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Floyd N, Hassan MT, Tang Z, Krivoš M, Blatnik M, Cude-Woods C, Clayton SM, Holley AT, Ito TM, Johnson BA, Liu CY, Makela M, Morris CL, Navazo ASC, O'Shaughnessy CM, Renner EL, Pattie RW, Young AR. Scintillation characteristics of the EJ-299-02H scintillator. Rev Sci Instrum 2024; 95:045108. [PMID: 38573050 DOI: 10.1063/5.0179451] [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] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 03/04/2024] [Indexed: 04/05/2024]
Abstract
A study of the dead layer thickness and quenching factor of a plastic scintillator for use in ultracold neutron (UCN) experiments is described. Alpha spectroscopy was used to determine the thickness of a thin surface dead layer to be 630 ± 110 nm. The relative light outputs from the decay of 241Am and Compton scattering of electrons were used to extract Birks' law coefficient, yielding a kB value of 0.087 ± 0.003 mm/MeV, consistent with some previous reports for other polystyrene-based scintillators. The results from these measurements are incorporated into the simulation to show that an energy threshold of (∼9 keV) can be achieved for the UCNProBe experiment. This low threshold enables high beta particle detection efficiency and the indirect measurement of UCN. The ability to make the scintillator deuterated, accompanied by its relatively thin dead layer, gives rise to unique applications in a wide range of UCN experiments, where it can be used to trap UCN and detect charged particles in situ.
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Affiliation(s)
- N Floyd
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
- University of Kentucky, Lexington, Kentucky 40506, USA
| | - Md T Hassan
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - Z Tang
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - M Krivoš
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - M Blatnik
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
- W. K. Kellogg Radiation Laboratory, California Institute of Technology, Pasadena, California 91125, USA
| | - C Cude-Woods
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
- North Carolina State University, Raleigh, North Carolina 27695, USA
| | - S M Clayton
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - A T Holley
- Tennessee Technological University, Cookeville, Tennessee 38505, USA
| | - T M Ito
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - B A Johnson
- Indiana University, Bloomington, Indiana 47405, USA
| | - C-Y Liu
- University of Illinois, Champaign, Illinois 61820, USA
| | - M Makela
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - C L Morris
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - A S C Navazo
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | | | - E L Renner
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - R W Pattie
- East Tennessee State University, Johnson City, Tennessee 37614, USA
| | - A R Young
- North Carolina State University, Raleigh, North Carolina 27695, USA
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Agrawal P, Rostom M, Alam R, Florissi I, Biles M, Rodriguez K, Hahn NM, Johnson BA, Matoso A, Smith A, Bivalacqua TJ, Kates M, Hoffman-Censits J, Patel SH. Clinicopathologic and Survival After Cystectomy Outcomes in Squamous Cell Carcinoma of the Bladder. Clin Genitourin Cancer 2023; 21:631-638.e1. [PMID: 37336703 DOI: 10.1016/j.clgc.2023.05.019] [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: 02/19/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Squamous cell carcinoma of the bladder (SqCC) is a rare disease with limited management data. Thus, we sought to characterize the clinicopathologic and survival outcomes amongst patients with SqCC and explore the association of squamous differentiation within urothelial carcinoma (UC w/Squam), as compared to muscle invasive pure UC. METHODS We conducted a single-center retrospective cohort study of patients, stratified by histology, who underwent cystectomy for MIBC. Baseline clinicopathologic characteristics were compared, and overall survival was assessed using Kaplan-Meier method. RESULTS We identified 1,034 patients; 37 (3.58%) with SqCC histology, 908 (87.81%) with UC histology, and 89 (8.61%) with UC w/ Squam histology. Among SqCC patients, a higher proportion were Black and similarly a higher proportion were women; amongst patients with UC w/ Squam a higher proportion had lower BMI; and amongst patients with UC a higher proportion had lower clinical (c) T, cN, pathological (p) T, and pN stages. Patients presenting with UC were more likely to receive intravesical therapy; patients presenting with SqCC were less likely to receive neoadjuvant chemotherapy (NAC). Adjuvant chemotherapy rates were similar. With post-hoc Bonferroni analysis, overall survival, cancer-specific survival, and recurrence-free survival were significantly worse for the UC w/ Squam cohort. CONCLUSIONS UC w/ Squam histology was associated with worse survival outcomes after cystectomy for muscle invasive bladder cancer compared to UC. Our results suggest that UC w/ Squam is associated with more advanced disease compared to UC, warranting further prospective work on consideration of combination therapies for patients with this disease state.
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Affiliation(s)
- Pranjal Agrawal
- Department of Urology, The James Buchannan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mary Rostom
- Department of Urology, Desai Sethi Urology Institute, Miller School of Medicine, Miami, FL
| | - Ridwan Alam
- Department of Urology, The James Buchannan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Isabella Florissi
- Department of Urology, The James Buchannan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael Biles
- Department of Urology, The James Buchannan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Katherine Rodriguez
- Department of Urology, The James Buchannan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Noah M Hahn
- Department of Urology, The James Buchannan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Burles A Johnson
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andres Matoso
- Department of Urology, The James Buchannan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Armine Smith
- Department of Urology, The James Buchannan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Trinity J Bivalacqua
- Department of Urology, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA
| | - Max Kates
- Department of Urology, The James Buchannan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jeannie Hoffman-Censits
- Department of Urology, The James Buchannan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sunil H Patel
- Department of Urology, The James Buchannan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
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3
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An P, Awe C, Barbeau PS, Becker B, Belov V, Bernardi I, Bock C, Bolozdynya A, Bouabid R, Brown A, Browning J, Cabrera-Palmer B, Cervantes M, Conley E, Daughhetee J, Detwiler J, Ding K, Durand MR, Efremenko Y, Elliott SR, Fabris L, Febbraro M, Gallo Rosso A, Galindo-Uribarri A, Germer AC, Green MP, Hakenmüller J, Heath MR, Hedges S, Hughes M, Johnson BA, Johnson T, Khromov A, Konovalov A, Kozlova E, Kumpan A, Kyzylova O, Li L, Link JM, Liu J, Mahoney M, Major A, Mann K, Markoff DM, Mastroberti J, Mattingly J, Mueller PE, Newby J, Parno DS, Penttila SI, Pershey D, Prior CG, Rapp R, Ray H, Raybern J, Razuvaeva O, Reyna D, Rich GC, Ross J, Rudik D, Runge J, Salvat DJ, Sander J, Scholberg K, Shakirov A, Simakov G, Sinev G, Skuse C, Snow WM, Sosnovtsev V, Subedi T, Suh B, Tayloe R, Tellez-Giron-Flores K, Tsai YT, Ujah E, Vanderwerp J, van Nieuwenhuizen EE, Varner RL, Virtue CJ, Visser G, Walkup K, Ward EM, Wongjirad T, Yoo J, Yu CH, Zawada A, Zettlemoyer J, Zderic A. Measurement of Electron-Neutrino Charged-Current Cross Sections on ^{127}I with the COHERENT NaIνE Detector. Phys Rev Lett 2023; 131:221801. [PMID: 38101357 DOI: 10.1103/physrevlett.131.221801] [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] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/02/2023] [Accepted: 11/08/2023] [Indexed: 12/17/2023]
Abstract
Using an 185-kg NaI[Tl] array, COHERENT has measured the inclusive electron-neutrino charged-current cross section on ^{127}I with pion decay-at-rest neutrinos produced by the Spallation Neutron Source at Oak Ridge National Laboratory. Iodine is one the heaviest targets for which low-energy (≤50 MeV) inelastic neutrino-nucleus processes have been measured, and this is the first measurement of its inclusive cross section. After a five-year detector exposure, COHERENT reports a flux-averaged cross section for electron neutrinos of 9.2_{-1.8}^{+2.1}×10^{-40} cm^{2}. This corresponds to a value that is ∼41% lower than predicted using the MARLEY event generator with a measured Gamow-Teller strength distribution. In addition, the observed visible spectrum from charged-current scattering on ^{127}I has been measured between 10 and 55 MeV, and the exclusive zero-neutron and one-or-more-neutron emission cross sections are measured to be 5.2_{-3.1}^{+3.4}×10^{-40} and 2.2_{-0.5}^{+0.4}×10^{-40} cm^{2}, respectively.
