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Ohno T, Shimada A, Terada Y, Ito T, Miyamoto K. Relapsing Polychondritis: A Case of Marked Improvement After Steroid Administration for Airway Obstruction. Cureus 2023; 15:e51101. [PMID: 38274918 PMCID: PMC10809030 DOI: 10.7759/cureus.51101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
Relapsing polychondritis is a rare disease that causes progressive and recurrent destruction of cartilage in the auricles, eyes, nose, and airways. A 90-year-old man was brought to the emergency department with fever, low SpO2, and effortful breathing. Arterial blood gas analysis showed that PaCO2 levels had accumulated to 120 mmHg. Although CT showed marked thickening of the bronchial wall from the central to the peripheral region, the cause was unknown. At the family's request, the patient was not placed on a ventilator, and treatment was started with steroids alone. After admission, the patient's condition improved with only intravenous steroids, and he was discharged to the facility with continued oral steroid medication. After a short treatment period, the possibility of relapsing polychondritis was considered and confirmed. The patient met Levine's diagnostic criteria, with findings of destruction of the bilateral auricular cartilage and the airway and a response to steroid administration. Although it is very difficult to diagnose relapsing polychondritis at the initial emergency department visit, early administration of steroids is worth trying in patients with asphyxia with extensive thickening of the airway on CT findings, as relapsing polychondritis may be considered, and early steroid administration may improve patient symptoms.
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Affiliation(s)
- Takanori Ohno
- Department of Emergency Medicine, Shin-Yurigaoka General Hospital, Kawasaki, JPN
| | - Ayako Shimada
- Department of Respiratory Medicine, Shin-Yurigaoka General Hospital, Kawasaki, JPN
| | - Yuuko Terada
- Department of Respiratory Medicine, Shin-Yurigaoka General Hospital, Kawasaki, JPN
| | - Toshitaka Ito
- Department of Emergency Medicine, Shin-Yurigaoka General Hospital, Kawasaki, JPN
| | - Kazuyuki Miyamoto
- Department of Emergency and Disaster Medicine, Showa University, Tokyo, JPN
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Myers RE, Hallman MH, Shimada A, DiCarlo M, Davis K, Leach WT, Jackson H, Indictor A, Chambers CV. Primary Care Patient Interest in Multi-Cancer Early Detection for Cancer Screening. J Pers Med 2023; 13:1613. [PMID: 38003928 PMCID: PMC10671850 DOI: 10.3390/jpm13111613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/27/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
Multi-cancer early detection (MCED) tests are being developed, but little is known about patient receptivity to their use for cancer screening. The current study assessed patient interest in such testing. Our team conducted a prospective, observational study among primary care patients in a large, urban health system. They were asked to complete a telephone survey that briefly described a new blood test in development to identify multiple types of cancer, but was not currently recommended or covered by insurance. The survey included items to assess respondent background characteristics, perceptions about MCED testing, and interest in having such an MCED test. We also used multivariable analyses to identify factors associated with patient interest in test use. In 2023, we surveyed 159 (32%) of 500 identified patients. Among respondents, 125 (79%) reported a high level of interest in having an MCED test. Interest was not associated with personal background characteristics, but was positively associated with the following expectations: testing would be recommended for cancer screening, be convenient, and be effective in finding early-stage disease (OR = 11.70, 95% CI: 4.02, 34.04, p < 0.001). Research is needed to assess patient interest and actual uptake when detailed information on testing is presented in routine care.
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Affiliation(s)
- Ronald E. Myers
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA 19107, USA (M.D.); (H.J.); (A.I.)
| | - Mie H. Hallman
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA 19107, USA (M.D.); (H.J.); (A.I.)
| | - Ayako Shimada
- Division of Biostatistics, Department of Pharmacology, Physiology, and Cancer Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA;
| | - Melissa DiCarlo
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA 19107, USA (M.D.); (H.J.); (A.I.)
| | - Kaitlyn Davis
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA; (K.D.); (W.T.L.); (C.V.C.)
| | - William T. Leach
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA; (K.D.); (W.T.L.); (C.V.C.)
| | - Hattie Jackson
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA 19107, USA (M.D.); (H.J.); (A.I.)
| | - Amanda Indictor
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA 19107, USA (M.D.); (H.J.); (A.I.)
| | - Christopher V. Chambers
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA; (K.D.); (W.T.L.); (C.V.C.)
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3
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Zhou X, Ye C, Iwao Y, Okamoto T, Kawata N, Shimada A, Haneishi H. Respiratory Diaphragm Motion-Based Asynchronization and Limitation Evaluation on Chronic Obstructive Pulmonary Disease. Diagnostics (Basel) 2023; 13:3261. [PMID: 37892082 PMCID: PMC10606604 DOI: 10.3390/diagnostics13203261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 10/10/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) typically causes airflow blockage and breathing difficulties, which may result in the abnormal morphology and motion of the lungs or diaphragm. Purpose: This study aims to quantitatively evaluate respiratory diaphragm motion using a thoracic sagittal magnetic resonance imaging (MRI) series, including motion asynchronization and limitations. Method: First, the diaphragm profile is extracted using a deep-learning-based field segmentation approach. Next, by measuring the motion waveforms of each position in the extracted diaphragm profile, obvious differences in the independent respiration cycles, such as the period and peak amplitude, are verified. Finally, focusing on multiple breathing cycles, the similarity and amplitude of the motion waveforms are evaluated using the normalized correlation coefficient (NCC) and absolute amplitude. Results and Contributions: Compared with normal subjects, patients with severe COPD tend to have lower NCC and absolute amplitude values, suggesting motion asynchronization and limitation of their diaphragms. Our proposed diaphragmatic motion evaluation method may assist in the diagnosis and therapeutic planning of COPD.
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Affiliation(s)
- Xingyu Zhou
- Graduate School of Science and Engineering, Chiba University, Chiba 263-8522, Japan; (X.Z.)
| | - Chen Ye
- School of Communications and Information Engineering, Nanjing University of Posts and Telecommunications, Nanjing 210003, China
- Center for Frontier Medical Engineering, Chiba University, Chiba 263-8522, Japan
| | - Yuma Iwao
- Center for Frontier Medical Engineering, Chiba University, Chiba 263-8522, Japan
- National Institutes for Quantum and Radiological Science and Technology, Chiba 263-0024, Japan
| | - Takayuki Okamoto
- Center for Frontier Medical Engineering, Chiba University, Chiba 263-8522, Japan
| | - Naoko Kawata
- Graduate School of Science and Engineering, Chiba University, Chiba 263-8522, Japan; (X.Z.)
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-0856, Japan;
| | - Ayako Shimada
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba 260-0856, Japan;
- Department of Respirology, Shin-Yurigaoka General Hospital, Kawasaki 215-0026, Japan
| | - Hideaki Haneishi
- Center for Frontier Medical Engineering, Chiba University, Chiba 263-8522, Japan
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Myers R, Hallman MH, Davis K, DiCarlo M, Daskalakis C, Shimada A, Chambers C. Primary care provider perspectives on a planned multi-cancer early detection test clinical trial. Contemp Clin Trials Commun 2023; 34:101183. [PMID: 37456505 PMCID: PMC10345238 DOI: 10.1016/j.conctc.2023.101183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/19/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023] Open
Affiliation(s)
- Ronald Myers
- Department of Medical Oncology, Thomas Jefferson University, 834 Chestnut Street, The Franklin Building, Suite 314, Philadelphia, PA, 19107, USA
| | - Mie H. Hallman
- Department of Medical Oncology, Thomas Jefferson University, 834 Chestnut Street, The Franklin Building, Suite 314, Philadelphia, PA, 19107, USA
| | - Kaitlyn Davis
- Department of Family and Community Medicine, Thomas Jefferson University, 1015 Walnut St., Suite 401, Philadelphia, PA, 19107, USA
| | - Melissa DiCarlo
- Department of Medical Oncology, Thomas Jefferson University, 834 Chestnut Street, The Franklin Building, Suite 314, Philadelphia, PA, 19107, USA
| | - Constantine Daskalakis
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, 1015 Chestnut Street, Suite 520, Philadelphia, PA, 19107, USA
| | - Ayako Shimada
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, 1015 Chestnut Street, Suite 520, Philadelphia, PA, 19107, USA
| | - Christopher Chambers
- Department of Family and Community Medicine, Thomas Jefferson University, 1015 Walnut St., Suite 401, Philadelphia, PA, 19107, USA
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Ryan NM, Hess JA, Robertson EJ, Tricoche N, Turner C, Davis J, Petrovsky N, Ferguson M, Rinaldi WJ, Wong VM, Shimada A, Zhan B, Bottazzi ME, Makepeace BL, Gray SA, Carter D, Lustigman S, Abraham D. Adjuvanted Fusion Protein Vaccine Induces Durable Immunity to Onchocerca volvulus in Mice and Non-Human Primates. Vaccines (Basel) 2023; 11:1212. [PMID: 37515028 PMCID: PMC10385774 DOI: 10.3390/vaccines11071212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
Onchocerciasis remains a debilitating neglected tropical disease. Due to the many challenges of current control methods, an effective vaccine against the causative agent Onchocerca volvulus is urgently needed. Mice and cynomolgus macaque non-human primates (NHPs) were immunized with a vaccine consisting of a fusion of two O. volvulus protein antigens, Ov-103 and Ov-RAL-2 (Ov-FUS-1), and three different adjuvants: Advax-CpG, alum, and AlT4. All vaccine formulations induced high antigen-specific IgG titers in both mice and NHPs. Challenging mice with O. volvulus L3 contained within subcutaneous diffusion chambers demonstrated that Ov-FUS-1/Advax-CpG-immunized animals developed protective immunity, durable for at least 11 weeks. Passive transfer of sera, collected at several time points, from both mice and NHPs immunized with Ov-FUS-1/Advax-CpG transferred protection to naïve mice. These results demonstrate that Ov-FUS-1 with the adjuvant Advax-CpG induces durable protective immunity against O. volvulus in mice and NHPs that is mediated by vaccine-induced humoral factors.
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Affiliation(s)
- Nathan M Ryan
- Department of Microbiology and Immunology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Jessica A Hess
- Department of Microbiology and Immunology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Erica J Robertson
- Department of Microbiology and Immunology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Nancy Tricoche
- Laboratory of Molecular Parasitology, Lindsey F. Kimball Research Institute, New York Blood Center, New York, NY 10065, USA
| | | | - Jenn Davis
- PAI Life Sciences Inc., Seattle, WA 98102, USA
| | | | | | | | | | - Ayako Shimada
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Bin Zhan
- Texas Children's Hospital Center for Vaccine Development, Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Maria Elena Bottazzi
- Texas Children's Hospital Center for Vaccine Development, Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Benjamin L Makepeace
- Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool L3 5RF, UK
| | - Sean A Gray
- PAI Life Sciences Inc., Seattle, WA 98102, USA
| | | | - Sara Lustigman
- Laboratory of Molecular Parasitology, Lindsey F. Kimball Research Institute, New York Blood Center, New York, NY 10065, USA
| | - David Abraham
- Department of Microbiology and Immunology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
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6
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Shimada A, Itano O, Ishida T, Tamura T, Minagawa T, Hirano Y, Tsuruta M, Oyama T, Hoshimoto S, Shinoda M. The impact of preclinical clerkship in general surgery on medical students' attitude to a surgical career. Surg Today 2023; 53:800-815. [PMID: 36462056 PMCID: PMC9734737 DOI: 10.1007/s00595-022-02626-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/09/2022] [Indexed: 12/04/2022]
Abstract
PURPOSE With the advent of a new program for postgraduate medical students in 2004, the number of applicants choosing surgical careers in Japan has been declining. We conducted this study to evaluate the impact of preclinical clerkship and how it affects students' attitudes toward a surgical career. METHODS The subjects of our study were fifth-year medical students who participated in a clinical clerkship in general surgery in our department between April 2021 and March 2022. We conducted pre- and post-preclinical clerkship surveys to assess the perceived image of surgeons and the impact of clerkship on surgical career interest. RESULTS Among 132 medical students (77 men and 55 women) who rotated through preclinical clerkship in our department, 125 participated in the survey and 66% expressed interest in a surgical career. In the post-clerkship survey, an increased interest in a surgical career was expressed by 79% of the students; notably, including those who initially expressed interest. Approximately 77% of students were satisfied with the practical skill training they received. CONCLUSION Engaging medical students early in surgical experience through a preclinical clerkship for general surgery appears to promote their interest in a surgical career.
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Affiliation(s)
- Ayako Shimada
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, 852, Hatakeda, Narita, Chiba, 286-8520, Japan
| | - Osamu Itano
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, 852, Hatakeda, Narita, Chiba, 286-8520, Japan.
| | - Takashi Ishida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, 852, Hatakeda, Narita, Chiba, 286-8520, Japan
| | - Takuya Tamura
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, 852, Hatakeda, Narita, Chiba, 286-8520, Japan
| | - Takuya Minagawa
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, 852, Hatakeda, Narita, Chiba, 286-8520, Japan
| | - Yuki Hirano
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, 852, Hatakeda, Narita, Chiba, 286-8520, Japan
| | - Masashi Tsuruta
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, 852, Hatakeda, Narita, Chiba, 286-8520, Japan
| | - Takashi Oyama
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, 852, Hatakeda, Narita, Chiba, 286-8520, Japan
| | - Sojun Hoshimoto
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, 852, Hatakeda, Narita, Chiba, 286-8520, Japan
| | - Masahiro Shinoda
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, 852, Hatakeda, Narita, Chiba, 286-8520, Japan
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Suzuki E, Kawata N, Shimada A, Sato H, Anazawa R, Suzuki M, Shiko Y, Yamamoto M, Ikari J, Tatsumi K, Suzuki T. Prognostic Nutritional Index (PNI) as a Potential Prognostic Tool for Exacerbation of COPD in Elderly Patients. Int J Chron Obstruct Pulmon Dis 2023; 18:1077-1090. [PMID: 37309393 PMCID: PMC10257926 DOI: 10.2147/copd.s385374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 04/28/2023] [Indexed: 06/14/2023] Open
Abstract
Purpose In COPD, exacerbation of the disorder causes a deterioration in the quality-of-life and worsens respiratory dysfunction, leading to a poor prognosis. In recent years, nutritional indices have been reported as significant prognostic factors in various chronic diseases. However, the relationship between nutritional indicators and prognosis in elderly subjects with COPD has not been investigated. Patients and methods We enrolled 91 subjects who received COPD assessment tests (CAT), spirometry, blood tests, and multidetector computed tomography (MDCT). We divided the subjects into two groups according to age (<75 years (n=57) and ≥ 75 years (n=34)). The prognostic nutritional index (PNI) was used to assess immune-nutritional status and was calculated as 10 x serum albumin + 0.005 x total lymphocyte count. We then examined the relationship between PNI and clinical parameters, including exacerbation events. Results There was no significant correlation between the PNI and CAT, the FEV1%pred, or low attenuation volume percentage (LAV%). In the elderly group, there were significant differences between the groups with or without exacerbation in the CAT and PNI (p=0.008, p=0.004, respectively). FEV1%pred, neutrophil-to-lymphocyte ratio (NLR) and LAV% did not differ between the two groups. The analytical model combining CAT and PNI improved the prediction of exacerbations in the elderly subjects (p=0.0068). Conclusion In elderly subjects with COPD, CAT were associated significantly with the risk of COPD exacerbation, with PNI also a potential predictor. The combined assessment of CAT and PNI may be a useful prognostic tool in subjects with COPD.
