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Srivastava AV, Brown R, Newport DJ, Rousseau JF, Wagner KD, Guzick A, Devargas C, Claassen C, Ugalde IT, Garrett A, Gushanas K, Liberzon I, Cisler JM, Nemeroff CB. The role of resilience in the development of depression, anxiety, and post-traumatic stress disorder after trauma in children and adolescents. Psychiatry Res 2024; 334:115772. [PMID: 38442477 DOI: 10.1016/j.psychres.2024.115772] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 03/07/2024]
Abstract
This investigation, conducted within the Texas Childhood Trauma Research Network, investigated the prospective relationships between resiliency and emergent internalizing symptoms among trauma-exposed youth. The cohort encompassed 1262 youth, aged 8-20, from twelve health-related institutions across Texas, who completed assessments at baseline and one- and six-month follow-ups for resiliency, symptoms of depression, generalized anxiety, posttraumatic stress disorder (PTSD), and other demographic and clinical characteristics. At baseline, greater resilience was positively associated with older age, male (vs female) sex assigned at birth, and history of mental health treatment. Unadjusted for covariates, higher baseline resilience was associated with greater prospective depression and PTSD symptoms but not anxiety symptoms. Upon adjusting for demographic and clinical factors, higher baseline resilience was no longer associated with depression, PTSD, or anxiety symptoms. Our analyses demonstrate that the predictive value of resilience on psychopathology is relatively small compared to more readily observable clinical and demographic factors. These data suggest a relatively minor prospective role of resilience in protecting against internalizing symptoms among trauma-exposed youth and highlight the importance of controlling for relevant youth characteristics when investigating a protective effect of resilience on internalizing symptoms.
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Affiliation(s)
- Arjun V Srivastava
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Health Discovery Building, 1601 Trinity Blvd, Austin, TX 78701, USA
| | - Ryan Brown
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Health Discovery Building, 1601 Trinity Blvd, Austin, TX 78701, USA
| | - D Jeffrey Newport
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Health Discovery Building, 1601 Trinity Blvd, Austin, TX 78701, USA; Department of Women's Health, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Justin F Rousseau
- Department of Population Health, University of Texas at Austin Dell Medical School, Austin, TX, USA; Department of Neurology, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Karen D Wagner
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Andrew Guzick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Cecilia Devargas
- Department of Psychiatry, Texas Tech University Health Sciences Center - El Paso Paul L. Foster School of Medicine, El Paso, TX, USA
| | - Cynthia Claassen
- Department of Psychiatry, JPS Health Network / University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Irma T Ugalde
- Department of Emergency Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Amy Garrett
- Department of Psychiatry, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Kim Gushanas
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Israel Liberzon
- Department of Psychiatry and Behavioral Sciences, Texas A&M University School of Medicine, Bryan, TX, USA
| | - Josh M Cisler
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Health Discovery Building, 1601 Trinity Blvd, Austin, TX 78701, USA.
| | - Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Health Discovery Building, 1601 Trinity Blvd, Austin, TX 78701, USA
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Trivedi MH, Minhajuddin A, Slater H, Baronia R, Blader JC, Blood J, Brown R, Claassen C, DeFilippis M, Farmer D, Garza C, Hughes JL, Kennard BD, Liberzon I, Martin S, Mayes TL, Soares JC, Soutullo CA, Storch EA, Wakefield SM. Texas Youth Depression and Suicide Research Network (TX-YDSRN) research registry and learning healthcare network: Rationale, design, and baseline characteristics. J Affect Disord 2023; 340:88-99. [PMID: 37459975 DOI: 10.1016/j.jad.2023.07.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 06/13/2023] [Accepted: 07/08/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND American youth are seriously impacted by depression and suicide. The Texas Youth Depression and Suicide Research Network (TX-YDSRN) Participant Registry Study was initiated in 2020 to develop predictive models for treatment outcomes in youth with depression and/or suicidality. This report presents the study rationale, design and baseline characteristics of the first 1000 participants. METHODS TX-YDSRN consists of the Network Hub (coordinating center), 12 medical school "Nodes" (manage/implement study), each with 1-5 primary care, inpatient, and/or outpatient Sub-Sites (recruitment, data collection). Participants are 8-20-year-olds who receive treatment or screen positive for depression and/or suicidality. Baseline data include mood and suicidality symptoms, associated comorbidities, treatment history, services used, and social determinants of health. Subsequent assessments occur every two months for 24 months. RESULTS Among 1000 participants, 68.7 % were 12-17 years, 24.6 % were ≥ 18 years, and 6.7 % were < 12. Overall, 36.8 % were non-Hispanic Caucasian, 73.4 % were female, and 79.9 % had a primary depressive disorder. Nearly half of the sample reported ≥1 suicide attempt, with rates similar in youth 12-17 years old (49.9 %) and those 18 years and older (45.5 %); 29.9 % of children <12 reported at least one suicide attempt. Depression and anxiety scores were in the moderate-severe range for all age groups (Patient Health Questionnaire for Adolescents [PHQ-A]: 12.9 ± 6.4; Generalized Anxiety Disorder [GAD-7]: 11.3 ± 5.9). LIMITATIONS The sample includes youth who are receiving depression care at enrollment and may not be representative of non-diagnosed, non-treatment seeking youth. CONCLUSIONS The TX-YDSRN is one of the largest prospective longitudinal cohort registries designed to develop predictive models for outcome trajectories based on disorder heterogeneity, social determinants of health, and treatment availability.
