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de Azambuja E, Agostinetto E, Procter M, Eiger D, Pondé N, Guillaume S, Parlier D, Lambertini M, Desmet A, Caballero C, Aguila C, Jerusalem G, Walshe JM, Frank E, Bines J, Loibl S, Piccart-Gebhart M, Ewer MS, Dent S, Plummer C, Suter T. Cardiac safety of dual anti-HER2 blockade with pertuzumab plus trastuzumab in early HER2-positive breast cancer in the APHINITY trial. ESMO Open 2023; 8:100772. [PMID: 36681013 PMCID: PMC10044361 DOI: 10.1016/j.esmoop.2022.100772] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/08/2022] [Accepted: 12/11/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Trastuzumab increases the incidence of cardiac events (CEs) in patients with breast cancer (BC). Dual blockade with pertuzumab (P) and trastuzumab (T) improves BC outcomes and is the standard of care for high-risk human epidermal growth factor receptor 2 (HER2)-positive early BC patients. We analyzed the cardiac safety of P and T in the phase III APHINITY trial. PATIENTS AND METHODS Left ventricular ejection fraction (LVEF) ≥ 55% was required at study entry. LVEF assessment was carried out every 3 months during treatment, every 6 months up to month 36, and yearly up to 10 years. Primary CE was defined as heart failure class III/IV and a significant decrease in LVEF (defined as ≥10% from baseline and to <50%), or cardiac death. Secondary CE was defined as a confirmed significant decrease in LVEF, or CEs confirmed by the cardiac advisory board. RESULTS The safety analysis population consisted of 4769 patients. With 74 months of median follow-up, CEs were observed in 159 patients (3.3%): 83 (3.5%) in P + T and 76 (3.2%) in T arms, respectively. Most CEs occurred during anti-HER2 therapy (123; 77.4%) and were asymptomatic or mildly symptomatic decreases in LVEF (133; 83.6%). There were two cardiac deaths in each arm (0.1%). Cardiac risk factors indicated were age > 65 years, body mass index ≥ 25 kg/m2, baseline LVEF between 55% and <60%, and use of an anthracycline-containing chemotherapy regimen. Acute recovery from a CE based on subsequent LVEF values was observed in 127/155 patients (81.9%). CONCLUSIONS Dual blockade with P + T does not increase the risk of CEs compared with T alone. The use of anthracycline-based chemotherapy increases the risk of a CE; hence, non-anthracycline chemotherapy may be considered, particularly in patients with cardiovascular risk factors.
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Affiliation(s)
- E de Azambuja
- Institut Jules Bordet and L'Université Libre de Bruxelles (U.L.B), Brussels, Belgium.
| | - E Agostinetto
- Institut Jules Bordet and L'Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - M Procter
- Frontier Science, Kincraig, Kingussie, UK
| | - D Eiger
- F.Hoffmann-La Roche Ltd, Basel, Switzerland
| | - N Pondé
- Clinical Oncology Department, AC Camargo Cancer Center, São Paulo, Brazil
| | - S Guillaume
- Institut Jules Bordet and L'Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - D Parlier
- Institut Jules Bordet and L'Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - M Lambertini
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - A Desmet
- Institut Jules Bordet and L'Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - C Caballero
- Breast International Group, Brussels, Belgium
| | - C Aguila
- F.Hoffmann-La Roche Ltd, Basel, Switzerland
| | - G Jerusalem
- CHU Liege and Liege University, Liege, Belgium
| | - J M Walshe
- Cancer Trials Ireland, St Vincent's University Hospital, Dublin, Ireland
| | - E Frank
- Dana-Farber Cancer Institute, Boston, USA
| | - J Bines
- Instituto Nacional de Cancer, INCA, Rio de Janeiro, Brazil
| | - S Loibl
- German Breast Group, Neu-Isenburg, Germany
| | - M Piccart-Gebhart
- Institut Jules Bordet and L'Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - M S Ewer
- University of Texas, MD Anderson Cancer Center, Houston
| | - S Dent
- Duke Cancer Institute, Duke University, Durham, USA
| | - C Plummer
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
| | - T Suter
- Department of Cardiology, Cardio-Oncology, Bern University Hospital, Bern, Switzerland
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Abstract
Abstract
Background
NextGenU.org and partners have offered (since 2012) free, accredited health sciences courses, with registrants in 192 (of 193) countries. We have now developed the world's first free, accredited degree: The Master of Public Health (MPH), including registration, teaching, testing, and co-granting of a degree. To this end, we continue collaborating with leading public health organizations and educational institutions.
Objectives
Our objective is to improve the health of the underserved, remove barriers to diversifying the health professional workforce, and promote understanding of global/population health. The MPH provides tested and validated interprofessional education in an ongoing timeframe. Institutions add to our MPH via qualified mentors to guide the competency-based mentored activities. Universities may use any/all parts and offer the courses/degrees to students for free or for the school's cost of mentoring. Knowledge acquisition continues to be computer-based via resources from academic, government, professional society, and peer-reviewed journal sources; local and remote peer and mentored activities are included.
Results
We have tested and published on this free model in North American public health, medical, and undergrad students, and in community health workers and primary care physicians in Kenya and India, showing as much knowledge gain and greater student satisfaction than with traditional courses. Peer-reviewed publications on NextGenU.org's efficacy are available at https://nextgenu.org/static/publications.html. All our trainings are reviewed/endorsed by our global academic, governmental and professional partners.
Conclusions
Our research shows the MPH creates local opportunities for health workers in their communities, reducing brain drain and exodus of health workers. We hope that conference attendees discovering these educational innovations translate our findings into action, distributing this resource to their institutions and countries.
Key messages
Our free MPH enables would-be and current health professionals and other learners globally to have equal access to first-class learning resources, without economic or geographic barriers. Because NextGenU.org is able to freely offer these first-class resources to all, our MPH can—and will—change the face of global health through creating worldwide communities of practice.
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Affiliation(s)
- E Frank
- UBC, NextGenU, Nanoose Bay, Canada
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3
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Petitti L, Axelrod J, Campbell-Kotler M, Frank E, Jaremek J, Levine J, McWilliams M, Migyanka F, Ryan N, Viggiano E, Metzger-Filho O, Oesterreich S, Pate L. Abstract P5-17-01: Lobular breast cancer alliance - Advocates advancing research, screening, treatment and follow-up care for lobular breast disease. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-17-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
Thirty patient advocates attended the First International Invasive Lobular Breast Cancer Symposium in 2016 at the University of Pittsburgh Cancer Center. The conference underscored that invasive lobular breast cancer (ILC) and other lobular pathologies are understudied. Specifically:
ILC is the sixth most prevalent cancer of women and the second most frequently diagnosed histological subtype of breast cancer impacting up to 34,000 patients a year in the US.
ILC is a molecularly distinct breast cancer with unique subtypes and variants with differences in presentation and behavior, including physical findings of thickening and a tendency to metastasize to unique locations.
While ILC is frequently associated with a good initial prognosis, recent analysis suggests that long-term outcomes of ILC may be worse than those stage-matched to ductal breast cancer.
Current imaging tools are less reliable for early detection of lobular disease and detection of distant recurrence.
Standard of care chemotherapy and endocrine therapies may have different effectiveness applied to ILC and IDC.
Challenges
Growing interest in ILC research requires improved methods to identify, communicate with and link patients with ILC to clinical trials and research. Advocates with advanced science training are needed as partners for research proposals and grant reviews.
Lobular breast cancer is under-represented in key meetings and literature. Encouraging opportunities to share ILC research as agenda topics and fostering collaborations between researchers, clinicians and advocates can accelerate progress and refine clinical practices for screening, treatment and follow-up.
Patients living with ILC lack a central on-line source of lobular breast cancer information and resources. This information gap is a barrier to help patients recognize signs of lobular breast cancer's unique presentation and metastatic behaviors.
Results
The Lobular Breast Cancer Alliance (LBCA) was formed by patient advocates who attended the First International ILC Symposium in response to advocate-identified opportunities to advance research, refine treatments and enhance patient education.
LBCA's mission is to bridge patients, clinicians and researchers to increase our knowledge of lobular breast disease and promote research that leads to advancements in prevention, diagnosis, treatment and patient follow-up care.
Conclusions
LBCA is driving an increased awareness of lobular breast cancer with specific goals:
Build a clinically accurate, patient centered website devoted to lobular breast cancer at www.LobularBreastCancer.org.
Elevate lobular research and foster opportunities for researcher, advocate and clinician collaborations at prominent conferences and meetings.
Identify barriers to conduct research on ILC and metastasis and link patients and advocates to ILC tumor research and clinical trials.
Initiate peer-to-peer clinician outreach strategy through targeted literature, meetings and education services to share information on ILC presentation, metastatic patterns and screening and treatment challenges of patients with ILC.
Build partnerships with existing breast cancer organizations to integrate ILC into existing information resources and work on common goals.
Citation Format: Petitti L, Axelrod J, Campbell-Kotler M, Frank E, Jaremek J, Levine J, McWilliams M, Migyanka F, Ryan N, Viggiano E, Metzger-Filho O, Oesterreich S, Pate L. Lobular breast cancer alliance - Advocates advancing research, screening, treatment and follow-up care for lobular breast disease [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-17-01.
