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Fahmy P, Kanthan A, Rao R, Alexander I, Kizana E. The Effects of Connexin45 Over-expression on Cardiac Physiology in the Intact Animal. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Rao R, Chawla N, Das SR, Kumar S, Mohanty SK, Shirure VS. Bone marrow hypoplasia : A rare presentation of SLE. JOURNAL OF MARINE MEDICAL SOCIETY 2012. [DOI: 10.4103/0975-3605.203216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Chattopadhyay R, Chawla N, Rao R, Kumar S, Gangu J, Kharolkar V. A study of multidrug resistant gram negative organisms at INHS Asvini. JOURNAL OF MARINE MEDICAL SOCIETY 2012. [DOI: 10.4103/0975-3605.203234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Fahmy P, Kanthan A, Rao R, Alexander I, Kizana E. Efficient Atrial and Ventricular Transduction Following Tail Vein Injection of AAV2/9 Viral Vector. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Noimark L, Wales J, Du Toit G, Pastacaldi C, Haddad D, Gardner J, Hyer W, Vance G, Townshend C, Alfaham M, Arkwright PD, Rao R, Kapoor S, Summerfield A, Warner JO, Roberts G. The use of adrenaline autoinjectors by children and teenagers. Clin Exp Allergy 2011; 42:284-92. [PMID: 22181034 DOI: 10.1111/j.1365-2222.2011.03912.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 09/24/2011] [Accepted: 10/06/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although adrenaline is recommended as first line treatment for anaphylaxis, it is often not utilized. There has been a debate about when adrenaline autoinjectors should be prescribed and how many should be dispensed. OBJECTIVES To see how many adrenaline autoinjectors were used during anaphylactic reactions and to determine why they were not used in situations where they were clinically indicated. METHODS Patients were recruited prospectively at 14 paediatric allergy clinics throughout UK. Participants completed a questionnaire covering demographic data, atopic status and details of allergic reactions in the previous year and reasons for using more than one device. RESULTS A total of 969 patients were recruited of whom 466 (48.1%, 95% CI: 37.9-58.2) had had at least one reaction in the previous year; 245 (25.3%, 95% CI: 16.2-34.4) of these reactions were anaphylaxis. An adrenaline autoinjector was used by 41 (16.7%, 95% CI: 11.7-21.3) participants experiencing anaphylaxis. Thirteen participants received more than one dose of adrenaline, for nine of these a health professional gave at least one. The commonest reasons for using more than one were severe breathing difficulties (40%), lack of improvement with first dose (20%) and miss-firing (13.3%). The commonest reasons for not using adrenaline in anaphylaxis were 'thought adrenaline unnecessary' (54.4%) and 'unsure adrenaline necessary' (19.1%). Many with wheeze did not use their autoinjector. CONCLUSIONS AND CLINICAL RELEVANCE Adrenaline is used by only a minority of patients experiencing anaphylaxis in the community. Thirteen of the 41 patients with anaphylaxis who used their autoinjector needed another dose of adrenaline. Further research is needed to consider how to best encourage the usage of adrenaline when clinically indicated in anaphylaxis.
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Pradeep CR, Koestler W, Lauriola M, Nair H, Rao R, Mills GB, Yarden Y. P2-03-04: Novel Pathways Underlying the Initiation and Transition of DCIS to IDC of HER2−Overexpressing Breast Cancer Model. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p2-03-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The HER2/Neu -oncogene is amplified in 20–25% percent of human primary breast cancers and this alteration is associated with disease behaviour. The HER2/neu oncogene encodes a receptor-like tyrosine kinase, whose overexpression in breast cancer predicts poor prognosis and resistance to conventional therapies. Whereas signalling pathways emanating from HER2 have been characterized, much less is known about the transcriptionally regulated genes controlled by HER2 that contribute to the initiation of Ductal Carcinoma Insitu (DCIS) and their transition to an invasive ductal carcinoma (IDC).