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Affiliation(s)
- Madhukar H Trivedi
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Abu Minhajuddin
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA; Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Holli Slater
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Regina Baronia
- Department of Psychiatry, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Joseph C Blader
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Jamon Blood
- University of Texas Health Science Center, Tyler, TX, USA
| | - Ryan Brown
- University of Texas at Austin Dell Medical School, Austin, TX, USA
| | | | | | - David Farmer
- University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Cynthia Garza
- Department of Psychiatry, University of Texas Rio Grande Valley, School of Medicine, Edinburg, TX, USA
| | - Jennifer L Hughes
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Beth D Kennard
- Department of Psychiatry, University of Texas Southwestern Medical Center in Dallas, TX, USA
| | | | - Sarah Martin
- Texas Tech University Health Science Center, El Paso, TX, USA
| | - Taryn L Mayes
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jair C Soares
- University of Texas Health Science Center, Houston, TX, USA
| | | | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Sarah M Wakefield
- Department of Psychiatry, Texas Tech University Health Science Center, Lubbock, TX, USA
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Hughes JL, Trombello JM, Kennard BD, Slater H, Rezaeizadeh A, Claassen C, Wakefield SM, Trivedi MH. Suicide risk assessment and suicide risk management protocol for the Texas Youth Depression and Suicide Research Network. Contemp Clin Trials Commun 2023; 33:101151. [PMID: 37288070 PMCID: PMC10241872 DOI: 10.1016/j.conctc.2023.101151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/25/2023] [Accepted: 05/13/2023] [Indexed: 06/09/2023] Open
Abstract
Introduction Suicide prevention research is a national priority, and national guidance includes the development of suicide risk management protocols (SRMPs) for the assessment and management of suicidal ideation and behavior in research trials. Few published studies describe how researchers develop and implement SRMPs or articulate what constitutes an acceptable and effective SRMP. Methods The Texas Youth Depression and Suicide Research Network (TX-YDSRN) was developed with the goal of evaluating screening and measurement-based care in Texas youth with depression or suicidality (i.e., suicidal ideation and/or suicidal behavior). The SRMP was developed for TX-YDSRN through a collaborative, iterative process, consistent with a Learning Healthcare System model. Results The final SMRP included training, educational resources for research staff, educational resources for research participants, risk assessment and management strategies, and clinical and research oversight. Conclusion The TX-YDSRN SRMP is one methodology for addressing youth participant suicide risk. The development and testing of standard methodologies with a focus on participant safety is an important next step to further the field of suicide prevention research.