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Affiliation(s)
- Eiko Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-shi, Chiba, 260-8677, Japan
| | - Naoko Kawata
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-shi, Chiba, 260-8677, Japan
| | - Ayako Shimada
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-shi, Chiba, 260-8677, Japan
- Department of Respirology, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, 215-0026, Japan
| | - Hirotaka Sato
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-shi, Chiba, 260-8677, Japan
- Department of Radiology, Soka Municipal Hospital, Souka-shi, Saitama, 340-8560, Japan
| | - Rie Anazawa
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-shi, Chiba, 260-8677, Japan
- Department of Infectious Diseases, NTT Medical Center Tokyo, Tokyo, 141-8625, Japan
| | - Masaki Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-shi, Chiba, 260-8677, Japan
- Department of Respirology, Kashiwa Kousei General Hospital, Kashiwa-shi, Chiba-ken, 277-8551, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba-shi, 260-8670, Japan
| | - Mayumi Yamamoto
- Department of Palliative Care Medicine, Chiba Rosai Hospital, Chiba-shi, Chiba, 290-0003, Japan
| | - Jun Ikari
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-shi, Chiba, 260-8677, Japan
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-shi, Chiba, 260-8677, Japan
| | - Takuji Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-shi, Chiba, 260-8677, Japan
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Nelson NG, Lombardo JF, Shimada A, Ruggiero ML, Smith AP, Ko K, Leader AE, Mitchell EP, Simone NL. Physician Perceptions on Cancer Screening for LGBTQ+ Patients. Cancers (Basel) 2023; 15:cancers15113017. [PMID: 37296978 DOI: 10.3390/cancers15113017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/21/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
The LGBTQ+ community experiences cancer disparities due to increased risk factors and lower screening rates, attributable to health literacy gaps and systemic barriers. We sought to understand the experiences, perceptions, and knowledge base of healthcare providers regarding cancer screening for LGBTQ+ patients. A 20-item IRB-approved survey was distributed to physicians through professional organizations. The survey assessed experiences and education regarding the LGBTQ+ community and perceptions of patient concerns with different cancer screenings on a 5-point Likert scale. Complete responses were collected from 355 providers. Only 100 (28%) reported past LGBTQ+-related training and were more likely to be female (p = 0.020), have under ten years of practice (p = 0.014), or practice family/internal medicine (p < 0.001). Most (85%) recognized that LGBTQ+ subpopulations experience nuanced health issues, but only 46% confidently understood them, and 71% agreed their clinics would benefit from training. Family/internal medicine practitioners affirmed the clinical relevance of patients' sexual orientation (94%; 62% for medical/radiation oncology). Prior training affected belief in the importance of sexual orientation (p < 0.001), confidence in understanding LGBTQ+ health concerns (p < 0.001), and willingness to be listed as "LGBTQ+-friendly" (p = 0.005). Our study suggests that despite a paucity of formal training, most providers acknowledge that LGBTQ+ patients have unique health needs. Respondents had a lack of consensus regarding cancer screenings for lesbian and transgender patients, indicating the need for clearer screening standards for LGBTQ+ subpopulations and educational programs for providers.
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Affiliation(s)
- Nicolas G Nelson
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Joseph F Lombardo
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Ayako Shimada
- Division of Biostatistics and Department of Experimental Pharmacology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Marissa L Ruggiero
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Alexandria P Smith
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Kevin Ko
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Amy E Leader
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
| | - Edith P Mitchell
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
| | - Nicole L Simone
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
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Leader AE, Melillo RJ, Greene Q, Blanding-Godbolt J, Shimada A, Eischen CM, Aplin AE. Engaging community members in cancer research: an assessment of an NCI-designated cancer center. Cancer Causes Control 2023; 34:307-319. [PMID: 36598655 DOI: 10.1007/s10552-022-01666-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 12/27/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Despite the importance of engaging community members in research, multiple barriers exist. We conducted a mixed-methods evaluation to understand the opportunities and challenges of engaging community members in basic, clinical, translational, and population science research. METHODS We designed a survey and an interview guide based on the constructs of the Consolidated Framework for Implementation Research. Surveys were distributed electronically to all cancer center investigators and interviews were conducted virtually with a select group of basic, clinical, and population science investigators. Survey data (n = 77) were analyzed across all respondents using frequency counts and mean scores; bivariate analyses examined differences in responses by research program affiliation, gender, race, and faculty rank. Interviews (n = 16) were audio recorded, transcribed verbatim, and analyzed using a reflective thematic approach. RESULTS There was strong agreement among investigators that "Community engagement in research will help the SKCC address cancer disparities in the catchment area" (M 4.2, SD 0.9) and less agreement with items such as "I know how to find and connect with community members who I can engage in my research" (M 2.5, SD 1.3). Investigators mentioned challenges in communicating complex science to a lay audience but were open to training and workshops to acquire skills needed to integrate community members into their research. CONCLUSION Cancer centers should develop and promote training and collaborative opportunities for investigators and community members. Overcoming challenges will lead to more patient- and community-centered cancer research in the future.
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Affiliation(s)
- Amy E Leader
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA. .,Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA. .,Thomas Jefferson University, 833 Chestnut Street, 11th Floor, Philadelphia, PA, 19107, USA.
| | - Rebecca J Melillo
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | - Ayako Shimada
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christine M Eischen
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Cancer Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Andrew E Aplin
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Cancer Biology, Thomas Jefferson University, Philadelphia, PA, USA
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Rising KL, Cameron KA, Salzman DH, Papanagnou D, Doty AMB, Piserchia K, Leiby BE, Shimada A, McGaghie WC, Powell RE, Klein MR, Zhang XC, Vozenilek J, McCarthy DM. Communicating Diagnostic Uncertainty at Emergency Department Discharge: A Simulation-Based Mastery Learning Randomized Trial. Acad Med 2023; 98:384-393. [PMID: 36205492 DOI: 10.1097/acm.0000000000004993] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE There are no standardized approaches for communicating with patients discharged from the emergency department with diagnostic uncertainty. This trial tested efficacy of the Uncertainty Communication Education Module, a simulation-based mastery learning curriculum designed to establish competency in communicating diagnostic uncertainty. METHOD Resident physicians at 2 sites participated in a 2-arm waitlist randomized controlled trial from September 2019 to June 2020. After baseline (T1) assessment of all participants via a standardized patient encounter using the Uncertainty Communication Checklist (UCC), immediate access physicians received training in the Uncertainty Communication Education Module, which included immediate feedback, online educational modules, a smartphone-based application, and telehealth deliberate practice with standardized patients. All physicians were retested 16-19 weeks later (T2) via in-person standardized patient encounters; delayed access physicians then received the intervention. A final test of all physicians occurred 11-15 weeks after T2 (T3). The primary outcome measured the percentage of physicians in the immediate versus delayed access groups meeting or exceeding the UCC minimum passing standard at T2. RESULTS Overall, 109 physicians were randomized, with mean age 29 years (range 25-46). The majority were male (n = 69, 63%), non-Hispanic/Latino (n = 99, 91%), and White (n = 78, 72%). At T2, when only immediate access participants had received the curriculum, immediate access physicians demonstrated increased mastery (n = 29, 52.7%) compared with delayed access physicians (n = 2, 3.7%, P < .001; estimated adjusted odds ratio of mastery for the immediate access participants, 31.1 [95% CI, 6.8-143.1]). There were no significant differences when adjusting for training site or stage of training. CONCLUSIONS The Uncertainty Communication Education Module significantly increased mastery in communicating diagnostic uncertainty at the first postintervention test among emergency physicians in standardized patient encounters. Further work should assess the impact of clinical implementation of these communication skills.
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Affiliation(s)
- Kristin L Rising
- K.L. Rising is professor and director of acute care transitions, Department of Emergency Medicine, Sidney Kimmel Medical College, professor of nursing, College of Nursing, and director, Center for Connected Care, Thomas Jefferson University, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0003-3882-4956
| | - Kenzie A Cameron
- K.A. Cameron is professor, Division of General Internal Medicine, Department of Medicine, and Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-3535-6459
| | - David H Salzman
- D.H. Salzman is associate professor, Department of Emergency Medicine and Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0001-5090-3433
| | - Dimitrios Papanagnou
- D. Papanagnou is professor and vice chair for education, Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0003-3682-8371
| | - Amanda M B Doty
- A.M.B. Doty is research coordinator, Center for Connected Care, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Katherine Piserchia
- K. Piserchia is clinical research coordinator, Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Benjamin E Leiby
- B.E. Leiby is professor and director, Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0003-0761-8383
| | - Ayako Shimada
- A. Shimada is statistician, Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; ORCID: https://orcid/org/0000-0002-9941-7660
| | - William C McGaghie
- W.C. McGaghie is professor, Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0003-1672-0398
| | - Rhea E Powell
- R.E. Powell is associate professor, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0002-4157-3070
| | - Matthew R Klein
- M.R. Klein is assistant professor, Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0001-7888-6372
| | - Xiao Chi Zhang
- X.C. Zhang is assistant professor, Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - John Vozenilek
- J. Vozenilek is vice president and chief medical officer, innovation and digital health, Jump Trading Simulation and Education Center, OSF Healthcare, Peoria, Illinois, clinical professor, Department of Emergency Medicine, University of Illinois College of Medicine, Peoria, Illinois, and clinical professor, Department of Bioengineering, University of Illinois Grainger College of Engineering, Urbana, Illinois; ORCID: https://orcid.org/0000-0001-7955-4089
| | - Danielle M McCarthy
- D.M. McCarthy is associate professor, Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-9038-2852
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11
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Alnemri A, Philips R, Sussman S, Xu V, Givens A, Patel A, Swendseid B, Agarwal A, Keith S, Shimada A, Selman Y, Cognetti DM, Heffelfinger R, Goldman R, Luginbuhl AJ, Wax MK, Sweeny L, Curry JM. Analysis of cost and outcomes in bony versus soft tissue midface free flap reconstruction. Head Neck 2022; 44:1896-1908. [PMID: 35665975 DOI: 10.1002/hed.27112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 05/01/2022] [Accepted: 05/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Outcomes and cost of soft tissue versus bony midface free flap reconstruction (MR) with and without virtual surgical planning (VSP) were evaluated. METHODS Retrospective review of MR including ischemic time (IT), operative duration (OD), length of stay (LOS), and total cost (TC). Eighty-one soft tissue and 76 bony MR (VSP = 23) were reviewed. RESULTS Bony MR was used for higher complexity defects (p = 0.003) and was associated with higher IT (p < 0.001), OD (p < 0.001), LOS (p = 0.032), and TC (p < 0.001). VSP was associated with a mean 111.2 ± 37.9 minute reduction in OD (p = 0.004) compared to non-VSP bony flaps. VSP was associated with higher itemized cost, but no increase in TC (p = 0.327). CONCLUSIONS Bony MR was used for higher complexity MR and was associated with increased TC, LOS, OD, and IT. VSP shortened OD with no significant increase in TC.
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Affiliation(s)
- Angela Alnemri
- Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ramez Philips
- Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sarah Sussman
- Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Vivian Xu
- Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alyssa Givens
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Anjali Patel
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brian Swendseid
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Aarti Agarwal
- Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Scott Keith
- Division of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ayako Shimada
- Division of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Yamil Selman
- Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - David M Cognetti
- Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ryan Heffelfinger
- Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Richard Goldman
- Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Adam J Luginbuhl
- Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mark K Wax
- Department of Otolaryngology - Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Larissa Sweeny
- Department of Otolaryngology - Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Joseph M Curry
- Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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12
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Smith AP, Ali A, Shimada A, Smith BC, Okere S, Hines K, Leader A, Simone NL. Abstract 5859: Impact of adverse SDOH on cancer knowledge and beliefs: Analysis of a NCI-designated cancer center’s catchment area survey. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-5859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Social determinants of health (SDOH) are social barriers that stratify health status. Specifically, socioeconomic status, education level, minority and immigration status correlate with higher risk of onset and severity of chronic disease. We sought to understand how SDOH affect a patient’s belief regarding autonomy over cancer risk and outcomes.
Methods: Data from the Sidney Kimmel Cancer Center catchment area including Delaware, Montgomery, and Philadelphia Counties in Pennsylvania; Camden and Burlington Counties in New Jersey were queried and analyzed. The survey included six cancer belief statements. Demographic characteristics of survey participants, as well as data related to cancer risk factors and beliefs were all calculated using unweighted data.
Results: 1,557 adults responded to this survey. Survey participants ranged in age from 18 to 88 years old, with 49.6% of participants 40 years old and younger. 64% of respondents identified as female vs 36% male. Poverty classification was based on ASPE 2020 Poverty Guidelines given family size and income information. Based on these parameters, 21.3% of respondents were considered impoverished. Additional demographics included housing security, food security, and health literacy. Results demonstrated, impoverished respondents were more likely to disagree that behavior/lifestyle causes cancer (63.3% vs 53.3%, p<0.001). Housing insecure respondents were more likely to disagree that behavior/lifestyle causes cancer (62.8% vs 54.8% p<0.001). Respondents who are more food insecure were more likely to disagree that behavior/lifestyle causes cancer than those who are food secure (food last: 57.9% vs 54.5%, p<0.001). Respondents who are more food insecure were more likely to agree that everything causes cancer (food last: 67.8% vs 59.2%, p<0.001).
Discussion: Adverse SDOH such as poverty, food insecurity, housing insecurity, and health literacy affect cancer beliefs. Overall, results demonstrated that respondents with adverse SDOH were more likely to disagree that behavior/lifestyle can cause cancer and more likely to agree that everything causes cancer. Patients with adverse SDOH may be less likely to actively engage in preventive health measures and screenings, clinical trials, and other factors known to positively impact cancer outcomes. SDOH should be evaluated on patient intake and patients should be provided with appropriate support and targeted education with broad cancer beliefs in mind.
Citation Format: Alexandria P. Smith, Ayesha Ali, Ayako Shimada, Brittany C. Smith, Samantha Okere, Kamryn Hines, Amy Leader, Nicole L. Simone. Impact of adverse SDOH on cancer knowledge and beliefs: Analysis of a NCI-designated cancer center’s catchment area survey [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5859.
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Affiliation(s)
| | - Ayesha Ali
- 2Thomas Jefferson University, Philadelphia, PA
| | | | | | | | | | - Amy Leader
- 2Thomas Jefferson University, Philadelphia, PA
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13
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DiCarlo M, Myers P, Daskalakis C, Shimada A, Hegarty S, Zeigler-Johnson C, Juon HS, Barta J, Myers RE. Outreach to primary care patients in lung cancer screening: A randomized controlled trial. Prev Med 2022; 159:107069. [PMID: 35469777 DOI: 10.1016/j.ypmed.2022.107069] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/11/2022] [Accepted: 04/17/2022] [Indexed: 11/29/2022]
Abstract
Current guidelines recommend annual lung cancer screening (LCS), but rates are low. The current study evaluated strategies to increase LCS. This study was a randomized controlled trial designed to evaluate the effects of patient outreach and shared decision making (SDM) about LCS among patients in four primary care practices. Patients 50 to 80 years of age and at high risk for lung cancer were randomized to Outreach Contact plus Decision Counseling (OC-DC, n = 314), Outreach Contact alone (OC, n = 314), or usual care (UC, n = 1748). LCS was significantly higher in the combined OC/OC-DC group versus UC controls (5.5% vs. 1.8%; hazard ratio, HR = 3.28; 95% confidence interval, CI: 1.98 to 5.41; p = 0.001). LCS was higher in the OC-DC group than in the OC group, although not significantly so (7% vs. 4%, respectively; HR = 1.75; 95% CI: 0.86 to 3.55; p = 0.123). LCS referral/scheduling was also significantly higher in the OC/OC-DC group compared to controls (11% v. 5%; odds ratio, OR = 2.02; p = 0.001). We observed a similar trend for appointment keeping, but the effect was not statistically significant (86% v. 76%; OR = 1.93; p = 0.351). Outreach contacts significantly increased LCS among primary care patients. Research is needed to assess the additional value of SDM on screening uptake.
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Affiliation(s)
- Melissa DiCarlo
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, 834 Chestnut St., Philadelphia, PA 19107, United States of America
| | - Pamela Myers
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, 834 Chestnut St., Philadelphia, PA 19107, United States of America
| | - Constantine Daskalakis
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, 1015 Chestnut St. Suite 520, Philadelphia, PA 19107, United States of America
| | - Ayako Shimada
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, 1015 Chestnut St. Suite 520, Philadelphia, PA 19107, United States of America
| | - Sarah Hegarty
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, 1015 Chestnut St. Suite 520, Philadelphia, PA 19107, United States of America
| | - Charnita Zeigler-Johnson
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, 834 Chestnut St., Philadelphia, PA 19107, United States of America
| | - Hee-Soon Juon
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, 834 Chestnut St., Philadelphia, PA 19107, United States of America
| | - Julie Barta
- The Jane and Leonard Korman Respiratory Institute, Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, 834 Walnut St., Philadelphia, PA 19107, United States of America
| | - Ronald E Myers
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, 834 Chestnut St., Philadelphia, PA 19107, United States of America.
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14
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Schafer JJ, Zimmerman M, Walshe C, Cerankowski J, Shimada A, Keith SW. Weight changes in patients with sustained viral suppression switching tenofovir disoproxil fumarate to tenofovir alafenamide. Obesity (Silver Spring) 2022; 30:1197-1204. [PMID: 35674696 DOI: 10.1002/oby.23443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/10/2022] [Accepted: 03/22/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Switching from tenofovir disoproxil fumarate (TDF)- to tenofovir alafenamide (TAF)-containing antiretroviral therapy may negatively influence weight, cholesterol, and atherosclerotic cardiovascular disease risk. The extent of these changes and their association with TAF remain unclear. METHODS This retrospective cohort evaluated metabolic changes in virologically suppressed patients with HIV infection who switched from TDF to TAF without switching other antiretroviral therapy medications. Adult patients on TDF and with no HIV viral load values >200 copies/mL for ≥2 years prior to and following a TAF switch were included. Weight and other variables were collected for 2 years before and after the switch. Longitudinal linear mixed-effects models evaluated changes at 1 and 2 years after the switch. RESULTS In the unadjusted analysis, there were increases in weight, BMI, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, systolic blood pressure, fasting glucose, and atherosclerotic cardiovascular disease risk scores 2 years after switching to TAF (each p ≤ 0.03). However, only increases in total and low-density lipoprotein cholesterol were associated with TAF and were significantly different from expected changes predicted in the adjusted longitudinal models. CONCLUSIONS Despite observing significant unadjusted metabolic changes after switching to TAF, only changes in cholesterol were associated with TAF and were different from changes expected in time-trend adjusted models.