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Affiliation(s)
- P An
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - C Awe
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - P S Barbeau
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - B Becker
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - V Belov
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
- National Research Center "Kurchatov Institute," Moscow, 123182, Russian Federation
| | - I Bernardi
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - C Bock
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - A Bolozdynya
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
| | - R Bouabid
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - A Brown
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Mathematics and Physics, North Carolina Central University, Durham, North Carolina 27707, USA
| | - J Browning
- Department of Physics, North Carolina State University, Raleigh, North Carolina 27695, USA
| | | | - M Cervantes
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - E Conley
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - J Daughhetee
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - J Detwiler
- Center for Experimental Nuclear Physics and Astrophysics and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - K Ding
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - M R Durand
- Center for Experimental Nuclear Physics and Astrophysics and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - Y Efremenko
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - S R Elliott
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - L Fabris
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - M Febbraro
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - A Gallo Rosso
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - A Galindo-Uribarri
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - A C Germer
- Department of Physics, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | - M P Green
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics, North Carolina State University, Raleigh, North Carolina 27695, USA
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - J Hakenmüller
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - M R Heath
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - S Hedges
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - M Hughes
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
| | - B A Johnson
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
| | - T Johnson
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - A Khromov
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
| | - A Konovalov
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
| | - E Kozlova
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
| | - A Kumpan
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
| | - O Kyzylova
- Center for Neutrino Physics, Virginia Tech, Blacksburg, Virginia 24061, USA
| | - L Li
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - J M Link
- Center for Neutrino Physics, Virginia Tech, Blacksburg, Virginia 24061, USA
| | - J Liu
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - M Mahoney
- Department of Physics, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | - A Major
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - K Mann
- Department of Physics, North Carolina State University, Raleigh, North Carolina 27695, USA
| | - D M Markoff
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Mathematics and Physics, North Carolina Central University, Durham, North Carolina 27707, USA
| | - J Mastroberti
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
| | - J Mattingly
- Department of Nuclear Engineering, North Carolina State University, Raleigh, North Carolina 27695, USA
| | - P E Mueller
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - J Newby
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - D S Parno
- Department of Physics, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | - S I Penttila
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - D Pershey
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - C G Prior
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - R Rapp
- Washington & Jefferson College, Washington, Pennsylvania 15301, USA
| | - H Ray
- Department of Physics, University of Florida, Gainesville, Florida 32611, USA
| | - J Raybern
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - O Razuvaeva
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
- National Research Center "Kurchatov Institute," Moscow, 123182, Russian Federation
| | - D Reyna
- Sandia National Laboratories, Livermore, California 94550, USA
| | - G C Rich
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - J Ross
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Mathematics and Physics, North Carolina Central University, Durham, North Carolina 27707, USA
| | - D Rudik
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
| | - J Runge
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - D J Salvat
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
| | - J Sander
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - K Scholberg
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - A Shakirov
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
| | - G Simakov
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
- National Research Center "Kurchatov Institute," Moscow, 123182, Russian Federation
| | - G Sinev
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - C Skuse
- Department of Physics, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | - W M Snow
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
| | - V Sosnovtsev
- National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow 115409, Russian Federation
| | - T Subedi
- Center for Neutrino Physics, Virginia Tech, Blacksburg, Virginia 24061, USA
- Department of Physical and Environmental Sciences, Concord University, Athens, West Virginia 24712, USA
| | - B Suh
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
| | - R Tayloe
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
| | | | - Y-T Tsai
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - E Ujah
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Mathematics and Physics, North Carolina Central University, Durham, North Carolina 27707, USA
| | - J Vanderwerp
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
| | - E E van Nieuwenhuizen
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - R L Varner
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - C J Virtue
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - G Visser
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
| | - K Walkup
- Center for Neutrino Physics, Virginia Tech, Blacksburg, Virginia 24061, USA
| | - E M Ward
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - T Wongjirad
- Department of Physics and Astronomy, Tufts University, Medford, Massachusetts 02155, USA
| | - J Yoo
- Department of Physics and Astronomy, Seoul National University, Seoul, 08826, Korea
| | - C-H Yu
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - A Zawada
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - J Zettlemoyer
- Department of Physics, Indiana University, Bloomington, Indiana 47405, USA
| | - A Zderic
- Center for Experimental Nuclear Physics and Astrophysics and Department of Physics, University of Washington, Seattle, Washington 98195, USA
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4
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Mokkapati S, Narayan VM, Manyam GC, Lim AH, Duplisea JJ, Kokorovic A, Miest TS, Mitra AP, Plote D, Anand SS, Metcalfe MJ, Dunner K, Johnson BA, Czerniak BA, Nieminen T, Heikura T, Yla-Herttuala S, Parker NR, Schluns KS, McConkey DJ, Dinney CP. Lentiviral interferon: A novel method for gene therapy in bladder cancer. Mol Ther Oncolytics 2022; 26:141-157. [PMID: 35847448 PMCID: PMC9251210 DOI: 10.1016/j.omto.2022.06.005] [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] [Received: 12/08/2021] [Accepted: 06/07/2022] [Indexed: 11/29/2022] Open
Abstract
Interferon alpha (IFNα) gene therapy is emerging as a new treatment option for patients with non-muscle invasive bladder cancer (NMIBC). Adenoviral vectors expressing IFNα have shown clinical efficacy treating bacillus Calmette-Guerin (BCG)-unresponsive bladder cancer (BLCA). However, transient transgene expression and adenoviral immunogenicity may limit therapeutic activity. Lentiviral vectors can achieve stable transgene expression and are less immunogenic. In this study, we evaluated lentiviral vectors expressing murine IFNα (LV-IFNα) and demonstrate IFNα expression by transduced murine BLCA cell lines, bladder urothelium, and within the urine following intravesical instillation. Murine BLCA cell lines (MB49 and UPPL1541) were sensitive to IFN-mediated cell death after LV-IFNα, whereas BBN975 was inherently resistant. Upregulation of interleukin-6 (IL-6) predicted sensitivity to IFN-mediated cell death mediated by caspase signaling, which when inhibited abrogated IFN-mediated cell killing. Intravesical therapy with LV-IFNα/Syn3 in a syngeneic BLCA model significantly improved survival, and molecular analysis of treated tumors revealed upregulation of apoptotic and immune-cell-mediated death pathways. In particular, biomarker discovery analysis identified three clinically actionable targets, PD-L1, epidermal growth factor receptor (EGFR), and ALDHA1A, in murine tumors treated with LV-IFNα/Syn3. Our findings warrant the comparison of adenoviral and LV-IFNα and the study of novel combination strategies with IFNα gene therapy for the BLCA treatment.
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Affiliation(s)
- Sharada Mokkapati
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
- Corresponding author Sharada Mokkapati, PhD, University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA.
| | - Vikram M. Narayan
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
| | - Ganiraju C. Manyam
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
| | - Amy H. Lim
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
| | - Jonathan J. Duplisea
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
| | - Andrea Kokorovic
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
| | - Tanner S. Miest
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
| | - Anirban P. Mitra
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
| | - Devin Plote
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
| | - Selvalakshmi Selvaraj Anand
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
| | - Michael J. Metcalfe
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
| | - Kenneth Dunner
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
| | - Burles A. Johnson
- James Buchanan Brady Urological Institute, John Hopkins Greenberg Bladder Cancer Institute, John Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Bogdan A. Czerniak
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
| | - Tiina Nieminen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Tommi Heikura
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
| | - Seppo Yla-Herttuala
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | | | - Kimberley S. Schluns
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
| | - David J. McConkey
- James Buchanan Brady Urological Institute, John Hopkins Greenberg Bladder Cancer Institute, John Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Colin P. Dinney
- University of Texas MD Anderson Cancer Center, Smith Research Building, 7777 Knight Road, Houston, TX 77584, USA
- Corresponding author Colin P. Dinney, MD, University of Texas MD Anderson Cancer Center, CPB7.3279, 1515 Holcombe Blvd., Houston, TX 77030, USA.
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5
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Aragaki AK, Jing Y, Hoffman-Censits J, Choi W, Hahn NM, Trock BJ, McConkey DJ, Johnson BA. Gender-specific Stratification of Survival Following Immune Checkpoint Inhibitor Therapy Based on Intratumoral Expression of a B cell Gene Signature. Eur Urol Oncol 2021; 5:338-346. [PMID: 34426176 DOI: 10.1016/j.euo.2021.07.003] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/25/2021] [Accepted: 07/02/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND There is a great need to identify biomarkers that can accurately identify patients who will obtain the most clinical benefit from immune checkpoint inhibitor (ICI) therapy. While high intratumoral B cell gene expression correlated with an ICI response in melanoma, whether it adds predictive value in other cancers is unknown. OBJECTIVE To examine the relationship between B cell gene signature (BCGS) expression and overall survival (OS) following ICI treatment. DESIGN, SETTING, AND PARTICIPANTS A total of 348 patients with advanced urothelial carcinoma from the IMvigor 210 phase 2 clinical trial of atezolizumab and 406 patients with muscle-invasive bladder cancer from The Cancer Genome Atlas (TCGA) were included. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We analyzed tumor RNA sequencing data of included patients to examine the relationships between a BCGS and clinical outcomes. RESULTS AND LIMITATIONS Tumors with high levels of B cell and CD8+ T cell gene signatures (BCGS/CD8TGS or B8T high/high) were associated with the longest OS of all B8T groups. Moreover, the B8T cell signature stratified patients whose tumors had a high tumor mutational burden or high programmed death ligand 1 (PD-L1) into subsets with differential OS outcomes. Whereas the B8T high/high tumors were associated with the best clinical outcomes in ICI-treated men, they were not associated with better OS in women. Conversely, women with B8T high/high tumors had the best clinical outcomes in non-ICI-treated muscle-invasive bladder cancer. CONCLUSIONS These data suggest that the B8T signature can enhance OS stratification in patients with advanced urothelial carcinoma who are treated with ICI therapy and that sex-specific differences in the tumor immune microenvironment may drive disparate outcomes. PATIENT SUMMARY We examined whether the presence of two immune cell gene signatures within tumor samples impact survival in patients with bladder cancer. High levels of both of these signatures (B cells and CD8+ T cells) associate with superior survival in patients who receive immune therapy.
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Affiliation(s)
- Adam K Aragaki
- Greenberg Bladder Cancer Institute, Johns Hopkins University, Baltimore, MD, USA; The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Yuezhou Jing
- Greenberg Bladder Cancer Institute, Johns Hopkins University, Baltimore, MD, USA; The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Jean Hoffman-Censits
- Greenberg Bladder Cancer Institute, Johns Hopkins University, Baltimore, MD, USA; The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA; The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Woonyoung Choi
- Greenberg Bladder Cancer Institute, Johns Hopkins University, Baltimore, MD, USA; The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Noah M Hahn
- Greenberg Bladder Cancer Institute, Johns Hopkins University, Baltimore, MD, USA; The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA; The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Bruce J Trock
- Greenberg Bladder Cancer Institute, Johns Hopkins University, Baltimore, MD, USA; The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA
| | - David J McConkey
- Greenberg Bladder Cancer Institute, Johns Hopkins University, Baltimore, MD, USA; The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA; The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Burles A Johnson
- Greenberg Bladder Cancer Institute, Johns Hopkins University, Baltimore, MD, USA.
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Tang Z, Watkins EB, Clayton SM, Currie SA, Fellers DE, Hassan MT, Hooks DE, Ito TM, Lawrence SK, MacDonald SWT, Makela M, Morris CL, Neukirch LP, Saunders A, O'Shaughnessy CM, Cude-Woods C, Choi JH, Young AR, Zeck BA, Gonzalez F, Liu CY, Floyd NC, Hickerson KP, Holley AT, Johnson BA, Lambert JC, Pattie RW. Ultracold neutron properties of the Eljen-299-02D deuterated scintillator. Rev Sci Instrum 2021; 92:023305. [PMID: 33648127 DOI: 10.1063/5.0030972] [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] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/19/2021] [Indexed: 06/12/2023]
Abstract
In this paper, we report studies of the Fermi potential and loss per bounce of ultracold neutrons (UCNs) on a deuterated scintillator (Eljen-299-02D). These UCN properties of the scintillator enable its use in a wide variety of applications in fundamental neutron research.