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Affiliation(s)
- Jennifer L. Hughes
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Joseph M. Trombello
- Center for Depression Research and Clinical Care, Department of Psychiatry and The Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry at the University of Texas Southwestern Medical Center, Dallas, TX, USA
- Janssen Research and Development, Titusville, NJ, USA
| | - Betsy D. Kennard
- The Peter O’Donnell Jr. Brain Institute, Department of Psychiatry at the University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Holli Slater
- Center for Depression Research and Clinical Care, Department of Psychiatry and The Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry at the University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Afsaneh Rezaeizadeh
- Center for Depression Research and Clinical Care, Department of Psychiatry and The Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry at the University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Sarah M. Wakefield
- The Department of Psychiatry, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Madhukar H. Trivedi
- Center for Depression Research and Clinical Care, Department of Psychiatry and The Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry at the University of Texas Southwestern Medical Center, Dallas, TX, USA
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Shahidullah JD, Custer J, Widales-Benitez O, Aksan N, Hatchell C, Newport DJ, Wagner KD, Storch EA, Claassen C, Garrett A, Ugalde IT, Weber W, Nemeroff CB, Rathouz PJ. Establishing a training plan and estimating inter-rater reliability across the multi-site Texas childhood trauma research network. Psychiatry Res 2023; 323:115168. [PMID: 36931015 DOI: 10.1016/j.psychres.2023.115168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/09/2023] [Accepted: 03/11/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVE Minimal guidance is available in the literature to develop protocols for training non-clinician raters to administer semi-structured psychiatric interviews in large, multi-site studies. Previous work has not produced standardized methods for maintaining rater quality control or estimating interrater reliability (IRR) in such studies. Our objective is to describe the multi-site Texas Childhood Trauma Research Network (TX-CTRN) rater training protocol and activities used to maintain rater calibration and evaluate protocol effectiveness. METHODS Rater training utilized synchronous and asynchronous didactic learning modules, and certification involved critique of videotaped mock scale administration. Certified raters attended monthly review meetings and completed ongoing scoring exercises for quality assurance purposes. Training protocol effectiveness was evaluated using individual measure and pooled estimated IRRs for three key study measures (TESI-C, CAPS-CA-5, MINI-KID [Major Depressive Episodes - MDE & Posttraumatic Stress Disorder - PTSD modules]). A random selection of video-recorded administrations of these measures was evaluated by three certified raters to estimate agreement statistics, with jackknife (on the videos) used for confidence interval estimation. Kappa, weighted kappa and intraclass correlations were calculated for study measure ratings. RESULTS IRR agreement across all measures was strong (TESI-C median kappa 0.79, lower 95% CB 0.66; CAPS-CA-5 median weighted kappa 0.71 (0.62), MINI-MDE median kappa 0.71 (0.62), MINI-PTSD median kappa 0.91 (0.9). The combined estimated ICC was ≥0.86 (lower CBs ≥0.69). CONCLUSIONS The protocol developed by TX-CTRN may serve as a model for other multi-site studies that require comprehensive non-clinician rater training, quality assurance guidelines, and a system for assessing and estimating IRR.
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Affiliation(s)
- Jeffrey D Shahidullah
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA.
| | - James Custer
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Oscar Widales-Benitez
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Nazan Aksan
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Carly Hatchell
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - D Jeffrey Newport
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA; Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Karen Dineen Wagner
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, Texas, USA
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | | | - Amy Garrett
- Department of Psychiatry, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Irma T Ugalde
- Department of Emergency Medicine, McGovern Medical School at UTHealth Houston, Houston, Texas, USA
| | - Wade Weber
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Paul J Rathouz
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
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Lowry NJ, Ryan PC, Mournet AM, Snyder DJ, Claassen C, Jobes D, Harrington C, Pao M, Horowitz LM, Bridge JA. Non-Suicidal Self-Injury and Suicide Risk Among Adult Medical Inpatients. Journal of Affective Disorders Reports 2023. [DOI: 10.1016/j.jadr.2023.100474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Ryan PC, Lowry NJ, Boudreaux E, Snyder D, Claassen C, Harrington CJ, Jobes DA, Bridge J, Pao M, Horowitz LM. (172) The Associations Between Pain, Hopelessness, and Suicide Risk Among Adult Medical Inpatients. J Acad Consult Liaison Psychiatry 2022. [DOI: 10.1016/j.jaclp.2022.10.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ramchand R, Colpe L, Claassen C, Brinton S, Carr C, McKeon R, Schoenbaum M. Prioritizing Improved Data and Surveillance for Suicide in the United States in Response to COVID-19. Am J Public Health 2021; 111:S84-S88. [PMID: 34314214 DOI: 10.2105/ajph.2021.306258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Rajeev Ramchand
