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Thompson LE, Davis BH, Narayan R, Goff B, Brown TM, Limdi NA. Personalizing Direct Oral Anticoagulant Therapy for a Diverse Population: Role of Race, Kidney Function, Drug Interactions, and Pharmacogenetics. Clin Pharmacol Ther 2023; 113:585-599. [PMID: 35857814 PMCID: PMC9852362 DOI: 10.1002/cpt.2714] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/13/2022] [Indexed: 01/24/2023]
Abstract
Oral anticoagulants (OACs) are commonly used to reduce the risk of venous thromboembolism and the risk of stroke in patients with atrial fibrillation. Endorsed by the American Heart Association, American College of Cardiology, and the European Society of Cardiology, direct oral anticoagulants (DOACs) have displaced warfarin as the OAC of choice for both conditions, due to improved safety profiles, fewer drug-drug and drug-diet interactions, and lack of monitoring requirements. Despite their widespread use and improved safety over warfarin, DOAC-related bleeding remains a major concern for patients. DOACs have stable pharmacokinetics and pharmacodynamics; however, variability in DOAC response is common and may be attributed to numerous factors, including patient-specific factors, concomitant medications, comorbid conditions, and genetics. Although DOAC randomized controlled trials included patients of varying ages and levels of kidney function, they failed to include patients of diverse ancestries. Additionally, current evidence to support DOAC pharmacogenetic associations have primarily been derived from European and Asian individuals. Given differences in genotype frequencies and disease burden among patients of different biogeographic groups, future research must engage diverse populations to assess and quantify the impact of predictors on DOAC response. Current under-representation of patients from diverse racial groups does not allow for proper generalization of the influence of clinical and genetic factors in relation to DOAC variability. Herein, we discuss factors affecting DOAC response, such as age, sex, weight, kidney function, drug interactions, and pharmacogenetics, while offering a new perspective on the need for further research including frequently excluded groups.
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Affiliation(s)
- Lorenzo E. Thompson
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL
| | - Brittney H. Davis
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL
| | - Renuka Narayan
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL
| | - Blake Goff
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL
| | - Todd M Brown
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Nita A. Limdi
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL
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Korf B, Absher D, Asif I, Bateman L, Barsh G, Bowling K, Cooper G, Davis B, East K, Finnila C, Goff B, Kelly M, Kelley W, Latner D, Lawlor J, Limdi N, May T, Might M, Moss I, Nakano M, Osborne T, Sodeke S, Stout A, Thompson M. eP494: Integration of genomics into primary care via the Alabama Genomic Health Initiative. Genet Med 2022. [DOI: 10.1016/j.gim.2022.01.526] [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: 10/18/2022] Open
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Kay A, Venn M, Urban R, Gray H, Goff B. Narcotic use after hospital discharge for ovarian cancer patients on our Enhanced Recovery After Surgery (ERAS) pathway. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2019.11.058] [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: 10/24/2022]
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Lichtman AS, Goff B, Parker W, Mehra N, Shore EM, Lefebvre G, Chiang A, Lenihan J, Schreuder HWR. Improving Cognitive Surgical Knowledge in Ob/Gyn Residents Using an Interactive Computer-Based Laparoscopic Hysterectomy Trainer. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.051] [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: 10/20/2022]
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Martin J, Urban R, Goff B. Bevacizumab toxicity in heavily pre-treated recurrent epithelial ovarian cancer. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.07.065] [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: 10/22/2022]
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Lichtman A, Goff B, Schreuder H, Lenihan J, Lefebvre G, Parker W, Mehra N, Ciotti M, Chiang A. A Validation Study: Does Use of an Interactive Computer Based Laparoscopic Hysterectomy Trainer Expand Cognitive Surgical Knowledge of Ob/Gyn Trainees beyond That of Traditional Educational Tools? J Minim Invasive Gynecol 2014. [DOI: 10.1016/j.jmig.2014.08.304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Renata R, Schiff M, Goff B. The impact of a comprehensive perioperative venous thromboembolism prophylaxis plan on a gynecologic oncology service. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.07.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dao M, Alwan L, Goff B, Liao J. Altered recurrence patterns after extended treatment with bevacizumab for ovarian, fallopian tube, and primary peritoneal cancer. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.343] [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: 10/26/2022]