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Affiliation(s)
- Z Tang
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - E B Watkins
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - S M Clayton
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - S A Currie
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - D E Fellers
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - Md T Hassan
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - D E Hooks
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - T M Ito
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - S K Lawrence
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - S W T MacDonald
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - M Makela
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - C L Morris
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - L P Neukirch
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - A Saunders
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | | | - C Cude-Woods
- North Carolina State University, Raleigh, North Carolina 27695, USA
| | - J H Choi
- North Carolina State University, Raleigh, North Carolina 27695, USA
| | - A R Young
- North Carolina State University, Raleigh, North Carolina 27695, USA
| | - B A Zeck
- North Carolina State University, Raleigh, North Carolina 27695, USA
| | - F Gonzalez
- Indiana University, Bloomington, Indiana 47405, USA
| | - C Y Liu
- Indiana University, Bloomington, Indiana 47405, USA
| | - N C Floyd
- University of Kentucky, Lexington, Kentucky 40506, USA
| | - K P Hickerson
- W. K. Kellogg Radiation Laboratory, California Institute of Technology, Pasadena, California 91125, USA
| | - A T Holley
- Tennessee Technological University, Cookeville, Tennessee 38505, USA
| | - B A Johnson
- Utah State University, Logan, Utah 84322, USA
| | - J C Lambert
- Utah State University, Logan, Utah 84322, USA
| | - R W Pattie
- East Tennessee State University, Johnson City, Tennessee 37614, USA
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7
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Brijkumar J, Johnson BA, Zhao Y, Edwards J, Moodley P, Pathan K, Pillay S, Castro KG, Sunpath H, Kuritzkes DR, Moosa MYS, Marconi VC. A packaged intervention to improve viral load monitoring within a deeply rural health district of South Africa. BMC Infect Dis 2020; 20:836. [PMID: 33176715 PMCID: PMC7659110 DOI: 10.1186/s12879-020-05576-5] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 11/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The KwaZulu-Natal (KZN) province of South Africa has the highest prevalence of HIV infection in the world. Viral load (VL) testing is a crucial tool for clinical and programmatic monitoring. Within uMkhanyakude district, VL suppression rates were 91% among patients with VL data; however, VL performance rates averaged only 38·7%. The objective of this study was to determine if enhanced clinic processes and community outreach could improve VL monitoring within this district. METHODS A packaged intervention was implemented at three rural clinics in the setting of the KZN HIV AIDS Drug Resistance Surveillance Study. This included file hygiene, outreach, a VL register and documentation revisions. Chart audits were used to assess fidelity. Outcome measures included percentage VL performed and suppressed. Each rural clinic was matched with a peri-urban clinic for comparison before and after the start of each phase of the intervention. Monthly sample proportions were modelled using quasi-likelihood regression methods for over-dispersed binomial data. RESULTS Mkuze and Jozini clinics increased VL performance overall from 33·9% and 35·3% to 75·8% and 72·4%, respectively which was significantly greater than the increases in the comparison clinics (RR 1·86 and 1·68, p < 0·01). VL suppression rates similarly increased overall by 39·3% and 36·2% (RR 1·84 and 1·70, p < 0·01). The Chart Intervention phase showed significant increases in fidelity 16 months after implementation. CONCLUSIONS The packaged intervention improved VL performance and suppression rates overall but was significant in Mkuze and Jozini. Larger sustained efforts will be needed to have a similar impact throughout the province.
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Affiliation(s)
- J Brijkumar
- University of KwaZulu Natal, Nelson R Mandela School of Medicine, Durban, South Africa
| | | | - Y Zhao
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - J Edwards
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - P Moodley
- School of Laboratory Medicine and Medical Sciences, National Health Laboratory Service, University of KwaZulu-Natal, Durban, South Africa
| | - K Pathan
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - S Pillay
- University of KwaZulu Natal, Nelson R Mandela School of Medicine, Durban, South Africa
| | - K G Castro
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - H Sunpath
- University of KwaZulu Natal, Nelson R Mandela School of Medicine, Durban, South Africa
| | - D R Kuritzkes
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - M Y S Moosa
- University of KwaZulu Natal, Nelson R Mandela School of Medicine, Durban, South Africa
| | - V C Marconi
- Emory University Rollins School of Public Health, Atlanta, GA, USA.
- Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA.
- Emory Vaccine Center, Atlanta, USA.
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8
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Yarchoan M, Myzak MC, Johnson BA, De Jesus-Acosta A, Le DT, Jaffee EM, Azad NS, Donehower RC, Zheng L, Oberstein PE, Fine RL, Laheru DA, Goggins M. Olaparib in combination with irinotecan, cisplatin, and mitomycin C in patients with advanced pancreatic cancer. Oncotarget 2018; 8:44073-44081. [PMID: 28454122 PMCID: PMC5546463 DOI: 10.18632/oncotarget.17237] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [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: 02/24/2016] [Accepted: 03/13/2017] [Indexed: 12/21/2022] Open
Abstract
Background Olaparib is an oral inhibitor of polyadenosine 5’-diphosphoribose polymerization (PARP) that has previously shown signs of activity in patients with BRCA mutations and pancreatic ductal adenocarcinoma (PDAC). Patients and Methods In this phase 1 dose-escalation trial in patients with unresectable PDAC, we determined the maximum tolerated dose (MTD) of olaparib (tablet formulation) in combination with irinotecan 70 mg/m2 on days 1 and 8 and cisplatin 25 mg/m2 on days 1 and 8 of a 28-day cycle (olaparib plus IC). We then studied the safety and tolerability of adding mitomycin C 5 mg/m2 on day 1 to this regimen (olaparib plus ICM). Results 18 patients with unresectable PDAC were enrolled. The MTD of olaparib plus IC was olaparib 100 mg twice-daily on days 1 and 8. The addition of mitomycin C to this dose level was not tolerated. Grade ≥3 drug-related adverse events (AEs) were encountered in 16 patients (89%). The most common grade ≥3 drug-related toxicities included neutropenia (89%), lymphopenia (72%), and anemia (22%). Two patients (11%), both of whom had remained on study for more than 12 cycles, developed drug-related myelodysplastic syndrome (MDS). The objective response rate (ORR) for all evaluable patients was 23%. One patient who carried a deleterious germline BRCA2 mutation had a durable clinical response lasting more than four years, but died from complications of treatment-related MDS. Conclusions Olaparib had substantial toxicity when combined with IC or ICM in patients with PDAC, and this treatment combination did not have an acceptable risk/benefit profile for further study. However, durable clinical responses were observed in a subset of patients and further clinical investigation of PARP inhibitors in PDAC is warranted. Trial registration This clinical trial was registered on ClinicalTrials.gov as NCT01296763.
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Affiliation(s)
- Mark Yarchoan
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Melinda C Myzak
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Burles A Johnson
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Ana De Jesus-Acosta
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Dung T Le
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Elizabeth M Jaffee
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Nilofer S Azad
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Ross C Donehower
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Lei Zheng
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | | | - Robert L Fine
- Columbia University Medical Center, New York, NY, USA
| | - Daniel A Laheru
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Michael Goggins
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
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9
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Johnson BA, Yarchoan M, Lee V, Laheru DA, Jaffee EM. Strategies for Increasing Pancreatic Tumor Immunogenicity. Clin Cancer Res 2018; 23:1656-1669. [PMID: 28373364 DOI: 10.1158/1078-0432.ccr-16-2318] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 01/23/2017] [Accepted: 01/27/2017] [Indexed: 12/15/2022]
Abstract
Immunotherapy has changed the standard of care for multiple deadly cancers, including lung, head and neck, gastric, and some colorectal cancers. However, single-agent immunotherapy has had little effect in pancreatic ductal adenocarcinoma (PDAC). Increasing evidence suggests that the PDAC microenvironment is comprised of an intricate network of signals between immune cells, PDAC cells, and stroma, resulting in an immunosuppressive environment resistant to single-agent immunotherapies. In this review, we discuss differences between immunotherapy-sensitive cancers and PDAC, the complex interactions between PDAC stroma and suppressive tumor-infiltrating cells that facilitate PDAC development and progression, the immunologic targets within these complex networks that are druggable, and data supporting combination drug approaches that modulate multiple PDAC signals, which should lead to improved clinical outcomes. Clin Cancer Res; 23(7); 1656-69. ©2017 AACRSee all articles in this CCR Focus section, "Pancreatic Cancer: Challenge and Inspiration."
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Affiliation(s)
- Burles A Johnson
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University, Baltimore, Maryland
| | - Mark Yarchoan
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University, Baltimore, Maryland
| | - Valerie Lee
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University, Baltimore, Maryland
| | - Daniel A Laheru
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University, Baltimore, Maryland
| | - Elizabeth M Jaffee
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University, Baltimore, Maryland. .,Department of Pathology, Sidney Kimmel Comprehensive Cancer Center, Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University, Baltimore, Maryland
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10
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11
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Abstract
The past decade of cancer research has been marked by a growing appreciation of the role of immunity in cancer. Mutations in the tumour genome can cause tumours to express mutant proteins that are tumour specific and not expressed on normal cells (neoantigens). These neoantigens are an attractive immune target because their selective expression on tumours may minimize immune tolerance as well as the risk of autoimmunity. In this Review we discuss the emerging evidence that neoantigens are recognized by the immune system and can be targeted to increase antitumour immunity. We also provide a framework for personalized cancer immunotherapy through the identification and selective targeting of individual tumour neoantigens, and present the potential benefits and obstacles to this approach of targeted immunotherapy.
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Affiliation(s)
- Mark Yarchoan
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland 21231, USA
| | - Burles A Johnson
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland 21231, USA
| | - Eric R Lutz
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland 21231, USA
| | - Daniel A Laheru
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland 21231, USA
| | - Elizabeth M Jaffee
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland 21231, USA
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12
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Johnson BA, Frostig RD. Long, intrinsic horizontal axons radiating through and beyond rat barrel cortex have spatial distributions similar to horizontal spreads of activity evoked by whisker stimulation. Brain Struct Funct 2015; 221:3617-39. [PMID: 26438334 DOI: 10.1007/s00429-015-1123-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 05/06/2015] [Accepted: 09/23/2015] [Indexed: 01/11/2023]
Abstract
Stimulation of a single whisker evokes a peak of activity that is centered over the associated barrel in rat primary somatosensory cortex, and yet the evoked local field potential and the intrinsic signal optical imaging response spread symmetrically away from this barrel for over 3.5 mm to cross cytoarchitectonic borders into other "unimodal" sensory cortical areas. To determine whether long horizontal axons have the spatial distribution necessary to underlie this activity spread, we injected adeno-associated viral vectors into barrel cortex and characterized labeled axons extending from the injection site in transverse sections of flattened cortex. Combined qualitative and quantitative analyses revealed labeled axons radiating diffusely in all directions for over 3.5 mm from supragranular injection sites, with density declining over distance. The projection pattern was similar at four different cortical depths, including infragranular laminae. Infragranular vector injections produced patterns similar to the supragranular injections. Long horizontal axons were detected both using a vector with a permissive cytomegalovirus promoter to label all neuronal subtypes and using a calcium/calmodulin-dependent protein kinase II α vector to restrict labeling to excitatory cortical pyramidal neurons. Individual axons were successfully reconstructed from series of supragranular sections, indicating that they traversed gray matter only. Reconstructed axons extended from the injection site, left the barrel field, branched, and sometimes crossed into other sensory cortices identified by cytochrome oxidase staining. Thus, radiations of long horizontal axons indeed have the spatial characteristics necessary to explain horizontal activity spreads. These axons may contribute to multimodal cortical responses and various forms of cortical neural plasticity.