- Rajeev Ramchand is with the RAND Corporation, Arlington, VA. Lisa Colpe and Michael Schoenbaum are with the National Institute of Mental Health, Bethesda, MD. Cynthia Claassen is with JPS Behavioral Health, JPS Health System, Fort Worth, TX. Sam Brinton is with The Trevor Project, Washington, DC. Colleen Carr is with the National Action Alliance for Suicide Prevention Secretariat and Education Development Center, Washington, DC. Richard McKeon is with the Substance Abuse and Mental Health Services Administration, Rockville, MD
| | - Lisa Colpe
- Rajeev Ramchand is with the RAND Corporation, Arlington, VA. Lisa Colpe and Michael Schoenbaum are with the National Institute of Mental Health, Bethesda, MD. Cynthia Claassen is with JPS Behavioral Health, JPS Health System, Fort Worth, TX. Sam Brinton is with The Trevor Project, Washington, DC. Colleen Carr is with the National Action Alliance for Suicide Prevention Secretariat and Education Development Center, Washington, DC. Richard McKeon is with the Substance Abuse and Mental Health Services Administration, Rockville, MD
| | - Cynthia Claassen
- Rajeev Ramchand is with the RAND Corporation, Arlington, VA. Lisa Colpe and Michael Schoenbaum are with the National Institute of Mental Health, Bethesda, MD. Cynthia Claassen is with JPS Behavioral Health, JPS Health System, Fort Worth, TX. Sam Brinton is with The Trevor Project, Washington, DC. Colleen Carr is with the National Action Alliance for Suicide Prevention Secretariat and Education Development Center, Washington, DC. Richard McKeon is with the Substance Abuse and Mental Health Services Administration, Rockville, MD
| | - Sam Brinton
- Rajeev Ramchand is with the RAND Corporation, Arlington, VA. Lisa Colpe and Michael Schoenbaum are with the National Institute of Mental Health, Bethesda, MD. Cynthia Claassen is with JPS Behavioral Health, JPS Health System, Fort Worth, TX. Sam Brinton is with The Trevor Project, Washington, DC. Colleen Carr is with the National Action Alliance for Suicide Prevention Secretariat and Education Development Center, Washington, DC. Richard McKeon is with the Substance Abuse and Mental Health Services Administration, Rockville, MD
| | - Colleen Carr
- Rajeev Ramchand is with the RAND Corporation, Arlington, VA. Lisa Colpe and Michael Schoenbaum are with the National Institute of Mental Health, Bethesda, MD. Cynthia Claassen is with JPS Behavioral Health, JPS Health System, Fort Worth, TX. Sam Brinton is with The Trevor Project, Washington, DC. Colleen Carr is with the National Action Alliance for Suicide Prevention Secretariat and Education Development Center, Washington, DC. Richard McKeon is with the Substance Abuse and Mental Health Services Administration, Rockville, MD
| | - Richard McKeon
- Rajeev Ramchand is with the RAND Corporation, Arlington, VA. Lisa Colpe and Michael Schoenbaum are with the National Institute of Mental Health, Bethesda, MD. Cynthia Claassen is with JPS Behavioral Health, JPS Health System, Fort Worth, TX. Sam Brinton is with The Trevor Project, Washington, DC. Colleen Carr is with the National Action Alliance for Suicide Prevention Secretariat and Education Development Center, Washington, DC. Richard McKeon is with the Substance Abuse and Mental Health Services Administration, Rockville, MD
| | - Michael Schoenbaum
- Rajeev Ramchand is with the RAND Corporation, Arlington, VA. Lisa Colpe and Michael Schoenbaum are with the National Institute of Mental Health, Bethesda, MD. Cynthia Claassen is with JPS Behavioral Health, JPS Health System, Fort Worth, TX. Sam Brinton is with The Trevor Project, Washington, DC. Colleen Carr is with the National Action Alliance for Suicide Prevention Secretariat and Education Development Center, Washington, DC. Richard McKeon is with the Substance Abuse and Mental Health Services Administration, Rockville, MD
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Abstract
The use and availability of cannabis for recreational and medical purposes has become more widespread with increased legalization. Adverse health outcomes of this increased use include cannabinoid hyperemesis syndrome (CHS), which is underrecognized in medical settings. Cessation of substance use is the recommendation of choice for the complete resolution of CHS. However, interventions that provide rapid relief may be necessary in treatment-refractory cases. Little evidence is available to guide care in these cases. Here we report 4 cases of treatment-refractory CHS, all of which remitted after treatment with olanzapine. Olanzapine is known to block multiple neurotransmitter receptors involved in nausea and vomiting in chemotherapy-induced nausea and vomiting. Outcomes of the cases reported here suggest that off-label use of olanzapine may be effective in the symptomatic treatment of refractory CHS and may be the preferred treatment in cases in which comorbid psychotic symptoms or agitation are present.