Materials and Methods: Normal and HER2 overexpressing mammary epithelial cells (MCF10A) were grown in extracellular matrix to form 3D structures, When grown in extracellular matrix as 3-dimensional spheroids, control cells developed a hollow lumen, but HER2−overexpressing cells populated the lumen by evading apoptosis. On the next step, uopon the growth factror stimulation HER2−overexpressing cells grown in extracellular matrix, which protruded invasive outgrowths. Highly variable genes were selected from the described phenotypes using RNA isolated from the 3D structures and hybridized to an Affymetrix HuGene 1.0 ST oligonucleotide array. Results: Using microarrays we analysed transcriptional events responsible for the morphological changes and found several novel sets of genes such as integral proteins, transcription factors, matrix proteases, Notch genes and chemokines were highly altered in the HER2 overexpressing group which were not appreciated before. Using gene annotation we defined molecular-pathways responsible for the phenotypical changes. More specifically, our study proposes a two hit model describes the pathways involved in the initiation of the Ductal Carcinoma Insitu and their transition to Invasive Cancer underlying the HER2 transcriptional network.
Discussion: According to the proposed model, expansion of ductal hyperplasia is limited by intraluminal apoptosis, unless they overexpress HER2, which drives proliferation and forms DCIS due to HER2 induced Notch pathways genes. Secondly, results obtained with the 3D system and their reflection in clinical outcome, we propose that neither HER2 amplification, nor the presence of GFs, is sufficient for development of IDC, but their co-occurrence can instigate metastasis by the activation of genes of integrin-adhesion signaling. The more virulent scenario combines HER2 amplification with GFs, thereby switching a robust, auto-stimulatory program.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-03-04.
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Ratnamani MS, Rao R. Importance and impact of surveillance of the microbial quality of dialysate and RO water in a tertiary health. BMC Proc 2011. [PMCID: PMC3239635 DOI: 10.1186/1753-6561-5-s6-p211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Rao R. Application of six sigma process to implement the infection control process and its impact on infection rates in a tertiary health care centre. BMC Proc 2011. [PMCID: PMC3239653 DOI: 10.1186/1753-6561-5-s6-p228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Rao R. Bedside brochoscopy a concern. BMC Proc 2011. [PMCID: PMC3239809 DOI: 10.1186/1753-6561-5-s6-p73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Chipara O, Plymoth AN, Liu F, Huang R, Evans B, Johansson P, Rao R, Griswold WG. Achieving reliable communication in dynamic emergency responses. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2011; 2011:238-247. [PMID: 22195075 PMCID: PMC3243219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Emergency responses require the coordination of first responders to assess the condition of victims, stabilize their condition, and transport them to hospitals based on the severity of their injuries. WIISARD is a system designed to facilitate the collection of medical information and its reliable dissemination during emergency responses. A key challenge in WIISARD is to deliver data with high reliability as first responders move and operate in a dynamic radio environment fraught with frequent network disconnections. The initial WIISARD system employed a client-server architecture and an ad-hoc routing protocol was used to exchange data. The system had low reliability when deployed during emergency drills. In this paper, we identify the underlying causes of unreliability and propose a novel peer-to-peer architecture that in combination with a gossip-based communication protocol achieves high reliability. Empirical studies show that compared to the initial WIISARD system, the redesigned system improves reliability by as much as 37% while reducing the number of transmitted packets by 23%.
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Khoynezhad A, Rao R, Trento A, Gewertz B. Management of acute type B aortic dissections and acute limb ischemia. THE JOURNAL OF CARDIOVASCULAR SURGERY 2011; 52:507-517. [PMID: 21792158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The aim of this study was to review the management of acute type B aortic dissection (TBAD) with acute limb ischemia. A search using the "Pubmed" resulted in 254 records by combining the Medical Subject Heading keywords (listed separately). The articles were assessed for their validity, correct pathology and patient cohort. Inclusion criteria included all patients with complicated acute TBAD who were candidates for open of thoracic endovascular aortic repair (TEVAR). The exclusion criteria included type A, asymptomatic acute or chronic TBAD, penetrating ulcer or intramural hematoma. TBAD with limb ischemia has a poor prognosis if not diagnosed, triaged and treated promptly. Clinical presentation and diagnostic strategy as well as various imaging are reviewed. Early mortality rate for complicated acute TBAD (with malperfusion to lower extremity) is 12%. The management has moved from open operation to primary TEVAR. In cases with anatomic obstruction, open surgical techniques such as femoral-femoral bypass, axillo-femoral bypass or surgical fenestration can be successful in relief of malperfusion to the affected limb. One-year-survival rates are 85%. A complete to partial reverse aortic remodeling occurred in 78% of survivors of acute TBAD, if primary TEVAR is applied. Acute TBAD with limb ischemia remains a clinical challenge that requires prompt diagnosis and treatment. TEVAR of acute TBAD is associated with relatively low morbidity and mortality, and is more often used as primary approach for patients with limb ischemia. The outcomes with TEVAR compare favorably to the open repair, and initiate reverse aortic remodeling in majority of the survivors.