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Affiliation(s)
- L Petitti
- Lobular Breast Cancer Alliance; Women's Cancer Research Center. University of Pittsburgh Cancer Institute. Magee Women's Research Institute; Dana-Farber Cancer Institute; New Hampshire Breast Cancer Coalition
| | - J Axelrod
- Lobular Breast Cancer Alliance; Women's Cancer Research Center. University of Pittsburgh Cancer Institute. Magee Women's Research Institute; Dana-Farber Cancer Institute; New Hampshire Breast Cancer Coalition
| | - M Campbell-Kotler
- Lobular Breast Cancer Alliance; Women's Cancer Research Center. University of Pittsburgh Cancer Institute. Magee Women's Research Institute; Dana-Farber Cancer Institute; New Hampshire Breast Cancer Coalition
| | - E Frank
- Lobular Breast Cancer Alliance; Women's Cancer Research Center. University of Pittsburgh Cancer Institute. Magee Women's Research Institute; Dana-Farber Cancer Institute; New Hampshire Breast Cancer Coalition
| | - J Jaremek
- Lobular Breast Cancer Alliance; Women's Cancer Research Center. University of Pittsburgh Cancer Institute. Magee Women's Research Institute; Dana-Farber Cancer Institute; New Hampshire Breast Cancer Coalition
| | - J Levine
- Lobular Breast Cancer Alliance; Women's Cancer Research Center. University of Pittsburgh Cancer Institute. Magee Women's Research Institute; Dana-Farber Cancer Institute; New Hampshire Breast Cancer Coalition
| | - M McWilliams
- Lobular Breast Cancer Alliance; Women's Cancer Research Center. University of Pittsburgh Cancer Institute. Magee Women's Research Institute; Dana-Farber Cancer Institute; New Hampshire Breast Cancer Coalition
| | - F Migyanka
- Lobular Breast Cancer Alliance; Women's Cancer Research Center. University of Pittsburgh Cancer Institute. Magee Women's Research Institute; Dana-Farber Cancer Institute; New Hampshire Breast Cancer Coalition
| | - N Ryan
- Lobular Breast Cancer Alliance; Women's Cancer Research Center. University of Pittsburgh Cancer Institute. Magee Women's Research Institute; Dana-Farber Cancer Institute; New Hampshire Breast Cancer Coalition
| | - E Viggiano
- Lobular Breast Cancer Alliance; Women's Cancer Research Center. University of Pittsburgh Cancer Institute. Magee Women's Research Institute; Dana-Farber Cancer Institute; New Hampshire Breast Cancer Coalition
| | - O Metzger-Filho
- Lobular Breast Cancer Alliance; Women's Cancer Research Center. University of Pittsburgh Cancer Institute. Magee Women's Research Institute; Dana-Farber Cancer Institute; New Hampshire Breast Cancer Coalition
| | - S Oesterreich
- Lobular Breast Cancer Alliance; Women's Cancer Research Center. University of Pittsburgh Cancer Institute. Magee Women's Research Institute; Dana-Farber Cancer Institute; New Hampshire Breast Cancer Coalition
| | - L Pate
- Lobular Breast Cancer Alliance; Women's Cancer Research Center. University of Pittsburgh Cancer Institute. Magee Women's Research Institute; Dana-Farber Cancer Institute; New Hampshire Breast Cancer Coalition
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Hasan A, Wobrock T, Guse B, Langguth B, Landgrebe M, Eichhammer P, Frank E, Cordes J, Wölwer W, Musso F, Winterer G, Gaebel W, Hajak G, Ohmann C, Verde PE, Rietschel M, Ahmed R, Honer WG, Dechent P, Malchow B, Castro MFU, Dwyer D, Cabral C, Kreuzer PM, Poeppl TB, Schneider-Axmann T, Falkai P, Koutsouleris N. Structural brain changes are associated with response of negative symptoms to prefrontal repetitive transcranial magnetic stimulation in patients with schizophrenia. Mol Psychiatry 2017; 22:857-864. [PMID: 27725655 DOI: 10.1038/mp.2016.161] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/06/2016] [Accepted: 08/04/2016] [Indexed: 12/13/2022]
Abstract
Impaired neural plasticity may be a core pathophysiological process underlying the symptomatology of schizophrenia. Plasticity-enhancing interventions, including repetitive transcranial magnetic stimulation (rTMS), may improve difficult-to-treat symptoms; however, efficacy in large clinical trials appears limited. The high variability of rTMS-related treatment response may be related to a comparably large variation in the ability to generate plastic neural changes. The aim of the present study was to determine whether negative symptom improvement in schizophrenia patients receiving rTMS to the left dorsolateral prefrontal cortex (DLPFC) was related to rTMS-related brain volume changes. A total of 73 schizophrenia patients with predominant negative symptoms were randomized to an active (n=34) or sham (n=39) 10-Hz rTMS intervention applied 5 days per week for 3 weeks to the left DLPFC. Local brain volume changes measured by deformation-based morphometry were correlated with changes in negative symptom severity using a repeated-measures analysis of covariance design. Volume gains in the left hippocampal, parahippocampal and precuneal cortices predicted negative symptom improvement in the active rTMS group (all r⩽-0.441, all P⩽0.009), but not the sham rTMS group (all r⩽0.211, all P⩾0.198). Further analyses comparing negative symptom responders (⩾20% improvement) and non-responders supported the primary analysis, again only in the active rTMS group (F(9, 207)=2.72, P=0.005, partial η 2=0.106). Heterogeneity in clinical response of negative symptoms in schizophrenia to prefrontal high-frequency rTMS may be related to variability in capacity for structural plasticity, particularly in the left hippocampal region and the precuneus.
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Affiliation(s)
- A Hasan
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - T Wobrock
- Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany.,Department of Psychiatry and Psychotherapy, County Hospitals Darmstadt-Dieburg, Groß-Umstadt, Germany
| | - B Guse
- Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany
| | - B Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - M Landgrebe
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.,Department of Psychiatry, Psychosomatics and Psychotherapy, kbo-Lech-Mangfall-Klinik Agatharied, Agatharied, Germany
| | - P Eichhammer
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - E Frank
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - J Cordes
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - W Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - F Musso
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - G Winterer
- Experimental and Clinical Research Centre, The Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - W Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - G Hajak
- Department of Psychiatry, Psychosomatics and Psychotherapy, Sozialstiftung Bamberg, Bamberg, Germany
| | - C Ohmann
- European Clinical Research Network, Düsseldorf, Germany
| | - P E Verde
- Coordination Centre for Clinical Trials, Heinrich-Heine University, Düsseldorf, Germany
| | - M Rietschel
- Department of Genetic Epidemiology in Psychiatry, Institute of Central Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - R Ahmed
- Institut für anwendungsorientierte Forschung und klinische Studien GmbH, Göttingen, Germany
| | - W G Honer
- Department of Genetic Epidemiology in Psychiatry, Institute of Mental Health, The University of British Columbia, Vancouver, BC, Canada
| | - P Dechent
- Department of Cognitive Neurology, Georg-August-University Goettingen, Goettingen, Germany
| | - B Malchow
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - M F U Castro
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - D Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - C Cabral
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - P M Kreuzer
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - T B Poeppl
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - T Schneider-Axmann
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - P Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - N Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
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Ligibel JA, Giobbie-Hurder A, Dillion D, Shockro L, Campbell N, Rhei E, Troyan S, Dominici L, Golshan M, Chagpar A, Yung R, Freedman R, Tolaney S, Winer E, Frank E, McTiernan A, Irwin M. Abstract P5-11-02: Impact of pre-operative exercise and mind-body interventions on patient-reported outcomes in women with newly diagnosed breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-11-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Breast cancer diagnosis has a number of adverse psychological effects. The Pre-Operative Health and Body (PreHAB) Study tested the impact of exercise and mind-body interventions upon on mood, quality of life, and patient-reported outcomes in women with newly diagnosed breast cancer.
Methods: Women with newly diagnosed Stage I-III breast cancer were enrolled through Dana-Farber Cancer Institute and Yale University breast cancer clinics prior to surgery. Participants were randomized 1:1 to an aerobic and strength-training exercise intervention, comprised of twice-weekly meetings with an exercise trainer and home based aerobic exercise, or to a self-directed mind-body relaxation intervention, comprised of a book and CD focused on relaxation and visualization. Participants engaged in the interventions between enrollment and surgery. The EORTC QLQ C-30, Hospital Anxiety and Depression Scale, and Perceived Stress Scale were collected at enrollment and prior to surgery.
Results: 49 women were randomized (27 exercise and 22 control). Mean time between enrollment and surgery was 4.2 weeks. At baseline, patients reported moderate levels of anxiety, stress, insomnia, and lack of appetite, as well as diminished emotional and cognitive functioning (Table). Exercise participants significantly increased minutes of weekly exercise vs. mind-body participants (increase of 203 vs. 23 min/wk, p<0.0001). Mind body participants engaged in the intervention on average 69% of days during the intervention period. Pre-post changes demonstrated that participation in the mind-body intervention led to improvements in emotional and cognitive functioning and a reduction in anxiety and stress, and participation in the exercise intervention led to improvements in global quality of life, insomnia, appetite, and stress (Table). Women in the mind-body group experienced a significantly greater improvement in cognitive functioning as compared to women in the exercise group.
Conclusions: Women with newly diagnosed breast cancer reported a number of physical and psychological symptoms in the pre-operative period. Exercise and mind-body interventions demonstrated promising benefits in improving functioning and reducing symptoms. More work is needed to develop pre-operative programs to help reduce the distress imparted by a cancer diagnosis in the critical time between diagnosis and surgery.
Table*
Exercise Mind Body Between Groups BaselineChangep valueBaselineChangep valuep valueEmotional Functioning68.6 (23.3)4.7 (18.3)0.2966.3 (24.2)10.0 (20.5)0.050.64Cognitive Functioning79.5 (24.6)-3.3 (24.1)0.6273.8 (22.1)11.7 (15.4)0.0020.03QOL74.0 (15.3)9.7 (15.9)0.00569.0 (21.1)7.5 (18.5)0.110.78Insomnia35.9 (32.6)-16.7 (32.6)0.0334.9 (35.7)-8.3 (21.3)0.060.52Lack of Appetite17.9 (27.0)-13.3 (27.2)0.0311.1 (19.2)-5.0 (22.4)0.530.29Anxiety8.3 (3.4)-0.6 (2.9)0.259.2 (2.5)-1.6 (2.3)0.0060.35Stress14.7 (7.2)-2.2 (4.9)0.0618.4 (5.5)-3.1 (6.8)0.060.77
*Results reported as means (SD). Positive scores on functional and QOL measures indicate improvements; negative scores on symptom measures indicate a decrease in symptoms.