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Affiliation(s)
- B A Johnson
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, 92697-4550, USA
| | - R D Frostig
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, 92697-4550, USA. .,Department of Biomedical Engineering and Center for the Neurobiology of Learning and Memory, University of California, Irvine, Irvine, CA, 92697, USA.
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13
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Corcoran TE, Niven R, Verret W, Dilly S, Johnson BA. Lung deposition and pharmacokinetics of nebulized cyclosporine in lung transplant patients. J Aerosol Med Pulm Drug Deliv 2013; 27:178-84. [PMID: 23668548 DOI: 10.1089/jamp.2013.1042] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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 Inhaled cyclosporine (CsA) is being investigated as a prophylaxis for lung transplant rejection. Lung deposition and systemic exposure of nebulized CsA in lung transplant patients was evaluated as part of the Phase 3 cyclosporine inhalation solution (CIS) trial (CYCLIST). METHODS Ten patients received 300 mg of CIS (62.5 mg/mL CsA in propylene glycol) admixed with 148 MBq of Tc-DTPA (technetium-99m bound to diethylenetriaminepentaacetic acid) administered using a Sidestream(®) disposable jet nebulizer. Deposition was assessed using a dual-headed gamma camera. Blood samples were collected over a 24-hr time period after aerosol dosing and analyzed for CsA levels. A pharmacokinetic analysis of the resulting blood concentration versus time profiles was performed. RESULTS The average total deposited dose was 53.7 ± 12.7 mg. Average pulmonary dose was 31.8 ± 16.3 mg, and stomach dose averaged 15.5 ± 11.1 mg. Device performance was consistent, with breathing maneuvers influencing dose variation. Predose coaching with five of 10 patients reduced stomach deposition (22.6 ± 11.2 vs. 8.3 ± 5.2 mg; p=0.03). Blood concentrations declined quickly from a maximum of 372 ± 140 ng/mL to 15.3 ± 9.7 ng/mL at 24 hr post dose. Levels of AUC(0-24) [area under the concentration vs. time curve from 0 to 24 hr] averaged 1,493 ± 746 ng hr/mL. On a three times per week dose regimen, this represents <5% of the weekly systemic exposure of twice per day oral administration. CONCLUSIONS Substantial doses of CsA can be delivered to the lungs of lung transplant patients by inhaled aerosol. Systemic levels are small relative to typical oral CsA administration.
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Affiliation(s)
- T E Corcoran
- 1 Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh , Pittsburgh, PA 15213
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14
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McElroy JP, Krupp LB, Johnson BA, McCauley JL, Qi Z, Caillier SJ, Gourraud PA, Yu J, Nathanson L, Belman AL, Hauser SL, Waubant E, Hedges DJ, Oksenberg JR. Copy number variation in pediatric multiple sclerosis. Mult Scler 2012; 19:1014-21. [PMID: 23239789 DOI: 10.1177/1352458512469696] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [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: 11/16/2022]
Abstract
BACKGROUND Pediatric onset multiple sclerosis (MS) accounts for 2-4% of all MS. It is unknown whether the disease shares the same underlying pathophysiology found in adult patients or an extreme early onset phenotype triggered by distinct biological mechanisms. It has been hypothesized that copy number variations (CNVs) may result in extreme early onset diseases because CNVs can have major effects on many genes in large genomic regions. OBJECTIVES AND METHODS The objective of the current research was to identify CNVs, with a specific focus on de novo CNVs, potentially causing early onset MS by competitively hybridizing 30 white non-Hispanic pediatric MS patients with each of their parents via comparative genomic hybridization (CGH) analysis on the Agilent 1M CGH array. RESULTS AND DISCUSSION We identified 10 CNVs not overlapping with any CNV regions currently reported in the Database of Genomic Variants (DGV). Fifty-five putatively de novo CNVs were also identified: all but one common in the DGV. We found the single rare CNV was a private variation harboring the SACS gene. SACS mutations cause autosomal-recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) disease. Additional clinical review revealed that the patient with the SACS gene CNV shared some features of both MS and ARSACS. CONCLUSIONS This is the first reported study analyzing pediatric MS CNVs. While not yielding causal variation in our initial pediatric dataset, our approach confirmed diagnosis of an ARSACS-like disease in addition to MS in the affected individual, which led to a more complete understanding of the patient's disease course and prognosis.
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Affiliation(s)
- J P McElroy
- Department of Neurology, University of California at San Francisco, USA.
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15
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Baban B, Chandler PR, Johnson BA, Huang L, Li M, Sharpe ML, Francisco LM, Sharpe AH, Blazar BR, Munn DH, Mellor AL. Physiologic control of IDO competence in splenic dendritic cells. J Immunol 2011; 187:2329-35. [PMID: 21813777 DOI: 10.4049/jimmunol.1100276] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Dendritic cells (DCs) competent to express the regulatory enzyme IDO in mice are a small but distinctive subset of DCs. Previously, we reported that a high-dose systemic CpG treatment to ligate TLR9 in vivo induced functional IDO exclusively in splenic CD19(+) DCs, which stimulated resting Foxp3-lineage regulatory T cells (Tregs) to rapidly acquire potent suppressor activity. In this paper, we show that IDO was induced in spleen and peripheral lymph nodes after CpG treatment in a dose-dependent manner. Induced IDO suppressed local T cell responses to exogenous Ags and inhibited proinflammatory cytokine expression in response to TLR9 ligation. IDO induction did not occur in T cell-deficient mice or in mice with defective B7 or programmed death (PD)-1 costimulatory pathways. Consistent with these findings, CTLA4 or PD-1/PD-ligand costimulatory blockade abrogated IDO induction and prevented Treg activation via IDO following high-dose CpG treatment. Consequently, CD4(+)CD25(+) T cells uniformly expressed IL-17 shortly after TLR9 ligation. These data support the hypothesis that constitutive interactions from activated T cells or Tregs and IDO-competent DCs via concomitant CTLA4→B7 and PD-1→PD-ligand signals maintain the default potential to regulate T cell responsiveness via IDO. Acute disruption of these nonredundant interactions abrogated regulation via IDO, providing novel perspectives on the proinflammatory effects of costimulatory blockade therapies. Moreover, interactions between IDO-competent DCs and activated T cells in lymphoid tissues may attenuate proinflammatory responses to adjuvants such as TLR ligands.
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Affiliation(s)
- Babak Baban
- Department of Oral Biology, Georgia Health Sciences University, Augusta, GA 30912, USA
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16
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Abstract
Natural immune tolerance is a formidable barrier to successful immunotherapy to treat established cancers and chronic infections. Conversely, creating robust immune tolerance via immunotherapy is the major goal in treating autoimmune and allergic diseases, and enhancing survival of transplanted organs and tissues. In this review, we focus on a natural mechanism that creates local T-cell tolerance in many clinically relevant settings of chronic inflammation involving expression of the cytosolic enzyme indoleamine 2,3-dioxygenase (IDO) by specialized subsets of dendritic cells. IDO-expressing dendritic cells suppress antigen-specific T-cell responses directly, and induce bystander suppression by activating regulatory T cells. Thus, manipulating IDO is a promising strategy to treat a range of chronic inflammatory diseases.
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Affiliation(s)
- Burles A Johnson
- Immunotherapy Center & Department of Medicine, Medical College of Georgia, Augusta, GA 30912, USA.
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17
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Abstract
Dendritic cells (DCs) are specialized to stimulate T cell immunity. Paradoxically, some DCs suppress T cell responses and activate regulatory T cells. In this review, we focus on a potent counter-regulatory pathway mediated by plasmacytoid DCs (pDCs) expressing the immunosuppressive enzyme indoleamine 2,3 dioxygenase (IDO). IDO-expressing pDCs inhibit effector T cell responses, activate regulatory T cells, and attenuate pro-inflammatory responses in settings of chronic inflammation that manifest in clinical syndromes, such as infectious, allergic, and autoimmune diseases; cancer; and transplantation. Thus, IDO-expressing pDCs create immune privilege and provide novel opportunities to improve immunotherapy in multiple disease syndromes.
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Affiliation(s)
- Lei Huang
- Immunotherapy Center and Department of Radiology, Medical College of Georgia, Augusta, GA, USA
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18
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Abstract
A new antibiotic "bacitracin" has been recovered from a strain of the B. subtilis group of organisms. It is neutral, water-soluble, non-toxic and relatively heat stable. In vitro it is active chiefly against Grampositive organisms, but the gonococcus and meningococcus are susceptible to its action. It is also active in vivo against experimentally produced hemolytic streptococcal infections in mice and gas gangrene infections in guinea pigs. Clinical use in hemolytic streptococcal and staphylococcal infections in man have given encouraging results.
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19
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Johnson BA, Kahler DJ, Baban B, Chandler PR, Kang B, Shimoda M, Koni PA, Pihkala J, Vilagos B, Busslinger M, Munn DH, Mellor AL. B-lymphoid cells with attributes of dendritic cells regulate T cells via indoleamine 2,3-dioxygenase. Proc Natl Acad Sci U S A 2010; 107:10644-8. [PMID: 20498068 PMCID: PMC2890795 DOI: 10.1073/pnas.0914347107] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [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] [Indexed: 11/18/2022] Open
Abstract
A discrete population of splenocytes with attributes of dendritic cells (DCs) and coexpressing the B-cell marker CD19 is uniquely competent to express the T-cell regulatory enzyme indoleamine 2,3-dioxygenase (IDO) in mice treated with TLR9 ligands (CpGs). Here we show that IDO-competent cells express the B-lineage commitment factor Pax5 and surface immunoglobulins. CD19 ablation abrogated IDO-dependent T-cell suppression by DCs, even though cells with phenotypic attributes matching IDO-competent cells developed normally and expressed IDO in response to interferon gamma. Consequently, DCs and regulatory T cells (Tregs) did not acquire T-cell regulatory functions after TLR9 ligation, providing an alternative perspective on the known T-cell regulatory defects of CD19-deficient mice. DCs from B-cell-deficient mice expressed IDO and mediated T-cell suppression after TLR9 ligation, indicating that B-cell attributes were not essential for B-lymphoid IDO-competent cells to regulate T cells. Thus, IDO-competent cells constitute a distinctive B-lymphoid cell type with quintessential T-cell regulatory attributes and phenotypic features of both B cells and DCs.