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Affiliation(s)
- Jennifer Hsu
- HSU, HERRMANN, KASHYAP, CLAASSEN: Department of Psychiatry, John Peter Smith Hospital, Fort Worth, TX
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Andaluz A, DeMoss D, Claassen C, Blair S, Hsu J, Bakre S, Khan M, Atem F, Rush AJ. Fixed-dose gabapentin augmentation in the treatment of alcohol withdrawal syndrome: a retrospective, open-label study. Am J Drug Alcohol Abuse 2019; 46:49-57. [PMID: 31490712 DOI: 10.1080/00952990.2019.1634085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Lorazepam use in the treatment of alcohol withdrawal syndrome (AWS) is not without risk.Objective: This study compares AWS outcomes using a standard, symptom-triggered lorazepam dosing protocol (control group) and symptom-triggered lorazepam dosing augmented with a gabapentin loading dose and taper (GABA group).Methods: Consecutive, non-randomized adults (n = 982; 64.0% male) undergoing treatment for AWS were included in this retrospective, open-label study. Symptom-triggered lorazepam dosing was informed by scores on the Clinical Institute Withdrawal Assessment-Alcohol, revised (CIWA-Ar). Gabapentin augmentation utilized an initial loading dose (900 mg) and a three-day taper. Outcomes included average symptom severity per treatment hour and average lorazepam dose per treatment hour. Average time in the protocol by group, stratified by highest CIWA-Ar score, was examined as a secondary outcome. A priori group differences were controlled statistically.Results: GABA patients were older and exhibited somewhat more severe withdrawal symptoms than controls. After controlling for confounders, gabapentin augmentation did not significantly lower average lorazepam dosing per treatment hour or withdrawal symptom severity per treatment hour. Compared to controls, overall withdrawal symptoms diminished somewhat more rapidly for GABA patients experiencing low or moderate-level withdrawal symptoms; however, severe withdrawal symptoms remitted more slowly in the GABA group. Results should be interpreted in light of the uncontrolled nature of group assignment and other confounders.Conclusions: Compared to symptom-triggered lorazepam dosing alone, gabapentin augmentation did not produce better outcomes during treatment of acute AWS. These results do not support the use of scheduled gabapentin as an augmentation to benzodiazepines during inpatient treatment of AWS.
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Affiliation(s)
- Alex Andaluz
- Psychiatry Residency Training Program, Dept. of Psychiatry, John Peter Smith Hospital, Fort Worth, USA
| | - Dustin DeMoss
- Psychiatry Residency Training Program, Dept. of Psychiatry, John Peter Smith Hospital, Fort Worth, USA
| | - Cynthia Claassen
- Research & Education, Behavioral Health Service, John Peter Smith Hospital, Fort Worth, USA
| | - Somer Blair
- Office of Clinical Research, John Peter Smith Hospital, Fort Worth, USA
| | - Jennifer Hsu
- Texas College of Osteopathic Medicine, UNT Health Science Center, Fort Worth, USA
| | - Sulaimon Bakre
- Dept. of Public Health, University of North Texas Health Science Center, Fort Worth, USA
| | - Mehreen Khan
- Research Division, Behavioral Health Service, John Peter Smith Hospital, Fort Worth, USA
| | - Folefac Atem
- Department of Biostatistics & Data Science, University of Texas Health Science Center School of Public Health-Houston, Houston, USA
| | - A John Rush
- Adj Prof, Duke Med Sch; Adj Prof, Texas Tech, CEO Curbstone Consultant, Durham, USA
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Mulenga LB, Musonda P, Chirwa L, Siwingwa M, Mweemba A, Suwilanji S, Fwoloshi S, Phiri H, Phiri D, Mulenga PL, Chisenga T, Nsakanya R, Shibemba A, Todd J, Nzala S, Kaile T, Kankasa C, Hachaambwa L, Claassen C, Sikazwe I, Koethe JR, Sinkala E, Heimburger DC, Wester CW. Insulin Resistance is Associated with Higher Plasma Viral Load Among HIV-Positive Adults Receiving Longer-Term (1 Year) Combination Antiretroviral Therapy (ART). J Infect Dis Ther 2019; 7:406. [PMID: 35538928 PMCID: PMC9082628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND As HIV-positive persons survive longer due to the success of combination antiretroviral therapy (ART) in decreasing mortality, the burden of non-communicable diseases including diabetes mellitus (DM) is anticipated to rise. HIV is characterized by systemic inflammations, markers of which decrease quickly following ART initiation, but typically do not completely normalize. Inflammation may be accompanied by insulin resistance (IR), and both are implicated in the pathogenesis of DM in HIV-positive individuals. Sub-Saharan Africa accounts for almost two-thirds of the global HIV burden but there are few reports of IR, DM and HIV in this region. We assessed the relationship between IR and viral suppression among HIV-positive adults in the Zambian national ART program. METHODS We conducted a cross-sectional survey evaluating HIV-positive adults that had received first line ART (usually TDF/FTC/EFV) for 12 months (± 3 months). Twenty clinics were sampled systematically based on the random starting-point, sampling interval and cumulative population size. Eligible patients had plasma viral load (VL), fasting insulin, and glucose performed. Insulin resistance was determined using Homeostatic model assessment (HOMA). We determined proportions for each outcome using linearized standard error 95% confidence intervals and summary estimates. Viral suppression was defined according to the detection threshold of<20 copies/mL and treatment failure was defined as VL>1,000 copies/mL. RESULTS Of 473 patients enrolled, 46.8% were male and 53.2% were female. 142 (30%) [95% CI: 0.26-0.34] had IR. Among those with IR, 55 (38.7%) were male whereas 87 (61.3%) were female (p value=0.104). 19% of individuals with IR had treatment failure compared to 5.7% without IR (p value<0.0001). 427 (90.3%) participants had treatment success (VL<1,000 copies/mL), and this was associated with a lower likelihood of IR (odds ratio (OR)=0.26 [0.14, 0.48], p value<0.0001). In addition, a significantly lower proportion of patients with IR were virologically suppressed at one-year compared to individuals without IR, 58% [0.54-0.70] versus 70% [0.65-0.75], respectively (p value=0.042). CONCLUSION In Zambian adults on ART for a year, the development of insulin resistance was strongly associated with suboptimal HIV outcomes, specifically non-viral suppression and treatment failure. Further investigations are warranted to determine if this positive association between IR and VL is causally related, and if so in which direction.