Citation Format: Ligibel JA, Giobbie-Hurder A, Dillion D, Shockro L, Campbell N, Rhei E, Troyan S, Dominici L, Golshan M, Chagpar A, Yung R, Freedman R, Tolaney S, Winer E, Frank E, McTiernan A, Irwin M. Impact of pre-operative exercise and mind-body interventions on patient-reported outcomes in women with newly diagnosed breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-11-02.
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Affiliation(s)
- JA Ligibel
- Dana-Farber Cancer Institute; Brigham and Women's Hospital; Yale University; Fred Hutchinson Cancer Research Center
| | - A Giobbie-Hurder
- Dana-Farber Cancer Institute; Brigham and Women's Hospital; Yale University; Fred Hutchinson Cancer Research Center
| | - D Dillion
- Dana-Farber Cancer Institute; Brigham and Women's Hospital; Yale University; Fred Hutchinson Cancer Research Center
| | - L Shockro
- Dana-Farber Cancer Institute; Brigham and Women's Hospital; Yale University; Fred Hutchinson Cancer Research Center
| | - N Campbell
- Dana-Farber Cancer Institute; Brigham and Women's Hospital; Yale University; Fred Hutchinson Cancer Research Center
| | - E Rhei
- Dana-Farber Cancer Institute; Brigham and Women's Hospital; Yale University; Fred Hutchinson Cancer Research Center
| | - S Troyan
- Dana-Farber Cancer Institute; Brigham and Women's Hospital; Yale University; Fred Hutchinson Cancer Research Center
| | - L Dominici
- Dana-Farber Cancer Institute; Brigham and Women's Hospital; Yale University; Fred Hutchinson Cancer Research Center
| | - M Golshan
- Dana-Farber Cancer Institute; Brigham and Women's Hospital; Yale University; Fred Hutchinson Cancer Research Center
| | - A Chagpar
- Dana-Farber Cancer Institute; Brigham and Women's Hospital; Yale University; Fred Hutchinson Cancer Research Center
| | - R Yung
- Dana-Farber Cancer Institute; Brigham and Women's Hospital; Yale University; Fred Hutchinson Cancer Research Center
| | - R Freedman
- Dana-Farber Cancer Institute; Brigham and Women's Hospital; Yale University; Fred Hutchinson Cancer Research Center
| | - S Tolaney
- Dana-Farber Cancer Institute; Brigham and Women's Hospital; Yale University; Fred Hutchinson Cancer Research Center
| | - E Winer
- Dana-Farber Cancer Institute; Brigham and Women's Hospital; Yale University; Fred Hutchinson Cancer Research Center
| | - E Frank
- Dana-Farber Cancer Institute; Brigham and Women's Hospital; Yale University; Fred Hutchinson Cancer Research Center
| | - A McTiernan
- Dana-Farber Cancer Institute; Brigham and Women's Hospital; Yale University; Fred Hutchinson Cancer Research Center
| | - M Irwin
- Dana-Farber Cancer Institute; Brigham and Women's Hospital; Yale University; Fred Hutchinson Cancer Research Center
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Ligibel JA, Irwin M, Dillon D, Barry W, Giobbie-Hurder A, Frank E, Winer EP, McTiernan A, Cornwell M, Pun M, Brown M, Jeselsohn R. Abstract S5-05: Impact of pre-operative exercise on breast cancer gene expression. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-s5-05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Exercise is linked to a lower risk of developing and dying from breast cancer, but the biological mechanisms through which exercise could impact breast cancer are unclear. In animal models, exercise impacts tumor formation and progression, but there are few data regarding direct effects of exercise on tumor tissue in humans. The Pre-Operative Health and Body (PreHAB) Study was a randomized window of opportunity trial designed to explore the impact of exercise on molecular pathways in women with breast cancer.
Methods: Inactive women with Stage I-III breast cancer were enrolled through Dana-Farber Cancer Institute and Yale University prior to surgery. Participants were randomized 1:1 to an aerobic and strength training exercise intervention or mind body control intervention and participated in the interventions between enrollment and the time of surgery. Tumor tissue was collected at enrollment and surgery; samples were reviewed by a breast pathologist and were macrodissected to include sections of tumor with at least 10% cellularity. Capture RNA-sequencing of the transcriptome coding regions was performed using the Illumina Truseq RNA access platform.
Results: 49 women were randomized (27 exercise and 22 control). At baseline, mean age was 52.6, BMI was 30.2kg/m2 and exercise was 49 min/wk. Mean time between enrollment and surgery was 4.2 weeks. Participants in the exercise arm significantly increased exercise vs. controls (increase of 203 vs. 23 min/wk, p<0.0001). Transcriptomic analysis was performed on the tumors from the pre and post intervention biopsies from 32 patients (16 exercise and 16 control). Quality Control analysis of the RNA-sequencing data showed an average read depth of 25 million reads per sample, mapping ∼79% to exonic regions. Principal Component Analysis revealed no read bias or batch effects and unsupervised clustering showed that pre- and post-operative samples clustered together by patient. Differential gene expression analysis by DEseq2 revealed a limited number of individual genes with significant changes after the intervention. KEGG pathway analysis, however, of 214 KEGG pathways using the bioconductor package GAGE (Generally Applicable Gene-Set Enrichment for Pathway Analysis) demonstrated upregulation of 13 unique pathways between the baseline biopsy and surgical excision in exercise participants and none in mind body participants (q<0.1). The top ranked upregulated pathway was cytokine-cytokine receptor interactions (q=6.93E-05, set size=238 genes). Il6, CCL3 and other cytokines are among the genes upregulated in this pathway. Analysis also demonstrated downregulation of 13 unique pathways (q<0.1) including cell cycle, RNA transport and DNA replication pathways, in exercise participants over the intervention period.
Conclusions: A pre-operative exercise intervention led to alterations in gene expression in tumor tissue in women with breast cancer. Validation in additional data sets and an analysis of which cellular compartments within the tumor are responsible for the changes is needed. These findings demonstrate that exercise may have a direct effect on breast tumor tissue in humans, providing new insights into the biologic mechanisms through which exercise could lower the risk of developing and dying from breast cancer.
Citation Format: Ligibel JA, Irwin M, Dillon D, Barry W, Giobbie-Hurder A, Frank E, Winer EP, McTiernan A, Cornwell M, Pun M, Brown M, Jeselsohn R. Impact of pre-operative exercise on breast cancer gene expression [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr S5-05.
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Affiliation(s)
- JA Ligibel
- Dana-Farber Cancer Institute; Yale University; Brigham and Women's Hospital; Fred Hutchinson Cancer Research Center
| | - M Irwin
- Dana-Farber Cancer Institute; Yale University; Brigham and Women's Hospital; Fred Hutchinson Cancer Research Center
| | - D Dillon
- Dana-Farber Cancer Institute; Yale University; Brigham and Women's Hospital; Fred Hutchinson Cancer Research Center
| | - W Barry
- Dana-Farber Cancer Institute; Yale University; Brigham and Women's Hospital; Fred Hutchinson Cancer Research Center
| | - A Giobbie-Hurder
- Dana-Farber Cancer Institute; Yale University; Brigham and Women's Hospital; Fred Hutchinson Cancer Research Center
| | - E Frank
- Dana-Farber Cancer Institute; Yale University; Brigham and Women's Hospital; Fred Hutchinson Cancer Research Center
| | - EP Winer
- Dana-Farber Cancer Institute; Yale University; Brigham and Women's Hospital; Fred Hutchinson Cancer Research Center
| | - A McTiernan
- Dana-Farber Cancer Institute; Yale University; Brigham and Women's Hospital; Fred Hutchinson Cancer Research Center
| | - M Cornwell
- Dana-Farber Cancer Institute; Yale University; Brigham and Women's Hospital; Fred Hutchinson Cancer Research Center
| | - M Pun
- Dana-Farber Cancer Institute; Yale University; Brigham and Women's Hospital; Fred Hutchinson Cancer Research Center
| | - M Brown
- Dana-Farber Cancer Institute; Yale University; Brigham and Women's Hospital; Fred Hutchinson Cancer Research Center
| | - R Jeselsohn
- Dana-Farber Cancer Institute; Yale University; Brigham and Women's Hospital; Fred Hutchinson Cancer Research Center
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7
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Painter CA, Anastasio E, Krevalin M, Kim D, Larken K, Lennon N, Frank E, Winer EP, Lander ES, Golub T. Abstract P1-05-13: The metastatic breast cancer project: Translational genomics through direct patient engagement. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-05-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The Metastatic Breast Cancer Project is a nationwide research initiative that directly engages patients through social media and advocacy groups and seeks to empower them to share their samples and clinical information to accelerate research. Because the vast majority of patients are treated in the community setting, we sought to determine the feasibility of remotely obtaining tumor and saliva samples as well as medical records from a large cohort of metastatic breast cancer (MBC) patients who receive their care in diverse settings around the country.
Methods: In collaboration with patients and advocacy groups, we developed a website to allow MBC patients across the U.S. to participate. Enrolled patients are sent a saliva kit and asked to mail back a saliva sample, which is used to extract germline DNA. We contact participants' medical providers and obtain medical records and part of their tumor biopsy. Whole exome and transcriptome sequencing is performed on tumor and germline samples. Clinically annotated genomic data are used to identify mechanisms of response and resistance to therapies. The database will be shared widely with researchers. Study updates and discoveries are shared with participants regularly.
