivery predicting models provide clinicians valuable tools and options to quantify the delivery risks and make better decisions on the optimal delivery time of PE patients at the time of diagnosis. Implementation of these actionable models into PE clinical care practice is expected to significantly improve the management of PE patients.

3. Peripartum women’s perspectives on research study participation in the OneFlorida Clinical Research Consortium

   Ke Xu, Chu Hsiao, Hailey Ballard, Nisha Chachad, Thu Kim, Callie Reeder, Elizabeth A Shenkman, and Dominick J Lemas

   American Journal of Obstetrics & Gynecology, 2022

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   Objective To evaluate research participation experiences and preferences among Florida women likely eligible to participate in clinical research studies related to pregnancy and postpartum. Study Design Participants were 18 years or older, pregnant or had an infant, and lived in Florida within 50 miles of sites participating in the OneFlorida Clinical Research Consortium. April to September 2020, respondents took a Qualtrics survey about socio-demographics, prior experiences with research, and barriers/facilitators to participation. Results Of 533 respondents, most were between 25-34 years of age (n=259, 49%), had a college degree (n=250, 47%), and identified as White (n=303, 47%) and non-Hispanic (n=344, 65%). Among those reporting prior research participation (n=129, 24%), over half participated in pregnancy-related research (n=74, 60%). The most frequently investigated pregnancy topic was allergy and immunology (n=37, 29%). The most common barriers to research participation were: study goals not well explained, discomforts to the infant, family concern, and time commitment. Participants preferred text (n=303, 57%) or email (n=296, 56%) as communication methods and only 19% preferred evening study visits. Recruitment through existing healthcare relations (i.e. physician) was perceived as the best way to learn about clinical research studies. In determining whether to participate, strong personal social ties (e.g. spouse) had greater importance than weak ties (e.g. neighbor/co-worker), with the most important voice being “myself.” Human milk, saliva and urine were highly favorable in terms of biospecimen collection and more than half of participants had a positive response to releasing personal health information and participating in a randomized study. Conclusion Women during pregnancy and postpartum were interested in clinical studies that require non-invasive biospecimen collection. Effective recruitment of women in perinatal studies should consider protocols that account for physical discomfort, communication style and time commitments.

4. Maternal gut microbiome during the lactational period

   Adetola F Louis-Jacques, Dominick J Lemas, Ke Xu, Shaheda Urmi, and Maureen Groer

   American Journal of Obstetrics & Gynecology, 2022

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   Objective Breastfeeding (BF) is associated with reduction in maternal risk of cardiometabolic diseases (CMD). We propose that lactation’s physiological effects lead to gut microbiome modifications, and these changes could have long-term effects on CMD. Our objective is to determine the influence of BF status on gut microbiome diversity and composition in postpartum (PP) women. Study Design Demographics, clinical data and maternal stool were collected longitudinally from 94 women in the first 6 months PP. We classified stool samples into 2 periods based on median sample collection timepoint (T1: < =130 days and T2: >130 days). Samples were divided into two BF groups. EBF implies 100% BF (N=148) and non-EBF implies less than 100% BF (N=50). Gut microbes were estimated using 16S rRNA gene amplicon sequencing. Data was analyzed using nf-core/ampliseq V1.1.3 pipeline. Beta diversity (between groups) was calculated. Alpha diversity (within samples) indices were analyzed for gut microbiota richness and diversity. Results We observed differences in the maternal diet (p< 0.001) and BMI (p=0.003) according to BF status and adjusted subsequent modeling for these covariates. We found significant differences in gut microbiota community between the BF groups at T1 and T2 (Figure). Linear mixed models showed that none of the covariates (BF status, BMI, or PRIME) had a significant influence on gut microbiota richness or diversity. Regarding individual microbiome analysis, we found significant changes (p< 0.05) in Bacilli, Lactobacillales, Enterobacteriales, and Enterobacteriaceae according to BF status at T1. Bacilli and Lactobacillales were significant before adjustment while Enterobacteriales and Enterobacteriaceae were significant after adjustment. At T2, we found significant changes (p< 0.05) in the Prevotellaceae according to BF status. Conclusion BF has a large influence on gut microbial community structure. Next steps are to assess the influence of microbial composition on PP cardiometabolic measures. BF offers a key preventative strategy and gut microbes may be a mediator between maternal BF status and CMD.