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Affiliation(s)
- LB Mulenga
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
- Ministry of Health, Ndeke House, Lusaka, Zambia
- Vanderbilt University Medical Center (VUMC), Department of Medicine, Division of Infectious Diseases, Nashville, TN, USA
- Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA
| | - P Musonda
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
| | - L Chirwa
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
| | - M Siwingwa
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
| | - A Mweemba
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
| | - S Suwilanji
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
| | - S Fwoloshi
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
| | - H Phiri
- Ministry of Health, Ndeke House, Lusaka, Zambia
| | - D Phiri
- Ministry of Health, Ndeke House, Lusaka, Zambia
| | - PL Mulenga
- Ministry of Health, Ndeke House, Lusaka, Zambia
| | - T Chisenga
- Ministry of Health, Ndeke House, Lusaka, Zambia
| | - R Nsakanya
- Ministry of Health, Ndeke House, Lusaka, Zambia
| | - A Shibemba
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
- Ministry of Health, Ndeke House, Lusaka, Zambia
| | - J Todd
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - S Nzala
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
| | - T Kaile
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
| | - C Kankasa
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
| | - L Hachaambwa
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
- University of Maryland, Baltimore, MD, USA
| | - C Claassen
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
- University of Maryland, Baltimore, MD, USA
| | - I Sikazwe
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- Centre for Infectious Diseases Research, Lusaka, Zambia
| | - JR Koethe
- Vanderbilt University Medical Center (VUMC), Department of Medicine, Division of Infectious Diseases, Nashville, TN, USA
- Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA
| | - E Sinkala
- University of Zambia, School of Medicine, Division of Infectious Diseases, Internal Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Diseases Center, Lusaka, Zambia
| | - DC Heimburger
- Vanderbilt University Medical Center (VUMC), Department of Medicine, Division of Infectious Diseases, Nashville, TN, USA
| | - CW Wester
- Vanderbilt University Medical Center (VUMC), Department of Medicine, Division of Infectious Diseases, Nashville, TN, USA
- Vanderbilt Institute for Global Health (VIGH), Nashville, TN, USA
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11
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Hedegaard H, Schoenbaum M, Claassen C, Crosby A, Holland K, Proescholdbell S. Issues in Developing a Surveillance Case Definition for Nonfatal Suicide Attempt and Intentional Self-harm Using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) Coded Data. Natl Health Stat Report 2018:1-19. [PMID: 29616901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Suicide and intentional self-harm are among the leading causes of death in the United States. To study this public health issue, epidemiologists and researchers often analyze data coded using the International Classification of Diseases (ICD). Prior to October 1, 2015, health care organizations and providers used the clinical modification of the Ninth Revision of ICD (ICD-9-CM) to report medical information in electronic claims data. The transition in October 2015 to use of the clinical modification of the Tenth Revision of ICD (ICD-10-CM) resulted in the need to update methods and selection criteria previously developed for ICD-9-CM coded data. This report provides guidance on the use of ICD-10-CM codes to identify cases of nonfatal suicide attempts and intentional self-harm in ICD-10-CM coded data sets. ICD-10-CM codes for nonfatal suicide attempts and intentional self-harm include: X71-X83, intentional self-harm due to drowning and submersion, firearms, explosive or thermal material, sharp or blunt objects, jumping from a high place, jumping or lying in front of a moving object, crashing of motor vehicle, and other specified means; T36-T50 with a 6th character of 2 (except for T36.9, T37.9, T39.9, T41.4, T42.7, T43.9, T45.9, T47.9, and T49.9, which are included if the 5th character is 2), intentional self-harm due to drug poisoning (overdose); T51-T65 with a 6th character of 2 (except for T51.9, T52.9, T53.9, T54.9, T56.9, T57.9, T58.0, T58.1, T58.9, T59.9, T60.9, T61.0, T61.1, T61.9, T62.9, T63.9, T64.0, T64.8, and T65.9, which are included if the 5th character is 2), intentional self-harm due to toxic effects of nonmedicinal substances; T71 with a 6th character of 2, intentional self-harm due to asphyxiation, suffocation, strangulation; and T14.91, Suicide attempt. Issues to consider when selecting records for nonfatal suicide attempts and intentional self-harm from ICD-10-CM coded administrative data sets are also discussed.