Results: In the first 8 months, 2285 MBC patients from all 50 states enrolled. 2163 (95%) completed the 16-question survey about their cancer, treatments, and demographic information. 1232 completed the online consent form permitting acquisition and analysis of medical records, tumor tissue, and saliva samples. 556 saliva samples have been received. Initial medical record and tumor sample requests have been made for patients who have provided saliva samples. To date, we have obtained medical records from 102 patients (93% success rate) and tumor samples from 32 patients (77% success rate). Whole exome and transcriptome sequencing has been successfully completed on initial samples received and is ongoing for additional samples.
Conclusions: Partnering directly with patients through social media and advocacy groups enables rapid identification of thousands of patients willing to share tumors, saliva, and medical records to accelerate research. This approach allows for rapid identification of patients with rare phenotypes such as extraordinary responders, who have been challenging to identify with traditional approaches. Remote acquisition of medical records, saliva samples, and tumor tissue for patients located throughout the U.S. is feasible. Genomic analysis and medical record abstraction for these patients is underway. As data is generated, a clinically annotated database will be shared widely with the research community.
Citation Format: Painter CA, Anastasio E, Krevalin M, Kim D, Larken K, Lennon N, Frank E, Winer EP, Lander ES, Golub T. The metastatic breast cancer project: Translational genomics through direct patient engagement [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-05-13.
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Affiliation(s)
- CA Painter
- Broad institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer, Boston, MA
| | - E Anastasio
- Broad institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer, Boston, MA
| | - M Krevalin
- Broad institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer, Boston, MA
| | - D Kim
- Broad institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer, Boston, MA
| | - K Larken
- Broad institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer, Boston, MA
| | - N Lennon
- Broad institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer, Boston, MA
| | - E Frank
- Broad institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer, Boston, MA
| | - EP Winer
- Broad institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer, Boston, MA
| | - ES Lander
- Broad institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer, Boston, MA
| | - T Golub
- Broad institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer, Boston, MA
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Abstract
This unique case reports the nonsurgical management of a late (2 years) methicillin-resistant Staphylococcus aureus neck infection around a Dacron-patched carotid endarterectomy. Because the patient was elderly with multiple serious risk factors and no drainable material, IV and oral antibiotics were selected as initial management. Follow-up computed tomography of the neck, however, documented complete resolution of the phlegmon. While the authors remain uncertain of the long-term outcome the patient is free of local infection 2 years after diagnosis and nonoperative treatment.
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Affiliation(s)
- A Byer
- Department of Surgery, Hackensack University Medical Center, Hackensack, NJ 07601, USA.
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9
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Soreca I, Wallace ML, Hall MH, Hasler BP, Frank E, Kupfer DJ. The association between meal timing and frequency with cardiometabolic profile in patients with bipolar disorder. Acta Psychiatr Scand 2016; 133:453-8. [PMID: 27084394 DOI: 10.1111/acps.12578] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The goal of this study was to explore the association of timing of and frequency of meals with markers of cardiometabolic risk in patients with bipolar disorder in out-patient maintenance treatment. METHODS We used Pittsburgh Sleep Diary and actigraphy measures for individuals with bipolar I disorder. Linear and logistic regression analyses were used to determine whether dinnertime, instability of dinnertime, and/or interval between meals were associated with metabolic syndrome and its components. RESULTS Later dinnertime was associated with greater waist circumference (β = 0.25, P = 0.02) after adjusting for age, sex, dinner-to-bed interval, and sleep duration. Longer breakfast-to-lunch intervals were also associated with greater waist circumferences (β =-.35, P = .002) after adjusting for age, sex, and sleep duration. Neither instability of dinnertime nor number of meals per day was associated with the metabolic syndrome or its components. CONCLUSION Weight gain is often perceived as inevitable side-effect of medications. While patients often need to be on medication to function, a more careful lifestyle assessment with attention to social rhythms and timing of activities may be critical not only for mood stability, but also to reduce cardiovascular risk.
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Affiliation(s)
- I Soreca
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - M L Wallace
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - M H Hall
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - B P Hasler
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - E Frank
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - D J Kupfer
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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10
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Wagle N, Painter CA, Ilzarbe M, Van Allen EM, Frank E, Oh C, Krevalin M, Lloyd M, Anderka K, Kryukov G, Boehm JS, Winer E, Lander ES, Golub TR. Abstract OT2-05-03: The metastatic breast cancer project: A national direct-to-patient research initiative to accelerate genomics research. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-ot2-05-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Over the past decade, genomic characterization of tumors has shed enormous light on the molecular underpinnings of cancer. These discoveries have led to the development of novel therapies and preventive measures that have already revolutionized cancer care. Despite this progress, the genomics of metastatic breast cancer (MBC), one of the leading causes of cancer death in the U.S., remains poorly understood.
The challenge in studying tumor samples from patients with MBC has been that the tumors from most patients are not available for research, largely because the vast majority of patients are cared for in community settings where genomics studies are not typically conducted. To address this, we have launched a nationwide study, The Metastatic Breast Cancer Project, which seeks to empower patients to accelerate cancer research through sharing their samples and clinical information. We have developed an outreach program in collaboration with MBC advocacy organizations to connect MBC patients around the country with genomics research performed at the Broad Institute, allowing them to participate regardless of where they live.
Working with MBC patients and advocates, we designed a website (www.mbcproject.org) with an online questionnaire that allows patients with MBC to provide information about themselves and their cancer. Based on their answers, patients are offered an electronic consent form that explains the risks and benefits of the study and asks for permission to obtain a portion of their stored tumor tissue, a saliva sample, and copies of their medical records. For patients who consent, our clinical research team contacts their physicians and obtains copies of their medical records, which are reviewed to confirm eligibility. Enrolled patients are sent a saliva kit and asked to mail back a saliva sample, which is used to extract germline DNA. The clinical research team also contacts the patient's pathology department and requests a portion of the tumor to be sent to the Broad Institute for genomic analysis. Whole exome and transcriptome sequencing is performed on tumor and germline DNA. Sequencing data are linked to de-identified clinical information, and the resulting data are used to identify drivers of tumorigenesis, mechanisms of response and resistance to therapies, and diagnostic, prognostic, and therapeutic biomarkers. The database of clinically annotated genomic information will be shared with the NIH and the cancer research community. Study updates and discoveries are shared at regular intervals with all patients who complete the initial questionnaire.
This direct-to-patient approach should be particularly enabling for the identification of patients with rare phenotypes or clinical behavior. For this reason, the first cohorts being studied are patients with extraordinary responses to therapies and patients who present with de novo MBC. Additional cohorts will be added in the future, including young women with MBC and patients with drug-resistant MBC. This project seeks to establish a patient-researcher partnership to accelerate genomic discoveries and improve outcomes in MBC, and may ultimately serve as a means to build a new clinical and translational research model for all patients with cancer.
Citation Format: Wagle N, Painter CA, Ilzarbe M, Van Allen EM, Frank E, Oh C, Krevalin M, Lloyd M, Anderka K, Kryukov G, Boehm JS, Winer E, Lander ES, Golub TR. The metastatic breast cancer project: A national direct-to-patient research initiative to accelerate genomics research. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr OT2-05-03.
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Affiliation(s)
- N Wagle
- Broad Institute, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - CA Painter
- Broad Institute, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - M Ilzarbe
- Broad Institute, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - EM Van Allen
- Broad Institute, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - E Frank
- Broad Institute, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - C Oh
- Broad Institute, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - M Krevalin
- Broad Institute, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - M Lloyd
- Broad Institute, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - K Anderka
- Broad Institute, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - G Kryukov
- Broad Institute, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - JS Boehm
- Broad Institute, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - E Winer
- Broad Institute, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - ES Lander
- Broad Institute, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - TR Golub
- Broad Institute, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
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11
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Zhang J, Azawi S, Cho-Lim J, Wei R, Williams R, Frank E. SU-E-J-17: Intra-Fractional Prostate Movement Correction During Treatment Delivery Period for Prostate Cancer Using the Intra-Fractional Orthogonal KV-MV Image Pairs. Med Phys 2015. [DOI: 10.1118/1.4924105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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12
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Frank E, Hall T, Evert J. CUGH's Educational Products Subcommittee (warning: You may feel compelled
to join us!). Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.1035] [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: 10/23/2022] Open
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13
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Peters A, Sylvia LG, da Silva Magalhães PV, Miklowitz DJ, Frank E, Otto MW, Hansen NS, Dougherty DD, Berk M, Nierenberg AA, Deckersbach T. Age at onset, course of illness and response to psychotherapy in bipolar disorder: results from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Psychol Med 2014; 44:3455-3467. [PMID: 25066366 PMCID: PMC4620042 DOI: 10.1017/s0033291714000804] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The course of bipolar disorder progressively worsens in some patients. Although responses to pharmacotherapy appear to diminish with greater chronicity, less is known about whether patients' prior courses of illness are related to responses to psychotherapy. METHOD Embedded in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) was a randomized controlled trial of psychotherapy for bipolar depression comparing the efficacy of intensive psychotherapy with collaborative care (a three-session psycho-educational intervention). We assessed whether the number of previous mood episodes, age of illness onset, and illness duration predicted or moderated the likelihood of recovery and time until recovery from a depressive episode in patients in the two treatments. RESULTS Independently of treatment condition, participants with one to nine prior depressive episodes were more likely to recover and had faster time to recovery than those with 20 or more prior depressive episodes. Participants with fewer than 20 prior manic episodes had faster time to recovery than those with 20 or more episodes. Longer illness duration predicted a longer time to recovery. Participants were more likely to recover in intensive psychotherapy than collaborative care if they had 10-20 prior episodes of depression [number needed to treat (NNT) = 2.0], but equally likely to respond to psychotherapy and collaborative care if they had one to nine (NNT = 32.0) or >20 (NNT = 9.0) depressive episodes. CONCLUSIONS Number of previous mood episodes and illness duration are associated with the likelihood and speed of recovery among bipolar patients receiving psychosocial treatments for depression.