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Goff B, Gee DG, Telzer EH, Humphreys KL, Gabard-Durnam L, Flannery J, Tottenham N. Reduced nucleus accumbens reactivity and adolescent depression following early-life stress. Neuroscience 2012; 249:129-38. [PMID: 23262241 DOI: 10.1016/j.neuroscience.2012.12.010] [Citation(s) in RCA: 156] [Impact Index Per Article: 13.0] [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: 08/16/2012] [Revised: 12/05/2012] [Accepted: 12/07/2012] [Indexed: 01/18/2023]
Abstract
Depression is a common outcome for those having experienced early-life stress (ELS). For those individuals, depression typically increases during adolescence and appears to endure into adulthood, suggesting alterations in the development of brain systems involved in depression. Developmentally, the nucleus accumbens (NAcc), a limbic structure associated with reward learning and motivation, typically undergoes dramatic functional change during adolescence; therefore, age-related changes in NAcc function may underlie increases in depression in adolescence following ELS. The current study examined the effects of ELS in 38 previously institutionalized children and adolescents in comparison to a group of 31 youths without a history of ELS. Consistent with previous research, the findings showed that depression was higher in adolescents than children with a history of ELS. Additionally, functional magnetic resonance imaging results showed atypical NAcc development, where the ELS group did not show a typical increase in NAcc reactivity during adolescence. Consequently, the ELS group showed NAcc hypoactivation during adolescence, and lower NAcc reactivity was correlated with higher depression scores. The results have important implications for understanding how ELS may influence increases in depression via neural development during the transition to adolescence and highlight the importance of identifying at-risk individuals in childhood, a potential critical period for depression-targeted intervention.
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Affiliation(s)
- B Goff
- University of California, Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, USA.
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Vogel T, Shah C, Dunsmoor-Su R, Knickerbocker A, McLean K, Garcia R, Goff B. A contemporary analysis of clear cell carcinoma of the endometrium. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.07.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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McLean K, Van Cleve W, Eckert L, Prager S, Swisher E, Hawes S, Goff B. Associations between Papanicolaou testing and cervical cancer in elderly women. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.07.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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McLean K, Amarosa E, Chiang S, Gray H, Swisher E, Goff B. Comparison of surgical complications in obese patients undergoing open vs. robotic gynecologic surgery. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.07.073] [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: 10/28/2022]
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Goff B, Lowe K, Kane J, Robertson M, Gaul M, Andersen M. The safety of symptom based screening for ovarian cancer. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.07.027] [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: 11/25/2022]
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Aghajanian C, Nycum L, Goff B, Nguyen H, Husain A, Blank S. Updated Overall Survival Analysis in Oceans, a Randomized Phase 3 Trial of Gemcitabine (G) + Carboplatin (C) and Bevacizumab (BV) or Placebo (PL) Followed by BV or PL in Platinum-Sensitive Recurrent Epithelial Ovarian (ROC), Primary Peritoneal (PPC), or Fallopian Tube Cancer (FTC). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33532-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Aghajanian C, Blank S, Goff B, Judson P, Nycum L, Sovak M, Yi J, Husain A. Late-Breaking Abstract 5: Results from a 2nd interim OS analysis in OCEANS: A randomized phase 3 trial of gemcitabine (G), carboplatin (C) and bevacizumab (BV) followed by BV to disease progression in patients with platinum-sensitive recurrent epithelial ovarian (OC), primary peritoneal (PPC), or fallopian tube cancer (FTC). Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.03.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Falchook G, Goff B, Kurzrock R, Gray H, Martin L, Coleman R, Xiao H, Zhou X, Benaim E, Schilder R. Phase 1/2 study of weekly paclitaxel with or without alisertib, an investigational aurora a kinase inhibitor: Phase 1 results in patients with recurrent epithelial ovarian, fallopian tube, primary peritoneal, or breast cancer. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.071] [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: 10/28/2022]
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Gogoi R, Urban R, Sun H, Goff B. Evaluation of Society of Gynecologic Oncologists (SGO) quality surgical measures. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.261] [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: 11/26/2022]
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Aghajanian C, Blank S, Goff B, Judson P, Makhija S, Sharma S, Nycum L, Yi J, Husain A. Efficacy in Patient Subgroups in OCEANS, a Randomized, Double-blinded, Placebo-controlled, Phase 3 Trial of Chemotherapy ± Bevacizumab in Patients with Platinum-sensitive Recurrent Epithelial Ovarian (OC), Primary Peritoneal (PPC), or Fallopian Tube Cancer (FTC). Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)70104-6] [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: 10/17/2022]