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Husain MM, McClintock SM, Rush AJ, Knapp RG, Fink M, Rummans TA, Rasmussen K, Claassen C, Petrides G, Biggs MM, Mueller M, Sampson S, Bailine SH, Lisanby SH, Kellner CH. The efficacy of acute electroconvulsive therapy in atypical depression. J Clin Psychiatry 2008; 69:406-11. [PMID: 18278988 PMCID: PMC3670137 DOI: 10.4088/jcp.v69n0310] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study examined the characteristics and outcomes of patients with major depressive disorder (MDD), with or without atypical features, who were treated with acute bilateral electroconvulsive therapy (ECT). METHOD Analyses were conducted with 489 patients who met DSM-IV criteria for MDD. Subjects were identified as typical or atypical on the basis of the Structured Clinical Interview for DSM-IV obtained at baseline prior to ECT. Depression symptom severity was measured by the 24-item Hamilton Rating Scale for Depression (HAM-D(24)) and the 30-item Inventory of Depressive Symptomatology-Self-Report (IDS-SR(30)). Remission was defined as at least a 60% decrease from baseline in HAM-D(24) score and a total score of 10 or below on the last 2 consecutive HAM-D(24) ratings. The randomized controlled trial was performed from 1997 to 2004. RESULTS The typical (N = 453) and atypical (N = 36) groups differed in several sociodemographic and clinical variables including gender (p = .0071), age (p = .0005), treatment resistance (p = .0014), and age at first illness onset (p < .0001) and onset of current episode (p = .0008). Following an acute course of bilateral ECT, a considerable portion of both the typical (67.1%) and the atypical (80.6%) groups reached remission. The atypical group was 2.6 (95% CI = 1.1 to 6.2) times more likely to remit than the typical group after adjustment for age, psychosis, gender, clinical site, and depression severity based on the HAM-D(24). CONCLUSION Acute ECT is an efficacious treatment for depressed patients with typical or atypical symptom features. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00000375.
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Boudreaux E, Allen M, Claassen C, Park J, Currier G, Camargo C. The Psychiatric Emergency Research Collaboration (PERC): A Multicenter Study of Insurance Status, Presentation, Management, and Disposition among Psychiatric Emergency Patients. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.1083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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14
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Larkin G, Claassen C. Prevalence and outcomes of occult suicidality in a multiethnic emergency department population. Ann Emerg Med 2004. [DOI: 10.1016/j.annemergmed.2004.07.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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van Roozendaal KE, Klijn JG, van Ooijen B, Claassen C, Eggermont AM, Henzen-Logmans SC, Foekens JA. Differential regulation of breast tumor cell proliferation by stromal fibroblasts of various breast tissue sources. Int J Cancer 1996; 65:120-5. [PMID: 8543388 DOI: 10.1002/(sici)1097-0215(19960103)65:1<120::aid-ijc20>3.0.co;2-j] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.8] [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: 01/31/2023]
Abstract
A stromal fibroblast-mediated paracrine regulation of epithelial tumor cell proliferation and differentiation plays an important role in the development and progression of breast tumors. We have studied the paracrine growth regulation of various phenotypically different breast cancer cell lines using conditioned serum-free media (C-SFM) from primary breast fibroblasts. Fibroblast cultures were established from malignant primary tumors and adjacent normal breast tissue, benign fibroadenomas, cosmetic reduction mammoplasties and breast skin tissues. All fibroblast-conditioned media were shown to stimulate the proliferation of breast cancer cell lines. However, the C-SFM-induced MCF-7 proliferative response was shown to be significantly higher than the proliferative response observed with any of the other cell lines tested. More importantly, the MCF-7 proliferative response obtained with malignant tumor tissue fibroblast C-SFM was shown to be significantly higher than the response to C-SFM from paired (and unpaired) normal adjacent breast tissue fibroblasts. The MCF-7 proliferative response to fibroblast C-SFM from normal tissue (adjacent to the tumor) was further shown to be comparable to the MCF-7 response using benign or reduction mammoplastic tissue fibroblast C-SFM. In addition, we show that IGFs are only partly responsible for the observed proliferative effect of the C-SFMs, while EGF, TGF alpha and basic-FGF are shown not to be involved. We conclude that stromal fibroblasts can differentially regulate breast cancer cell proliferation. Both the fibroblast's tissue source as well as the target tumor cell's phenotype will determine the extent of the proliferative response.