2021

1. A Six-Day, Lifestyle-Based Immersion Program Mitigates Cardiovascular Risk Factors and Induces Shifts in Gut Microbiota, Specifically Lachnospiraceae, Ruminococcaceae, Faecalibacterium prausnitzii: A Pilot Study

   Angelica P Ahrens, Tyler Culpepper, Brittany Saldivar, Stephen Anton, Scott Stoll, Eileen M Handberg, Ke Xu, Carl Pepine, Eric W Triplett, and Monica Aggarwal

   Nutrients, 2021

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   Cardiovascular disease (CVD) prevalence remains elevated globally. We have previously shown that a one-week lifestyle “immersion program” leads to clinical improvements and sustained improvements in quality of life in moderate to high atherosclerotic CVD (ASCVD) risk individuals. In a subsequent year of this similarly modeled immersion program, we again collected markers of cardiovascular health and, additionally, evaluated intestinal microbiome composition. ASCVD risk volunteers (n = 73) completed the one-week “immersion program” involving nutrition (100% plant-based foods), stress management education, and exercise. Anthropometric measurements and CVD risk factors were compared at baseline and post intervention. A subgroup (n = 22) provided stool, which we analyzed with 16S rRNA sequencing. We assessed abundance changes within-person, correlated the abundance shifts with clinical changes, and inferred functional pathways using PICRUSt. Reductions in blood pressure, total cholesterol, and triglycerides, were observed without reduction in weight. Significant increases in butyrate producers were detected, including Lachnospiraceae and Oscillospirales. Within-person, significant shifts in relative abundance (RA) occurred, e.g., increased Lachnospiraceae (+58.8% RA, p = 0.0002), Ruminococcaceae (+82.1%, p = 0.0003), Faecalibacterium prausnitzii (+54.5%, p = 0.002), and diversification and richness. Microbiota changes significantly correlated with body mass index (BMI), blood pressure (BP), cholesterol, high-sensitivity C-reactive protein (hsCRP), glucose, and trimethylamine N-oxide (TMAO) changes. Pairwise decreases were inferred in microbial genes corresponding to cancer, metabolic disease, and amino acid metabolism. This brief lifestyle-based intervention improved lipids and BP and enhanced known butyrate producers, without significant weight loss. These results demonstrate a promising non-pharmacological preventative strategy for improving cardiovascular health.

2. A Multidisciplinary Preventive Cardiology Clinic Model to Improve Cardiovascular Risk - A Pilot Study

   Mohammed Elzeneini, Jerin George, Hassan Ashraf, Ke Xu, John Petersen, R David Anderson, Eileen Handberg, Carl Pepine, and Monica Aggarwal

   Journal of the American College of Cardiology, 2021

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   Background Conventional cardiology practice often focuses on management pre and post interventional therapy and defers cardiovascular preventive strategies to “usual care” providers. This study investigated whether a multidisciplinary preventive cardiology clinic model, focusing on nutrition and lifestyle education/modification, was associated with improved patient cardiovascular risk compared to conventional clinic care. Methods We identified patients enrolled in our preventive clinic compared to 2 conventional cardiology clinics (general and interventional) between January 2016 and October 2020. Cardiovascular risk profile, weight, blood pressure, and lipid profile including LDL cholesterol (LDL-C), total cholesterol (TC) and triglycerides (TG) were collected at baseline and each follow-up visit. Comparative analysis was performed on initial and last follow-up (median time 6 and 16 months), then stratified into primary and secondary prevention. A propensity score-matched analysis was done to adjust for baseline covariates and statin use. Results Among a cohort of 239 patients, enrollment in preventive clinic (n=99) was associated with greater weight loss compared to conventional clinics (n=140) (mean -1.7kg vs +0.1kg, p 0.007). Preventive clinic was associated with greater reduction in LDL-C (mean -24.8 vs -7.1, p 0.021), TC (mean -29.3 vs -2.0, p 0.003) and TG (mean -19.7 vs +13.3, p 0.002) on initial follow-up, with a similar association on longer follow-up. The association with reduction in TG was observed in both primary and secondary prevention, but reduction in LDL-C and TC was only significant in secondary prevention. In a multiple linear regression model, preventive clinic was independently associated with greater LDL-C reduction (b -15.7, r -0.2, p 0.043, as well as in secondary prevention b-25.7, r -0.3, p 0.034). After matching, preventive clinic remained associated with greater LDL-C reduction (b -14.7, r -0.3, p 0.038). Conclusion Adherence to a multidisciplinary preventive clinic model is associated with greater weight loss and a more favorable lipid panel compared to conventional care, with the potential for greater impact in secondary prevention.