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Miossec P, Verweij CL, Klareskog L, Pitzalis C, Barton A, Lekkerkerker F, Reiter S, Laslop A, Breedveld F, Abadie E, Flamion B, Dere W, Mpofu S, Goel N, Ethgen D, Mitlak B, Ormarsdóttir S, Rao R, Tsouderos Y, Reginster JY. Biomarkers and personalised medicine in rheumatoid arthritis: a proposal for interactions between academia, industry and regulatory bodies. Ann Rheum Dis 2011; 70:1713-8. [PMID: 21784723 DOI: 10.1136/ard.2011.154252] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Rheumatoid arthritis (RA) is one of the most appropriate conditions for the application of personalised medicine as a high degree of heterogeneity has been recognised, which remains to be explained. Such heterogeneity is also reflected in the large number of treatment targets and options. A growing number of biologics as well as small molecules are already in use and there are promising new drugs in development. In order to make the best use of treatment options, both targeted and non-targeted biomarkers have to be identified and validated. To this aim, new rules are needed for the interaction between academia and industry under regulatory control. Setting up multi-centre biosample collections with clear definition of access, organising early, possibly non-committing discussions with regulatory authorities, and defining a clear route for the validation, qualification and registration of the biomarker-drug combination are some of the more critical areas where effective collaboration between the drug industry, academia and regulators is needed.
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Rao R, Bryowsky K, Mao J, Bunton D, McPherson C, Mathur A. Gastrointestinal complications associated with ibuprofen therapy for patent ductus arteriosus. J Perinatol 2011; 31:465-70. [PMID: 21252965 DOI: 10.1038/jp.2010.199] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To review intestinal complications associated with ibuprofen treatment of patent ductus arteriosus (PDA). STUDY DESIGN Data from preterm infants treated with ibuprofen were retrospectively reviewed. χ(2) test and Fischer's exact test were used for univariate analyses. Multivariate analyses with logistic regression modeling were used to identify risk factors. RESULT One hundred and two infants were treated with ibuprofen for PDA. Nine (9/102, 8.8%) infants developed spontaneous intestinal perforation (SIP), whereas 93/102 (91.2%) did not. The mean (± s.d.) gestational age (GA) at birth in infants with and without SIP was 25.2 (± 1.3) vs 27.6 (± 2.4) weeks (P=0.02) and the median (interquartile) length of stay (LOS) was 109.5 (91.0 to 116.5) vs 75.0 (53.0 to 94.5) days (P=0.002), respectively. The mean (± s.d.) age at starting ibuprofen was 3.3 (± 1.3) vs 5.8 (± 3.5) days in infants with and without SIP, respectively (P=0.03). In logistic regression analyses, increasing GA and later initiation of ibuprofen treatment were protective against risk of SIP; odds ratio, 95% confidence interval (OR, 95% CI)=0.26 (0.09 to 0.75), P=0.01 and 0.63 (0.41 to 0.95), P=0.03, respectively. CONCLUSION Infants at lower GA are at risk of SIP when treated early with ibuprofen for symptomatic PDA.