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Affiliation(s)
- Jason J Schafer
- Department of Pharmacy Practice, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Matty Zimmerman
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ciara Walshe
- Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jesse Cerankowski
- Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ayako Shimada
- Sidney Kimmel Medical College, Division of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Scott W Keith
- Sidney Kimmel Medical College, Division of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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15
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Seedor RS, Orloff MM, Sharpe-Mills E, Hulse L, Shelat R, Shimada A, Chervoneva I, Shields CL, Shields JA, Mastrangelo MJ, Sato T. Randomized phase II study of adjuvant sunitinib or valproic acid in high-risk patients with uveal melanoma: The final analysis of cohort 1. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.9586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9586 Background: Despite successful treatment of primary uveal melanoma (UM), tumors with monosomy 3 and 8q amplification (M3 + 8q amp) or DecisionDx-UM Class 2 have high metastatic death rates. We report the final analysis of Cohort 1 in the randomized phase II clinical trial of 6 months of adjuvant sunitinib or valproic acid (VPA) in high-risk UM patients. Methods: High risk for systemic metastasis was defined as the following: A) M3 + 8q amp; B) Class 2. Patients within 6 months of initial treatment of primary UM were randomized 1:1 to receive either sunitinib 25 mg daily or VPA 750 mg daily for 6 consecutive months. The primary endpoint was to evaluate the improvement of 2-year overall survival (OS) rate from 70% (historical references) to 85% in each arm. Secondary endpoints included 1) systemic relapse-free survival (RFS) rate at 18 months, 2) ability to complete adjuvant treatment and, 3) toxicity assessment. Results: Eighty-eight patients were included in the final analysis. There were no differences in tumor size or T stage between the two treatment arms. Nine of 45 patients in the sunitinib arm and 4 of 43 patients in the VPA arm could not complete the 6-month treatment due to toxicity (sunitinib n = 6, VPA n = 2) or systemic progression (sunitinib n = 3, VPA n = 2). All but 9 patients (death due to metastasis, sunitinib n =4, VPA n = 5) were followed for at least 2 years. With a median follow-up of 52.6 months, both drugs met the primary end point with 2-year OS rates of 95.6% (sunitinib, 90% CI 86.5-98.6%) and 90.7% (VPA, 90% CI 80.1-95.8%). The 18-month RFS rates were 75.6% (sunitinib, 90% CI 63.1-84.3%) and 62.8% (VPA, 90% CI 49.4-73.5%). Although not statistically significant, there was a trend of superior RFS with sunitinib over VPA in primary UM with T-stage 3-4 (p=0.131) or >12mm (p=0.129). There was no significant difference in median RFS in HLA-A*02:01 positive or negative status (24.6 vs. 24.8 months). It is of note that the potential survival benefit of sunitinib over VPA diminished after 3 years, indicating longer duration of sunitinib administration might be required. In the multivariable Cox analysis, the RFS was not significantly different in the two treatment arms, but increase of tumor diameter was associated with increase hazard of progression (HR=1.23, 95% CI: 1.13, 1.33; p<0.001). Conclusions: Six months of adjuvant sunitinib or VPA resulted in 2-year OS of 95.6% and 90.7%, respectively, meeting the primary endpoint of the study. Sunitinib showed a tendency for a better outcome until 3 years after randomization, thus Cohort 2 was created to investigate the safety and prolonged improvement of RFS and OS with 12 months of sunitinib. Additionally, Cohort 3 with adjuvant sunitinib in combination with VPA for 12 months is currently ongoing. The size of primary tumor influenced the survival and should be adjusted for future adjuvant studies. Clinical trial information: NCT02068586.
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Affiliation(s)
- Rino S. Seedor
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Marlana M. Orloff
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Erin Sharpe-Mills
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Liam Hulse
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Reshma Shelat
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Ayako Shimada
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Inna Chervoneva
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | | | | | | | - Takami Sato
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
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16
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Worster B, Ashare R, Meghani SH, Smith D, Case AA, Selvan P, Shimada A, Garber GD, Leader A. Prevalence and perceptions of cannabis use among racially diverse patients with cancer pain: Results from a multi-site survey. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.12125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12125 Background: While access to cannabis is prevalent among cancer patients1, unknowns persist about real-time use, perceived effectiveness in cancer pain management and impact on other medication use, including opioids. Moreover, racial disparities in cancer pain management persist2-3 with Black patients more likely to have undiagnosed pain.4 Studies on the intersection of cannabis, opioids, race and cancer pain are needed. As part of an NCI-funded initiative, we assessed the perceived effectiveness of cannabis vs. opioids for pain control by race. Methods: A survey was created by three Mid-Atlantic, cancer centers to examine self-reported cannabis use and knowledge, barriers and perceptions about cannabis among cancer patients. All sites assessed common core questions and included additional questions assessing cannabis and opioid use. Patients were eligible to participate if they were treated for cancer within the prior year. Surveys were distributed both by mail and electronically via REDCap. Results are compared separately by site. Results: In all, 2,734 patients are included in this analysis. Rates of cannabis use since diagnosis ranged from 32-41% of respondents, with similar rates of use between gender and race. Patients under age 65 more frequently reported cannabis use. Across sites, only 7-8% of patients reported currently using opioids. A sizable number patients who use cannabis reported using cannabis instead of opioids to treat pain. Of those using cannabis, most felt that cannabis was better in managing their pain than opioids, with Black patients reporting this much more frequently than White patients across two sites (Site A 62.2% vs 43.2%, Site B 77.78 vs 48.96%, Site C 50.0% vs. 65.5%). The most common reasons patients reported using cannabis instead of opioids included the perception that: “cannabis is safer” (80-82%), “cannabis is less addictive” (70-73%), and “cannabis has fewer side effects” (68-74%). Conclusions: Cannabis is frequently used by cancer patients, with many reporting use instead of opioids for pain management. Of those using cannabis for pain management, a significant majority felt that it is more effective than opioids. Black patients report cannabis as more effective than opioids for pain control more frequently than other races. Given the ongoing under-treatment of cancer pain in Black patients, more data is needed to understand whether cannabis is an effective tool to reduce disparities in cancer pain management. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | - Ayako Shimada
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | | | - Amy Leader
- Thomas Jefferson University Hospital, Philadelphia, PA
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Shimada A, Tanaka M, Ishii S, Okamoto N, Yamamoto Y, Osaki M, Nishijima W, Omura K, Wakabayashi G. Utility of Concurrent Surgical Treatment Strategy with Thoracoscopic Esophagectomy for Patients with Synchronous Esophageal and Head and Neck Cancer. J Laparoendosc Adv Surg Tech A 2022; 32:550-555. [PMID: 35443808 DOI: 10.1089/lap.2021.0441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Patients with esophageal squamous cell cancer (ESCC) have a high frequency to coincide with head and neck cancer (HNC). This study aims to analyze the treatment results and prognosis of patients with synchronous ESCC and HNC. Methods: From January 2016 to December 2019, 5 patients underwent concurrent surgical resection of synchronous ESCC and HNC in our institution. We retrospectively reviewed the surgical outcomes and prognosis of these patients with synchronous ESCC and HNC (HNEC group) and compared the results with those of 20 patients who underwent esophagectomy with three regional lymph node dissections for ESCC during the same period (EC group). Results: The locations of HNCs were pharynx/tongue (4/1) and the clinical stages were Stage IV in all patients. Meanwhile, the clinical stages of ESCCs were Stages 0/I/II/III (1/1/2/1). All patients underwent thoracoscopic esophagectomy. The surgical procedures concurrently performed for HNC were pharyngolaryngectomy with free jejunum transfer in 3 patients, wide tongue and mandibular segment resection with mandibular reconstruction in 1 patient, and mandibular transection with radial forearm flap reconstruction in 1 patient. There was no significant difference in the frequency of postoperative complication between these two groups. The HNEC group had a significantly shorter recurrence-free survival than the EC group (P = .046). Conclusion: Head and neck surgery with thoracoscopic esophagectomy can be safely performed concurrently with local control. The risk of recurrence is higher in ESCC patients with HNC; therefore, it is important to move on to adjuvant therapy without delay.
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Affiliation(s)
- Ayako Shimada
- Department of Gastrointestinal Surgery, Ageo Central General Hospital, Ageo, Japan.,Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, Narita Hospital, Narita, Japan
| | - Motomu Tanaka
- Department of Surgery, Ashikaga Red Cross Hospital, Ashikaga, Japan
| | - Satoru Ishii
- Department of Gastrointestinal Surgery, Ageo Central General Hospital, Ageo, Japan
| | - Nobuhiko Okamoto
- Department of Gastrointestinal Surgery, Ageo Central General Hospital, Ageo, Japan
| | - Yusuke Yamamoto
- Department of Plastic & Reconstructive Surgery, Ageo Central General Hospital, Ageo, Japan
| | - Masaumi Osaki
- Department of Otorhinolaryngology, Ageo Central General Hospital, Ageo, Japan
| | - Wataru Nishijima
- Department of Head & Neck Surgery, Ageo Central General Hospital, Ageo, Japan
| | - Kenji Omura
- Department of Gastrointestinal Surgery, Ageo Central General Hospital, Ageo, Japan
| | - Go Wakabayashi
- Department of Gastrointestinal Surgery, Ageo Central General Hospital, Ageo, Japan
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18
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Handley NR, Wen KY, Gomaa S, Brassil K, Shimada A, Leiby B, Jackson L, McMorris M, Calvaresi A, Dicker AP. A Pilot Feasibility Study of Digital Health Coaching for Men With Prostate Cancer. JCO Oncol Pract 2022; 18:e1132-e1140. [PMID: 35394806 DOI: 10.1200/op.21.00712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Prostate cancer is the most common cancer among men in the United States. The majority of prostate cancer treatment occurs in the ambulatory setting, and patients and their caregivers take on significant responsibility for monitoring and managing treatment and disease-related toxicity. Digital health coaching has shown promise as a tool to positively influence outcomes. We completed a single-arm pilot study to assess the feasibility of digital health coaching in men with prostate cancer. METHODS Men with a history of prostate cancer requiring treatment in the past 2 years were eligible for inclusion. Participants engaged in a 12-week health coaching program, consisting of a combination of at least one telephone call and up to four digital nudges (defined as content delivered via text, e-mail, or app on the basis of the participant's preference) per week. Prostate cancer-specific content addressed one of the following topics each week: fatigue, pain management, healthy eating, exercise, managing incontinence, sexual health, managing stress and anxiety, financial toxicity, goal setting during treatment, managing side effects, communicating with the health care team, and medication adherence. Services were provided at no cost to the participant. RESULTS A hundred patients were consented for the study, and 88 enrolled. The feasibility threshold of 60% was met with 63 of the 88 enrolled individuals completing the 3-month program (proportion = 71.6%; 90% CI, 62.6 to 79.4; P = .016). CONCLUSION Digital health coaching for men with prostate cancer is feasible. These findings support further evaluation of digital health coaching for men with prostate cancer in larger randomized controlled trials.
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Affiliation(s)
- Nathan R Handley
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA.,Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Kuang-Yi Wen
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Sameh Gomaa
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | | | - Ayako Shimada
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA
| | - Benjamin Leiby
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA
| | | | | | - Anne Calvaresi
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Adam P Dicker
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
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19
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Shimada A, Ohnaka S, Kubo K, Nakashima M, Nagai A. COVID-19-Associated Pulmonary Aspergillosis in a Patient Treated With Remdesivir, Dexamethasone, and Baricitinib: A Case Report. Cureus 2022; 14:e23755. [PMID: 35518522 PMCID: PMC9064704 DOI: 10.7759/cureus.23755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2022] [Indexed: 12/15/2022] Open
Abstract
Remdesivir, dexamethasone, and baricitinib have recently been used to treat patients with coronavirus disease 2019 (COVID-19) and respiratory failure. However, the adverse effects of combination therapy have not been fully explored. A 64-year-old man was diagnosed with COVID-19 and was treated with remdesivir, dexamethasone, and baricitinib. His respiratory condition worsened on day 17, and in the following days, he was diagnosed with pneumomediastinum and COVID-19-associated pulmonary aspergillosis (CAPA). His condition improved with a reduction in the corticosteroid regime and antifungal treatment. This is the first case of pulmonary aspergillosis in a patient with COVID-19 that was treated with remdesivir, dexamethasone, and baricitinib.
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Affiliation(s)
- Ayako Shimada
- Department of Respiratory Medicine, Shin-Yurigaoka General Hospital, Kanagawa, JPN
| | - Shinnosuke Ohnaka
- Department of Respiratory Medicine, Shin-Yurigaoka General Hospital, Kanagawa, JPN
| | - Kosumi Kubo
- Department of Respiratory Medicine, Shin-Yurigaoka General Hospital, Kanagawa, JPN
| | - Masanao Nakashima
- Department of Respiratory Medicine, Shin-Yurigaoka General Hospital, Kanagawa, JPN
| | - Atsushi Nagai
- Department of Respiratory Medicine, Shin-Yurigaoka General Hospital, Kanagawa, JPN
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20
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Lombardo J, Ko K, Shimada A, Nelson N, Wright C, Chen J, Maity A, Ruggiero ML, Richard S, Papanagnou D, Mitchell E, Leader A, Simone NL. Perceptions of and barriers to cancer screening by the sexual and gender minority community: a glimpse into the health care disparity. Cancer Causes Control 2022; 33:559-582. [PMID: 34984592 PMCID: PMC9076188 DOI: 10.1007/s10552-021-01549-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE A disparity exists in cancer screening rates for the Sexual and Gender Minority (SGM) community. We sought to understand the perceptions and baseline knowledge of cancer screening among SGM community members. METHODS Survey administered via social media from June 2018 to October 2018. We asked 31 questions focused on cancer screening, human papillomavirus, emotional distress, and experience with the health care system. Those included were 18 years or older. Cancer screening attitudes and knowledge, as well as perceptions of the health care system were investigated. RESULTS There were 422 respondents analyzed: 24.6% identified as female, 25.5% as male, 40.1% transgender, and 9.6% as other. 65.4% of the SGM community is not certain what cancer screening to do for themselves. Only 27.3% and 55.7% knew that HPV was a risk factor associated with head and neck cancer and anal cancer, respectively. Half stated their emotional distress prevents them from getting cancer screening. It was identified that process changes in making appointments, comforts during the visit, and formal training for physicians and nurses could increase cancer screening compliance for this community. The transgender population had a trend in more gaps in knowledge of appropriate cancer screening and significant excess emotional distress. CONCLUSION Gaps in cancer screening knowledge and emotional and financial distress may be responsible for the disparity of lower cancer screening rates for the SGM population and the transgender population may be most at risk. Appreciating the cancer screening concerns of the SGM population can help shape future clinical and institutional approaches to improve health care delivery.
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Affiliation(s)
- Joseph Lombardo
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Kevin Ko
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Ayako Shimada
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Nicolas Nelson
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher Wright
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jerry Chen
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Alisha Maity
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Marissa L Ruggiero
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Scott Richard
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Dimitrios Papanagnou
- Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Edith Mitchell
- Department of Medical Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Amy Leader
- Department of Medical Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Nicole L Simone
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
- Department of Radiation Oncology, Bodine Center for Cancer Treatment, Thomas Jefferson University, 111 S. 11th Street, Philadelphia, PA, 19107, USA.
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21
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Capparelli C, Purwin TJ, Glasheen M, Caksa S, Tiago M, Wilski N, Pomante D, Rosenbaum S, Nguyen MQ, Cai W, Franco-Barraza J, Zheng R, Kumar G, Chervoneva I, Shimada A, Rebecca VW, Snook AE, Hookim K, Xu X, Cukierman E, Herlyn M, Aplin AE. Targeting SOX10-deficient cells to reduce the dormant-invasive phenotype state in melanoma. Nat Commun 2022; 13:1381. [PMID: 35296667 PMCID: PMC8927161 DOI: 10.1038/s41467-022-28801-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 02/07/2022] [Indexed: 12/13/2022] Open
Abstract
Cellular plasticity contributes to intra-tumoral heterogeneity and phenotype switching, which enable adaptation to metastatic microenvironments and resistance to therapies. Mechanisms underlying tumor cell plasticity remain poorly understood. SOX10, a neural crest lineage transcription factor, is heterogeneously expressed in melanomas. Loss of SOX10 reduces proliferation, leads to invasive properties, including the expression of mesenchymal genes and extracellular matrix, and promotes tolerance to BRAF and/or MEK inhibitors. We identify the class of cellular inhibitor of apoptosis protein-1/2 (cIAP1/2) inhibitors as inducing cell death selectively in SOX10-deficient cells. Targeted therapy selects for SOX10 knockout cells underscoring their drug tolerant properties. Combining cIAP1/2 inhibitor with BRAF/MEK inhibitors delays the onset of acquired resistance in melanomas in vivo. These data suggest that SOX10 mediates phenotypic switching in cutaneous melanoma to produce a targeted inhibitor tolerant state that is likely a prelude to the acquisition of resistance. Furthermore, we provide a therapeutic strategy to selectively eliminate SOX10-deficient cells.