3. County-level Analysis of Perinatal Health Indicators Within a Single Health System Catchment

   Dominick J Lemas, Claire Layton, Hailey Ballard, Ke Xu, John C Smulian, Matthew Gurka, Matthew Shane Loop, Erica L Smith, Callie F Reeder, Adetola Louis-Jacques, and  others

   Research Square, 2021

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   Background: Adverse perinatal health outcomes are disproportionally impacted in rural communities. Social determinants of health (SDoH) defined by nonclinical social, behavioral, and economic factors may impact up to 90% of health outcomes in rural communities. Objective: To evaluate county-level perinatal patterns in health outcomes, health behaviors, socioeconomic vulnerability, and healthcare providers across rural and non-rural Florida counties within a single health system catchment. Methods: Socioeconomic vulnerability metrics, digital connectivity, licensed provider metrics, and behavioral data and were obtained from Floridahealthcharts.com and the County Health Rankings. County-level birth and perinatal health outcome data were obtained from the Florida Department of Health. The University of Florida Health Perinatal Catchment Area (UFHPCA) was defined as all Florida counties where ≥5% of all infants were delivered at Shands Hospital in Alachua county between June 2011 and April 2017. County-level rurality was determined by Florida Statutes 288.0656 rurality designations. Results: The UFHPCA included three non-rural and ten rural counties that represented more than 64,000 deliveries over a 5-year 9-month period. We found that nearly 1 in 3 infants resided in a rural county (n=20,899), and 7 out of 13 counties did not have a licensed obstetrician gynecologist. Nine counties reported maternal death rates that were between 1 and 4-fold higher than the statewide rate, and rural counties generally reported neonatal mortality and preterm birth rates that were higher than the statewide averages. We found maternal smoking rates (range 6.8% – 24.8%) were above the statewide rate (6.2%) for all counties in the catchment. Except for Alachua county, breastfeeding initiation rates (range 54.9% - 81.4%) and access to household computing devices (range 72.8% - 86.4%) were below the statewide rate (82.9% and 87.9%, respectively). Finally, we found that childhood poverty rates (range 16.3% - 36.9%) in our catchment was above the statewide rate (18.5%), except for Suwanee and Columbia counties. Conclusions: The health burden of the UFHPCA is characterized by both rural and non-rural counties with increased maternal and neonatal death and preterm birth, as well as adverse health behaviors that include smoking during pregnancy and lower levels of breastfeeding.

4. Impact of a preventive cardiology clinic focusing on lifestyle and nutrition counseling: A pilot analysis

   Mohammed Elzeneini, Jerin George, Hassan Ashraf, Ke Xu, John Petersen, R David Anderson, Eileen M Handberg, Carl J Pepine, and Monica Aggarwal

   American Heart Journal Plus: Cardiology Research and Practice, 2021

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   Standard cardiology practice often defers preventive strategies to primary care providers. We aimed to evaluate the effectiveness of a preventive cardiology clinic focused on lifestyle and nutrition counseling combined with guideline-directed medical therapy on reducing cardiovascular disease (CVD) risk. We queried the University of Florida-Health database for patients enrolled in the preventive cardiology clinic, and a general and interventional cardiology clinic from January 2016 to October 2019. Mean change in weight and blood cholesterol including LDL cholesterol (LDL-C), total cholesterol (TC) and triglycerides (TG) were compared in the three clinics in the initial cohort and stratified into primary and secondary prevention. A propensity score-matched analysis was done to adjust for CVD risk factors and statin use. Among a cohort of 239 patients, enrollment in the preventive clinic (n = 99) was associated with greater weight loss at 6 months compared to other clinics (n = 140) (mean −1.7 vs +0.1 kg, p 0.007). Preventive clinic was also associated with greater mean reduction in LDL-C (−24.8 vs −7.1 mg/dl, p 0.021), TC (−29.3 vs −2.0, p 0.003) and TG (−19.7 vs +13.3, p 0.002) at both initial and last follow-up (median time 6 and 16 months). The association with reduction in TG was observed in both primary and secondary prevention, but reduction in LDL-C and TC was only significant in secondary prevention. In a propensity-matched linear regression analysis, preventive clinic was independently associated with LDL-C reduction (b −14.7, r −0.3, p 0.038). A preventive cardiology clinic focused on patient education can be effective in reducing CVD risk.