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Goff B, Lowe K, Kane J, Robertson M, Gaul M, Andersen M. Symptom-triggered screening for ovarian cancer: A pilot study of feasibility and acceptability. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.189] [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: 11/26/2022]
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Goff B, Andrilla H, Baldwin L, Lishner D, Matthews B, Miller J, Trivers K. Ovarian cancer: Predictors of primary care physicians' referral to gynecologic oncologists. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Norquist B, Garcia R, Agnew K, Gross J, Swensen R, Goff B, Gray H, Karlan B, Swisher E. A history of breast carcinoma predicts worse survival in BRCA1 and BRCA2 mutation carriers with ovarian carcinoma. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.057] [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: 10/18/2022]
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Thrall M, Gray H, Symons R, Flum D, Weiss N, Goff B. Sequencing of therapy and outcomes associated with use of neoadjuvant chemotherapy in advanced epithelial ovarian cancer in the Medicare population. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.182] [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: 10/18/2022]
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Lachance JA, Everett EN, Greer B, Mandel L, Swisher E, Tamimi H, Goff B. The effect of age on clinical/pathologic features, surgical morbidity, and outcome in patients with endometrial cancer. Gynecol Oncol 2006; 101:470-5. [PMID: 16413048 DOI: 10.1016/j.ygyno.2005.11.009] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2005] [Revised: 11/02/2005] [Accepted: 11/07/2005] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the effect of age on clinical/pathologic features, surgical morbidity, and outcome in patients with endometrial cancer. METHODS All women with surgically treated endometrial cancer at the University of Washington in Seattle, Washington between January 1990 and January 2000 were eligible; 396 patients underwent retrospective chart review. Statistical analysis was performed by SPSS. Median follow-up time was 33 months (range, 1 to 120 months). RESULTS Age was < 45 years in 15% of patients, between 46 and 64 years in 47% of patients, and > 65 years in 38% of patients. Younger patients were statistically more obese than older patients (Body Mass Index of 40.3 kg/m2 vs. 35.3 kg/m2 vs. 31.0 kg/m2, P < 0.001). Intraoperatively, there were no differences between the three groups in the percentage of patients with lymph node sampling, operative time, blood loss, or complications. Postoperatively, older patients had more wound infections (P = 0.002), more cardiac events (P = 0.001), and more episodes of ileus (P = 0.025). Evaluation of pathology revealed that patients < 45 years old were statistically more likely to have endometrioid histology, grade I tumors, and stage IA disease. Women over age 65 were significantly more likely to have papillary serous histology, grade 3 tumors, and stage IC as compared to the younger patients. A subset analysis of patients > 75 years of age showed an increase in the percentage of patients with papillary serous histology (22% vs. 3%, P = 0.055), grade 3 disease (42% vs. 16%, P < 0.001), and stage IC disease (21% vs. 3%, P = 0.001) when compared to patients < 45 years old. Evaluation of endometrioid tumors only revealed a similar pattern of deeper myometrial invasion and higher tumor grade as age increased. CONCLUSIONS Younger patients with endometrial cancer are generally more obese, with lower grade, lower stage disease, and with more favorable histologic cell types. Despite this, approximately a quarter have stage II-IV disease and 9% have positive lymph nodes. The older patients represent a dramatically different subset of patients. They are more likely to have aggressive papillary serous histology, higher grade tumors, and advanced stage disease. Age should be a consideration in appropriate referrals to gynecologic oncologists.
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Affiliation(s)
- J A Lachance
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Box 356460, Seattle, WA 98195, USA
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Manthorpe M, Hobart P, Hermanson G, Ferrari M, Geall A, Goff B, Rolland A. Plasmid vaccines and therapeutics: from design to applications. Adv Biochem Eng Biotechnol 2005; 99:41-92. [PMID: 16568888 DOI: 10.1007/10_003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
In the late 1980s, Vical and collaborators discovered that the injection into tissues of unformulated plasmid encoding various proteins resulted in the uptake of the plasmid by cells and expression of the encoded proteins. After this discovery, a period of technological improvements in plasmid delivery and expression and in pharmaceutical and manufacturing development was quickly followed by a plethora of human clinical trials testing the ability of injected plasmid to provide therapeutic benefits. In this chapter, we summarize in detail the technologies used in the most recent company-sponsored clinical trials and discuss the potential for future improvements in plasmid design, manufacturing, delivery, formulation and administration. A generic path for the clinical development of plasmid-based products is outlined and then exemplified using a case study on the development of a plasmid vaccine from concept to clinical trial.