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Affiliation(s)
- Claudia Capparelli
- Department of Cancer Biology, Thomas Jefferson University, Philadelphia, PA, 19107, USA. .,Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, 19107, USA.
| | - Timothy J. Purwin
- grid.265008.90000 0001 2166 5843Department of Cancer Biology, Thomas Jefferson University, Philadelphia, PA 19107 USA
| | - McKenna Glasheen
- grid.265008.90000 0001 2166 5843Department of Cancer Biology, Thomas Jefferson University, Philadelphia, PA 19107 USA
| | - Signe Caksa
- grid.265008.90000 0001 2166 5843Department of Cancer Biology, Thomas Jefferson University, Philadelphia, PA 19107 USA
| | - Manoela Tiago
- grid.265008.90000 0001 2166 5843Department of Cancer Biology, Thomas Jefferson University, Philadelphia, PA 19107 USA
| | - Nicole Wilski
- grid.265008.90000 0001 2166 5843Department of Cancer Biology, Thomas Jefferson University, Philadelphia, PA 19107 USA
| | - Danielle Pomante
- grid.265008.90000 0001 2166 5843Department of Cancer Biology, Thomas Jefferson University, Philadelphia, PA 19107 USA
| | - Sheera Rosenbaum
- grid.265008.90000 0001 2166 5843Department of Cancer Biology, Thomas Jefferson University, Philadelphia, PA 19107 USA
| | - Mai Q. Nguyen
- grid.265008.90000 0001 2166 5843Department of Cancer Biology, Thomas Jefferson University, Philadelphia, PA 19107 USA
| | - Weijia Cai
- grid.265008.90000 0001 2166 5843Department of Cancer Biology, Thomas Jefferson University, Philadelphia, PA 19107 USA
| | - Janusz Franco-Barraza
- grid.249335.a0000 0001 2218 7820Cancer Signaling and Epigenetics Program, Marvin & Concetta Greenberg Pancreatic Cancer Institute, Fox Chase Cancer Center, Philadelphia, PA 19111 USA
| | - Richard Zheng
- grid.265008.90000 0001 2166 5843Department of Surgery, Thomas Jefferson University, Philadelphia, PA 19107 USA
| | - Gaurav Kumar
- grid.265008.90000 0001 2166 5843Department of Cancer Biology, Thomas Jefferson University, Philadelphia, PA 19107 USA ,grid.265008.90000 0001 2166 5843Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107 USA
| | - Inna Chervoneva
- grid.265008.90000 0001 2166 5843Division of Biostatistics, Thomas Jefferson University, Philadelphia, PA 19107 USA ,grid.265008.90000 0001 2166 5843Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA 19107 USA
| | - Ayako Shimada
- grid.265008.90000 0001 2166 5843Division of Biostatistics, Thomas Jefferson University, Philadelphia, PA 19107 USA ,grid.265008.90000 0001 2166 5843Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA 19107 USA
| | - Vito W. Rebecca
- grid.251075.40000 0001 1956 6678Melanoma Research Center, The Wistar Institute, Philadelphia, PA 19104 USA ,grid.21107.350000 0001 2171 9311Biochemistry and Molecular Biology Department, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205 USA
| | - Adam E. Snook
- grid.265008.90000 0001 2166 5843Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107 USA ,grid.265008.90000 0001 2166 5843Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA 19107 USA
| | - Kim Hookim
- grid.265008.90000 0001 2166 5843Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, PA 19107 USA
| | - Xiaowei Xu
- grid.25879.310000 0004 1936 8972Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Edna Cukierman
- grid.249335.a0000 0001 2218 7820Cancer Signaling and Epigenetics Program, Marvin & Concetta Greenberg Pancreatic Cancer Institute, Fox Chase Cancer Center, Philadelphia, PA 19111 USA
| | - Meenhard Herlyn
- grid.251075.40000 0001 1956 6678Melanoma Research Center, The Wistar Institute, Philadelphia, PA 19104 USA
| | - Andrew E. Aplin
- grid.265008.90000 0001 2166 5843Department of Cancer Biology, Thomas Jefferson University, Philadelphia, PA 19107 USA ,grid.265008.90000 0001 2166 5843Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107 USA
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22
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Luginbuhl AJ, Johnson JM, Harshyne LA, Linnenbach AJ, Shukla SK, Alnemri A, Kumar G, Cognetti DM, Curry JM, Kotlov N, Antysheva Z, Degryse S, Mannion K, Gibson MK, Netterville J, Brown B, Axelrod R, Zinner R, Tuluc M, Gargano S, Leiby BE, Shimada A, Mahoney MG, Martinez-Outschoorn U, Rodeck U, Kim YJ, South AP, Argiris A. Tadalafil Enhances Immune Signatures in Response to Neoadjuvant Nivolumab in Resectable Head and Neck Squamous Cell Carcinoma. Clin Cancer Res 2022; 28:915-927. [PMID: 34911681 PMCID: PMC8898272 DOI: 10.1158/1078-0432.ccr-21-1816] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/07/2021] [Accepted: 12/10/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE We hypothesize that the addition of the phosphodiesterase-5 inhibitor tadalafil to the PD-1 inhibitor nivolumab, is safe and will augment immune-mediated antitumor responses in previously untreated squamous cell carcinoma of the head and neck (HNSCC). PATIENTS AND METHODS We conducted a two-arm multi-institutional neoadjuvant randomized trial in any-stage resectable HNSCC (NCT03238365). Patients were stratified at randomization by human papillomavirus (HPV) status. Patients in both arms received nivolumab 240 mg intravenously on days 1 and 15 followed by surgery on day 28. Those in the combination therapy arm also received tadalafil 10 mg orally once daily for 4 weeks. Imaging, blood, and tumor were obtained pretreatment and posttreatment for correlative analysis. RESULTS Neoadjuvant therapy was well-tolerated with no grade 3 to 5 adverse events and no surgical delays. Twenty-five of 46 (54%) evaluable patients had a pathologic treatment response of ≥20%, including three (7%) patients with a complete pathologic response. Regardless of HPV status, tumor proliferation rate was a negative predictor of response. A strong pretreatment T-cell signature in the HPV-negative cohort was a predictor of response. Tadalafil altered the immune microenvironment, as evidenced by transcriptome data identifying enriched B- and natural killer cell gene sets in the tumor and augmented effector T cells in the periphery. CONCLUSIONS Preoperative nivolumab ± tadalafil is safe in HNSCC and results in more than 50% of the patients having a pathologic treatment response of at least 20% after 4 weeks of treatment. Pretreatment specimens identified HPV status-dependent signatures that predicted response to immunotherapy while posttreatment specimens showed augmentation of the immune microenvironment with the addition of tadalafil.
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Affiliation(s)
- Adam J. Luginbuhl
- Department of Otolaryngology – Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania.,Corresponding Author: Adam J. Luginbuhl, Department of Otolaryngology – Head and Neck Surgery, Thomas Jefferson University Hospitals, 925 Chestnut Street, Floor 6, Philadelphia, PA 19107. Phone: 215-240-0748; E-mail:
| | - Jennifer M. Johnson
- Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Larry A. Harshyne
- Department of Cancer Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alban J. Linnenbach
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University; Philadelphia, Pennsylvania
| | - Sanket K. Shukla
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University; Philadelphia, Pennsylvania
| | - Angela Alnemri
- Department of Otolaryngology – Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Gaurav Kumar
- Department of Cancer Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - David M. Cognetti
- Department of Otolaryngology – Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Joseph M. Curry
- Department of Otolaryngology – Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | | | | | | | - Kyle Mannion
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael K. Gibson
- Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James Netterville
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brandee Brown
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rita Axelrod
- Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ralph Zinner
- Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Madalina Tuluc
- Department of Pathology, Anatomy and Cell Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Stacey Gargano
- Department of Pathology, Anatomy and Cell Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Benjamin E. Leiby
- Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ayako Shimada
- Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - My G. Mahoney
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University; Philadelphia, Pennsylvania
| | - Ubaldo Martinez-Outschoorn
- Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ulrich Rodeck
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University; Philadelphia, Pennsylvania
| | - Young J. Kim
- Department of Otolaryngology – Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Andrew P. South
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University; Philadelphia, Pennsylvania
| | - Athanassios Argiris
- Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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23
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Ackermann L, Thum A, Meagher K, Molyneaux D, Neff R, Zabriskie K, Shimada A, Riggio J. Video engagement to improve handwashing duration: A longitudinal study assessing creative and messaging fatigue. Am J Infect Control 2022; 50:295-299. [PMID: 35125216 DOI: 10.1016/j.ajic.2021.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Poor hand hygiene can contribute to increased rates of health care and community-acquired infections. Effective hand hygiene involves both a washer's technique and the duration of their wash. METHODS The purpose of this longitudinal study was 2-fold: to improve the ability of hand-washers to meet the recommended handwashing duration of ≥20 seconds and to assess the effect of washer fatigue with the intervention. An innovative system of smart connected soap and towel dispensers synchronized to engaging video content was implemented to meet this objective. RESULTS The intervention increased mean handwashing duration by 7.5 seconds (95% CI: 6.6, 8.4) and improved handwashing duration ≥20 seconds by 39.3% (P < .001). Using a similar cohort of hand-washers over 26 months, the video content had peak effect in month 1, and declined to a new steady state at month 11. DISCUSSION Handwashing for the recommended time can be difficult to achieve. Most hand hygiene studies examine the rate of completion without measuring duration. CONCLUSIONS Video engagement can improve and sustain handwashing duration. To mitigate creative and messaging fatigue, video content refresh for this intervention should be considered at 3 months for optimal effect or at 11 months prior to full decline to new steady state.
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Affiliation(s)
- Lily Ackermann
- Departments of Medicine, Infection Control, Nursing, Pharmacology & Experimental Therapeutics, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Andrew Thum
- Departments of Medicine, Infection Control, Nursing, Pharmacology & Experimental Therapeutics, Thomas Jefferson University Hospital, Philadelphia, PA.
| | - Kristine Meagher
- Departments of Medicine, Infection Control, Nursing, Pharmacology & Experimental Therapeutics, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Donna Molyneaux
- Departments of Medicine, Infection Control, Nursing, Pharmacology & Experimental Therapeutics, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Robert Neff
- Departments of Medicine, Infection Control, Nursing, Pharmacology & Experimental Therapeutics, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Kelly Zabriskie
- Departments of Medicine, Infection Control, Nursing, Pharmacology & Experimental Therapeutics, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Ayako Shimada
- Departments of Medicine, Infection Control, Nursing, Pharmacology & Experimental Therapeutics, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Jeffrey Riggio
- Departments of Medicine, Infection Control, Nursing, Pharmacology & Experimental Therapeutics, Thomas Jefferson University Hospital, Philadelphia, PA
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24
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Giri VN, Gross L, Russo J, Shimada A, McNair C, Kelly WK, Gomella LG. Prevalence of Fanconi anemia gene mutations among men undergoing multigene germline testing for prostate cancer: Interim results from the EMPOWeR study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
188 Background: Germline testing for prostate cancer (PCA) is now central to treatment, screening, and hereditary cancer management. The Fanconi anemia (FA) pathway is a key DNA repair pathway involved in PCA biology and treatment. Prevalence of FA genes BRCA2, PALB2, and BRIP1 is well-described; however, multiple other FA genes are not routinely tested, with limited prevalence data. Here we report mutation prevalence of a spectrum of FA genes among men undergoing PCA multigene testing on the Evaluation and Management for Prostate Oncology, Wellness, and Risk (EMPOWeR) study. Methods: Eligibility includes any male with PCA or at-risk for PCA. Multigene testing includes 51 genes; FA pathway genes include BRCA2, PALB2, BRIP1, FANCA, FANCB, FANCC, FANCD2, FANCE, FANCF, FANCG, FANCI, FANCL, and FANCM. Multiple additional cancer risk genes were tested. Fisher’s exact tests were conducted to compare the prevalence of FA gene mutations between participants in the EMPOWeR study vs population prevalence reported in the literature. Statistical significance level of all tests was set a priori to 0.05. Results: The current cohort includes 235 participants. Characteristics are White (83.3%), Black (13.7%), PCA diagnosis (83.4%), mean age of PCA diagnosis 61.7 + 7.69 years, Gleason score >=7 (66.2%), and T3 or higher (29.4%). Genetic results were available for 179 participants. Overall, 11.1% of participants (n=20) had a pathogenic/likely pathogenic mutation identified. Among mutation carriers, 45% (n=9) had mutations in FA genes, including FANCA (n=3), BRCA2 (n=2), FANCM (n=1), FANCD2 (n=1), PALB2 (n=1), and BRIP1 (n=1). Table shows clinical characteristics of participants with mutations in FANCA, FANCM, and FANCD2. Further mutation spectrum included: CHEK2 (n=3), NBN (n=2), MUTYH (n=2), BRCA (n=1), ATM (n=1), HOXB13 (n=1), APC (n=1). Compared to population prevalence, FA mutation prevalence was significantly higher overall (5.0% vs. 0.6%, p = 0.010) and among mutation carriers (45% vs. 0.6%, p<0.001). Conclusions: While prevalence of FA genes BRCA2, PALB2, and BRIP1 is well-described, our study supports testing a broader range of FA genes given the prevalence rates, potential implications for clinical trials, targeted therapy, inherited syndromes, and reproductive implications.[Table: see text]
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Affiliation(s)
- Veda N. Giri
- Departments of Medical Oncology, Cancer Biology, and Urology, Cancer Risk Assessment and Clinical Cancer Genetics Program, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Laura Gross
- Thomas Jefferson University, Philadelphia, PA
| | | | - Ayako Shimada
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | | | - William Kevin Kelly
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | - Leonard G. Gomella
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
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25
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Abu-Khalaf M, Nikita F, Shimada A, Hackbart H, Alnabulsi D, Keith S, Lopez AM, Butryn M. Abstract P4-11-32: Change in body mass index in breast cancer survivors. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p4-11-32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Obesity is associated with an increased risk of breast cancer recurrence and poor survival. Obesity rate in adults in the city of Philadelphia is high, with non-Hispanic blacks and Hispanics having the highest rates. We sought to evaluate changes in body mass index (BMI) in breast cancer survivors within the first 2 years from initial encounter for a breast cancer (BC) diagnosis (dx), and investigate factors that may correlate with a change in BMI. Methods: We identified 5,423 BC patients (pts) in our electronic medical record, (1/2015-present), using ICD-10 code C50.X. We then selected pts with BMI values at the three-time points: baseline, 1 year and 2 year intervals from baseline. The closest BMI value before the 1st encounter within 6 months prior to BC dx was considered as the baseline BMI. BMI at 1 year +/- 3 months after the BC dx was considered 1-year interval BMI. BMI at 2 years +/- 6 months after the BC dx was considered 2-year interval BMI. Subjects needed baseline BMI and at least 1 year or 2 year follow-up BMI for inclusion. After all BMI exclusions, 630 pts were included in the study cohort. We used a mixed effects model to predict BMI changes as a linear function of association with time, sex, race and ethnicity, age at BC dx, baseline BMI, treatments (i.e., chemotherapy [CT], endocrine therapy [ET], or immunotherapy [IO] and the interaction of race and ethnicity and treatment in estimating mean change of BMI. The significance level of all tests was set a priori to the 0.05 level. Results: The mean age at BC dx was 61 years; pts identified were mostly white, non-Hispanic/Caucasian (55%), or Black/African American (AA) (34%). By BMI category, we did not observe any substantial difference in the mean age at BC dx and gender distribution (p = 0.81 for age and p = 0.86 for gender). However, the distributions of race and ethnicity differed among BMI categories (p < .01) where the percentage of Black/AA pts was high in the BMI ≥ 30 category. Black/AA pts receiving IO were likely to have BMI change (decrease) compare to white non-Hispanic pts with similar conditions. Black/AA pts receiving no treatment or non IO-treatment were more likely to change BMI (increased, 95% CI: 0.22, 1.03) after BC dx compared to white, non-Hispanic pts. Interestingly, Black/AA pts receiving IO tended to change BMI (decreased) compared to Black/AA pts not receiving IO. Conclusion: We observed the interaction effect of race/ethnicity and treatment on BMI change in BC survivors within 2 years after a BC dx, with Black/AA pts more likely to have an increase in BMI.