5. Antihypertensive medication adherence trends by sex and drug class: A pilot study

   Henry Reed Holmes, Qian Li, Ke Xu, Seungbum Kim, Elaine M Richards, Ellen C Keeley, Eileen M Handberg, Steven M Smith, Mohan K Raizada, Carl J Pepine, and  others

   American Heart Journal Plus: Cardiology Research and Practice, 2021

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   Introduction Antihypertensive medication nonadherence is a prevalent issue but is very difficult to accurately assess. To clarify this problem among hypertensive patients attending a cardiovascular disease outpatient clinic, we utilized high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS) to assess antihypertensive medication adherence and identify trends by sex and drug class. Methods Serum was extracted from blood samples obtained from patients with either drug-controlled or drug resistant hypertension (RHTN) and analyzed via HPLC-MS for antihypertensive drugs which were categorized by drug class as beta blockers, aldosterone antagonists, diuretics, ACE inhibitor/ARBs, or calcium channel blockers. Clinic blood pressure (BP), sex, and prescription regimens were extracted from medical records at or near the time of blood collection. “Adherence” or “nonadherence” was determined by comparison of the patient’s prescribed drug regimen and the presence/absence of prescribed drug(s) in their serum. Results Among 76 patients (47 women; mean age 63; 53% white), nonadherence was confirmed in 29%. RHTN was more frequently identified in women than men (55% vs 38%) and nonadherence was higher in women than men (34% vs 21%). BP in those who were adherent to prescribed antihypertensive drugs was significantly lower than in those who were nonadherent (129/75 vs 145/83 mmHg, p = 0.0015). Overall, ACE inhibitors/ARBs were associated with the least nonadherence. Among women, nonadherence was highest for aldosterone antagonists, whereas among men, nonadherence was highest for diuretics. Conclusion We observed nonadherence was more frequent among older women in a cohort of HTN and RHTN patients with cardiovascular disease based on HPLC-MS confirmed drug levels.

2020

1. International Classification of Diseases, Tenth Revision, Clinical Modification social determinants of health codes are poorly used in electronic health records

   Yi Guo, Zhaoyi Chen, Ke Xu, Thomas J George, Yonghui Wu, William Hogan, Elizabeth A Shenkman, and Jiang Bian

   Medicine, 2020

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   There have been increasing calls for clinicians to document social determinants of health (SDOH) in electronic health records (EHRs). One potential source of SDOH in the EHRs is in the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) Z codes (Z55–Z65). In February 2018, ICD-10-CM Official Guidelines for Coding and Reporting approved that all clinicians, not just the physicians, involved in the care of a patient can document SDOH using these Z codes.

2. Electrocardiographic (ECG) predictors of major adverse cardiac events in women with ischemia and no obstructive coronary artery disease (INOCA)

   YK Taha, Ke Xu, AA Mahmoud, SM Smith, EM Handberg, CN Bairey Merz, and CJ Pepine

   European Heart Journal, 2020

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   Introduction The Women’s Ischemia Syndrome Evaluation (WISE) studies observed that majority of women undergoing coronary angiography for symptoms/signs of ischemia have no obstructive coronary artery disease (INOCA) but have an increased risk of major adverse cardiac events (MACE) exceeding 2.5% yearly by 5 years. Identifying modifiable and non-modifiable factors that help predict or contribute to adverse outcomes in this population is important. Purpose Identifying electrocardiographic predictors of MACE in women with INOCA. Methods In a cohort of women referred for coronary angiography between 1996–2001 for symptoms and/or signs of ischemia, 944 underwent a resting 12-lead ECG at baseline read at core lab. No obstructive CAD was found in 567/944 (60%), (mean age 55.6±11 years). Complete follow up information for MACE as (first occurrence of all-cause death, nonfatal myocardial infarction (MI), nonfatal stroke, or hospitalization for heart failure) or angina was available in 425 women. Results At follow up (median 5.9 years) MACE had occurred in 17.6% with angina hospitalization in 22.8% of these women. Women who experienced MACE were older (mean age 59±11 vs 55±10 years, P=0.02) and had longer corrected QT interval (mean QTc 437±29.7 vs 425±26.7 ms, P=0.001) vs. women without MACE. Diabetes, hypertension and history of smoking did not differ between MACE groups. Predictors of MACE by univariate analysis were: age at presentation (P=0.013), baseline heart rate (P=0.03), and QTc (P=0.0005). Baseline ST-T wave changes, QTc and waist circumference predicted angina hospitalization (P=0.003, 0.003 and 0.013 respectively). After adjusting for other risk factors in the multivariate analysis (see Figure) QTc, peripheral arterial disease (PAD) and current smoking were found to be independent predictors for MACE. ST-T wave changes and QTc independently predicted angina hospitalizations. Conclusion Among ECG findings in women with INOCA, QTc was a significant predictor of MACE and this was driven by hospitalization with angina. Ongoing ischemia likely contributes to these baseline ECG signals which could prove useful to better select subgroups for more intense anti-ischemic management.