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Affiliation(s)
| | | | - Babak Baban
- Immunotherapy and Cancer Centers, Departments of
- Pathology and
| | | | - Baolin Kang
- Immunotherapy and Cancer Centers, Departments of
| | - Michiko Shimoda
- Immunotherapy and Cancer Centers, Departments of
- Pathology and
| | | | - Jeanene Pihkala
- Flow Cytometry Core Facility, Medical College of Georgia, Augusta, GA 30912
| | - Bojan Vilagos
- Research Institute of Molecular Pathology, A-1030 Vienna, Austria; and
| | | | - David H. Munn
- Immunotherapy and Cancer Centers, Departments of
- Department of Pediatrics, Medical College of Georgia, Augusta, GA 30912
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Johnson BA, Wang J, Taylor EM, Caillier SJ, Herbert J, Khan OA, Cross AH, De Jager PL, Gourraud PAF, Cree BCA, Hauser SL, Oksenberg JR. Multiple sclerosis susceptibility alleles in African Americans. Genes Immun 2010; 11:343-50. [PMID: 19865102 PMCID: PMC2880217 DOI: 10.1038/gene.2009.81] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 09/11/2009] [Accepted: 09/15/2009] [Indexed: 12/24/2022]
Abstract
Multiple sclerosis (MS) is an autoimmune demyelinating disease characterized by complex genetics and multifaceted gene-environment interactions. Compared to whites, African Americans have a lower risk for developing MS, but African Americans with MS have a greater risk of disability. These differences between African Americans and whites may represent differences in genetic susceptibility and/or environmental factors. SNPs from 12 candidate genes have recently been identified and validated with MS risk in white populations. We performed a replication study using 918 cases and 656 unrelated controls to test whether these candidate genes are also associated with MS risk in African Americans. CD6, CLEC16a, EVI5, GPC5, and TYK2 contained SNPs that are associated with MS risk in the African American data set. EVI5 showed the strongest association outside the major histocompatibility complex (rs10735781, OR=1.233, 95% CI=1.06-1.43, P-value=0.006). In addition, RGS1 seems to affect age of onset whereas TNFRSF1A seems to be associated with disease progression. None of the tested variants showed results that were statistically inconsistent with the effects established in whites. The results are consistent with shared disease genetic mechanisms among individuals of European and African ancestry.
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Affiliation(s)
- B A Johnson
- Department of Neurology, University of California, San Francisco, CA 94143, USA
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Pobiel RS, Schellhas KP, Eklund JA, Golden MJ, Johnson BA, Chopra S, Broadbent P, Myers ME, Shrack K. Selective cervical nerve root blockade: prospective study of immediate and longer term complications. AJNR Am J Neuroradiol 2009; 30:507-11. [PMID: 19193762 DOI: 10.3174/ajnr.a1415] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Selective cervical nerve root blockade (SCNRB) is a useful procedure for evaluating and treating patients with cervical radiculopathy. Reports of complications related to injections within the cervical nerve root foramen have raised serious doubts regarding the safety of this procedure. This study was performed to prospectively evaluate the safety of fluoroscopically guided outpatient diagnostic and therapeutic SCNRB. MATERIALS AND METHODS Eight hundred two consecutive fluoroscopically guided diagnostic and/or therapeutic SCNRBs in 659 patients were performed during a 14-month period (November 2006-December 2007) at affiliated outpatient imaging centers. Each examination was performed by 1 of 8 experienced procedural radiologists by using an anterior oblique approach, with the needle position confirmed with radiographic contrast before injection of an admixture of local anesthetic and steroid. All patients were assessed immediately and at 30 minutes following the procedure. Additionally, 460 patients were called by telephone 30 days following the procedure. All complications were recorded. RESULTS Of the 802 attempted procedures, 799 were successfully completed. Three procedures were aborted due to anxiety, challenging body habitus, or persistent venous opacification observed during contrast injection and despite needle repositioning. There were no serious complications, such as stroke, spinal cord insult, permanent nerve root deficit, infection, or significant hematoma. There were 33 minor complications occurring within 30 minutes of the procedure; the most common was vasovagal symptoms. Three hundred forty-five patients were successfully contacted by telephone at 30 days postinjection, 9 of whom reported increased or new pain symptoms. CONCLUSIONS With our technique, fluoroscopically guided SCNRB is a safe outpatient procedure with a low immediate and delayed complication rate.
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Affiliation(s)
- R S Pobiel
- Center for Diagnostic Imaging, St Louis Park, MN 55416, USA.
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Johnson BA, Mussatto K, Uhing MR, Zimmerman H, Tweddell J, Ghanayem N. Variability in the preoperative management of infants with hypoplastic left heart syndrome. Pediatr Cardiol 2008; 29:515-20. [PMID: 18034198 DOI: 10.1007/s00246-007-9022-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [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] [Received: 06/08/2007] [Accepted: 06/13/2007] [Indexed: 11/27/2022]
Abstract
Infants with hypoplastic left heart syndrome (HLHS) commonly undergo initial surgical palliation during the first week of life. Few data exist on optimal preoperative management strategies; therefore, the management of these infants prior to surgery is anecdotal and variable. To more fully define this variability in preoperative care of infants with HLHS, a survey was designed to describe current preoperative management practices in the infant with HLHS. The questionnaire explored management styles as well as preoperative monitoring techniques and characteristics of the respondent's health care institution. The responses were compiled and are reported. A striking lack of consistency in preoperative management techniques for infants with HLHS is apparent. The impact of these preoperative strategies is unknown. Despite challenges in anatomic and hemodynamic variability at presentation, a prospective randomized controlled trial comparing ventilatory management techniques, enteral feeding strategies, and the utility of various monitoring tools on short- and long-term outcome is needed.
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Affiliation(s)
- B A Johnson
- Department of Pediatrics, Division of Cardiology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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Schellhas KP, Pollei SR, Johnson BA, Golden MJ, Eklund JA, Pobiel RS. Selective cervical nerve root blockade: experience with a safe and reliable technique using an anterolateral approach for needle placement. AJNR Am J Neuroradiol 2007; 28:1909-14. [PMID: 17905892 PMCID: PMC8134229 DOI: 10.3174/ajnr.a0707] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [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: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE [corrected] Our aim was to evaluate the safety and clinical utility of a fluoroscopically guided anterolateral oblique approach technique for outpatient diagnostic and therapeutic selective cervical nerve root blockade (SCNRB). MATERIALS AND METHODS During a 13-year period (1994 through February 2007), 4612 patients underwent fluoroscopically guided diagnostic and/or therapeutic extraforaminal SCNRB by using an anterior oblique approach at affiliated outpatient imaging centers. Each procedure was performed by 1 of 6 procedural radiologists, all highly experienced in and actively performing spinal injections on a full-time basis in clinical practice. All of the proceduralists were thoroughly experienced with lumbar injections before endeavoring to perform SCNRBs. Nonionic contrast was injected in nearly all patients (except isolated patients with contrast allergy), and a minimum of 2 projection filming procedures were performed to document the accuracy of needle placement and contrast dispersal before the injection of therapeutic substances. All clinically significant complications beyond skin discoloration and temporary exacerbation of symptoms were recorded. RESULTS There were no serious neurologic complications, such as stroke, spinal cord insult, or permanent nerve root deficit. One life-threatening anaphylactic reaction occurred and was attributed to the injected materials and not the specific procedure itself. Another patient had a 3- to 4-minute grand mal seizure, from which he fully recovered within 30 minutes. There were no infections. CONCLUSION The technique we describe for fluoroscopically guided SCNRB is a useful and safe outpatient procedure when performed by skilled and experienced proceduralists.
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Affiliation(s)
- K P Schellhas
- Center for Diagnostic Imaging, St Louis Park, MN 55416, USA.
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Johnson BA, Meleney FL. THE ANTISEPTIC AND DETOXIFYING ACTION OF ZINC PEROXIDE ON CERTAIN SURGICAL AEROBIC, ANAEROBIC AND MICRO-AEROPHILIC BACTERIA. Ann Surg 2007; 109:881-911. [PMID: 17857377 PMCID: PMC1391281 DOI: 10.1097/00000658-193906000-00001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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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Pobiel RS, Schellhas KP, Pollei SR, Johnson BA, Golden MJ, Eklund JA. Diskography: infectious complications from a series of 12,634 cases. AJNR Am J Neuroradiol 2006; 27:1930-2. [PMID: 17032869 PMCID: PMC7977892] [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: 05/12/2023]
Abstract
BACKGROUND AND PURPOSE Diskography is commonly performed to investigate pain of suspected diskogenic origin. Although uncommon, diskitis is a feared complication of this procedure. We reviewed the incidence of diskitis and other infectious complications following diskography in a large busy outpatient practice and discuss technical aspects that may contribute to infection prevention. METHODS We reviewed the electronic records of all diskograms obtained at our institution during a 12.25-year period, looking for all cases of procedure-related infection. All diskograms had been obtained by skilled and experienced procedural radiologists in dedicated spine-injection suites with specialized technical staff. RESULTS There were 12,634 examinations performed on 10,663 patients for a total of 37,135 disk levels. Of the disk levels, 5981 were cervical; 3083, thoracic; and 28,071, lumbar. Two cases of confirmed lumbar diskitis and no cases of either cervical or thoracic diskitis were seen in our series. No other infectious complications were found. The incidence of diskitis was 0.016% per examination and 0.0054% per disk level. CONCLUSION In skilled and experienced hands using proper technique, diskography is a safe outpatient procedure with an extremely low incidence of diskitis and other procedure-related infections.
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Affiliation(s)
- R S Pobiel
- Center for Diagnostic Imaging, St. Louis Park, MN 55416, USA.
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Tan LH, Johnson BA, Mawad ME, Chang AC. Neonate with vein of Galen malformation and heart failure: serial changes in plasma B-type natriuretic peptide following endovascular embolization. Pediatr Cardiol 2006; 27:276-8. [PMID: 16501882 DOI: 10.1007/s00246-005-1088-z] [Citation(s) in RCA: 3] [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] [Received: 05/05/2005] [Indexed: 10/25/2022]
Abstract
We report a neonate with vein of Galen malformation (VGM) who developed congestive heart failure (CHF) early after birth. Serial changes in plasma B-type natriuretic peptide (BNP) following an endovascular embolization procedure for VGM were mirrored in his clinical CHF status. The plasma BNP level markedly increased to 1800 pg/ml (normal, <100 pg/ml) in accordance with the severity of CHF. It rapidly decreased to 356 pg/ml during the first week after endovascular embolization for VGM. In the following 3 weeks there was an unexpected upward trend in plasma BNP despite echocardiography revealing normal biventricular function. After additional evaluation and treatment for CHF, BNP decreased again and the patient's clinical status concurrently improved. The patient was discharged with a normal BNP level. Monitoring serial plasma BNP provides valuable information regarding the need for additional evaluation or treatment of newborns with CHF and may be used to document improvement.