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Goff B, Paley PJ, Gooley T, Holmberg LA. Phase II trial of docetaxel (D) / carboplatin (C) as treatment for first relapsed platinum-sensitive stage III/IV ovarian cancer. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.5051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- B. Goff
- University of Washington, Seattle, WA; Swedish Medical Center, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - P. J. Paley
- University of Washington, Seattle, WA; Swedish Medical Center, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - T. Gooley
- University of Washington, Seattle, WA; Swedish Medical Center, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - L. A. Holmberg
- University of Washington, Seattle, WA; Swedish Medical Center, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
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Everett E, Tamimi H, Greer B, Swisher E, Paley P, Mandel L, Goff B. The effect of body mass index on clinical/pathologic features, surgical morbidity, and outcome in patients with endometrial cancer. Gynecol Oncol 2003; 90:150-7. [PMID: 12821356 DOI: 10.1016/s0090-8258(03)00232-4] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the effect of body mass index (BMI) on clinical/pathologic features, surgical morbidity, and outcome in patients with endometrial cancer. METHODS All women with surgically treated endometrial cancer at the University of Washington in Seattle, Washington, between 1 January 1990 and 1 January 2000 were eligible; 439 patients were identified and 43 were excluded due to incomplete medical records; 396 patients underwent retrospective chart review. Statistical analysis was performed by SPSS. Median follow-up time was 27 months (range, 1 to 120 mo). RESULTS Mean BMI was 34 (range, 15 to 69). BMI was <30 in 40.7% of patients, 30 to 40 in 32.3%, and >40 in 27.0%. Clinically, patients with a BMI of >40 were more likely to have hypertension, diabetes, and pulmonary disease. Those patients with a BMI of >40 had statistically longer operating times (209 vs. 159 min) and more blood loss (604 vs. 324 ml) than patients with a BMI of <30. However, there was no difference between the three groups in number of lymph nodes removed, units of blood transfused, length of hospital stay, number of intensive care unit (ICU) days, or intraoperative complications. Postoperatively, patients with a BMI of >40 were more likely to have a wound separation than thinner patients. Pathologically, patients with a BMI of >40 were more likely to have endometrioid histology, lower stage disease, and lower grade tumors than women with a BMI of <30. However, 11.3% of patients with lymph node sampling and a BMI of >40 had positive lymph nodes and 23% were stage II or higher. Forty-two patients (10.6%) recurred. There were no postoperative deaths, and there was no difference in survival between the three groups. CONCLUSIONS Patients with a BMI of >40 frequently have favorable stage I endometrial cancers. However, approximately a quarter of these patients have evidence of cervical or extrauterine disease. This study confirms that surgical staging can be performed adequately and safely in morbidly obese patients with no difference in length of hospital stay, number of ICU days, intraoperative or postoperative complications.
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Affiliation(s)
- E Everett
- Department of Obstetrics and Gynecology, University of Washington Medical Center, Seattle, WA 98195-6460, USA.
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Kar S, Seigel R, Eigler N, Robinson A, Goff B, Makkar R. Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy (HOCM) using myocardial contrast echocardiography (MCE). An initial experience: Early and mid term results. Heart Lung Circ 2000. [DOI: 10.1046/j.1443-9506.2000.08734.x] [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: 11/20/2022]
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Makkar R, Goff B, Eigler N, Sebastian M, Fischell T, Barr L, D'Haem C, Shah PK, Effron MB, Litvack F. Effect of glycoprotein IIb/IIIa inhibition without thrombolytic therapy on reperfusion in acute myocardial infarction: results of ReoMI pilot study. Catheter Cardiovasc Interv 1999; 48:430-4. [PMID: 10559827 DOI: 10.1002/(sici)1522-726x(199912)48:4<430::aid-ccd20>3.0.co;2-g] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [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] [Indexed: 11/08/2022]
Abstract
The efficacy of abciximab and moderate dose heparin in attaining reperfusion in acute MI was tested in a multicenter pilot study. Patients with acute MI of less than 6-hr onset triaged to primary PTCA received intravenous abciximab bolus and infusion and heparin (70 u/kg) in the emergency room. Mean time to angiography from administration of abciximab was 34 +/- 23 min. TIMI flow rates were: grade 0-62%, grade I-20%, grade II-9%, and grade III-9%. Primary PTCA was performed with 100% success rate. Access site bleeding occurred in 10% of patients with no incidence of intracranial bleeding. TIMI II/III flow rates were 50% in a patient subset where angiography was delayed by 45 min. While not an alternative to thrombolytics in AMI, abciximab administration in the emergency room in patients triaged to PTCA may be beneficial in situation where door to needle time is delayed as TIMI II/III flows may be attained in some patients. Cathet. Cardiovasc. Intervent. 48:430-434, 1999.