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Affiliation(s)
- A. Peters
- University of Illinois at Chicago, Chicago, IL, USA
| | - L. G. Sylvia
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | | | - E. Frank
- University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - D. D. Dougherty
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - M. Berk
- Deakin University, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - A. A. Nierenberg
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - T. Deckersbach
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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14
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Langguth B, Landgrebe M, Frank E, Schecklmann M, Sand PG, Vielsmeier V, Hajak G, Kleinjung T. Efficacy of different protocols of transcranial magnetic stimulation for the treatment of tinnitus: Pooled analysis of two randomized controlled studies. World J Biol Psychiatry 2014; 15:276-85. [PMID: 22909265 DOI: 10.3109/15622975.2012.708438] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [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] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Tinnitus is related to alterations in neuronal activity of auditory and nonauditory brain areas. Targeted modulation of these areas by repetitive transcranial magnetic stimulation (rTMS) has been proposed as a new therapeutic approach for chronic tinnitus. METHODS Two randomized, double-blind, parallel-group, controlled clinical trials were performed subsequently and pooled for analysis. A total of 192 tinnitus patients were randomly allocated to receive 10 stimulation sessions of either sham rTMS, PET-based neuronavigated 1 Hz rTMS, 1Hz r TMS over the left auditory cortex, or combined 20 Hz rTMS over the left frontal cortex, followed by 1 Hz rTMS over the left auditory cortex. RESULTS rTMS treatment was well tolerated and no severe side effects were observed. All active rTMS treatments resulted in significant reduction of the TQ as compared to baseline. The comparison between treatment groups failed to reach significant differences. The number of treatment responders was higher for temporal rTMS(38%) and combined frontal and temporal rTMS (43%), as compared to sham (6%). CONCLUSIONS This large study demonstrates the safety and tolerability of rTMS treatment in patients with chronic tinnitus. While the overall effect did not prove superior to placebo, secondary outcome parameters argue in favour of the active stimulation groups, and specifically the combined frontal and temporal rTMS protocol.
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Affiliation(s)
- B Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg , Regensburg , Germany
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15
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Seah DSE, Scott SM, Guo H, Najita J, Lederman R, Frank E, Sohl J, Kronwitz C, Stadler ZK, Silverman SG, Peppercorn J, Winer EP, Come SE, Lin NU. Abstract P4-19-01: Attitudes of medical oncologists towards research biopsies. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p4-19-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
There is increasing interest in studying tissue from patients (pts) with metastatic breast cancer (MBC). Historically, limited tissue has been available. Possible barriers to research biopsies (bx) include pt and provider opinions; the contribution of each factor is unknown.
Methods:
309 academic breast medical oncologists (MOs) identified from the websites of each of the National Cancer Institute - designated cancer centers were invited to complete either a self-administered paper or online survey. Eligible MOs (MOs who saw breast cancer pts and who saw pts 4 hours/week.) were asked to predict what proportion of their pts with MBC would consent to additional bx (ABs, additional bx performed with a clinically indicated bx) or research purposes only bx(RPOBs, research bx performed as a standalone procedure). They were also asked about their comfort levels in asking pts with MBC to consider participating in ABs or RPOBs for various organs. Median values are reported. Two-sided Fisher's exact test was used to compare categorical variables using a a level of .05.
Results:
191 (101F,85M, 5 unknown) eligible MOs completed the survey. 29 MOs were ineligible (response rate = 191/280,68%). Median age was 50 (Range 33-80). Median years of oncology experience was 15 (Range 1-45). MOs predicted that 90%, 75%, 70% and 50%, of their pts would definitely/probably consider ABs of blood, skin, breast, or liver respectively. MOs predicted that 90%, 60%, 33%, and 20% of their pts would definitely/probably consider RPOBs of blood, skin, breast, or liver. 98% (95% CI 96%-100%), 96% (95% CI 92%-98%), 93% (95% CI 88%-96%) and 70% (95% CI 63%-77%) of MOs were very/somewhat comfortable asking pts for an AB of blood, skin, breast and liver respectively. 98% (95% CI 95%-99%), 93% (95% CI 89%-96%), 78% (95% CI 72%-84%) and 50% (95% CI 43%-58%) of MOs were very/somewhat comfortable asking pts to participate in a RPOB of blood, skin, breast and liver respectively.
No demographic characteristics (eg. sex, age) were associated with MOs’ comfort levels of asking pts to have an AB of blood, skin and breast.
Factors associated with increased comfort discussing an AB of the liver were: age < 50 years (p = 0.01), in practice for < 15 years (p = 0.01), ≥ 1 pt enrolled on clinical trials per month (p = 0.02), or having pts who had undergone bx for research in prior 3 months (p<0.01).
MOs with ≥ 4 patients enrolled on clinical trials/month or whose pts had undergone research bx in the past 3 months were more likely to feel comfortable asking pts to have a RPOB of the breast (p<0.01; p<0.01) or liver (p = 0.03; p<0.01).
The 3 most common reasons why MOs were reluctant to refer pts for participation in an AB include risk of a bx procedure (n = 128, 67%), pain/discomfort of a bx (n = 125, 65%), and logistical barriers (n = 42, 22%). These reasons are similar for RPOB; risk of a bx procedure, (n = 137, 72%), pain/discomfort of a bx (n = 134, 70%), and inconvenience to pt (time involved, travel, etc) (n = 58, 30%).
Conclusions:
Many MOs predict that the majority of their MBC pts will consider ABs of various organs. However, this decreases with RPOBs, particularly as the procedure becomes more invasive. More research is needed to understand factors that may influence MOs’ comfort levels asking pts to participate in such studies.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-19-01.
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Affiliation(s)
- DSE Seah
- Dana-Farber Cancer Institute, Boston, MA; Beth Israel Deconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA; Duke University School of Medicine, Durham, NC; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - SM Scott
- Dana-Farber Cancer Institute, Boston, MA; Beth Israel Deconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA; Duke University School of Medicine, Durham, NC; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - H Guo
- Dana-Farber Cancer Institute, Boston, MA; Beth Israel Deconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA; Duke University School of Medicine, Durham, NC; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - J Najita
- Dana-Farber Cancer Institute, Boston, MA; Beth Israel Deconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA; Duke University School of Medicine, Durham, NC; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - R Lederman
- Dana-Farber Cancer Institute, Boston, MA; Beth Israel Deconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA; Duke University School of Medicine, Durham, NC; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - E Frank
- Dana-Farber Cancer Institute, Boston, MA; Beth Israel Deconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA; Duke University School of Medicine, Durham, NC; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - J Sohl
- Dana-Farber Cancer Institute, Boston, MA; Beth Israel Deconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA; Duke University School of Medicine, Durham, NC; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - C Kronwitz
- Dana-Farber Cancer Institute, Boston, MA; Beth Israel Deconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA; Duke University School of Medicine, Durham, NC; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - ZK Stadler
- Dana-Farber Cancer Institute, Boston, MA; Beth Israel Deconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA; Duke University School of Medicine, Durham, NC; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - SG Silverman
- Dana-Farber Cancer Institute, Boston, MA; Beth Israel Deconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA; Duke University School of Medicine, Durham, NC; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - J Peppercorn
- Dana-Farber Cancer Institute, Boston, MA; Beth Israel Deconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA; Duke University School of Medicine, Durham, NC; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - EP Winer
- Dana-Farber Cancer Institute, Boston, MA; Beth Israel Deconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA; Duke University School of Medicine, Durham, NC; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - SE Come
- Dana-Farber Cancer Institute, Boston, MA; Beth Israel Deconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA; Duke University School of Medicine, Durham, NC; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - NU Lin
- Dana-Farber Cancer Institute, Boston, MA; Beth Israel Deconess Medical Center, Boston, MA; Brigham and Women's Hospital, Boston, MA; Duke University School of Medicine, Durham, NC; Memorial Sloan-Kettering Cancer Center, New York, NY