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Affiliation(s)
- L H Tan
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030, USA
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Iacono AT, Corcoran TE, Griffith BP, Grgurich WF, Smith DA, Zeevi A, Smaldone GC, McCurry KR, Johnson BA, Dauber JH. Aerosol cyclosporin therapy in lung transplant recipients with bronchiolitis obliterans. Eur Respir J 2004; 23:384-90. [PMID: 15065826 DOI: 10.1183/09031936.04.00058504] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [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: 11/05/2022]
Abstract
The majority of patients who develop bronchiolitis obliterans, after lung transplantation, die within 2-3 yrs after onset since treatment with conventional immunosuppression is typically ineffective. A case/control study was conducted in lung transplant recipients with biopsy-documented bronchiolitis obliterans to determine whether aerosol cyclosporin use contributed to increased survival. The cases comprised 39 transplant recipients who received open-label aerosol cyclosporin treatment in addition to conventional immunosuppression. The controls were transplant recipients treated with conventional immunosuppression alone. There were 51 controls from the University of Pittsburgh Medical Center and 100 from a large multicentric database (Novartis Lung Transplant Database). Forced expiratory volume in one second expressed as a percentage of the predicted value was an independent predictor of survival in all patients with bronchiolitis obliterans. Cox proportional-hazards analysis revealed a survival advantage for aerosol cyclosporin cases compared to the Pittsburgh control group. A survival advantage was also seen when comparing study cases to multicentric controls. Aerosol cyclosporin, given with conventional immunosuppression to lung transplant recipients with bronchiolitis obliterans, provides a survival advantage over conventional therapy alone.
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Affiliation(s)
- A T Iacono
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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Burns KEA, Johnson BA, Iacono AT. Diagnostic properties of transbronchial biopsy in lung transplant recipients who require mechanical ventilation. J Heart Lung Transplant 2003; 22:267-75. [PMID: 12633693 DOI: 10.1016/s1053-2498(02)00563-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [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: 10/27/2022] Open
Abstract
INTRODUCTION Bronchoscopy with transbronchial biopsy (TBBx) and bronchoalveolar lavage is useful and safe for diagnosing acute rejection and infection in lung transplant recipients. However, its role is less well defined in determining the etiology of allograft dysfunction in the setting of respiratory failure necessitating mechanical ventilation. METHODS We retrospectively identified 41 mechanically ventilated patients with respiratory failure in whom 42 TBBx were followed within a 10 day period by surgical lung biopsy (SLBx) to determine the sensitivity, specificity, and positive and negative predictive values of TBBx compared with SLBx. RESULTS The sensitivity, specificity, and positive and negative predictive values of TBBx for all episodes of acute rejection and for significant episodes of acute cellular rejection were 53.3% and 36.0%; 91.7% and 94.1%; 94.1% and 90.0%; 44.0% and 50.0%, respectively. A significantly higher histologic grade was noted on SLBx compared with TBBx specimens obtained within a 10-day period (2.39 +/- 1.02 vs 0.97 +/- 0.11, p <or= 0.0001). Performing SLBx in this setting increased histopathologic diagnoses by 33% and resulted in treatment changes in 15 of 41 (37%) patients. CONCLUSIONS Transbronchial biopsy has low sensitivity, high specificity, and high positive predictive value for diagnosing acute rejection. We found a significant tendency for TBBx to underestimate the presence and severity of clinically significant grades of rejection while simultaneously overestimating the presence of clinically insignificant rejection. Adding SLBx is valuable in lung transplant recipients with respiratory failure who require mechanical ventilation.
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Affiliation(s)
- K E A Burns
- Division of Pulmonary Transplantation, University of Pittsburgh Medical Center-Presbyterian Hospital, Pittsburgh, Pennsylvania 15261, USA
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Linster C, Johnson BA, Yue E, Morse A, Xu Z, Hingco EE, Choi Y, Choi M, Messiha A, Leon M. Perceptual correlates of neural representations evoked by odorant enantiomers. J Neurosci 2001; 21:9837-43. [PMID: 11739591 PMCID: PMC6763025] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Spatial activation patterns within the olfactory bulb are believed to contribute to the neural representation of odorants. In this study, we attempted to predict the perceptions of odorants from their evoked patterns of neural activity in the olfactory bulb. We first describe the glomerular activation patterns evoked by pairs of odorant enantiomers based on the uptake of [(14)C]2-deoxyglucose in the olfactory bulb glomerular layer. Using a standardized data matrix enabling the systematic comparison of these spatial odorant representations, we hypothesized that the degree of similarity among these representations would predict their perceptual similarity. The two enantiomers of carvone evoked overlapping but significantly distinct regions of glomerular activity; however, the activity patterns evoked by the enantiomers of limonene and of terpinen-4-ol were not statistically different from one another. Commensurate with these data, rats spontaneously discriminated between the enantiomers of carvone, but not between the enantiomers of limonene or terpinen-4-ol, in an olfactory habituation task designed to probe differences in olfactory perception.
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Affiliation(s)
- C Linster
- Department of Neurobiology and Behavior, Cornell University, Ithaca, New York 14853, USA.
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Johnson BA. Test your knowledge of the physician self-referral law. An FAQ on Stark law requirements for designated health services. MGMA Connex 2001; 1:56-9. [PMID: 11757162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Johnson BA, Welter RT. Stark reality: what services are and are not covered by the self-referral law. MGMA Connex 2001; 1:64-7. [PMID: 11706648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Abstract
BACKGROUND The aim of this study was to evaluate the severity and patterns of fatigue during preoperative chemoradiation therapy for locally advanced rectal cancer and determine whether there are predictors for patients who develop severe fatigue. METHODS Seventy-two patients with resectable rectal cancer received chemoradiation (total radiation dose, 45 gray/25 fractions to the pelvis; continuous infusion of 5-fluorouracil [300 mg/m(2)]). The Brief Fatigue Inventory (BFI), a measure that categorizes fatigue severity on a 0-10 scale, was administered weekly during treatment. Severe fatigue was defined as 7-10 on the "worst level of fatigue" item. Demographics, disease information, toxicities, and blood counts were collected. Descriptive statistics, repeated measure analysis of variance, and multiple regression were used to examine fatigue and its correlates. RESULTS Fatigue increased in 67% of patients during chemoradiation (CTX/XRT). The mean fatigue score increased from 3.16 before treatment to 4.62 at the end of treatment. A significant linear trend suggested that fatigue progressively got worse during CTX/XRT (F = 16.497, P < 0.001). However, 18% of patients experienced severe fatigue before CTX/XRT; this was predicted by uncontrolled pain (r(2) = 0.321; F = 16.52; P < 0.001). During CTX/XRT, uncontrolled diarrhea was the only predictor for increased fatigue (r(2) = 0.182; F = 7.77; P < 0.01). Approximately one-third of patients had severe fatigue, which impaired their function at the end of CTX/XRT. CONCLUSIONS Preoperative chemoradiation therapy for patients with rectal cancer was associated with progressive fatigue during therapy. Based on identified predictors for fatigue, more active pain management before CXT/XRT and bowel management during CTX/XRT might reduce cancer-related fatigue in these patients.
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Affiliation(s)
- X S Wang
- Pain Research Group,The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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Abstract
Cancer-related fatigue is now the most prevalent symptom of cancer, occurring in 60-90% of patients. Fatigue has been identified by cancer patients as a factor influencing functionality and quality of life. Our objectives in developing a fatigue specialty clinic at The University of Texas M. D. Anderson Cancer Center were to improve our patients' quality of life by decreasing fatigue; educate health care providers, patients, and patients' families about cancer-related fatigue; develop an appropriate clinical and diagnostic evaluation for this symptom; correlate objective measures of fatigue with its clinical evaluation; and develop innovative treatment plans for cancer-related fatigue. This article describes the general clinic design and operations and the preliminary analysis of the first 40 patients evaluated in the fatigue clinic.
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Affiliation(s)
- C P Escalante
- Department of General Internal Medicine, Ambulatory Treatment and Emergency Care, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Abstract
OBJECTIVE The authors reviewed the pathogenesis of cocaine-related cerebral ischemia, appraised current knowledge of its sequelae, and assessed the role of putative therapeutic agents, particularly dihydropyridine-class calcium channel antagonists. METHOD The authors performed an OVID-based literature review of all indexed journals between 1966 and 2000. RESULTS Cocaine abuse significantly increases the risk of ischemic stroke. The principal mechanism of cocaine-induced cerebral ischemia is vasospasm of large cranial arteries or within the cortical microvasculature. Increased levels of extracellular monoamines, particularly dopamine, mediate vasospasm. Neuroanatomical and labeling studies also have shown that dopamine-innervated neurons may regulate cerebral blood flow. Indeed, dopamine-rich brain regions appear to be relatively specific targets for cocaine-induced cerebral ischemia. Neuroimaging studies show that cocaine-induced hypoperfusion can persist even after 6 months of abstinence. Hypoperfusion can result in deficits on complex and simple psychomotor tasks but perhaps not on memory or attention. Severe cerebral ischemia can directly precipitate neuronal death and degradation, a condition exacerbated by liberation of the excitatory amino acid glutamate. Dihydropyridine-class calcium channel antagonists inhibit cocaine-mediated dopamine release on neurons involved in vasospasm and the control of cortical circulation. Other causes of cerebral ischemia include thrombogenesis and vasculitis. Although antithrombotic agents have potential in alleviating cocaine's neurotoxic effects, their use may be limited by the risk of spontaneous hemorrhage. CONCLUSIONS Cocaine abuse can result in stroke, neuroischemia, and cognitive deficits that can persist even after prolonged abstinence. Dihydropyridine-class calcium channel antagonists, such as isradipine, show promise as therapeutic agents for preventing cocaine-induced cerebral ischemia.
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Affiliation(s)
- B A Johnson
- Department of Psychiatry and Pharmacology, University of Texas Health Science Center at San Antonio, TX 78229, USA.
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Ait-Daoud N, Johnson BA, Javors M, Roache JD, Zanca NA. Combining ondansetron and naltrexone treats biological alcoholics: corroboration of self-reported drinking by serum carbohydrate deficient transferrin, a biomarker. Alcohol Clin Exp Res 2001; 25:847-9. [PMID: 11410720] [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: 02/20/2023]
Abstract
BACKGROUND Recently, we showed by using self-report that combining ondansetron (4 microg/kg twice a day) and naltrexone (25 mg twice a day) was effective at reducing drinking and increasing abstinence among early-onset alcoholics (EOAs), who are characterized by a range of antisocial behaviors and high biological and familial disease predisposition. Here, we investigated whether the self-reported differences in drinking would be corroborated by measurements of serum carbohydrate-deficient transferrin (CDT) level, a sensitive, reliable, and well-validated marker of transient alcohol consumption. METHOD An 8-week double-blind clinical trial was performed in which 20 EOAs were randomized to receive ondansetron (4 microg/kg twice a day) and naltrexone (25 mg twice a day) or placebo as an adjunct to weekly standardized cognitive behavioral therapy. Serum CDT was assessed at weeks 0 (baseline), 4, and 8. RESULTS Log serum CDT was significantly lower in the ondansetron and naltrexone group (group mean, 1.44 +/- 0.076) compared with the placebo group (group mean, 1.82 +/- 0.113), as evidenced by a main effect of group [F(1,15) = 7.2, p = 0.017; effect size = 0.32], visit [F(1,16) = 11.2, p = 0.004; effect size = 0.41], and an interaction between group and visit [F(1,16) = 27.54, p < 0.001; effect size = 0.63]. CONCLUSIONS The combination of ondansetron plus naltrexone was superior to placebo at reducing serum CDT. This corroborated our self-reported drinking data and demonstrated that the medication combination is an effective treatment for EOAs.