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Affiliation(s)
- R Makkar
- Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
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Abstract
BACKGROUND Cesarean scar rupture of a gravid uterus in early gestation is rare. CASE A 38-year-old woman, gravida 4, para 2-0-1-1, presented at 13 weeks' gestation with cramping and spotting. She had a history of two cesareans. Ultrasound and magnetic resonance imaging indicated probable uterine dehiscence and a viable extrauterine pregnancy. After embolization of the uterine arteries with subsequent fetal death, the subject had a hysterectomy. Intraoperatively, she had complete rupture of the lower uterine segment, but the pregnancy was enclosed within scar tissue between the uterus and bladder. Placenta percreta was found by histologic examination. CONCLUSION Women with histories of cesareans might be at risk of early uterine rupture.
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Affiliation(s)
- S Marcus
- Department of Obstetrics and Gynecology, University of Washington Medical Center, Seattle 98195-6460, USA.
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Makkar R, Eigler N, Goff B, Fry E, Barr L, D'Haem C, Fischell T, Litvack F. Primary reperfusion in acute myocardial infection with ReoPro and heparin: interim results of ReoMI pilot study. J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(98)81052-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Anderson S, Shera K, Ihle J, Billman L, Goff B, Greer B, Tamimi H, McDougall J, Klingelhutz A. Telomerase activation in cervical cancer. Am J Pathol 1997; 151:25-31. [PMID: 9212727 PMCID: PMC1857907] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
It has been hypothesized that infection with high-risk human papillomaviruses (HPVs), in conjunction with other cellular events, plays a critical role in the development of cervical cancer. Activation of telomerase, a ribonucleoprotein enzyme complex that synthesizes telomere repeats, has been associated with acquisition of the immortal phenotype in vitro and is commonly observed in human cancers. In this study, we have examined 10 high-grade cervical cancers for telomerase activity and for the presence of HPV. Telomerase activity was detected in all of the cancers but in none of the paired histopathologically normal uterine tissues or in normal cervical epithelium. Analysis of these same tissues for HPV nucleic acids by polymerase chain reaction (PCR) using primers from the HPV L1 and E6 open reading frames demonstrated that 7 of 10 cancers were positive for HPV, 3 for HPV type 16 (HPV-16), and 4 for HPV-18. In one case, HPV-16 was detected in histopathologically normal uterine tissue, the same type as that detected in the cancer from the same patient. HPV DNA was not detected in 3 of 10 cancers. These results indicate that telomerase activation is common in high-grade cervical cancers and suggests that telomerase activity may be a useful diagnostic marker for the disease.
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Affiliation(s)
- S Anderson
- Program in Cancer Biology, Fred Hutchinson Cancer Research Center, University of Washington, Seattle 98104, USA
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Abstract
Seventy-three percent of a sample of 46 Cambodian youth interviewed in 1984 and 1987 were reinterviewed in 1990 as part of a pretest for a multisite study of Cambodian refugee trauma now under way. An additional sample of convenience of 38 youth were also interviewed to determine reliability and validity of the diagnostic instruments chosen for the larger study. The DSM-III-R diagnosis of post-traumatic stress disorder (PTSD) was found to persist, but the symptoms appeared less intense over time. In contrast, the prevalence of depression dropped markedly since 1987. Subjects remained largely free of comorbid conditions. Diagnostic reliability and validity were satisfactory. The follow-up sample appeared to be functioning well despite their PTSD profiles. The findings are discussed in light of several current controversies surrounding the concept and measurement of PTSD.