Table 1.Descriptive Statistics Summary, n = 630.VariableALL (n=630)BMI ≤ 24.9 (n=160, 25%)25 ≤ BMI ≤ 29.9 (n=180, 29%)BMI ≥ 30 (n=290, 46%)p-valueAge at 1st Encounter with BC dx, mean (SD)61.8 (11.8)62.1 (12.5)62.1 (12.1)61.5 (11.2)0.808Sex, n (%)Female625 (99.2)159 (99.4)178 (98.9)288 (99.3)0.857Male5 (0.8)1 (0.6)2 (1.1)2 (0.7)Race & Ethnicity, n (%)White/Caucasian348 (55.2)103 (64.4)106 (58.9)139 (47.9)<.001Black/AA215 (34.1)35 (21.9)48 (26.7)132 (45.5)Hispanic/Latino20 (3.2)5 (3.1)5 (2.8)10 (3.4)Asian/Pacific Islander39 (6.2)17 (10.6)18 (10.0)4 (1.4)American Indian/Alaskan Native2 (0.3)0 (0.0)0 (0.0)2 (0.7)Unknown6 (1.0)0 (0.0)3 (1.7)3 (1.0)BMI (baseline), mean (SD)29.9 (7.1)22.2 (2.0)27.1 (1.4)35.9 (5.7)<.001Treatment (Yes) , n (%)HistoricalCT2 (0.3)1 (0.6)1 (0.6)0 (0.0)0.294ET35 (5.6)7 (4.4)12 (6.7)16 (5.5)0.663IO4 (0.6)2 (1.3)1 (0.6)1 (0.3)0.487BaselineCT20 (3.2)4 (2.5)7 (3.9)9 (3.1)0.815ET54 (8.6)16 (10.0)15 (8.3)23 (7.9)0.742IO11 (1.7)5 (3.1)2 (1.1)4 (1.4)0.3111 yearCT154 (24.4)41 (25.6)42 (23.3)71 (24.5)0.886ET309 (49.0)73 (45.6)93 (51.7)143 (49.3)0.535IO29 (4.6)10 (6.3)8 (4.4)11 (3.8)0.4892 yearsCT71 (11.3)20 (12.5)15 (8.3)36 (12.4)0.337ET231 (36.7)50 (31.3)73 (40.6)108 (37.2)0.198IO32 (5.1)7 (4.4)4 (2.2)21 (7.2)0.051
Citation Format: Maysa Abu-Khalaf, Fnu Nikita, Ayako Shimada, Hannah Hackbart, Dina Alnabulsi, Scott Keith, Ana Maria Lopez, Meghan Butryn. Change in body mass index in breast cancer survivors [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-11-32.
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Affiliation(s)
- Maysa Abu-Khalaf
- Sidney Kimmel Cancer Center at Jefferson Health, Thomas Jefferson University, Philadelphia, PA
| | - Fnu Nikita
- Sidney Kimmel Cancer Center at Jefferson Health, Thomas Jefferson University, Philadelphia, PA
| | - Ayako Shimada
- Sidney Kimmel Cancer Center at Jefferson Health, Thomas Jefferson University, Philadelphia, PA
| | - Hannah Hackbart
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Dina Alnabulsi
- Sidney Kimmel Cancer Center at Jefferson Health, Thomas Jefferson University, Philadelphia, PA
| | - Scott Keith
- Sidney Kimmel Cancer Center at Jefferson Health, Thomas Jefferson University, Philadelphia, PA
| | - Ana Maria Lopez
- Sidney Kimmel Cancer Center at Jefferson Health, Thomas Jefferson University, Philadelphia, PA
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Shimada A, Kawata N, Sato H, Ikari J, Suzuki E, Anazawa R, Suzuki M, Masuda Y, Haneishi H, Tatsumi K. Dynamic Quantitative Magnetic Resonance Imaging Assessment of Areas of the Lung During Free-Breathing of Patients with Chronic Obstructive Pulmonary Disease. Acad Radiol 2022; 29 Suppl 2:S215-S225. [PMID: 34144888 DOI: 10.1016/j.acra.2021.03.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 12/25/2022]
Abstract
RATIONALE AND OBJECTIVES Changes in the geometry of the chest wall due to lung hyperinflation occur in COPD. However, the quantitative assessment of impaired lung motions and its association with the clinical characteristics of COPD patients are unclear. This study aimed to investigate the respiratory kinetics of COPD patients by dynamic MRI. MATERIALS AND METHODS This study enrolled 22 COPD patients and 10 normal participants who underwent dynamic MRI and pulmonary function testing (PFT). Changes in the areas of the lung and mediastinum during respiration were compared between the COPD patients and the normal controls. Relationships between MRI, CT parameters, and clinical measures that included PFT results also were evaluated. RESULTS Asynchronous movements and decreased diaphragmatic motion were found in COPD patients. COPD patients had a larger ratio of MRI-measured lung areas at expiration to inspiration, a smaller magnitude of the peak area change ratio, and a smaller mediastinal-thoracic area ratio than the normal participants. The lung area ratio was associated with FEV1/FVC, predicted RV%, and CT lung volume/predicted total lung capacity (pTLC). The lung area ratio of the right lower and left lower lungs was significantly correlated with emphysema of each lower lobe. The expiratory mediastinal-thoracic area ratio was associated with FEV1% predicted and RV/TLC. CONCLUSION Changes in the lung areas of COPD patients as shown on MRI reflected the severity of airflow limitation, hyperinflation, and the extent of emphysema. Dynamic MRI provides essential information about respiratory kinetics in COPD.
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Schafer JJ, Zimmerman M, Walshe CE, Cerankowski J, Shimada A, Keith S. 828. Short- and Long-Term Metabolic Changes in Virologically Suppressed Patients Switching from TDF to TAF Containing Antiretroviral Therapy. Open Forum Infect Dis 2021. [PMCID: PMC8643897 DOI: 10.1093/ofid/ofab466.1024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) containing antiretroviral therapy (ART) may negatively influence weight, cholesterol, and atherosclerotic cardiovascular disease (ASCVD) risk. The timing, duration, and extent of these changes and their definitive associations with TAF remain unclear. Methods This retrospective observational study evaluated weight, body mass index (BMI), cholesterol, and ASCVD risk score changes in virologically suppressed patients living with HIV infection (PLWH) who switched from TDF to TAF without switching any other ART regimen components. Adult patients on TDF and no HIV viral load values > 200 copies/mL for ≥ 2 years prior to and following a TAF switch were included. Body weight, BMI, cholesterol and other variables were collected for the 2 years before and after the switch. The Wilcoxon signed-rank test compared median values for each measurement pre and post switch in a univariate analysis. Longitudinal linear mixed effects models evaluated changes for each outcome measure at 1 and 2 years after the switch. Models were built with random effects for patients and included covariates such as time on TAF, age, sex, race, time with HIV, diabetes, smoking status, and concomitant medications associated with weight gain or loss. Results A total of 86 patients met study criteria (table 1). In the univariate analysis, there were significant increases in weight, BMI, total cholesterol, LDL, HDL, triglycerides, and ASCVD risk scores 2 years after switching to TAF (each p ≤ 0.05, table 2). However, after controlling for covariates, only the increases in total and LDL cholesterol were associated with switching to TAF and significantly different from expected changes predicted in the linear model. In terms of weight gain with TAF, patients gained an average of 4.3 pounds in year 1 and 3.8 pounds in year 2 after the switch. Neither of these increases were statistically different from the expected changes in weight predicted in the linear model (3.1 pounds/year, 95% CI: 1.6-4.6). ![]()
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Conclusion Despite observing significant increases in weight, BMI, cholesterol and ASCVD risk scores after switching to TAF, only the changes in cholesterol were significantly associated with TAF and different from changes expected in PLWH over time. Disclosures Jason J. Schafer, PharmD, MPH, Gilead (Research Grant or Support)Merck (Advisor or Review Panel member, Research Grant or Support)ViiV (Advisor or Review Panel member)
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Abstract
Dynamic magnetic resonance imaging (MRI) provides essential information on the respiratory kinetics in chronic obstructive pulmonary disease (COPD), such as impaired diaphragm and chest wall motions. The purpose of this study was to develop the semi-automated segmentation program of lungs using cine MRI. We enrolled five control participants and five patients with COPD who underwent cine MRI. The coronal balanced FFE images from each subject were used. The procedures were as follows: First, the maximum inspiratory image was selected from the time-sequential series, and the lung area was manually segmented, which was used for a mask image. Second, both mask image and cine image were accumulated to create a weighted cine image. Lung areas were segmented using the k-means method. Finally, lungs were detected as contiguous image regions with similar signal values using the flood-fill technique. We evaluated the correlation coefficients between the lung area segmented by the semi-automated method and those segmented by a pulmonologist. The correlation coefficients between the semi-automated method and the manual segmentations were excellent (r=0.99, p<0.001). The Dice index was also perfect (0.97). The best number of clusters in the k-means method was 8. These results suggested that the new segmentation method can appropriately extract lungs and help analyze respiratory dynamics in patients with COPD.
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Affiliation(s)
- Hirotaka Sato
- Department of Radiological Technology, Soka Municipal Hospital.,Department of Respirology, Chiba University Graduate School of Medicine
| | - Naoko Kawata
- Department of Respirology, Chiba University Graduate School of Medicine
| | - Ayako Shimada
- Department of Respirology, Shin-Yurigaoka General Hospital
| | - Takuji Suzuki
- Department of Respirology, Chiba University Graduate School of Medicine
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Giri VN, Shimada A, Leader AE. Predictors of Population Awareness of Cancer Genetic Tests: Implications for Enhancing Equity in Engaging in Cancer Prevention and Precision Medicine. JCO Precis Oncol 2021; 5:PO.21.00231. [PMID: 34778693 PMCID: PMC8585288 DOI: 10.1200/po.21.00231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/07/2021] [Accepted: 09/17/2021] [Indexed: 12/17/2022] Open
Abstract
Racial and ethnic disparities in genetic awareness (GA) can diminish the impact of personalized cancer treatment and risk assessment. We assessed factors predictive of GA in a diverse population-based sample to inform awareness strategies and reduce disparities in genetic testing. METHODS A cross-sectional study was conducted from July 2019 to August 2019, with the survey e-mailed to 7,575 adult residents in southeastern Pennsylvania and New Jersey. Constructs from National Cancer Institute Health Information and National Trends Survey assessed cancer attitudes or beliefs, health literacy, and numeracy. Characteristics were summarized with mean ± standard deviation for numeric variables and frequency counts and percentages for categorical variables. Comparison of factors by race or ethnicity (non-Hispanic White and non-Hispanic Black) and sex was conducted by t-tests, chi-square, or Fisher's exact tests. Multivariate logistic regression models were conducted to identify factors independently predictive of GA. RESULTS Of 1,557 respondents, data from 940 respondents (the mean age was 45 ± 16.2 years, 35.5% males, and 23% non-Hispanic Blacks) were analyzed. Factors associated with higher GA included female gender (P < .001), non-Hispanic White (P < .001), college education (P < .001), middle-higher income (P < .001), stronger belief in genetic basis of cancer (P < .001), lower cancer fatalism (P = .004), motivation for cancer information (P < .001), and higher numeracy (P = .002). On multivariate analysis, college education (odds ratio [OR] 1.79; 95% CI, 1.22 to 2.63), higher motivation for cancer information (OR 1.56; 95% CI, 1.17 to 2.09), stronger belief in genetics of cancer (OR 2.21; 95% CI, 1.48 to 3.30), and higher medical literacy (OR 2.21; 95% CI, 1.34 to 3.65) predicted greater GA. CONCLUSION This population-based study conducted in the precision medicine era identified novel modifiable factors, importantly perceptions of cancer genetics and medical literacy, as predictive of GA, which informs strategies to promote equitable engagement in genetically based cancer care.
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Affiliation(s)
- Veda N. Giri
- Departments of Medical Oncology, Cancer Biology, and Urology, Cancer Risk Assessment and Clinical Cancer Genetics, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
- Division of Population Science, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Ayako Shimada
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA
| | - Amy E. Leader
- Division of Population Science, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
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Handley N, Wen KY, Gomaa S, Shimada A, Leiby B, Brassil KJ, Jackson L, Calvaresi A, Dicker AP. Outcomes of a pilot study exploring the role of digital health coaching for men with prostate cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2020.39.28_suppl.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
102 Background: As the most common cancer among men in the US, prostate cancer (PCa) affects nearly 250,000 men annually, accounting for over 13% of all new cancer cases. Health-related quality of life (HRQoL) during and post-treatment is impacted by sexual, urinary and bowel function which can persist for months or years after treatment completion. As individuals primarily manage such symptoms in the community setting there is a need for interventions that can address overall health and wellness concerns needs of men with PCa beyond the clinical setting. Digital health coaching (DHC) is one such solution that has potential to address HRQoL for individuals with cancer. Methods: The aim of this pilot study was to evaluate the feasibility of a DHC program for individuals with PCa. One hundred English-speaking men with PCa requiring active treatment within the past 2 years were recruited from across the Delaware Valley. Consented individuals were enrolled in a 3-month DHC program, consisting of a weekly call from a health advisor along with delivery of evidence-based supplemental content via text or email focused on exercise nutrition, physical, emotional and sexual health, as well as financial toxicity. Secondary endpoints evaluated the relationship between the DHC intervention and health self-efficacy, as measured by the Cancer Behavior Inventory-Brief Form (CBI-B), quality of life (EPIC-CP), financial toxicity (COST) and global health (PROMIS- SF10). Results: 82 individuals enrolled in the study for which the mean age was 68 years old (1.2 % Black, 2.4% Rural). The feasibility threshold of 60% was met with 58 individuals completing the 3-month program (proportion = 70.7%, 90% CI: 61.4, 78.9). Health self-efficacy improved with a mean change in CBI-B of 4.1 (95% CI: 0.4, 7.8). The financial toxicity improved with a mean score change of 2.5 (95% CI: 1.0, 4.0). All symptom scores of EPIC-CP were improved by showing a decrease of mean scores. PROMIS-GH also improved in both mental and physical health domains with mean changes of 0.5 and 1.4 (95% CIs for mental: -1.6, 2.6, for physical: -0.1, 2.8). Conclusions: DHC demonstrated feasibility in a cross-sectional population of men with PCA recruited in the community setting. Data suggest that HRQoL, health-self efficacy and global health can be positively impacted by DHC. Results support the further evaluation of DHC in larger RCTs.
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Affiliation(s)
| | | | - Sameh Gomaa
- Thomas Jefferson University, Philadelphia, PA
| | - Ayako Shimada
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Benjamin Leiby
- Thomas Jefferson University, Department of Pharmacology and Experimental Therapeutics, Philadelphia, PA
| | | | | | | | - Adam P. Dicker
- The Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
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Shimada A, Kawata N, Abe M, Sato H, Suzuki M, Yokota H, Matsuoka S, Haneishi H, Tatsumi K, Suzuki T. Longitudinal structural changes using MDCT in patients with combined pulmonary fibrosis with emphysema. Imaging 2021. [DOI: 10.1183/13993003.congress-2021.oa1563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Russo J, McDougall C, Bowler N, Shimada A, Gross L, Hyatt C, Kelly WK, Calvaresi A, Handley NR, Hirsch IH, Izes JK, Lallas CD, Mann M, Mark JR, Mille PJ, Preate D, Trabulsi EJ, Tsang M, Chandrasekar T, Weiner PR, Gomella LG, Giri VN. Pretest Genetic Education Video Versus Genetic Counseling for Men Considering Prostate Cancer Germline Testing: A Patient-Choice Study to Address Urgent Practice Needs. JCO Precis Oncol 2021; 5:PO.21.00238. [PMID: 34589662 PMCID: PMC8462590 DOI: 10.1200/po.21.00238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/02/2021] [Accepted: 07/21/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Germline testing (GT) for prostate cancer (PCA) is now central to treatment and hereditary cancer assessment. With rising demand for and shortage of genetic counseling (GC), tools to deliver pretest informed consent across practice settings are needed to improve access to GT and precision care. Here, we report on Evaluation and Management for Prostate Oncology, Wellness, and Risk (EMPOWER), a patient-choice study for pretest video-based genetic education (VBGE) versus GC to inform urgent practice needs. PATIENTS AND METHODS Men with PCA or at risk for PCA (family history of PCA) were eligible and could choose pretest VBGE or GC. Outcomes included decisional conflict for GT, change in genetics knowledge, satisfaction, and intention to share results with family and/or providers. Descriptive statistics summarized results with counts and percentages for categorical variables and mean ± standard deviation for continuous variables. Data were compared with Fisher's exact, chi-squared, or Wilcoxon two-sample tests. Mean change in genetics knowledge was compared with t tests. The significance level was set a priori at .05. RESULTS Data on the first 127 participants were analyzed. Characteristics were White (85.8%), bachelor's degree (66.9%), and PCA diagnosis (90.6%). The majority chose VBGE (71%) versus GC (29%; P < .001). No differences were observed in decisional conflict for GT or satisfaction. Cancer genetics knowledge improved in both groups without significant difference (+0.9 VBGE, +1.8 GC, P = .056). Men who chose VBGE had higher intention to share GT results (96.4% VBGE v 86.4% GC, P = .02). Both groups had high rates of GT uptake (VBGE 94.4%, GC 92%). CONCLUSION A substantial proportion of men opted for pretest VBGE, with comparable patient-reported outcomes and uptake of GT. The results support the use of pretest video to address the critical GC shortage in the precision era.