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Affiliation(s)
- N Ait-Daoud
- Department of Psychiatry and the Southwest Texas Addiction Research and Technology (START) Center, University of Texas Health Science Center at San Antonio, San Antonio 78229-3900, Texas, USA.
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Wang QC, Johnson BA. Fingertip injuries. Am Fam Physician 2001; 63:1961-6. [PMID: 11388710] [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: 02/20/2023]
Abstract
The family physician often provides the first and only medical intervention for fingertip injuries. Proper diagnosis and management of fingertip injuries are vital to maintaining proper function of the hand and preventing permanent disability. A subungual hematoma is a painful condition that involves bleeding beneath the nail, usually after trauma. Treatment requires subungual decompression, which is achieved by creating small holes in the nail. A nail bed laceration is treated by removing the nail and suturing the injured nail bed. Closed fractures of the distal phalanx may require reduction but usually are minimally displaced and stable, and can be splinted. Open or intra-articular fractures of the distal phalanx may warrant referral. Patients with mallet finger cannot extend the distal interphalangeal joint because of a disruption of the extensor mechanism. Radiographs help to differentiate between tendinous and bony mallet types. Most mallet finger injuries heal with six to eight weeks of splinting, but some require referral. Flexor digitorum profundus avulsion always requires referral. Dislocations of the distal interphalangeal joint are rare and usually occur dorsally.
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Affiliation(s)
- Q C Wang
- Kaiser Permanente, Long Beach, California, USA
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Abstract
A 35-year-old woman experienced symptomatic calf pain while taking a combination of fenfluramine and phentermine. All symptoms resolved when the medications were stopped, but pain returned when fenfluramine was restarted. Laboratory evaluation revealed mild elevations of aspartate aminotransferase and lactate dehydrogenase and a remarkably shortened prothrombin time (6.3 seconds). Additional studies revealed that the clots were composed of very thin fibrin fibers. All laboratory abnormalities, including the abnormal fibrin structure, completely resolved when fenfluramin was stopped. Direct addition of fenfluramine or phentermine to normal plasma did not alter either coagulation kinetics or fibrin structure, supporting the concept that the induced changes may have originated at the hepatic level. Clots composed of thin fibers are much more resistant to fibrinolysis, and could potentially put such patients at risk for thrombotic complications. This is the first report of clotting abnormalities associated with fenfluramine use. Subsequent to its use in this patient, fenfluramine was removed from clinical use due to reports of acquired valvular heart disease.
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Affiliation(s)
- M E Carr
- Department of Internal Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298-0230, USA
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Neylon TA, Johnson BA, Laroche RA. Use of the lapidus bunionectomy in first ray insufficiency. Clin Podiatr Med Surg 2001; 18:365-75. [PMID: 11417162] [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: 02/10/2023]
Abstract
Surgical management of first ray insufficiency in HAV or hallux limitus is crucial to long-term success. Although technically demanding, the Lapidus fusion serves to address the deformity at its apex and restores normal weight bearing to the foot. This arthrodesis offers predictable, durable results in addressing various first ray deformities and occupies an important place in the foot and ankle surgeon's armamentarium. The authors' technique is described herein for the interest of and evaluation by surgeons performing this procedure. As clinicians recognize the importance of addressing proximal components of the HAV deformity, the Lapidus and other procedures will likely see increased use in the surgical management of first ray deformities.
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Affiliation(s)
- T A Neylon
- Department of Orthopaedic Surgery, Wilford Hall Medical Center, Lackland Air Force Base, Texas, USA
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Johnson BA, Cloninger CR, Roache JD, Bordnick PS, Ruiz P. Age of onset as a discriminator between alcoholic subtypes in a treatment-seeking outpatient population. Am J Addict 2001; 9:17-27. [PMID: 10914290 DOI: 10.1080/10550490050172191] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.2] [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] [Indexed: 10/17/2022] Open
Abstract
Subtyping alcoholics may provide a more accurate guide as to the course and character of the disease. Classifications of different ages of onset of problem drinking have so far resulted in categorical inconsistencies. In the past, hospital-based alcoholics have over-represented those most severely ill, and comprehensive evaluations of psychopathology for discriminating between alcoholic subtypes have been infrequent. In a heterogeneous treatment-seeking, outpatient, alcoholic population, we tested the hypothesis that age of onset represents a continuum of disease, and that greater severity of psychopathology is associated with lower ages of onset. Using a standard questionnaire, 253 male and female treatment-seeking alcoholics were stratified according to specific ages of onset: a) < 20 years; b) 20-25 years, and c) > 25 years. These age of onset groups were compared on alcohol severity and craving, family history, childhood behavior, personality, hostility, overt aggression, mood, and social functioning. Symptom severity and age of onset were negatively correlated, and the 20-25-year onset group usually had intermediate scores. The < 20 year onset group was characterized by greater severity of alcohol-related problems, family history, childhood behavioral problems, craving, hostility, antisocial traits, mood disturbance, and poor social functioning. Alcoholics with an earlier age of onset have relatively greater psychopathology than those of later onset. While the preponderance of psychopathology among those in the < 20-year onset group could be conceptualized as a clinical "subtype," such a characterization would not define an entirely homogeneous category. Yet, this clinical characterization would be clinically important if specific age of onset levels were found to be differentially sensitive to pharmacological and/or psychological treatments.
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Affiliation(s)
- B A Johnson
- Department of Psychiatry, University of Texas, San Antonio 78284-7792, USA.
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Ait-Daoud N, Johnson BA, Prihoda TJ, Hargita ID. Combining ondansetron and naltrexone reduces craving among biologically predisposed alcoholics: preliminary clinical evidence. Psychopharmacology (Berl) 2001; 154:23-7. [PMID: 11292002 DOI: 10.1007/s002130000607] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [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] [Indexed: 10/27/2022]
Abstract
RATIONALE Previously, we have reported that the combination of ondansetron (a 5-HT3 antagonist) and naltrexone (a mu opioid antagonist) appears to act synergistically at improving the drinking outcomes of early onset alcoholics (EOA). a subtype of alcoholic characterized by developing problem-drinking earlier, antisocial behaviors, high familial loading, and biological disease predisposition. Presumably, this medication combination counteracts the interaction between activated central 5-HT3 receptors and the endogenous opioid system during the mediation of alcohol-induced reward. We now hypothesize further that an important mechanism by which the combination diminishes alcohol consumption is through a reduction in craving. OBJECTIVE To determine whether the combination of naltrexone and ondansetron is superior to a placebo at reducing craving among EOA, and the relationship between craving and drinking behavior in both treatment groups. METHODS We conducted an 8-week double-blind placebo-controlled clinical trial in which 10 EOA were randomized to receive ondansetron (4 microg/kg b.i.d.) + naltrexone (25 mg b.i.d.) and 10 EOA had a placebo (total n=20) as an adjunct to weekly standardized group cognitive behavioral therapy. Craving was measured by using the obsessive compulsive drinking scale (OCDS). RESULTS Craving ratings were scored on four subscales which where derived empirically by principal component structure analysis of the OCDS. EOA who received the medication combination, compared with the placebo, had significantly lower scores on "automaticity of drinking" and "alcohol consumption ". Reduction in automaticity of drinking was correlated with self-reported drinking for only the medication combination group. CONCLUSIONS By reducing automaticity of drinking, the medication combination presumably decreased drinking salience and intensity. Larger scale studies testing these medications, both alone and together, among alcoholic subtypes are needed to establish and extend these promising findings.
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Affiliation(s)
- N Ait-Daoud
- Treatment Research Center, Department of Psychiatry, University of Texas, Health Science Center at San Antonio, 78229-3900, USA.
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Abstract
Ductography of the breast is an underused procedure that often helps define the cause of unilateral, single-pore, spontaneous nipple discharge. Since nipple discharge may be caused by benign tumors, such as papillomas, or by carcinoma, such as ductal carcinoma in situ, identification of intraductal abnormalities with ductography is important. Further, diagnostic ductography and preoperative ductography help guide accurate surgical intervention. Without prior ductography, central duct excision may not result in removal of the abnormal ductal tissue or may result in removal of only a portion of the abnormal ductal system, causing the extent of disease to be effectively understaged. Once fundamental ductographic principles are learned, the procedure is easy to perform. If extravasation occurs, ductography is rescheduled for 7-14 days later. Elimination of air bubbles from the cannula, syringe, and extension tubing is vital. When reflux occurs, radiologists must be aware of a possible tumor in the distal-most duct. When ductal ectasia or fibrocystic changes are the cause of the discharge, conservative follow-up may be considered. Diagnostic radiologists who learn the technique of ductography and include it in their evaluation of nipple discharge will improve their interdisciplinary approach to this important sign of breast cancer.
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Affiliation(s)
- S H Slawson
- Susan G. Komen Breast Center, 4911 Executive Dr., Peoria, IL 61614, USA.
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Abstract
BACKGROUND Vitamin D deficiency is associated with bone loss and bone fractures, and the identification of vulnerable populations is important to clinical practice and public health. OBJECTIVE The objectives of this study were to determine the prevalence of vitamin D deficiency and to examine associated risk factors for vitamin D deficiency in older women. DESIGN We measured serum concentrations of 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D [1, 25(OH)(2)D], intact parathyroid hormone (PTH), osteocalcin, and ionized calcium in women aged >/=65 y who were participating in the Women's Health and Aging Study I, an observational study of women representing the approximately one-third most disabled women living in the community, and women aged 70-80 y who were participating in the Women's Health and Aging Study II, an observational study of women among the two-thirds least disabled women living in the community in Baltimore. RESULTS The women were classified into 4 domains of physical disability. Among 371 women with 0 or 1 domain of disability and 682 women with >/=2 domains of disability, 6.2% and 12.6%, respectively, had vitamin D deficiency [serum concentrations of 25(OH)D < 25 nmol/L]. In univariate analyses, risk factors for vitamin D deficiency included increasing age, black race, low educational level, high body mass index, high triceps skinfold thickness, increasing level of disability, winter season, and elevated creatinine concentration. In multivariate models, black race had a strong association with vitamin D deficiency when other risk factors were adjusted for. CONCLUSIONS Vitamin D deficiency, a preventable disorder, is a common and important public health problem for older disabled women living in the community; black women are at higher risk than are white women.