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Lenert LA, Kirsh D, Griswold WG, Buono C, Lyon J, Rao R, Chan TC. Design and evaluation of a wireless electronic health records system for field care in mass casualty settings. J Am Med Inform Assoc 2011; 18:842-52. [PMID: 21709162 DOI: 10.1136/amiajnl-2011-000229] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND There is growing interest in the use of technology to enhance the tracking and quality of clinical information available for patients in disaster settings. This paper describes the design and evaluation of the Wireless Internet Information System for Medical Response in Disasters (WIISARD). MATERIALS AND METHODS WIISARD combined advanced networking technology with electronic triage tags that reported victims' position and recorded medical information, with wireless pulse-oximeters that monitored patient vital signs, and a wireless electronic medical record (EMR) for disaster care. The EMR system included WiFi handheld devices with barcode scanners (used by front-line responders) and computer tablets with role-tailored software (used by managers of the triage, treatment, transport and medical communications teams). An additional software system provided situational awareness for the incident commander. The WIISARD system was evaluated in a large-scale simulation exercise designed for training first responders. A randomized trial was overlaid on this exercise with 100 simulated victims, 50 in a control pathway (paper-based), and 50 in completely electronic WIISARD pathway. All patients in the electronic pathway were cared for within the WIISARD system without paper-based workarounds. RESULTS WIISARD reduced the rate of the missing and/or duplicated patient identifiers (0% vs 47%, p<0.001). The total time of the field was nearly identical (38:20 vs 38:23, IQR 26:53-1:05:32 vs 18:55-57:22). CONCLUSION Overall, the results of WIISARD show that wireless EMR systems for care of the victims of disasters would be complex to develop but potentially feasible to build and deploy, and likely to improve the quality of information available for the delivery of care during disasters.
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Vijayashree R, Kumar A, Nott A, Rao R. Syringolymphoid hyperplasia with alopecia and anhidrosis in a 12-year-old boy: a case report from rural south India. Int J Dermatol 2011; 50:1552-4. [PMID: 21623775 DOI: 10.1111/j.1365-4632.2011.04908.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Biswas A, Rao R, Umashankar S, Mynampati KC, Reuben S, Parab G, Swarup S. datPAV--an online processing, analysis and visualization tool for exploratory investigation of experimental data. Bioinformatics 2011; 27:1585-6. [DOI: 10.1093/bioinformatics/btr179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Pai VV, Hanumanthayya K, Naveen KN, Rao R, Dinesh US. Bowen's disease over the abdomen--a histological pigmented variety. Indian J Cancer 2011; 48:121-2. [PMID: 21330759 DOI: 10.4103/0019-509x.76637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kanthan A, Ross J, Rao R, Fahmy P, Thomas S, Kizana E. A System for Studying Electrical Conduction in Lentivector Gene-Modified Primary Cardiomyocytes. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Henderson S, Xie XJ, Peng Y, Euhus D, Leitch M, Rao R, Haley B, Sarode V. Abstract P4-08-07: Correlation of Oncotype Dx Recurrence Score and Luminal Subtypes of Breast Cancer. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p4-08-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Molecular subtypes of breast cancer have been characterized by gene expression analysis. Luminal subtypes are hormone receptor (HR) positive and Her2/neu negative. Immunohistochemistry (IHC) has been used as a surrogate test for gene expression. Ki67 is a proliferation marker that identifies high-risk subtype of luminal breast cancer. Recently, the proposed Ki67 index (KI) of 14% was suggested as a cut-off to distinguish between luminal A and luminal B tumors (JNCI. 2009;101:736-750). The oncotype dx (ODx) is a 21- gene test that provides prognostic and predictive information in early stage HR-positive breast cancer patients. The test is reported as low (<18), intermediate (18-30) and high (>30) risk recurrence scores (RS)
Design: We investigated the relationship between ODx RS and luminal subtypes of breast cancers using the KI of 14% as the cut-off for distinguishing luminal A and B tumors. Biomarker analysis (ER, PR, Her2/neu, Ki67 and p53) was performed as part of the diagnostic work-up using standard IHC procedures. Scoring was done by automated image analysis. Her2/neu FISH was performed on all IHC 2+ and 3 + results.
Pathologic parameters such as, tumor size, grade, and presence of LVI were evaluated. Ploidy was performed by the Autocyte system (Tripath) on Feulgen stained paraffin sections.