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Abe K, Adam J, Aihara H, Akiri T, Andreopoulos C, Aoki S, Ariga A, Ariga T, Assylbekov S, Autiero D, Barbi M, Barker GJ, Barr G, Bass M, Batkiewicz M, Bay F, Bentham SW, Berardi V, Berger BE, Berkman S, Bertram I, Bhadra S, Blaszczyk FDM, Blondel A, Bojechko C, Bordoni S, Boyd SB, Brailsford D, Bravar A, Bronner C, Buchanan N, Calland RG, Caravaca Rodríguez J, Cartwright SL, Castillo R, Catanesi MG, Cervera A, Cherdack D, Christodoulou G, Clifton A, Coleman J, Coleman SJ, Collazuol G, Connolly K, Cremonesi L, Curioni A, Dabrowska A, Danko I, Das R, Davis S, de Perio P, De Rosa G, Dealtry T, Dennis SR, Densham C, Di Lodovico F, Di Luise S, Drapier O, Duboyski T, Duffy K, Dufour F, Dumarchez J, Dytman S, Dziewiecki M, Emery S, Ereditato A, Escudero L, Finch AJ, Frank E, Friend M, Fujii Y, Fukuda Y, Furmanski AP, Galymov V, Gaudin A, Giffin S, Giganti C, Gilje K, Golan T, Gomez-Cadenas JJ, Gonin M, Grant N, Gudin D, Hadley DR, Haesler A, Haigh MD, Hamilton P, Hansen D, Hara T, Hartz M, Hasegawa T, Hastings NC, Hayato Y, Hearty C, Helmer RL, Hierholzer M, Hignight J, Hillairet A, Himmel A, Hiraki T, Hirota S, Holeczek J, Horikawa S, Huang K, Ichikawa AK, Ieki K, Ieva M, Ikeda M, Imber J, Insler J, Irvine TJ, Ishida T, Ishii T, Ives SJ, Iyogi K, Izmaylov A, Jacob A, Jamieson B, Johnson RA, Jo JH, Jonsson P, Joo KK, Jung CK, Kaboth AC, Kajita T, Kakuno H, Kameda J, Kanazawa Y, Karlen D, Karpikov I, Kearns E, Khabibullin M, Khotjantsev A, Kielczewska D, Kikawa T, Kilinski A, Kim J, Kim SB, Kisiel J, Kitching P, Kobayashi T, Kogan G, Kolaceke A, Konaka A, Kormos LL, Korzenev A, Koseki K, Koshio Y, Kreslo I, Kropp W, Kubo H, Kudenko Y, Kumaratunga S, Kurjata R, Kutter T, Lagoda J, Laihem K, Laveder M, Lawe M, Lazos M, Lee KP, Licciardi C, Lim IT, Lindner T, Lister C, Litchfield RP, Longhin A, Lopez GD, Ludovici L, Macaire M, Magaletti L, Mahn K, Malek M, Manly S, Marino AD, Marteau J, Martin JF, Maruyama T, Marzec J, Masliah P, Mathie EL, Matveev V, Mavrokoridis K, Mazzucato E, McCarthy M, McCauley N, McFarland KS, McGrew C, Metelko C, Mijakowski P, Miller CA, Minamino A, Mineev O, Mine S, Missert A, Miura M, Monfregola L, Moriyama S, Mueller TA, Murakami A, Murdoch M, Murphy S, Myslik J, Nagasaki T, Nakadaira T, Nakahata M, Nakai T, Nakamura K, Nakayama S, Nakaya T, Nakayoshi K, Naples D, Nielsen C, Nirkko M, Nishikawa K, Nishimura Y, O'Keeffe HM, Ohta R, Okumura K, Okusawa T, Oryszczak W, Oser SM, Otani M, Owen RA, Oyama Y, Pac MY, Palladino V, Paolone V, Payne D, Pearce GF, Perevozchikov O, Perkin JD, Petrov Y, Pinzon Guerra ES, Pistillo C, Plonski P, Poplawska E, Popov B, Posiadala M, Poutissou JM, Poutissou R, Przewlocki P, Quilain B, Radicioni E, Ratoff PN, Ravonel M, Rayner MAM, Redij A, Reeves M, Reinherz-Aronis E, Retiere F, Robert A, Rodrigues PA, Rondio E, Roth S, Rubbia A, Ruterbories D, Sacco R, Sakashita K, Sánchez F, Sato F, Scantamburlo E, Scholberg K, Schwehr J, Scott M, Seiya Y, Sekiguchi T, Sekiya H, Sgalaberna D, Shiozawa M, Short S, Shustrov Y, Sinclair P, Smith B, Smith RJ, Smy M, Sobczyk JT, Sobel H, Sorel M, Southwell L, Stamoulis P, Steinmann J, Still B, Suda Y, Suzuki A, Suzuki K, Suzuki SY, Suzuki Y, Szeglowski T, Tacik R, Tada M, Takahashi S, Takeda A, Takeuchi Y, Tanaka HK, Tanaka HA, Tanaka MM, Taylor IJ, Terhorst D, Terri R, Thompson LF, Thorley A, Tobayama S, Toki W, Tomura T, Totsuka Y, Touramanis C, Tsukamoto T, Tzanov M, Uchida Y, Ueno K, Vacheret A, Vagins M, Vasseur G, Wachala T, Waldron AV, Walter CW, Wark D, Wascko MO, Weber A, Wendell R, Wilkes RJ, Wilking MJ, Wilkinson C, Williamson Z, Wilson JR, Wilson RJ, Wongjirad T, Yamada Y, Yamamoto K, Yanagisawa C, Yen S, Yershov N, Yokoyama M, Yuan T, Zalewska A, Zalipska J, Zambelli L, Zaremba K, Ziembicki M, Zimmerman ED, Zito M, Zmuda J. Measurement of neutrino oscillation parameters from muon neutrino disappearance with an off-axis beam. Phys Rev Lett 2013; 111:211803. [PMID: 24313479 DOI: 10.1103/physrevlett.111.211803] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 10/09/2013] [Indexed: 06/02/2023]
Abstract
The T2K Collaboration reports a precision measurement of muon neutrino disappearance with an off-axis neutrino beam with a peak energy of 0.6 GeV. Near detector measurements are used to constrain the neutrino flux and cross section parameters. The Super-Kamiokande far detector, which is 295 km downstream of the neutrino production target, collected data corresponding to 3.01×10(20) protons on target. In the absence of neutrino oscillations, 205±17 (syst) events are expected to be detected while only 58 muon neutrino event candidates are observed. A fit to the neutrino rate and energy spectrum, assuming three neutrino flavors and normal mass hierarchy yields a best-fit mixing angle sin2(θ23)=0.514±0.082 and mass splitting |Δm(32)(2)|=2.44(-0.15)(+0.17)×10(-3) eV2/c4. Our result corresponds to the maximal oscillation disappearance probability.
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Affiliation(s)
- K Abe
- University of Tokyo, Institute for Cosmic Ray Research, Kamioka Observatory, Kamioka, Japan
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Kamphuis C, Frank E, Burke J, Verkerk G, Jago J. Applying additive logistic regression to data derived from sensors monitoring behavioral and physiological characteristics of dairy cows to detect lameness. J Dairy Sci 2013; 96:7043-7053. [DOI: 10.3168/jds.2013-6993] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 07/16/2013] [Indexed: 11/19/2022]
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Landgrebe M, Schecklmann M, Kreuzer P, Frank E, Pöppl T, Prasser J, Langguth B. OP 5. Combined left-and right-prefrontal rTMS in depression: Theta-burst vs. tonic rTMS vs. sham stimulation. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.04.072] [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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Schecklmann M, Frank E, Kleinjung T, Landgrebe M, Langguth B. P 187. Tinnitus-related neuroplastic alterations in the motor cortex. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.04.264] [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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Rastelli C, Cheng Y, Weingarden J, Frank E, Swartz HA. Differences between unipolar depression and bipolar II depression in women. J Affect Disord 2013; 150:1120-4. [PMID: 23721924 PMCID: PMC3759529 DOI: 10.1016/j.jad.2013.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 05/03/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Bipolar disorder II (BPII) and unipolar depression (UD) are both characterized by episodes of major depression (MDE), however DSM-IV criteria for MDE are identical, regardless of diagnosis. As a result, misdiagnosis of BP II and UD is common, leading to inappropriate treatment. Because women are twice as likely as men to experience MDE, differentiating UD from BP II in the context of depression is especially important for women. We examined symptoms and clinical features of MDE in women with UD and BPII to compare presentations of the two disorders in women. METHODS We compared characteristics of depressed women meeting DSM-IV criteria for BPII (n=48) or UD (n=48), matched on age. RESULTS Feelings of worthlessness occurred in 98% of participants with UD versus 85% with BPII (p=0.03). Participants with UD experienced either insomnia or hypersomnia, but participants with BPII were more likely to experience both simultaneously (p=0.04). Those with UD were significantly less likely to have >5 prior mood episodes compared to those with BP II (12% versus 61%; p<0.0001) and had a later age of onset (p=0.003). LIMITATIONS Small sample size and exclusion criteria (i.e., comorbid substance abuse) may limit generalizability of findings. CONCLUSIONS Among a sample of women, number of prior episodes, feelings of worthlessness, age of onset, and sleep patterns distinguished between UD and BP II depressive episodes. A better understanding of differential presentation of BP II versus UD depression in women may help guide clinicians to more accurate diagnoses and, ultimately, better treatment.
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Affiliation(s)
- C.P.B Rastelli
- Department of Psychiatry, University of Pittsburgh, School of Medicine,Department of Psychiatry Residency, Hospital Nossa Senhora da Luz, Brazil
| | - Y Cheng
- Department of Psychiatry, University of Pittsburgh, School of Medicine,Department of Statistics, University of Pittsburgh
| | | | - E Frank
- Department of Psychiatry, University of Pittsburgh, School of Medicine
| | - H. A Swartz
- Department of Psychiatry, University of Pittsburgh, School of Medicine
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Rajanayagam J, Frank E, Shepherd RW, Lewindon PJ. Artificial neural network is highly predictive of outcome in paediatric acute liver failure. Pediatr Transplant 2013; 17:535-42. [PMID: 23802584 DOI: 10.1111/petr.12100] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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] [Accepted: 04/29/2013] [Indexed: 12/28/2022]
Abstract
Current prognostic models in PALF are unreliable, failing to account for complex, non-linear relationships existing between multiple prognostic factors. A computational approach using ANN should provide superior modelling to PELD-MELD scores. We assessed the prognostic accuracy of PELD-MELD scores and ANN in PALF in children presenting to the QLTS, Australia. A comprehensive registry-based data set was evaluated in 54 children (32M, 22F, median age 17 month) with PALF. PELD-MELD scores calculated at (i) meeting PALF criteria and (ii) peak. ANN was evaluated using stratified 10-fold cross-validation. Outcomes were classified as good (transplant-free survival) or poor (death or LT) and predictive accuracy compared using AUROC curves. Mean PELD-MELD scores were significantly higher in non-transplanted non-survivors (i) 37 and (ii) 46 and transplant recipients (i) 32 and (ii) 43 compared to transplant-free survivors (i) 26 and (ii) 30. Threshold PELD-MELD scores ≥27 and ≥42, at meeting PALF criteria and peak, gave AUROC 0.71 and 0.86, respectively, for poor outcome. ANN showed superior prediction for poor outcome with AUROC 0.96, sensitivity 82.6%, specificity 96%, PPV 96.2% and NPV 85.7% (cut-off 0.5). ANN is superior to PELD-MELD for predicting poor outcome in PALF.