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Affiliation(s)
- W H Sack
- Division of Child Psychiatry, Oregon Health Sciences University, Portland 97201
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Abstract
Sixty-nine Cambodian adolescents and young adults were interviewed to determine their experience as children surviving the Pol Pot regime (1975-1979); their first-year experience of resettlement in this country; and their experience of stressful events during the past year. Current DSM-III-R diagnostic status was also determined. A strong relationship between earlier war trauma, resettlement strain, and symptoms of posttraumatic stress disorder (PTSD) was found. In contrast, the strongest relationship with depressive symptoms was found for recent stressful events. These results are discussed in light of current findings from stress and PTSD research.
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Affiliation(s)
- G Clarke
- Division of Child Psychiatry, Oregon Health Sciences University, Portland 97201
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Goff B. Management--forward planning. Nurs Times 1992; 88:38-9. [PMID: 1289852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Muntz H, Lage J, Goff B, Feldman S, Bell D, Rice L. Adenocarcinoma in situ of the uterine cervix. Gynecol Oncol 1992. [DOI: 10.1016/0090-8258(92)90551-s] [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: 10/26/2022]
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Lobel SM, Meyerovitz MF, Benson CC, Goff B, Bengtson JM. Preoperative angiographic uterine artery embolization in the management of cervical pregnancy. Obstet Gynecol 1990; 76:938-41. [PMID: 2216260] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The diagnosis of a cervical ectopic pregnancy is often made intraoperatively in the presence of extensive hemorrhage during attempted evacuation. In some cases, hysterectomy has been the necessary treatment to control bleeding. We report two cases of cervical pregnancy detected by ultrasound. Before pregnancy termination, the uterine arteries were successfully embolized using angiographic techniques. As a result, surgical evacuation was performed with minimal hemorrhage; hysterectomy was not required and the patients' potential fertility was retained.
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Affiliation(s)
- S M Lobel
- Department of Obstetrics and Gynecology Brigham and Women's Hospital, Boston, Massachusetts
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Goff B, Rice L, Leavitt T. Assessment of depth of myometrial invasion in endometrial adenocarcinoma. Gynecol Oncol 1990. [DOI: 10.1016/0090-8258(90)90200-5] [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: 10/26/2022]
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Abstract
A study was conducted to assess the psychosocial characteristics of individuals who become involved in large group awareness training (LGAT) programs. Prospective participants in The Forum, which has been classified as an LGAT, were compared with nonparticipating peers and with available normative samples on measures of well-being, negative life events, social support, and philosophical orientation. Results revealed that prospective participants were significantly more distressed than peer and normative samples of community residents and had a higher level of impact of recent negative life events compared with peer (but not normative) samples. Prospective participants also held preparticipation values more similar to those espoused by the LGAT than peer or normative samples, and the three groups failed to be distinguished by their levels of social support. The implications of the findings are considered for understanding participation in LGATs and other self-change promoting activities.
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Affiliation(s)
- Y Klar
- University of Connecticut, Storrs 06269-1020
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Abstract
We characterized the gangliosides from cells of eight patients with different forms of acute leukemia (four lymphoblastic, four nonlymphoblastic) by thin-layer chromatography and high-performance liquid chromatography combined with glycosidase treatment. Our analysis indicated both quantitative and qualitative differences between the gangliosides of acute leukemia and those of normal leukocytes: 1, the absolute amount of ganglioside was decreased in the acute leukemia cells; 2, in general, acute leukemias had a more simplified ganglioside pattern in that they contained a greater proportion of the short-chain ganglioside, II3NeuAc-LacCer (GM#); 3, all of the acute leukemia cells contained reduced quantities of the ganglioside N-acetylneuraminosyl-lactotriaosylceramide, a compound previously found only in normal leukocytes; and 4, a disialylated ganglioside, II3(NeuAc)2-LacCer (GD3), which is not found in normal leukocytes, was isolated from the cells of one patient with acute nonlymphoblastic leukemia. These findings demonstrate important differences between the gangliosides of acute leukemia cells and normal leukocytes.
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Goff B. Grading of spasticity and its effect on voluntary movement. Physiotherapy 1976; 62:358-61. [PMID: 1005515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Goff B. The application of recent advances in neurophysiology to Miss M. Rood's concept of neuromuscular facilitation. Physiotherapy 1972; 58:409-15. [PMID: 4668364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Goff B. Excitatory cold. Physiotherapy 1969; 55:467-8. [PMID: 5349468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Goff B. Appropriate afferent stimulation. Physiotherapy 1969; 55:9-17. [PMID: 5763368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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