2019

1. A Pilot Study of Antihypertensive Medication Adherence Trends by Sex and Drug Class

   Rhonda M Cooper-Dehoff, Henry R Holmes, Qian Li, Ke Xu, Seungbum Kim, Elain M Richards, Ellen C Keeley, Eileen M Handberg, Steven M Smith, Mohan K Raizada, and  others

   Hypertension, 2019

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   Background: Antihypertensive medication nonadherence is believed to be a prevalent issue but is very difficult to accurately assess. As a result, using a variety methods, nonadherence rates ranging from 3-86% have been suggested. To clarify this problem among hypertensive patients attending a CVD outpatient clinic, we utilized high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS) to assess antihypertensive medication adherence and identify trends by sex and drug class Methods: Plasma was obtained from patients with either drug-controlled or drug resistant hypertension (RHTN) and analyzed via HPLC-MS for antihypertensive drugs which were categorized by drug class as: beta blockers, aldosterone antagonists, thiazide diuretics, ACE inhibitor/ARBs, or calcium antagonists. Clinic blood pressure (BP) measurements, sex, and prescription regimens were extracted from patient medical records at or near the time of plasma collection. “Adherence” or “nonadherence” was determined by comparison of the patient’s prescribed drug regimen and the presence/absence of prescribed drug(s) in their plasma. Results: Among 76 patients (47 women, mean age 63 ± SD 10), and 53% (43 of 76) white. Overall, nonadherence was confirmed in 29% (22 of 76). RHTN was more frequently identified in women than men (55%, 26 of 47 vs 38% 11 of 29) and nonadherence was higher in women than men (34%, 16 of 47 vs 21%, 6 of 29). As expected, BP in those who were fully adherent to prescribed antihypertensive drugs was significantly lower than in those who were nonadherent with one or more medications (129/75 vs 145/83 mm Hg, p=0.0015). Overall, ACE inhibitors or ARBs were associated with the least nonadherence. Among women, nonadherence was highest for aldosterone antagonists, whereas among men, nonadherence was highest for thiazide diuretics. Nonadherence appeared among those with RHTN (38%, 14 of 37) and those with controlled HTN (21%, 8 of 39). Conclusion: We observed nonadherence was more frequent among older women in a cohort of HTN and RHTN patients based on HPLC-MS confirmed drug levels. Nonadherence was variable based on drug class but lowest with angiotensin II active agents, which, if validated, should be considered when optimizing antihypertensive prescribing.

2017

1. Analysis of Hydrophobin Genes from Aspergillus niger

   Yan Zhang, Ke Xu, and Jianguo Zhang

   Life Science Research, 2017

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   Hydrophobins play an important role in the morphology engineering of filamentous fungi. To clarify hydrophobin genes of Aspergillus niger for further research, assumed hydrophobin genes were analyzed based on the cysteine pattern and hydropathy pattern of hydrophobin amino acid sequences. Eight genes were obtained from 20 assumed hydrophobin genes based on gene sequence similarity. The proteins coded by these eight genes had the 8 cysteines pattern which all belong to class I hydrophobin. While only two hydrophobins had hydropathy pattern of class I, and the other 6 were considered as intermediate type of hydrophobin according to their hydropathy patterns. Finally, the similarity of amino acid sequences of these 8 hydrophobins was 0.5%. The clarification of assumed hydrophobin genes builds a solid base for hydrophobin gene cloning and knockout to confirm their function in fungal spore aggregation.

2. 两种微载体培养鼠肝细胞对低温保存后的影响

   Bo Yang, Lingxia Zhuang, Baolin Liu, Zheng Wang, and Ke Xu

   中国细胞生物学学报, 2017

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2016

1. TTC 比色法筛选高存活率的毕赤酵母突变株

   Shengnan Liu, Yan Zhang, Taiyu Liu, Ke Xu, and Jianguo Zhang

   Chemistry & Bioengineering, 2016

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