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Affiliation(s)
- R D Semba
- Johns Hopkins Medical Institutions, Baltimore, and the Epidemiology, Demography, and Biometry Program, National Institute on Aging, Bethesda, MD, USA.
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Johnson BA. Integration of student-health physicians into U.S. medical schools and their affiliated teaching hospitals. Acad Med 2000; 75:1125-1129. [PMID: 11078675 DOI: 10.1097/00001888-200011000-00021] [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] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE To determine whether physicians in the student health services (SHSs) at U.S. medical schools and their affiliated teaching hospitals, referred to here as academic medical centers (AMCs), have unique opportunities for integration into AMCs that do not exist for physician-faculty at SHSs on purely academic campuses. METHOD A survey of SHS offices at the 124 U.S. medical schools was conducted in the spring of 1999. The questionnaire asked about the reporting relationships of the SHS within the AMC, whether the student-health physicians had academic appointments within the AMC, and whether these physicians participated in the AMC's clinical services, administration, research, or teaching activities. RESULTS There were 116 (94%) responses (not all responses were complete and eight were excluded because their campuses offered no formal SHS). Approximately half of the SHSs (52/107, 49%) reported to their AMCs. Student-health physicians with career-track appointments were more likely to be found at SHSs reporting to AMCs (35/58, 60%) than at SHSs reporting solely to a division of student affairs (20/58, 34%). Having a career-track appointment increased the likelihood of the student-health physicians' attending on the wards (34/59, 58%), seeing private patients in an AMC's faculty practice (40/59, 68%), participating in administrative activities for an AMC (50/56, 89%), and participating in research activities (36/57, 63%). CONCLUSIONS Student health services that reported to their AMCs were more likely to have faculty with career-track appointments, and these appointments were more likely to result in the integration of student-health physicians into their AMC's clinical services, administration, and research activities. Career-track appointments, however, had no influence on whether teaching activities occurred within the SHS. Fully integrating student-health physicians into the AMC's activities enhances outcomes for both the SHS and its AMC.
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Affiliation(s)
- B A Johnson
- Division of General Medicine, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
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Abstract
Organic acid odorants of differing carbon number produce systematically different spatial patterns of [(14)C]2-deoxyglucose uptake in the glomerular layer of the olfactory bulb. Because increasing carbon number correlates with progressive increases in several molecular features, including hydrophobicity, length, and volume, we determined which of these properties was most associated with systematic changes in the location of an anterior, dorsomedial module responding to fatty acids. We exposed groups of rats to two series of organic acids that each had the same number of carbons, but differed in their hydrocarbon structures. These straight-chained, branched, cyclic, and double-bonded molecules differed independently in hydrophobicity, length, and volume. The only molecular property that was strongly correlated with the location of the module was molecular length, suggesting that this molecular feature is the principal determinant of the chemotopic organization of glomeruli within the module. We also found that distinct hydrocarbon structures produced large differences in spatial patterns of 2-deoxyglucose uptake in posterior parts of the bulb. Even subtly distinct structural isomers evoked posterior responses that differed greatly. The odorant 2-methylbutyric acid evoked much greater uptake in the posterior bulb than did its structural isomer 3-methylbutyric acid (isovaleric acid). These data suggest that posterior portions of the bulb may encode specific steric features of odorant molecules and that some odorant features may have an inherent or acquired greater representation than do others.
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Affiliation(s)
- B A Johnson
- Department of Neurobiology and Behavior, University of California, Irvine, California 92697-4550, USA.
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Johnson BA, Nunley JR. Use of systemic agents in the treatment of acne vulgaris. Am Fam Physician 2000; 62:1823-30, 1835-6. [PMID: 11057839] [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: 02/18/2023]
Abstract
Effective treatment of acne vulgaris can prevent emotional and physical scarring. Therapy varies according to the severity of the disease. Topical medication is generally adequate in clearing comedonal acne, while inflammatory acne usually requires the addition of oral medication. Systemic antibiotics are used most frequently and can be highly effective. Newer formulations of combined oral contraceptives are also helpful in modulating sebum production in the female patient. Severe nodulocystic acne that does not respond to topical retinoids and systemic antibiotics may be treated with isotretinoin. However, the side effect profile of this medication is extensive, and physicians should be well-versed in its potential adverse effects.
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Affiliation(s)
- B A Johnson
- Virginia Commonwealth University Medical College of Virginia School of Medicine, Richmond 23298-0230, USA
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Johnson BA. Serotonergic agents and alcoholism treatment: rebirth of the subtype concept--an hypothesis. Alcohol Clin Exp Res 2000; 24:1597-601. [PMID: 11045870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- B A Johnson
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, USA.
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McIvor ZJ, Heyworth CM, Johnson BA, Pearson S, Fiegler H, Hampson L, Dexter TM, Cross MA. A transient assay for regulatory gene function in haemopoietic progenitor cells. Br J Haematol 2000; 110:674-81. [PMID: 10997980 DOI: 10.1046/j.1365-2141.2000.02214.x] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This work aimed to provide a means of assaying directly the effects of transient expression of introduced genes on the survival, proliferation, lineage commitment and differentiation of haemopoietic progenitor cells. For this purpose, we have developed a system that allows isolation of productively transfected, mulitipotent haemopoietic cells within a few hours of the introduction of test genes. We have shown that FDCP-mix cells productively transfected with expression plasmids encoding green fluorescent protein (GFP) differentiate normally and retain colony-forming potential. We constructed an expression vector consisting of a bicistronic cassette in which a GFP marker gene and a test gene are driven from the same promoter. The vector design has been optimized for co-expression and the test gene was shown to be biologically active. The expression profile from a transiently transfected template under different growth conditions reveals that active expression continues for at least 2 d after transfection. The transient transfection of FDCP-mix cells with the vectors described provides a powerful tool for analysis of the immediate early effects of test gene overexpression during haemopoietic differentiation.
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Affiliation(s)
- Z J McIvor
- Laboratory of Molecular Medicine, IZKF University of Leipzig, Leipzig, Germany.
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Johnson BA, Roache JD, Javors MA, DiClemente CC, Cloninger CR, Prihoda TJ, Bordnick PS, Ait-Daoud N, Hensler J. Ondansetron for reduction of drinking among biologically predisposed alcoholic patients: A randomized controlled trial. JAMA 2000; 284:963-71. [PMID: 10944641 DOI: 10.1001/jama.284.8.963] [Citation(s) in RCA: 273] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
CONTEXT Early-onset alcoholism differs from late-onset alcoholism by its association with greater serotonergic abnormality and antisocial behaviors. Thus, individuals with early-onset alcoholism may be responsive to treatment with a selective serotonergic agent. OBJECTIVE To test the hypothesis that drinking outcomes associated with early vs late-onset alcoholism are differentially improved by the selective 5-HT(3) (serotonin) antagonist ondansetron. DESIGN Double-blind, randomized, placebo-controlled clinical trial. SETTINGS University of Texas Health Science Center in Houston (April 1995-June 1998) and University of Texas Health Science Center in San Antonio (July 1998-December 1999). PARTICIPANTS A total of 321 patients with diagnosed alcoholism (mean age, 40.6 years; 70.5% male; 78.6% white) were enrolled, 271 of whom proceeded to randomization. INTERVENTIONS After 1 lead-in week of single-blind placebo, patients were randomly assigned to receive 11 weeks of treatment with ondansetron, 1 microg/kg (n = 67), 4 microg/kg (n = 77), or 16 microg/kg (n = 71) twice per day; or identical placebo (n = 56). All patients also participated in weekly standardized group cognitive behavioral therapy. MAIN OUTCOME MEASURES Self-reported alcohol consumption (drinks per day, drinks per drinking day, percentage of days abstinent, and total days abstinent per study week); and plasma carbohydrate deficient transferrin (CDT) level, an objective and sensitive marker of transient alcohol consumption. RESULTS Patients with early-onset alcoholism who received ondansetron (1, 4, and 16 microg/kg twice per day) compared with those who were administered placebo, had fewer drinks per day (1.89, 1.56, and 1.87 vs 3.30; P =.03, P =.01, and P =.02, respectively) and drinks per drinking day (4.75, 4.28, and 5.18 vs 6.90; P =.03, P =.004, and P =.03, respectively). Ondansetron, 4 microg/kg twice per day, was superior to placebo in increasing percentage of days abstinent (70.10 vs 50.20; P =.02) and total days abstinent per study week (6.74 vs 5.92; P =.03). Among patients with early-onset alcoholism, there was a significant difference in the mean log CDT ratio between those who received ondansetron (1 and 4 microg/kg twice per day) compared with those who received the placebo (-0.17 and -0.19 vs 0.12; P =.03 and P =.01, respectively). CONCLUSION Our results suggest that ondansetron (particularly the 4 microg/kg twice per day dosage) is an effective treatment for patients with early-onset alcoholism, presumably by ameliorating an underlying serotonergic abnormality. JAMA. 2000;284:963-971
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Affiliation(s)
- B A Johnson
- Department of Psychiatry, University of Texas Health Science Center, 7703 Floyd Curl Dr, Mail Stop 7792, San Antonio, TX 78229-3900, USA.
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Johnson BA. First patient. Pharos Alpha Omega Alpha Honor Med Soc 2000; 63:31-3. [PMID: 10918800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Johnson BA. Image-guided epidural injections. Neuroimaging Clin N Am 2000; 10:479-91. [PMID: 11083014] [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: 02/18/2023]
Abstract
Epidural steroid injection is a safe outpatient procedure, which is performed best using image guidance in conjunction with epidurography. Using the techniques described earlier, complications are minimized, and serious complications can be avoided, in experienced hands. The author has performed several thousand procedures in an outpatient setting without any serious complications. Optimal safety and efficacy require an excellent working knowledge of the radiographic anatomy, and the imaging equipment used to perform these procedures. Several studies have demonstrated the difficulty and uncertainty of obtaining an accurate injection without imaging guidance. Radiologists who are well trained in the performance of image-guided percutaneous injection procedures are thus armed with the background to perform these procedures in a safe and efficacious manner. In addition, referral of these procedures to a third party (radiologist) without economic incentives reduces the potential abuse of self-referral--which may occur (or be suspected by payors) when the primary clinician recommends, and then performs, pain management procedures. The use of sedation to perform these procedures is unnecessary, and deep sedation may be dangerous when injections are performed in the vicinity of the spinal cord. The author's experience, which includes clinical feedback and formal trials, shows the technique described in this article to be performed safely without sedation in an outpatient setting, with a high success rate for alleviating pain symptoms. When properly performed, epidural steroid injections have a clinically established role in the management of neck and back pain.
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Affiliation(s)
- B A Johnson
- Department of Radiology, University of Minnesota Medical School, Minneapolis, USA
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