Results: We identified 106 patients with HR positive breast cancer who were tested for ODx from February 2006 to May 2010. 85/106 had Ki67 data available for analysis. 46/85 (54%) were luminal A and 39/85 (46%) luminal B tumors. The mean KI in luminal A was 6.93% versus 31.1% in luminal B (P<0.0001). The mean tumor size was 1.94 and 1.92 cm in luminal A and B respectively. Grade 1, 2 and 3 comprised 28/85 (32.9%), 49 (57.6%) and 8 (9.41%) of all tumors respectively. Of the grade1 tumors, 75% were luminal A, and grade 3 tumors were predominantly luminal B (p=0.013). LVI was present in 16 cases, 11 (68.8%) in luminal B and 5/16 (31.2%) in luminal A tumors (p=0.0416). Luminal A tumors were predominantly diploid 30/45 (66.6%) and luminal B were mostly aneuploid 21/32 (65.6%) (p=0.019). The overall mean RS in luminal A and B tumors was 14.67 and 20.15 respectively (P<0.0004). Luminal A tumors had low RS in 32/46 (66.6%). and luminal B tumors had predominantly intermediate/high RS in 23/39 (62.1%) (p=0.0082). ER Allred Scores were 7.1 and 7.3 and percent positivity was 88.1% and 91% respectively for luminal A and B subtypes. PR Allred scores were 5.6 and 5.8, and percent positivity was 62.1 and 52.9% for A and B tumors respectively. Information regarding treatment was available in 72 cases. 19 (26.3%) were treated by a combination of chemo and anti-hormonal therapy and 53 (73.6%) were treated by anti hormonal therapy alone, 8 of the 19 (42.1%) luminal A patients received combination therapy versus 11 (57.8%) in the luminal B category (p=0.277).
Conclusion: Ki67 is a useful marker that showed significant correlation with RS by ODx. Luminal A tumors are more likely to be low grade, diploid with low RS compared to luminal B tumors. Ki67 in conjunction with other pathologic parameters may serve as a surrogate marker for the ODx RS.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-08-07.
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Henderson S, Xie XJ, Peng Y, Haley B, Euhus D, Leitch M, Rao R, Sarode V. Abstract P4-08-10: Correlation of Oncotype Dx Recurrence Score with Histologic Parameters, Biomarker Expression and KI-67 Index. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p4-08-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Oncotype Dx (ODx) is a 21-gene RT-PCR based assay that provides prognostic and predictive information in patients with hormone receptor (HR) positive breast cancer. The test predicts the likelihood of disease recurrence in the form of a recurrence score (RS), which is categorized into low, intermediate and high-risk types. We examined the relationship between ODx RS and histologic parameters, DNA ploidy, tumor markers (ER, PR, Her2, Ki67, p53) expression by immunohistochemistry (IHC).
Design: We identified 106 patients with HR-positive invasive breast cancer who were tested for ODx from the department files. Pathologic variables such as, tumor size, grade, histologic type, lymphovascular invasion (LVI) were reviewed. Tumor markers ER, PR, Her2, p53 expression, Ki67 index (KI) and ploidy were performed as part of the patient's diagnostic work-up using standard procedures. Scoring was done by automated image analysis. Results of biomarker expression were compared to the ODx RS. All Her2neu 3+ and 2+ results by IHC were confirmed by FISH. Ploidy was performed by the Autocyte system (Tripath) on Feulgen stained sections. Oncotype RS was reported as low (<18), intermediate (18-30) and high risk (>30).