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Affiliation(s)
- K E van Roozendaal
- Department of Medical Oncology, Dr. Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
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16
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van Roozendaal CE, Klijn JG, van Ooijen B, Claassen C, Eggermont AM, Henzen-Logmans SC, Foekens JA. Transforming growth factor beta secretion from primary breast cancer fibroblasts. Mol Cell Endocrinol 1995; 111:1-6. [PMID: 7649348 DOI: 10.1016/0303-7207(95)03539-j] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [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: 01/26/2023]
Abstract
Transforming growth factor beta (TGF-beta) is a hormonally regulated growth inhibitor with autocrine and/or paracrine functions in human breast cancer. In vivo, enhanced immunohistochemical staining of extracellular TGF-beta 1 has been detected around stromal fibroblasts in response to the antiestrogen treatment. We have investigated the effects of tamoxifen on the production of TGF-beta by primary human breast fibroblast cultures in serum-free medium. Highly variable levels of mainly latent TGF-beta 1 were detected in conditioned media from both tumor and normal tissue derived fibroblasts. Hydroxy-tamoxifen was shown to increase latent TGF-beta 1 secretion in three of the eight tumor tissue-derived fibroblast cultures. Such effect of hydroxy-tamoxifen was not observed in fibroblast cultures established from normal adjacent breast tissue.
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Affiliation(s)
- C E van Roozendaal
- Department of Medical Oncology, Dr Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
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van Roozendaal C, Claassen C, Klijn J, van Ooijen B, Eggermont A, Henzen-Logmans S, Foekens J. Transforming growth factor beta secretion by human breast fibroblasts in vitro. Breast 1993. [DOI: 10.1016/0960-9776(93)90150-e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Kuenen-Boumeester V, Van der Kwast TH, van Putten WL, Claassen C, van Ooijen B, Henzen-Logmans SC. Immunohistochemical determination of androgen receptors in relation to oestrogen and progesterone receptors in female breast cancer. Int J Cancer 1992; 52:581-4. [PMID: 1399140 DOI: 10.1002/ijc.2910520415] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.1] [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: 12/26/2022]
Abstract
The expression of oestrogen (ER), progesterone (PR) and androgen (AR) receptors in female breast cancer was investigated by immunohistochemistry on snap-frozen tissue specimens of a series of 100 breast cancers. For detection of the AR we used a recently developed mouse monoclonal antibody specific for the N-terminal domain of the human AR. Expression of AR was compared with that of ER and PR as well as with tumour grade and age. Of the breast cancers investigated, 76% were AR-positive. This high percentage corresponds well with previous data on AR expression in breast cancer determined with ligand-binding assays. In 53% of the tumours AR, ER and PR were present, while 9% of the tumours were positive for AR and negative for ER and PR. In 13% of the tumours no ER, PR or AR expression was seen; these were all grade-III tumours. A positive correlation was found between age and ER expression, but no correlation was seen between age and PR or AR. Future studies should establish the prognostic value of the combination ER, PR and AR determinations on female breast cancer with regard to biological behaviour and response rate to hormonal therapy.
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Affiliation(s)
- V Kuenen-Boumeester
- Department of Pathology, Erasmus University, Rotterdam, Pays-Bas, The Netherlands
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Abstract
Paracrine influences from fibroblasts derived from different sources of breast tissue on epithelial breast cancer cell growth in vitro were investigated. Medium conditioned (CM) by fibroblasts derived from tumours, adjacent normal breast tissue, and normal breast tissue obtained from reduction mammoplasty or from skin tissue significantly stimulated the growth of the steroid-receptor positive cell lines MCF-7 and ZR 75.1. The proliferation index (PI) on MCF-7 cells with CM from fibroblasts derived from breast tumour tissue was significantly higher than that obtained with fibroblasts derived from adjacent normal breast tissue (2p less than 0.05, n = 8). The PI obtained with CM from normal fibroblast cultures from reduction mammoplasty tissue, like normal tissue adjacent to the tumour, fell in the lower range of values. Skin fibroblast, like tumour tissue derived fibroblast, CM caused a high range PI. MDA-MB-231 and Evsa-T, two steroid-receptor negative cell lines, showed only a minor growth stimulatory responses with some of the fibroblast CM's. Evsa-T was occasionally inhibited by CM's. In conclusion, stromal factors play a role in the growth regulation of human breast cancer cells. The effects on cancer cell growth are, however, varying depending on the source of the stroma and the characteristics of the epithelial tumour cells.
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Affiliation(s)
- C E van Roozendaal
- Division of Endocrine Oncology (Department Medical Oncology), Dr Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
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