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Affiliation(s)
- Jessica Russo
- Cancer Risk Assessment and Clinical Cancer Genetics Program, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Carey McDougall
- Cancer Risk Assessment and Clinical Cancer Genetics Program, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Nicholas Bowler
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Ayako Shimada
- Biostatistics Facility, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA
| | - Laura Gross
- Cancer Risk Assessment and Clinical Cancer Genetics Program, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Colette Hyatt
- University of Vermont Medical Center, Burlington, VT
| | - William K. Kelly
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Anne Calvaresi
- Department of Urology, Thomas Jefferson University, Philadelphia, PA
| | - Nathan R. Handley
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Irvin H. Hirsch
- Department of Urology, Thomas Jefferson University, Philadelphia, PA
| | - Joseph K. Izes
- Department of Urology, Thomas Jefferson University, Philadelphia, PA
| | - Costas D. Lallas
- Department of Urology, Thomas Jefferson University, Philadelphia, PA
| | - Mark Mann
- Department of Urology, Thomas Jefferson University, Philadelphia, PA
| | - James Ryan Mark
- Department of Urology, Thomas Jefferson University, Philadelphia, PA
| | - Patrick J. Mille
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | | | | | - Miranda Tsang
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | | | - Perry R. Weiner
- Department of Urology, Thomas Jefferson University, Philadelphia, PA
| | | | - Veda N. Giri
- Cancer Risk Assessment and Clinical Cancer Genetics Program, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
- Department of Urology, Thomas Jefferson University, Philadelphia, PA
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Leader AE, Capparella LM, Waldman LB, Cammy RB, Petok AR, Dean R, Shimada A, Yocavitch L, Rising KL, Garber GD, Worster B, Dicker AP. Digital Literacy at an Urban Cancer Center: Implications for Technology Use and Vulnerable Patients. JCO Clin Cancer Inform 2021; 5:872-880. [PMID: 34428075 PMCID: PMC8807016 DOI: 10.1200/cci.21.00039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/01/2021] [Accepted: 07/12/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE eHealth literacy, or the ability to seek, find, understand, and appraise health information from electronic sources, has become increasingly relevant in the era of COVID-19, when so many aspects of patient care became dependent on technology. We aimed to understand eHealth literacy among a diverse sample of patients with cancer and discuss ways for health systems and cancer centers to ensure that all patients have access to high-quality care. METHODS A cross-sectional survey of patients with cancer and caregivers was conducted at an NCI-designated cancer center to assess access to the Internet, smartphone ownership, use of mobile apps, willingness to engage remotely with the health care team, and use of the patient portal. Descriptive statistics and bivariate analyses were used to assess frequencies and significant differences between variables. RESULTS Of 363 participants, 55% (n = 201) were female, 71% (n = 241) identified as non-Hispanic White, and 29% (n = 85) reported that their highest level of education was a high school diploma. Most (90%, n = 323) reported having access to the Internet and most (82%, n = 283) reported owning a smartphone. Younger patients or those with a college degree were significantly more likely to own a smartphone, access health information online, know how to download an app on their own, have an interest in communicating with their health care team remotely, or have an account on the electronic patient portal. CONCLUSION As cancer centers increasingly engage patients through electronic and mobile applications, patients with low or limited digital literacy may be excluded, exacerbating current cancer health disparities. Patient-, provider- and system-level technology barriers must be understood and mitigated.
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Affiliation(s)
- Amy E Leader
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Lisa M Capparella
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Lauren B Waldman
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Rebecca B Cammy
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Alison R Petok
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Rebecca Dean
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA
| | - Ayako Shimada
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Liana Yocavitch
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Kristin L Rising
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Gregory D Garber
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Brooke Worster
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Adam P Dicker
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
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Takeuchi M, Kawakubo H, Shimada A, Hoshino S, Matsuda S, Mayanagi S, Irino T, Fukuda K, Nakamura R, Wada N, Takeuchi H, Kitagawa Y. The Results of Sentinel Node Mapping for Patients with Clinically Early Staged Gastric Cancer Diagnosed with pT2/deeper Tumors. World J Surg 2021; 45:3350-3358. [PMID: 34333682 DOI: 10.1007/s00268-021-06254-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Sentinel node (SN) mapping based on the SN concept has been applied to early gastric cancer. However, it is still controversial whether or not the oncological safety is ensured in case pathological stage was advanced in these patients. The aim of this study was to investigate the validity of SN mapping in patients with clinically early staged gastric cancer diagnosed with pT2/deeper tumors. METHODS We retrospectively analyzed 40 patients with a diagnosis of cT1N0 or cT2N0 single-lesion gastric cancer who were shown to have pT2 or deeper tumors after gastrectomy with SN mapping. We adopted a dual-tracer method using a radioactive colloid and blue dye to detect SNs. The diagnostic accuracy and distribution of SNs at each tumor site were analyzed. RESULTS Of the 40 patients, 24 (60%) were postoperatively diagnosed as pT2, and 16 (40%) as pT3 or T4. SNs were detected in all patients. The false negative rate was 9% (1/11), and in that patient, the non-SN metastasis was observed within the SN basin. Diagnostic accuracy was 98% (39/40). Overall distribution of SNs was similar to that for patients with early gastric cancer. No significant differences in overall and recurrence-free survival were observed between the patients who underwent standard gastrectomy and those who underwent function-preserving gastrectomy, based on the results of SN mapping. CONCLUSIONS Our results confirmed validity of SN mapping for patients with clinically early staged gastric cancer diagnosed with pT2/deeper tumors after gastrectomy. Closed surveillance without additional surgical treatment is an option for these patients.
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Affiliation(s)
- Masashi Takeuchi
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Ayako Shimada
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, Narita Hospital, Chiba, 286-8520, Japan
| | - Shota Hoshino
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Satoru Matsuda
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shuhei Mayanagi
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tomoyuki Irino
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazumasa Fukuda
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Rieko Nakamura
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Norihito Wada
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Capparelli C, Purwin TJ, Tiago M, Wilski N, Pomante D, Glasheen M, Rosenbaum S, Nguyen MQ, Cai W, Zheng R, Kumar G, Chervoneva I, Shimada A, Snook AE, Fortina P, Xu X, Hookim K, Cukierman E, Davies MA, Herlyn M, Aplin AE. Abstract 40: Targeting SOX10-deficient cells to reduce resistance to targeted therapy in melanoma. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Intratumoral heterogeneity and cellular plasticity enable tumors to alter phenotypes and adapt to foreign microenvironments and resist targeted inhibitors. While the ability to switch between phenotypic states has been broadly characterized, the key mechanisms that underlie tumor plasticity remain poorly understood. We studied the neural crest lineage transcription factor, SOX10, in the context of cutaneous melanoma and resistance to targeted therapies. SOX10 is heterogeneously expressed in melanoma samples. Using bio-informatics as well as in vivo and 3D in vitro melanoma models, SOX10 loss was sufficient to induce an invasive but slow proliferating phenotype in vitro and in vivo that was associated with expression of a mesenchymal gene set. Interestingly, while SOX10 knockout initially induced a targeted inhibitor tolerant state, longer exposure of co-mixed populations of SOX10 proficient and SOX10 deficient to targeted therapy drives the clonal selection of SOX10 knockout cells. Furthermore, cell lines generated from xenograft tumors that have acquired resistance to either vemurafenib, paradox-breaking BRAFi or the combination of BRAFi + MEKi showed dramatically reduced SOX10 expression compared to their parental counterparts. Altogether these data suggest that acquired resistant clones may arise from drug tolerant persister cells. As a strategy to selectively target this invasive, drug-tolerant SOX10-deficient sub-population, we screened a drug compound library and identified a class of cIAP1/2 inhibitors to be synthetically lethal for SOX10-deficient cells. Our preliminary data suggest that birinapant can delay or prevent resistance to BRAFi/MEKi in vivo. Together, these data suggest that SOX10 mediates phenotypic switching in cutaneous melanoma and enables tumor adaptation to altered microenvironments and drug treatments which could be targeted using cIAP1/2 inhibitors.
Citation Format: Claudia Capparelli, Timothy J. Purwin, Manoela Tiago, Nicole Wilski, Danielle Pomante, McKenna Glasheen, Sheera Rosenbaum, Mai Q. Nguyen, Weijia Cai, Richard Zheng, Gaurav Kumar, Inna Chervoneva, Ayako Shimada, Adam E. Snook, Paolo Fortina, Xiaowei Xu, Kim Hookim, Edna Cukierman, Michael A. Davies, Meenhard Herlyn, Andrew E. Aplin. Targeting SOX10-deficient cells to reduce resistance to targeted therapy in melanoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 40.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Weijia Cai
- 1Thomas Jefferson University, Philadelphia, PA
| | | | | | | | | | | | | | - Xiaowei Xu
- 2University of Pennsylvania, Philadelphia, Pennsylvania, Philadelphia, PA
| | - Kim Hookim
- 1Thomas Jefferson University, Philadelphia, PA
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36
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Yasukawa K, Minami T, Boulware DR, Shimada A, Fischer EA. Point-of-Care Lung Ultrasound for COVID-19: Findings and Prognostic Implications From 105 Consecutive Patients. J Intensive Care Med 2021; 36:334-342. [PMID: 33535883 PMCID: PMC7863119 DOI: 10.1177/0885066620988831] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: The prognostic value of point-of-care lung ultrasound has not been evaluated in a large cohort of patients with COVID-19 admitted to general medicine ward in the United States. The aim of this study was to describe lung ultrasound findings and their prognostic value in patients with COVID-19 admitted to internal medicine ward. Method: This prospective observational study consecutively enrolled 105 hospitalized participants with COVID-19 at 2 tertiary care centers. Ultrasound was performed in 12 lung zones within 24 hours of admission. Findings were assessed relative to 4 outcomes: intensive care unit (ICU) need, need for intensive respiratory support, length of stay, and death. Results: We detected abnormalities in 92% (97/105) of participants. The common findings were confluent B-lines (92%), non-homogenous pleural lines (78%), and consolidations (54%). Large confluent B-lines, consolidations, bilateral involvement, and any abnormality in ≥ 6 areas were associated with a longer hospitalization and need for intensive respiratory support. Large confluent B-lines and bilateral involvement were also associated with ICU stay. A total lung ultrasound score <5 had a negative predictive value of 100% for the need of intensive respiratory support. A higher total lung ultrasound score was associated with ICU need (median total 18 in the ICU group vs. 11 non-ICU, p = 0.004), a hospitalization ≥ 9d (15 vs 10, p = 0.016) and need for intensive respiratory support (18 vs. 8.5, P < 0.001). Conclusions: Most patients hospitalized with COVID-19 had lung ultrasound abnormalities on admission and a higher lung ultrasound score was associated with worse clinical outcomes except death. A low total lung ultrasound score (<5) had a negative predictive value of 100% for the need of intensive respiratory support. Point-of-care ultrasound can aid in the risk stratification for patients with COVID-19 admitted to general wards.
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Affiliation(s)
- Kosuke Yasukawa
- Division of Hospital Medicine, Department of Medicine, 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Taro Minami
- Division of Pulmonary, Critical Care, and Sleep Medicine, Care New England Medical Group, Pawtucket, RI, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, the Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - David R Boulware
- Division of Infectious Diseases and International Medicine, Department of Medicine, 5635University of Minnesota, Minneapolis, MN, USA
| | - Ayako Shimada
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ernest A Fischer
- Division of Hospital Medicine, Department of Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
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Johnston TE, Jakavick AE, Mancuso CA, McGee KC, Wei L, Wright ML, Close J, Shimada A, Leiby BE. Risk Factors for Stress Fractures in Female Runners: Results of a Survey. Int J Sports Phys Ther 2021; 16:72-86. [PMID: 33604137 PMCID: PMC7872445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 07/25/2020] [Indexed: 11/11/2023] Open
Abstract
BACKGROUND Few studies compare women with and without stress fractures and most focus on younger, elite runners. HYPOTHESIS/PURPOSE Compare risk factors between female runners with and without a stress fracture history. STUDY DESIGN Case control. METHODS An online survey targeting women age ≥18 years was distributed primarily via social media. Questions included demographics, running details, cross training, nutrition, injury history, medical/menstrual history, and medications. Women with stress fracture histories answered questions about location, number, and changes made. Data were compared between groups using t-tests, chi-square tests, or Fisher's exact tests. Multivariable logistic regression models simultaneously investigated associations of multiple factors using backward variable selection. RESULTS Data from 1648 respondents were analyzed. Mean age was 40 years, and 25.4% reported stress fractures. Significant differences were found between groups for days/week running, mileage/week, running pace, years running, having a coach, cycling or swimming, calorie consumption for activity, other running injuries, medical history, medication/supplement intake, age at menarche, and going ≥6 months without a menstrual period. Odds of having a stress fracture were increased with osteopenia (OR 4.14), shin splints (OR 3.24), tendon injuries (OR 1.49), running >20 miles/week (OR 1.74-1.77) compared to 11-20 miles/week, having a coach (OR 1.86), and cycling (OR 1.15). Women running 11:00-11:59 minutes/mile or slower were less likely to have a stress fracture compared to those running 9:00-9:59 minutes/mile (OR 0.43-0.54). The odds of having a stress fracture were 1.43 times higher for going ≥ 6 months without a menstrual period. Use of calcium, probiotics, and vitamin D increased odds. Post fracture, common changes made were with cross training (49%), mileage (49%), and strength training (35%). CONCLUSIONS Multiple intrinsic and extrinsic factors were identified for female runners who sustained one or more stress fracture during running. Prospective studies are warranted to infer a cause and effect relationship amongst these variables and stress fracture risk. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Therese E Johnston
- Thomas Jefferson University, Jefferson College of Rehabilitation Sciences, Department of Physical Therapy, Philadelphia, PA, USA
| | - Allison E Jakavick
- Thomas Jefferson University, Jefferson College of Rehabilitation Sciences, Department of Physical Therapy, Philadelphia, PA, USA
| | - Caroline A Mancuso
- Thomas Jefferson University, Jefferson College of Rehabilitation Sciences, Department of Physical Therapy, Philadelphia, PA, USA
| | - Kathleen C McGee
- Thomas Jefferson University, Jefferson College of Rehabilitation Sciences, Department of Physical Therapy, Philadelphia, PA, USA
| | - Lily Wei
- Thomas Jefferson University, Jefferson College of Rehabilitation Sciences, Department of Physical Therapy, Philadelphia, PA, USA
| | - Morgan L Wright
- Thomas Jefferson University, Jefferson College of Rehabilitation Sciences, Department of Physical Therapy, Philadelphia, PA, USA
| | - Jeremy Close
- Thomas Jefferson University, Department of Family and Community Medicine, Philadelphia, PA, USA
| | - Ayako Shimada
- Thomas Jefferson University, Department of Biostatistics, Philadelphia, PA, USA
| | - Benjamin E Leiby
- Thomas Jefferson University, Department of Biostatistics, Philadelphia, PA, USA
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38
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Ryan NM, Hess JA, de Villena FPM, Leiby BE, Shimada A, Yu L, Yarmahmoodi A, Petrovsky N, Zhan B, Bottazzi ME, Makepeace BL, Lustigman S, Abraham D. Onchocerca volvulus bivalent subunit vaccine induces protective immunity in genetically diverse collaborative cross recombinant inbred intercross mice. NPJ Vaccines 2021; 6:17. [PMID: 33500417 PMCID: PMC7838260 DOI: 10.1038/s41541-020-00276-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/11/2020] [Indexed: 01/04/2023] Open
Abstract
This study tests the hypothesis that an Onchocerca volvulus vaccine, consisting of two recombinant antigens (Ov-103 and Ov-RAL-2) formulated with the combination-adjuvant Advax-2, can induce protective immunity in genetically diverse Collaborative Cross recombinant inbred intercross mice (CC-RIX). CC-RIX lines were immunized with the O. volvulus vaccine and challenged with third-stage larvae. Equal and significant reductions in parasite survival were observed in 7 of 8 CC-RIX lines. Innate protective immunity was seen in the single CC-RIX line that did not demonstrate protective adaptive immunity. Analysis of a wide array of immune factors showed that each line of mice have a unique set of immune responses to vaccination and challenge suggesting that the vaccine is polyfunctional, inducing different equally-protective sets of immune responses based on the genetic background of the immunized host. Vaccine efficacy in genetically diverse mice suggests that it will also be effective in genetically complex human populations.