Results: Mean tumor size was 1.96 cm. Of the 106 cases, 87 (82%), 14 (13.2%) and 2(1.8%) were ductal, lobular and mixed types respectively. Grade 1, 2 and 3 comprised 35 (33.0%), 62 (58.4%) and 9 (8.5%) respectively. Twenty-one (19.8%) had LVI. Oncotype RS was low in 56 (52.8%), intermediate in 45 (42.4%) and high in 5 (4.7%). Mean tumor size in low RS group was 2.2 cm versus 1.6 cm in the intermediate/high RS group (p <0.05). There was no significant association of grade and LVI with RS. ER Allred score was 7.2, 7.2 and 8.0 and percent positivity was 88.0%, 91.1% and 96.3% in low, intermediate and high RS respectively (p=0.6325). The PR Allred score was 6.0, 5.3 and 3.5 and percent positivity was 64.7%, 51.8% and 16.6% in low, intermediate and high RS respectively (p=0.0432). There was 100% concordance between ER by IHC and ODx. Concordance for PR was 71/75 (94.6%). The four discordant PR results by ODx had mean score of 20% by IHC. The mean KI was 14.4%, 21.8% and 25.6% in low, intermediate and high RS respectively (p=0.0248). Low KI (<14%) and high KI (>14%) showed significant correlation with RS (p=0.0055). Her2neu IHC was negative in 43/49 (87.7%) and borderline in 6/49 (12.2%) and all were negative by FISH. Her2 FISH showed 100% (44/44) concordance with Her2 results by ODx. There was no association between DNA ploidy and RS (p=0.7143). P53 expression showed no significant correlation with RS (p=0.2602). Patients in the intermediate/high RS group were more likely to be treated with a combination of chemo plus anti-hormonal therapy (P<0.0001) and radiation (P<0.05) compared to the low RS group.
Conclusions: This study shows a complete concordance between ER IHC and Her2 FISH with RT-PCR by ODx. Low PR scores and high KI predict
high RS by ODx. There is a significant association between KI and ODx RS. Ki67 index identifies low and high RS groups, which correspond to the luminal A, and B subtypes of breast cancer respectively.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-08-10.
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Carpenter CM, Sun C, Pratx G, Rao R, Xing L. Hybrid x-ray/optical luminescence imaging: characterization of experimental conditions. Med Phys 2010; 37:4011-8. [PMID: 20879562 DOI: 10.1118/1.3457332] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The feasibility of x-ray luminescence imaging is investigated using a dual-modality imaging system that merges x-ray and optical imaging. This modality utilizes x-ray activated nanophosphors that luminesce when excited by ionizing photons. By doping phosphors with lanthanides, which emit light in the visible and near infrared range, the luminescence is suitable for biological applications. This study examines practical aspects of this new modality including phosphor concentration, light emission linearity, detector damage, and spectral emission characteristics. Finally, the contrast produced by these phosphors is compared to that of x-ray fluoroscopy. METHODS Gadolinium and lanthanum oxysulfide phosphors doped with terbium (green emission) or europium (red emission) were studied. The light emission was imaged in a clinical x-ray scanner with a cooled CCD camera and a spectrophotometer; dose measurements were determined with a calibrated dosimeter. Using these properties, in addition to luminescence efficiency values found in the literature for a similar phosphor, minimum concentration calculations are performed. Finally, a 2.5 cm agar phantom with a 1 cm diameter cylindrical phosphor-filled inclusion (diluted at 10 mg/ml) is imaged to compare x-ray luminescence contrast with x-ray fluoroscopic contrast at a superficial location. RESULTS Dose to the CCD camera in the chosen imaging geometry was measured at less than 0.02 cGy/s. Emitted light was found to be linear with dose (R(2)= 1) and concentration (R(2)= 1). Emission peaks for clinical x-ray energies are less than 3 nm full width at half maximum, as expected from lanthanide dopants. The minimum practical concentration necessary to detect luminescent phosphors is dependent on dose; it is estimated that subpicomolar concentrations are detectable at the surface of the tissue with typical mammographic doses, with the minimum detectable concentration increasing with depth and decreasing with dose. In a reflection geometry, x-ray luminescence had nearly a 430-fold greater contrast to background than x-ray fluoroscopy. CONCLUSIONS X-ray luminescence has the potential to be a promising new modality for enabling molecular imaging within x-ray scanners. Although much work needs to be done to ensure biocompatibility of x-ray exciting phosphors, the benefits of this modality, highlighted in this work, encourage further study.
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Pratx G, Carpenter C, Sun C, Rao R, Xing L. X-ray Activated Optical Contrast Agents for Simultaneous Anatomical/Functional CT Imaging. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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