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Affiliation(s)
- J Rajanayagam
- Department of Pediatric Gastroenterology Hepatology and Nutrition, Starship Children's Hospital, Auckland, New Zealand
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Seah DS, Scott SM, Najita J, Openshaw T, Krag K, Frank E, Sohl J, Stadler ZK, Garrett M, Silverman SG, Peppercorn J, Winer EP, Come SE, Lin NU. Attitudes of patients with metastatic breast cancer toward research biopsies. Ann Oncol 2013; 24:1853-1859. [PMID: 23493137 DOI: 10.1093/annonc/mdt067] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [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] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Research studies involving human tissue are increasingly common. However, patients' attitudes toward research biopsies are not well characterized, particularly when the biopsies are carried out outside the context of therapeutic trials. PATIENTS AND METHODS One hundred sixty patients with metastatic breast cancer (MBC) from two academic (n = 80) and two community (n = 80) hospitals completed a 29-item self-administered survey to evaluate their willingness to consider providing research purposes only biopsies (RPOBs) (as a stand-alone procedure) and additional biopsies (ABs) (additional needle passes at the time of a clinically indicated biopsy). RESULTS Eighty-two (51%) of 160 patients would consider having RPOBs, of which 42 (53%) and 40 (50%) patients were from academic and community hospitals, respectively. Patients who had more prior biopsies were less likely to consider RPOBs (RR = 0.6, 95% CI: 0.4-1.0, P = 0.03). Of 160 patients, 115 (72%) patients would consider having ABs. Of these, 64 (80%) and 51 (64%) patients from academic and community hospitals, respectively, would consider ABs (RR = 1.2, 95% CI: 1.0-1.5, P = 0.03). CONCLUSIONS Many patients with MBC in both academic and community settings report willingness to consider undergoing biopsies for research. Further research is needed to understand ethical, logistical and provider-based barriers to broader participation in such studies.
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Affiliation(s)
- D S Seah
- Deparment of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - S M Scott
- Department of Medical Oncology, Beth Israel Deaconess Medical Center, Boston
| | - J Najita
- Department of Biostatics and Computational Biology, Dana-Farber Cancer Institute, Boston
| | - T Openshaw
- Department of Medical Oncology, Cancer Care of Maine, Bangor
| | - K Krag
- Department of Medical Oncology, North Short Cancer Center, Danvers
| | - E Frank
- Deparment of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - J Sohl
- Deparment of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - Z K Stadler
- Department of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York
| | - M Garrett
- Department of Medical Oncology, Cancer Care of Maine, Bangor
| | - S G Silverman
- Department of Radiology, Brigham and Women's Hospital, Boston
| | - J Peppercorn
- Department of Medicine, Duke University Medical Center, Durham, USA
| | - E P Winer
- Deparment of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - S E Come
- Department of Medical Oncology, Beth Israel Deaconess Medical Center, Boston
| | - Nancy U Lin
- Deparment of Medical Oncology, Dana-Farber Cancer Institute, Boston.
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Zhang J, Azawi S, Williams R, Frank E. SU-E-J-19: Prostate Movement Evaluation During Treatment Delivery Period for Prostate Cancer. Med Phys 2013. [DOI: 10.1118/1.4814231] [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: 11/07/2022] Open
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Abe K, Abgrall N, Aihara H, Akiri T, Albert JB, Andreopoulos C, Aoki S, Ariga A, Ariga T, Assylbekov S, Autiero D, Barbi M, Barker GJ, Barr G, Bass M, Batkiewicz M, Bay F, Bentham SW, Berardi V, Berger BE, Berkman S, Bertram I, Beznosko D, Bhadra S, Blaszczyk FDM, Blondel A, Bojechko C, Boyd S, Brailsford D, Bravar A, Bronner C, Brook-Roberge DG, Buchanan N, Calland RG, Caravaca Rodríguez J, Cartwright SL, Castillo R, Catanesi MG, Cervera A, Cherdack D, Christodoulou G, Clifton A, Coleman J, Coleman SJ, Collazuol G, Connolly K, Cremonesi L, Curioni A, Dabrowska A, Danko I, Das R, Davis S, Day M, de André JPAM, de Perio P, De Rosa G, Dealtry T, Dennis SR, Densham C, Di Lodovico F, Di Luise S, Dobson J, Drapier O, Duboyski T, Dufour F, Dumarchez J, Dytman S, Dziewiecki M, Dziomba M, Emery S, Ereditato A, Escudero L, Finch AJ, Frank E, Friend M, Fujii Y, Fukuda Y, Furmanski AP, Galymov V, Gaudin A, Giffin S, Giganti C, Gilje K, Golan T, Gomez-Cadenas JJ, Gonin M, Grant N, Gudin D, Guzowski P, Hadley DR, Haesler A, Haigh MD, Hamilton P, Hansen D, Hara T, Hartz M, Hasegawa T, Hastings NC, Hayato Y, Hearty C, Helmer RL, Hierholzer M, Hignight J, Hillairet A, Himmel A, Hiraki T, Holeczek J, Horikawa S, Huang K, Ichikawa AK, Ieki K, Ieva M, Ikeda M, Imber J, Insler J, Irvine TJ, Ishida T, Ishii T, Ives SJ, Iyogi K, Izmaylov A, Jacob A, Jamieson B, Johnson RA, Jo JH, Jonsson P, Joo KK, Jung CK, Kaboth A, Kaji H, Kajita T, Kakuno H, Kameda J, Kanazawa Y, Karlen D, Karpikov I, Kearns E, Khabibullin M, Khanam F, Khotjantsev A, Kielczewska D, Kikawa T, Kilinski A, Kim JY, Kim J, Kim SB, Kirby B, Kisiel J, Kitching P, Kobayashi T, Kogan G, Kolaceke A, Konaka A, Kormos LL, Korzenev A, Koseki K, Koshio Y, Kowalik K, Kreslo I, Kropp W, Kubo H, Kudenko Y, Kumaratunga S, Kurjata R, Kutter T, Lagoda J, Laihem K, Laing A, Laveder M, Lawe M, Lee KP, Licciardi C, Lim IT, Lindner T, Lister C, Litchfield RP, Longhin A, Lopez GD, Ludovici L, Macaire M, Magaletti L, Mahn K, Malek M, Manly S, Marchionni A, Marino AD, Marteau J, Martin JF, Maruyama T, Marzec J, Masliah P, Mathie EL, Matveev V, Mavrokoridis K, Mazzucato E, McCauley N, McFarland KS, McGrew C, McLachlan T, Messina M, Metelko C, Mezzetto M, Mijakowski P, Miller CA, Minamino A, Mineev O, Mine S, Missert A, Miura M, Monfregola L, Moriyama S, Mueller TA, Murakami A, Murdoch M, Murphy S, Myslik J, Nagasaki T, Nakadaira T, Nakahata M, Nakai T, Nakajima K, Nakamura K, Nakayama S, Nakaya T, Nakayoshi K, Naples D, Nicholls TC, Nielsen C, Nishikawa K, Nishimura Y, O’Keeffe HM, Obayashi Y, Ohta R, Okumura K, Okusawa T, Oryszczak W, Oser SM, Otani M, Owen RA, Oyama Y, Pac MY, Palladino V, Paolone V, Payne D, Pearce GF, Perevozchikov O, Perkin JD, Pinzon Guerra ES, Plonski P, Poplawska E, Popov B, Posiadala M, Poutissou JM, Poutissou R, Przewlocki P, Quilain B, Radicioni E, Ratoff PN, Ravonel M, Rayner MAM, Reeves M, Reinherz-Aronis E, Retiere F, Robert A, Rodrigues PA, Rondio E, Roth S, Rubbia A, Ruterbories D, Sacco R, Sakashita K, Sánchez F, Scantamburlo E, Scholberg K, Schwehr J, Scott M, Scully DI, Seiya Y, Sekiguchi T, Sekiya H, Sgalaberna D, Shibata M, Shiozawa M, Short S, Shustrov Y, Sinclair P, Smith B, Smith RJ, Smy M, Sobczyk JT, Sobel H, Sorel M, Southwell L, Stamoulis P, Steinmann J, Still B, Suzuki A, Suzuki K, Suzuki SY, Suzuki Y, Szeglowski T, Szeptycka M, Tacik R, Tada M, Takahashi S, Takeda A, Takeuchi Y, Tanaka HA, Tanaka MM, Tanaka M, Taylor IJ, Terhorst D, Terri R, Thompson LF, Thorley A, Tobayama S, Toki W, Tomura T, Totsuka Y, Touramanis C, Tsukamoto T, Tzanov M, Uchida Y, Ueno K, Vacheret A, Vagins M, Vasseur G, Wachala T, Waldron AV, Walter CW, Wang J, Wark D, Wascko MO, Weber A, Wendell R, Wilkes RJ, Wilking MJ, Wilkinson C, Williamson Z, Wilson JR, Wilson RJ, Wongjirad T, Yamada Y, Yamamoto K, Yanagisawa C, Yen S, Yershov N, Yokoyama M, Yuan T, Zalewska A, Zambelli L, Zaremba K, Ziembicki M, Zimmerman ED, Zito M, Żmuda J. Measurement of the inclusiveνμcharged current cross section on carbon in the near detector of the T2K experiment. Int J Clin Exp Med 2013. [DOI: 10.1103/physrevd.87.092003] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Fournier JC, Keener MT, Mullin BC, Hafeman DM, Labarbara EJ, Stiffler RS, Almeida J, Kronhaus DM, Frank E, Phillips ML. Heterogeneity of amygdala response in major depressive disorder: the impact of lifetime subthreshold mania. Psychol Med 2013; 43:293-302. [PMID: 22571805 PMCID: PMC3773940 DOI: 10.1017/s0033291712000918] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [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: 01/27/2023]
Abstract
BACKGROUND Patients with major depressive disorder (MDD) present with highly heterogeneous symptom profiles. We aimed to examine whether individual differences in amygdala activity to emotionally salient stimuli were related to heterogeneity in lifetime levels of depressive and subthreshold manic symptoms among adults with MDD. METHOD We compared age- and gender-matched adults with MDD (n = 26) with healthy controls (HC, n = 28). While undergoing functional magnetic resonance imaging, participants performed an implicit emotional faces task: they labeled a color flash superimposed upon initially neutral faces that dynamically morphed into one of four emotions (angry, fearful, sad, happy). Region of interest analyses examined group differences in amygdala activity. For conditions in which adults with MDD displayed abnormal amygdala activity versus HC, within-group analyses examined amygdala activity as a function of scores on a continuous measure of lifetime depression-related and mania-related pathology. RESULTS Adults with MDD showed significantly greater right-sided amygdala activity to angry and happy conditions than HC (p < 0.05, corrected). Multiple regression analyses revealed that greater right-amygdala activity to the happy condition in adults with MDD was associated with higher levels of subthreshold manic symptoms experienced across the lifespan (p = 0.002). CONCLUSIONS Among depressed adults with MDD, lifetime features of subthreshold mania were associated with abnormally elevated amygdala activity to emerging happy faces. These findings are a first step toward identifying biomarkers that reflect individual differences in neural mechanisms in MDD, and challenge conventional mood disorder diagnostic boundaries by suggesting that some adults with MDD are characterized by pathophysiological processes that overlap with bipolar disorder.