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Affiliation(s)
- Nathan M Ryan
- Department of Microbiology and Immunology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jessica A Hess
- Department of Microbiology and Immunology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Benjamin E Leiby
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ayako Shimada
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lei Yu
- Flow Cytometry Core Facility, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Amir Yarmahmoodi
- Flow Cytometry Core Facility, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Bin Zhan
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital Center for Vaccine Development, 1102 Bates St, Ste. 550, Houston, TX, USA
| | - Maria Elena Bottazzi
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital Center for Vaccine Development, 1102 Bates St, Ste. 550, Houston, TX, USA
| | - Benjamin L Makepeace
- Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, 146 Brownlow Hill, Liverpool, L3 5RF, UK
| | - Sara Lustigman
- Laboratory of Molecular Parasitology, Lindsey F. Kimball Research Institute, New York Blood Center, 310 E 67th St, New York, NY, USA
| | - David Abraham
- Department of Microbiology and Immunology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
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Suzuki M, Ikari J, Anazawa R, Tanaka N, Katsumata Y, Shimada A, Suzuki E, Tatsumi K. PAD4 Deficiency Improves Bleomycin-induced Neutrophil Extracellular Traps and Fibrosis in Mouse Lung. Am J Respir Cell Mol Biol 2021; 63:806-818. [PMID: 32915635 DOI: 10.1165/rcmb.2019-0433oc] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Excessive release of neutrophil extracellular traps (NETs) has been implicated in several organ fibrosis, including pulmonary fibrosis. NETs constitute a phenomenon in which decorated nuclear chromatin with cytosolic proteins is released into the extracellular space. PAD4 (peptidylarginine deiminase 4) plays an important role in the formation of NETs. However, the role of NETs in the pathogenesis of pulmonary fibrosis remains undefined. Here, we identified NETs in the alveolar and interstitial lung space of mice undergoing bleomycin (BLM)-induced lung fibrosis, which was suppressed by a pan-PAD inhibitor, Cl-amidine. In vitro, BLM directly induced NETs in blood neutrophils, which was also inhibited by Cl-amidine. Furthermore, Padi4 gene knockout (PAD4-KO) in mice led to the alleviation of BLM-induced NETs and pulmonary fibrosis and to the expression of inflammatory and fibrotic genes. PAD4 deficiency prevented decreases in alveolar epithelial and pulmonary vascular endothelial cell numbers and increases in ACTA2-positive mesenchymal cells and S100A4-positive fibroblasts in the lung. Hematopoietic cell grafts from PAD4-KO mice, not wild-type mice, resolved BLM-induced lung fibrosis and fibrotic gene expression in wild-type and PAD4-KO mice, suggesting that expression of PAD4 in hematopoietic cells may be involved in the development of lung fibrosis. These data suggest that PAD4 deficiency could ameliorate BLM-induced formation of NETs and lung fibrosis, suggesting that this pathway could serve as a therapeutic target for pulmonary fibrosis treatment.
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Affiliation(s)
- Masaki Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba City, Chiba, Japan
| | - Jun Ikari
- Department of Respirology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba City, Chiba, Japan
| | - Rie Anazawa
- Department of Respirology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba City, Chiba, Japan
| | - Nozomi Tanaka
- Department of Respirology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba City, Chiba, Japan
| | - Yusuke Katsumata
- Department of Respirology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba City, Chiba, Japan
| | - Ayako Shimada
- Department of Respirology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba City, Chiba, Japan
| | - Eiko Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba City, Chiba, Japan
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba City, Chiba, Japan
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40
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Schafer JJ, Pandit NS, Cha A, Huesgen E, Badowski ME, Sherman E, Cocohoba J, Shimada A, Keith S. 1044. The Incidence and Severity of Drug interactions Before and After Switching Antiretroviral Therapy to Bictegravir/Emtricitabine/Tenofovir Alafenamide in Treatment Experienced Patients. Open Forum Infect Dis 2020. [PMCID: PMC7776504 DOI: 10.1093/ofid/ofaa439.1230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Switching antiretroviral therapy (ART) in virally suppressed people with HIV (PWH) can simplify treatment, improve tolerability, and limit long-term toxicity. It can also influence the presence of drug interactions (DIs) in a positive or negative manner among patients receiving concomitant medications (CMs). The extent to which switching ART to bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) influences DIs in treatment-experienced PWH is unclear. The purpose of this study was to assess changes in the incidence and severity of DIs after switching to BIC/FTC/TAF. Methods This was a multicenter retrospective cohort study of PWH on ART and at least one prescription CM who switched to BIC/FTC/TAF between 3/2018 and 6/2019. Using the University of Liverpool’s HIV drug interaction checker, two DI analyses were performed for each patient. The first assessed patients’ pre-switch ART regimen with their CM list. The second assessed the same CM list with BIC/FTC/TAF. Each ART-CM combination was given a numerical score of 0 (no or potential weak interaction), 1 (potential interaction), or 2 (contraindicated interaction). Total DI scores for each patient, both before and after switching to BIC/FTC/TAF, were then calculated. A paired t-test analyzed changes in DI scores following ART switches and a linear regression model examined factors contributing to DI score reductions. Results A total of 411 patients were included in the analysis (Table 1) of which 236 (57%) had at least one DI present at baseline. On average, patients had a baseline DI score of 1.4 (SD 1.8) and experienced a 1 point reduction (95% CI -1.1,-0.8) after switching to BIC/FTC/TAF (p < 0.0001). After adjusting for demographic variables as well as baseline ART and CM categories in the regression model, switching to BIC/FTC/TAF led to significant DI score reductions in patients receiving CMs for the following conditions: cardiovascular disease, neurologic and psychiatric disorders, chronic pain, inflammation, gastrointestinal and urologic conditions and conditions requiring hormonal therapy (Table 2). Table 1. Descriptive Summary of Baseline Characteristics, n =411. ![]()
Table 2. Linear Regression for the Difference of DI scores (post – pre), n =376. ![]()
Conclusion Switching ART to BIC/FTC/TAF can reduce the incidence of DIs among treatment-experienced PWH who are receiving CMs for a broad range of comorbid conditions. Disclosures Jason J. Schafer, PharmD, MPH, Gilead (Research Grant or Support)Merck (Grant/Research Support, Advisor or Review Panel member)ViiV (Advisor or Review Panel member) Elizabeth Sherman, PharmD, Gilead (Grant/Research Support) Jennifer Cocohoba, PharmD, AAHIVP, BCPS, Viiv (Grant/Research Support)
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Affiliation(s)
| | - Neha S Pandit
- University of Maryland Baltimore, Baltimore, Maryland
| | - Agnes Cha
- Northwell Health, Rego Park, New York
| | | | | | | | - Jennifer Cocohoba
- University of California San Francisco, School of Pharmacy, San Francisco, California
| | | | - Scott Keith
- Thomas Jefferson University, Philadelphia, PA
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41
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Schafer JJ, Pandit NS, Cha A, Huesgen E, Badowski M, Sherman EM, Cocohoba J, Shimada A, Keith SW. Incidence and Severity of Drug Interactions Before and After Switching Antiretroviral Therapy to Bictegravir/Emtricitabine/Tenofovir Alafenamide in Treatment-Experienced Patients. Open Forum Infect Dis 2020; 8:ofaa625. [PMID: 33511239 PMCID: PMC7813207 DOI: 10.1093/ofid/ofaa625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/15/2020] [Indexed: 12/13/2022] Open
Abstract
Background Switching antiretroviral therapy (ART) in people with HIV (PWH) can influence their risk for drug–drug interactions (DDIs). The purpose of this study was to assess changes in the incidence and severity of DDIs among PWH who switched their ART to bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF). Methods This was a multicenter retrospective cohort study of PWH on ART and at least 1 concomitant medication (CM) who switched to BIC/FTC/TAF between 3/2018 and 6/2019. Using the University of Liverpool’s HIV Drug Interaction Database, 2 DDI analyses were performed for each patient. The first assessed patients’ preswitch ART regimens with their CM list. The second assessed the same CM list with BIC/FTC/TAF. Each ART-CM combination was given a score of 0 (no or potential weak interaction), 1 (potential interaction), or 2 (contraindicated interaction). A paired t test analyzed changes in total DDI scores following ART switches, and linear regression examined factors contributing to DDI score reductions. Results Among 411 patients, 236 (57%) had at least 1 DDI present at baseline. On average, baseline DDI scores (SD) were 1.4 (1.8) and decreased by 1 point (95% CI, –1.1 to –0.8) after patients switched to BIC/FTC/TAF (P < .0001). After adjusting for demographics, baseline ART, and CM categories, switching to BIC/FTC/TAF led to significant DDI score reductions in patients receiving CMs for cardiovascular disease, neurologic/psychiatric disorders, chronic pain, inflammation, gastrointestinal/urologic conditions, and conditions requiring hormonal therapy. Conclusions Treatment-experienced PWH eligible to switch their ART may experience significant declines in number and severity of DDIs if switched to BIC/FTC/TAF.
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Affiliation(s)
- Jason J Schafer
- Department of Pharmacy Practice, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Neha S Pandit
- Department of Pharmacy Practice and Science, University of Maryland Baltimore School of Pharmacy, Baltimore, Maryland, USA
| | - Agnes Cha
- Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Emily Huesgen
- Department of Pharmacy Practice, Indiana University Health, Indianapolis, Indianapolis, USA
| | - Melissa Badowski
- Section of Infectious Diseases Pharmacotherapy, Department of Pharmacy Practice, University of Illinois at Chicago, College of Pharmacy, Chicago, Illinois, USA
| | - Elizabeth M Sherman
- Department of Pharmacy Practice, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida, USA.,Division of Infectious Diseases, Memorial Healthcare System, Hollywood, Florida, USA
| | - Jennifer Cocohoba
- Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, California, USA
| | - Ayako Shimada
- Division of Biostatistics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Scott W Keith
- Division of Biostatistics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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42
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Ehara M, Yamada S, Shibata K, Kameshima M, Fujiyama H, Matsui Y, Higashida Y, Shimada A, Ito T, Sano T, Okumura H, Masaoka K, Okawa Y. Changes in nutritional status by recovery phase interventions would be a powerful determinant of cardiovascular prognosis in heart failure patients. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Adequate nutrition has been proposed for better cardiovascular prognosis as well as fitness, although the impact of the “changes” in nutrition and fitness at recovery phase on the future prognosis has been unclear.
Purpose
We aimed to examine whether the change in nutritional level as a result of dietary intervention combined with exercise would determine patients' cardiovascular prognosis.
Methods
This study involved 398 consecutive patients who participated in phase II comprehensive cardiac rehabilitation (CCR) for at least three months. All patients underwent cardiopulmonary exercise test (CPX) at the initial and completion periods of CCR. Individual dietary guidance was periodically performed with exercise. Peak oxygen uptake (PVO2) was measured through CPX to evaluate the fitness level, whereas nutritional status was evaluated using the geriatric nutritional risk index (GNRI). Patients were divided in two groups according to the baseline GNRI and the change in GNRI (ΔGNRI) by the median, respectively, to compare their prognosis between groups. Then they were classified into four categories according to the median values of the changes in GNRI (ΔGNRI) and PVO2 (ΔPVO2) during CCR: “Both improved”, “Only GNRI improved”, “Only PVO2 improved” and “Both NOT improved”, to compare MACCE-free rate between categories.
Results
The rate of MACCE showed significant difference between categories (14%, 18%, 19% and 36%, p<0.001), which was approximately 2 times higher in “Both NOT improved” than the others. Kaplan-Meier analysis showed that according to the level of ΔGNRI, “higher ΔGNRI group” showed significantly higher in MACCE-free survival rate than “lower ΔGNRI group” (log rank p=0.010), whereas there was no significant difference according to the baseline GNRI (see figure). According to the categories divided by ΔGNRI and ΔPVO2, MACCE-free rate was significantly lower in “Both NOT improved” (log rank p<0.001) compared to the other categories. Cox proportional hazard regression analysis revealed that “both NOT improved” was an independent predictor of MACCE (hazard ratio, 2.1, 95% confident interval, 1.344–3.175, p<0.001).
Conclusion
Changes in nutritional level would determine patients' cardiovascular prognosis rather than the baseline nutritional level. Non-responders who showed no improvement in nutritional or fitness by interventions may result in a poor cardiovascular outcome.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Ehara
- Nagoya Heart Center, Nagoya, Japan
| | - S Yamada
- Nagoya University, Nagoya, Japan
| | | | | | | | - Y Matsui
- Nagoya Heart Center, Nagoya, Japan
| | | | | | - T Ito
- Nagoya Heart Center, Nagoya, Japan
| | - T Sano
- Nagoya Heart Center, Nagoya, Japan
| | | | | | - Y Okawa
- Nagoya Heart Center, Nagoya, Japan
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Leader A, Selvan P, Capparella L, Cammy R, Palidora J, Shimada A, Leiby B, Garber G, Worster B. Abstract S11-01: Assessing the impact of the COVID-19 pandemic on cancer patients, survivors, and caregivers. Clin Cancer Res 2020. [DOI: 10.1158/1557-3265.covid-19-s11-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The COVID-19 global pandemic created significant and unprecedented disruptions in in medical care and social services. Cancer patients are at increased risk of COVID-19 infection due to their immunosuppressive state and may fare worse than others who are COVID-19 positive because of their aggressive underlying disease. While presumed to be substantial, the extent of the impact of the pandemic on cancer patients, survivors, and caregivers was unknown.
Methods: Between April 23, 2020 and May 19, 2020, our urban, NCI-designated cancer center launched a “COVID and Cancer” survey for cancer patients, survivors, and caregivers. The purpose of the survey was to assess disruptions to cancer care, use and perceptions of telemedicine, access to social services and cancer support programs, and psychosocial well-being. The online survey was distributed through our cancer center’s email list for patient and survivor programming, via the electronic patient portal to patients in active treatment, and across our cancer center’s social media platforms. Descriptive statistics reported mean scores and frequencies while bivariate statistics reported differences in outcomes by respondent characteristics. The protocol and survey were approved by our Institutional Review Board.
Results: In less than one month and in the height of the pandemic, 1,107 people completed the survey. After removing duplicate and incomplete responses, the final sample of 985 respondents included 377 (38%) patients in active treatment, 576 (56%) survivors, and 18 (2%) caregivers. Fifty-six percent (n=555) were female; the mean age of respondents was 63 years old (SD= 11.9). Seventy-two percent (n=705) of respondents had solid tumor cancers while some had either a heme malignancy (22%) or both (4%). Among the 688 respondents who needed cancer care during the pandemic, 294 (43%) reported disruptions in appointments, labs, or scans. Fewer (<5%) reported disruptions in surgery, chemotherapy, or radiation. Almost half (n=335, 49%) reported a telehealth visit during this time. Most respondents (n=612, 62%) were worried about contracting COVID-19. Cancer patients who were in active treatment were significantly more likely to be worried about contracting COVID-19, as well as accessing medication, transportation, or caregiver support, than those who were not in active treatment.
Conclusions: Disruptions in cancer care were observed during the pandemic. Cancer patients in active treatment were more worried that resources needed for their care such as medication, transportation, and caregiver support would be impacted by the pandemic. At our cancer center, we tried to mitigate some of the survey observations by developing COVID-specific patient and caregiver support programs, partnering with local agencies to provide groceries and transportation to patients, and enhancing infrastructure to assist with telehealth appointments. Cancer center support services can overcome these barriers and ensure patient care, even in a pandemic.
Citation Format: Amy Leader, Preethi Selvan, Lisa Capparella, Rebecca Cammy, Janene Palidora, Ayako Shimada, Benjamin Leiby, Gregory Garber, Brooke Worster. Assessing the impact of the COVID-19 pandemic on cancer patients, survivors, and caregivers [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr S11-01.
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Affiliation(s)
- Amy Leader
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Preethi Selvan
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Lisa Capparella
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Rebecca Cammy
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Janene Palidora
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Ayako Shimada
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Benjamin Leiby
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Gregory Garber
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Brooke Worster
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
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Shimada A, Kawata N, Sato H, Ikari J, Suzuki E, Anazawa R, Suzuki M, Masuda Y, Haneishi H, Tatsumi K. Quantitative assessments for lung hyperinflation and chest wall geometry change by dynamic breathing MRI in patients with COPD. Imaging 2020. [DOI: 10.1183/13993003.congress-2020.864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Ugai K, Matsuda S, Mikami H, Shimada A, Misawa T, Nakamura H, Tatsumi K, Hatano M, Murayama T, Kasuya Y. Inhibition of the SET8 Pathway Ameliorates Lung Fibrosis Even Through Fibroblast Dedifferentiation. Front Mol Biosci 2020; 7:192. [PMID: 32850975 PMCID: PMC7419601 DOI: 10.3389/fmolb.2020.00192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/20/2020] [Indexed: 12/11/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a fatal lung disease of unknown etiopathogenesis. The activation of extracellular matrix (ECM)-producing myofibroblasts plays a key role in fibrotic tissue remodeling. The dedifferentiation of myofibroblasts has attracted considerable attention as a promising target for the development of effective therapeutic interventions against IPF. Here, we screened a small library of epigenetics-related inhibitors using dedifferentiation assay of lung myofibroblasts prepared from a patient at the terminal stages of IPF and chose UNC0379. The inhibition of SET8, a histone H4 lysine 20 (H4K20) monomethyltransferase, by UNC0379 markedly suppressed the expression of α-smooth muscle actin (SMA) and ED-A-fibronectin in myofibroblasts. In IPF myofibroblasts, SET8 expression and H4K20 monomethylation (H4K20me1) levels, which were significantly higher than those in normal human lung fibroblasts, were reduced upon treatment with UNC0379. Hence, the changes in the expression of the two fibrotic markers clearly correlated with those in SET8 expression and H4K20me1 level. Furthermore, in a mouse model of bleomycin (BLM)-induced lung fibrosis, the intratracheal administration of UNC0379 at an early fibrotic stage markedly ameliorated the histopathological changes associated with collagen deposition in the lungs. However, treatment with UNC0379 did not significantly affect the number of proinflammatory cells or cytokine production in the bronchoalveolar lavage fluids from mice treated with BLM. In the BLM-injured lung, SET8 was predominantly localized to the nuclei of α-SMA-positive cells, which colocalized with H4K20me1. Taken together, our results indicate that the inhibition of SET8 resulting in myofibroblast dedifferentiation may partly mitigate lung fibrosis without affecting the inflammatory responses.
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Affiliation(s)
- Keita Ugai
- Department of Biomedical Science, Graduate School of Medicine, Chiba University, Chiba, Japan.,Laboratory of Chemical Pharmacology, Graduate School of Pharmaceutical Sciences, Chiba, Japan
| | - Shuichi Matsuda
- Department of Biomedical Science, Graduate School of Medicine, Chiba University, Chiba, Japan.,Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hideki Mikami
- Department of Biomedical Science, Graduate School of Medicine, Chiba University, Chiba, Japan.,Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ayako Shimada
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomoko Misawa
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroyuki Nakamura
- Laboratory of Chemical Pharmacology, Graduate School of Pharmaceutical Sciences, Chiba, Japan
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masahiko Hatano
- Department of Biomedical Science, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Toshihiko Murayama
- Laboratory of Chemical Pharmacology, Graduate School of Pharmaceutical Sciences, Chiba, Japan
| | - Yoshitoshi Kasuya
- Department of Biomedical Science, Graduate School of Medicine, Chiba University, Chiba, Japan.,Department of Biochemistry and Molecular Pharmacology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Shimada A, Fujita K, Kitago M, Ichisaka S, Ishikawa K, Kikunaga H, Kumai K, Miura H. Perforated duodenal diverticulum successfully treated with a combination of surgical drainage and endoscopic nasobiliary and nasopancreatic drainage: a case report. Surg Case Rep 2020; 6:129. [PMID: 32514821 PMCID: PMC7280391 DOI: 10.1186/s40792-020-00891-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/29/2020] [Indexed: 12/03/2022] Open
Abstract
Background Perforation of a duodenal diverticulum is a rare complication that may become fatal with a delay in appropriate treatment. However, the optimal treatment for perforated duodenal diverticulum remains controversial, ranging from conservative therapy to surgery including pancreatoduodenectomy. Case presentation The patient was a 60-year-old woman with no particular medical history who visited our hospital with chief complaints of continuous fever and right dorsal pain. Upon arrival, she had tenderness in the right upper quadrant of the abdomen. Laboratory data showed the elevation of inflammatory markers. Computed tomography revealed free air with abscess formation around the duodenum, which was diagnosed as duodenal perforation with abdominal abscess. We decided on emergent surgery, and we identified the perforation site on the dorsal side of the second portion of the duodenum intraoperatively. However, the inflammation around the perforation site was severe, and it was difficult to perform primary closure or dissection of the perforated diverticulum. Therefore, we finished surgery by placing four indwelling intra-abdominal tubes. Since postoperative day (POD) 1, the elevation of inflammation markers appeared to be uncontrollable, owing to the leakage of bile and pancreatic juice. We decided to perform endoscopic retrograde cholangiopancreatography on POD 2, and inserted endoscopic nasobiliary drainage and nasopancreatic drainage tubes. The patient showed a good postoperative course and was discharged on POD 57. Conclusions Endoscopic nasobiliary and nasopancreatic drainage in combination with surgical drainage may be an effective treatment for perforated duodenal diverticulum.
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Affiliation(s)
- Ayako Shimada
- Department of Surgery, Hino Municipal Hospital, 4-3-1 Tamadaira, Hino, Tokyo, 191-0062, Japan. .,Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare Narita Hospital, Narita, Japan.
| | - Koji Fujita
- Department of Surgery, Hino Municipal Hospital, 4-3-1 Tamadaira, Hino, Tokyo, 191-0062, Japan
| | - Minoru Kitago
- Department of Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Shunsuke Ichisaka
- Department of Surgery, Hino Municipal Hospital, 4-3-1 Tamadaira, Hino, Tokyo, 191-0062, Japan
| | - Keiichi Ishikawa
- Department of Surgery, Hino Municipal Hospital, 4-3-1 Tamadaira, Hino, Tokyo, 191-0062, Japan
| | - Hiroyuki Kikunaga
- Department of Surgery, Hino Municipal Hospital, 4-3-1 Tamadaira, Hino, Tokyo, 191-0062, Japan
| | - Koichiro Kumai
- Department of Surgery, Hino Municipal Hospital, 4-3-1 Tamadaira, Hino, Tokyo, 191-0062, Japan
| | - Hiroshi Miura
- Department of Radiology, Hino Municipal Hospital, Hino, Japan
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Leader A, Waldman L, Yocavitch L, Shimada A, Cammy R, Garber GD, Worster B. Screening for health literacy at an urban academic cancer center. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e19034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19034 Background: Low health literacy is more prevalent among older adults and minority populations, and it has been linked to excess health care utilization and poor health outcomes in cancer patients. Screening for health literacy may improve communication and care, such that discussions and information can be tailored to patient need. The purpose of this study was to describe health literacy levels and correlates among patients at an urban, NCI-designated cancer center. Methods: In September 2019, we began health literacy screening for each newly diagnosed, English-speaking cancer patient. Patients were categorized as having low, medium, or high health literacy using the BRIEF health literacy screener; results are visible in the EMR. For this analysis, we included patient age, gender, insurance type, race/ethnicity, and socio-economic status (SES), which was calculated using an Area Deprivation Index (ADI) ranging from 0 (no deprivation) to 100 (extreme deprivation). Data was summarized using descriptive statistics; ANOVA and Chi-squared tests investigated associations between patient’s health literacy levels and potential correlates. Results: Among 284 patients, 68%, (n = 195) were Caucasian, 25% (n = 70) were African American and 7%, (n = 19) identified as Hispanic, Asian American or some other race. Seventy-five percent (n = 211) were male; the mean age was 63 years (SD: 12). The mean ADI was 42 (SD: 28), indicating a low to moderate SES. Seventy percent (n = 200) had a high health literacy score, 20% (n = 57) had a medium score, and 10% (n = 27) had a low health literacy score. Only a patient’s race/ethnicity and the ADI were significantly associated with their health literacy score. Seventy-seven percent of Caucasian patients had high health literacy scores compared to 59% of African American patients and 48% patients of Hispanic, Asian or some other origin (P < .001). Patients with low health literacy had an ADI score (65.1) that was almost double the score of patients with high health literacy scores (38.5) (p < .001). Conclusions: Roughly one-third of patients seen at this urban cancer center did not have a high health literacy score. Socio-economic status was a stronger correlate to health literacy than patient age, marital status, or insurance type. EMRs should capture a patient’s SES in some manner, as this is strongly associated with health literacy.
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Affiliation(s)
- Amy Leader
- Sidney Kimmel Cancer Center, Philadelphia, PA
| | - Lauren Waldman
- Sidney Kimmel Cancer Center at Jefferson, Philadelphia, PA
| | - Liana Yocavitch
- Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Ayako Shimada
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | | | - Gregory D. Garber
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
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Worster B, Garber GD, Cammy R, Yocavitch L, Shimada A, Csik VP, Chapman AE, Leader A. Effect of a supportive medicine program for cancer patients on patient connectivity to care and health care utilization. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.2034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2034 Background: The benefits of supportive medicine (SM) for cancer patients include improved quality of life, increased patient satisfaction, improved symptom management, increased cost savings and improved survival rates. At one NCI-designated cancer center, all patients were screened for distress; those who screened positive or were directly referred by a provider were enrolled into our multi-disciplinary SM program. Here, we document the impact of the supportive medicine program on outcomes of emergency department (ED) visits, hospital readmission, and non-billable touchpoints associated with patient navigation and resource referrals. Methods: The program systematically screened for biopsychosocial distress utilizing the National Comprehensive Cancer Center Distress Thermometer (DT) and the Problem Checklist (PC) to identify practical, emotional, spiritual and physical issues. Patients were categorized into three types: screened and enrolled in the SM program, and screened and not enrolled in the SM program, or provider referral into the SM program. Data included patient’s age, number of hospital admissions, emergency department visits, and non-billable touchpoints at 90 and 180 days after the distress screening or referral. Descriptive data were analyzed with counts and percentages for categorical variables and summarized with mean and standard deviation for numerical variables. For investigation of the effects of time and patient type on the change in utilization rate, generalized estimation equations for Poisson regression were conducted for each outcome. Results: In all, 2,738 patients were included in the analysis. Patients who were referred from a provider tended to be younger (p < .01) and more likely to die within 90 days (p < .001). At 180 days, ED visits decreased 18% for patients referred to the SM program and 42% for patients screened into the SM program, compared to a 3% decrease in ED visits among those not enrolled in the SM program (p < .01). Similarly, hospital admissions decreased 34% for patients referred to and 39% screened into the SM program, compared to a 4% increase for patients not enrolled in the SM program (p < .01). Non-billable touchpoints increased among all types of patients. Conclusions: An SM program reduces hospital admissions and ED visits, therefore improving outcomes and potentially reducing the cost of care for cancer patients. Future research should link this data to claims data to definitely evaluate the impact of SM programs on cost.
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Affiliation(s)
| | | | | | - Liana Yocavitch
- Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Ayako Shimada
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | | | | | - Amy Leader
- Sidney Kimmel Cancer Center, Philadelphia, PA
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Sato T, Orloff MM, Valsecchi ME, Shimada A, Chervoneva I, Sharpe-Mills E, Klose H, Norcini J, Belinsky J, Sato S, Hulse L, Shields CL, Shields JA, Mastrangelo MJ. A randomized phase II study of adjuvant sunitinib or valproic acid in high-risk patients with uveal melanoma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e22059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e22059 Background: Uveal melanoma is the most common primary intraocular cancer in adults. Despite successful treatment of primary tumors, up to 50% of patients later die of distant metastases. Currently, no effective adjuvant treatment is available. Presence of both monosomy 3 and 8q amplification (M3 + 8q amp) or DecisionDx-UM Class 2 in the primary uveal melanoma characterizes a group of patients with high metastatic death rates with reported 2-year survival rates ranging from 50% to 78%. This study aims to decrease or delay the death from metastatic uveal melanoma. Methods: Uveal melanoma patients with high risk for systemic metastasis defined as any of the following were eligible: A) M3 + 8q amp; B) Class 2. Patients must show no evidence of systemic metastasis and they need to be enrolled within 6 months of initial treatment of primary uveal melanoma. Patients were randomized to receive either sunitinib 25 mg daily or valproic acid (VPA) 750 mg daily as adjuvant treatment for 6 consecutive months. Improvement of 2-year overall survival (OS) rate from historical reference (70%) to 85% was the primary endpoint. The secondary endpoints included 1) systemic relapse-free survival (RFS) rate at 18 months, 2) ability to complete adjuvant treatment and, 3) toxicity assessment. The study was not powered to compare the efficacy between each arm. Results: A total of 90 patients were enrolled in this study. Two patients were excluded from the study including one in the sunitinib arm (did not start treatment after randomization) and one in the VPA arm (refused to stop VPA at 6 months). Nine of 45 patients in the sunitinib arm and 4 of 43 patients in the VPA arm could not complete the 6-month treatment due to toxicity (sunitinib n = 6, VPA n = 2) or systemic progression (sunitinib n = 3, VPA n = 2). The rest of patients completed the 6-month course of study treatments and all patients were followed at least for 2 years. With a median follow-up of 40.2 months, the 2-year OS rates of the sunitinib and VPA group were 95.6% (90% CI 86.5-98.6) and 90.7% (90% CI 80.1 - 95.8), respectively. The 18-month RFS rates of the sunitinib and VPA group were 75.6% (90% CI 63.1 - 84.3) and 62.8% (90% CI 49.4 - 73.5), respectively. Conclusions: Although the study is still ongoing, adjuvant sunitinib and VPA were considered to be safe and tolerable treatments for high-risk uveal melanoma. Sunitinib showed a tendency for a better outcome, thus a Cohort 2 was created to investigate the safety and potential improvement of 18-month RFS rate with 12 months of treatment with sunitinib. Clinical trial information: NCT02068586.
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Affiliation(s)
- Takami Sato
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Marlana M. Orloff
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | | | - Ayako Shimada
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Inna Chervoneva
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Erin Sharpe-Mills
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Haley Klose
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Jessica Norcini
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Jill Belinsky
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Shingo Sato
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Liam Hulse
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
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Abu-Khalaf MM, Shimada A, Nikita N, Micaily I, Hackbart H, Lu-Yao GL, Butryn M. Change in body mass index in breast cancer patients in the first two years from diagnosis. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e19020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19020 Background: The rate of obesity in adults is 34% in the city of Philadelphia, with rates being highest among non-Hispanic blacks and Hispanics. We sought to evaluate how BMI varies by age and race/ethnicity at time of initial encounter for a breast cancer (BC) diagnosis (dx), and investigate factors predictive of BMI change in the first 2 years of dx. Methods: We identified 1,833 patients (pts) in our electronic medical record, (1/2015-present), who had a BC dx at their first hospital or ambulatory encounter using ICD-10 code C50.X, and had BMI recorded at baseline (BL) (6 mo pre-and up to 3 mo post), at 1 yr +/- 3 mo and 2 yr +/- 6 mo. We summarized demographic data (age, gender, marital status, race/ethnicity) with mean and standard deviation for continuous variables and with count and percentage for categorical variables. Descriptive statistics were summarized by 3-level BMI categories: underweight/normal (≤ 24.9), overweight (25 to 29.9), and obese (>30) and compared with ANOVA test, Chi-square-test or Fisher’s exact test as appropriate. Mixed effect regression analysis was conducted to adjust for the effects of time (i.e., BL, 1 yr, 2 yr), gender, race/ethnicity and the interaction of time and race and ethnicity in estimating mean BMI. We calculated the mean change of BMI between the BL and later time points by race/ethnicity. The significance level of all tests was set a priori to the 0.05 level. Results: 99.4% of pts were female; mean age was 63 yrs; White (60 %), Black/AA (27 %). By BMI category, we did not observe a substantial difference in the mean age of dx and gender (p = 0.18 for age and p = 0.55 for gender). We observed a substantial difference in race/ethnicity among BMI categories (p < .0001); the highest percentage of obese pts were Black/AA. In the mixed effect model, the reference level was set as a white female with an average (avg) systolic blood pressure of 137.8. The estimated avg BL BMI of this reference group was 28.8. We observed that among Asian/Pacific Islander (API) pts the avg BL BMI is lower by 3.5 ( p < .0001) and among female Black/AA pts the avg BL BMI is higher by 2.6 ( p < .0001) compared to reference group. No significant change was noted in mean BMI between BL and 1 yr for any race and ethnicity group, and only the Hispanic/Latino group had a declining trend for change in BMI between BL and 2 yr (estimate: -1.9; 95% CI: -5.9, 2.1). Conclusions: In our cohort, Black/AA pts likely have higher BL BMI and API pts likely have lower BL BMI compared to White pts. We found no significant difference in change of BMI by race and ethnicity group during the first 2 years from an initial encounter for a BC dx.
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Affiliation(s)
| | - Ayako Shimada
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
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