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Affiliation(s)
- J C Fournier
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, USA.
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Abe K, Abgrall N, Aihara H, Akiri T, Albert JB, Andreopoulos C, Aoki S, Ariga A, Ariga T, Assylbekov S, Autiero D, Barbi M, Barker GJ, Barr G, Bass M, Batkiewicz M, Bay F, Bentham SW, Berardi V, Berger BE, Berkman S, Bertram I, Beznosko D, Bhadra S, Blaszczyk FDM, Blondel A, Bojechko C, Boyd S, Bravar A, Bronner C, Brook-Roberge DG, Buchanan N, Calland RG, Caravaca Rodríguez J, Cartwright SL, Castillo R, Catanesi MG, Cervera A, Cherdack D, Christodoulou G, Clifton A, Coleman J, Coleman SJ, Collazuol G, Connolly K, Curioni A, Dabrowska A, Danko I, Das R, Davis S, Day M, de André JPAM, de Perio P, De Rosa G, Dealtry T, Densham C, Di Lodovico F, Di Luise S, Dobson J, Duboyski T, Dufour F, Dumarchez J, Dytman S, Dziewiecki M, Dziomba M, Emery S, Ereditato A, Escudero L, Esposito LS, Finch AJ, Frank E, Friend M, Fujii Y, Fukuda Y, Galymov V, Gaudin A, Giffin S, Giganti C, Gilje K, Golan T, Gomez-Cadenas JJ, Gonin M, Grant N, Gudin D, Guzowski P, Hadley DR, Haesler A, Haigh MD, Hansen D, Hara T, Hartz M, Hasegawa T, Hastings NC, Hayato Y, Hearty C, Helmer RL, Hignight J, Hillairet A, Himmel A, Hiraki T, Holeczek J, Horikawa S, Huang K, Hyndman A, Ichikawa AK, Ieki K, Ieva M, Ikeda M, Imber J, Insler J, Ishida T, Ishii T, Ives SJ, Iyogi K, Izmaylov A, Jamieson B, Johnson RA, Jo JH, Jonsson P, Joo KK, Jover-Manas GV, Jung CK, Kaji H, Kajita T, Kakuno H, Kameda J, Kanazawa Y, Karlen D, Karpikov I, Kearns E, Khabibullin M, Khanam F, Khotjantsev A, Kielczewska D, Kikawa T, Kilinski A, Kim JY, Kim J, Kim SB, Kirby B, Kisiel J, Kitching P, Kobayashi T, Kogan G, Konaka A, Kormos LL, Korzenev A, Koseki K, Koshio Y, Kowalik K, Kreslo I, Kropp W, Kubo H, Kudenko Y, Kumaratunga S, Kurjata R, Kutter T, Lagoda J, Laihem K, Laing A, Laveder M, Lawe M, Lee KP, Licciardi C, Lim IT, Lindner T, Lister C, Litchfield RP, Longhin A, Lopez GD, Ludovici L, Macaire M, Magaletti L, Mahn K, Malek M, Manly S, Marchionni A, Marino AD, Marteau J, Martin JF, Maruyama T, Marzec J, Masliah P, Mathie EL, Matsumura C, Matsuoka K, Matveev V, Mavrokoridis K, Mazzucato E, McCauley N, McFarland KS, McGrew C, McLachlan T, Messina M, Metelko C, Mezzetto M, Mijakowski P, Miller CA, Minamino A, Mineev O, Mine S, Missert A, Miura M, Monfregola L, Moriyama S, Mueller TA, Murakami A, Murdoch M, Murphy S, Myslik J, Nagasaki T, Nakadaira T, Nakahata M, Nakai T, Nakajima K, Nakamura K, Nakayama S, Nakaya T, Nakayoshi K, Naples D, Nicholls TC, Nielsen C, Nishikawa K, Nishimura Y, O’Keeffe HM, Obayashi Y, Ohta R, Okumura K, Oryszczak W, Oser SM, Otani M, Owen RA, Oyama Y, Pac MY, Palladino V, Paolone V, Payne D, Pearce GF, Perevozchikov O, Perkin JD, Pinzon Guerra ES, Plonski P, Poplawska E, Popov B, Posiadala M, Poutissou JM, Poutissou R, Przewlocki P, Quilain B, Radicioni E, Ratoff PN, Ravonel M, Rayner MA, Reeves M, Reinherz-Aronis E, Retiere F, Rodrigues PA, Rondio E, Rossi B, Roth S, Rubbia A, Ruterbories D, Sacco R, Sakashita K, Sánchez F, Scantamburlo E, Scholberg K, Schwehr J, Scott M, Scully DI, Seiya Y, Sekiguchi T, Sekiya H, Shibata M, Shiozawa M, Short S, Shustrov Y, Sinclair P, Smith B, Smith RJ, Smy M, Sobczyk JT, Sobel H, Sorel M, Southwell L, Stamoulis P, Steinmann J, Still B, Sulej R, Suzuki A, Suzuki K, Suzuki SY, Suzuki Y, Szeglowski T, Szeptycka M, Tacik R, Tada M, Takahashi S, Takeda A, Takeuchi Y, Tanaka HA, Tanaka M, Tanaka MM, Taylor IJ, Terhorst D, Terri R, Thompson LF, Thorley A, Tobayama S, Toki W, Tomura T, Totsuka Y, Touramanis C, Tsukamoto T, Tzanov M, Uchida Y, Ueno K, Vacheret A, Vagins M, Vasseur G, Wachala T, Waldron AV, Walter CW, Wang J, Wark D, Wascko MO, Weber A, Wendell R, Wikström G, Wilkes RJ, Wilking MJ, Wilkinson C, Williamson Z, Wilson JR, Wilson RJ, Wongjirad T, Yamada Y, Yamamoto K, Yanagisawa C, Yano T, Yen S, Yershov N, Yokoyama M, Yuan T, Zalewska A, Zambelli L, Zaremba K, Ziembicki M, Zimmerman ED, Zito M, Żmuda J. T2K neutrino flux prediction. Int J Clin Exp Med 2013. [DOI: 10.1103/physrevd.87.012001 10.1103/physrevd.87.019902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Seah DS, Scott SM, Najita J, Openshaw T, Krag KJ, Frank E, Sohl J, Stadler ZK, Garrett M, Winer EP, Come S, Lin NU. Abstract P2-16-04: Attitudes of metastatic breast cancer patients towards research biopsies. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p2-16-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In the era of molecularly targeted therapy, developing an understanding of the molecular basis of cancer is a principal or secondary goal of many research studies. For this reason, studies collecting tissue for research purposes are increasingly common. Understanding patients' attitudes towards research biopsies may lead to improvement in accrual to research biopsy studies.
Methods: Patients with metastatic breast cancer from two academic and two community hospitals completed a self-administered paper survey consisting of 29 questions in clinic to evaluate their willingness to consider providing additional biopsies (additional biopsy performed with a clinically indicated biopsy) and research purposes only biopsies (RPOB) (research biopsy performed as a stand alone procedure).
Results: 160 patients (n = 80 academic, n=80 community) completed the survey, with a response rate of 98%. As expected, demographic variables differed between sites, with patients from academic sites likely to be younger (p = 0.01), more educated (p = 0.002), employed (p = 0.01), have prior trial participation (P <0.001) and have a longer travel time (P <0.0001). 64 (80%) academic patients and 51 (64%) community patients would definitely or probably consider additional biopsies. 42 (53%) academic patients and 40 (50%) community patients would consider RPOB.
In univariate analyses of patients' willingness to have additional biopsies, patients in academic sites were more likely to agree to additional biopsies than those at community sites (RR = 1.2, 95% CI 1.0–1.5, p = 0.03). Statistically significant differences based on demographic characteristics such as age, education, marital status, prior trial participation, number of prior biopsies, and travel time were not observed.
For RPOB, patients having had more prior biopsies were less likely to consider research biopsies (RR = 0.6, 95% CI 0.4–1.0, p = 0.03). The following variables did not reach statistical significance: type of practice, age, education, marital status, prior trial participation, and travel time.
Patients' willingness in both academic and community sites to consider RPOB declined with more invasive biopsies. Although differences were observed, none were statistically significant between academic and community; skin (56%, 65%), bone marrow (30%, 27%), breast (43%, 49%) or liver (24%, 19%).
Of the 13/160 (8%) patients who would not consider additional biopsies, the most common reasons cited included pain or discomfort (n = 8/13, 62%), risk of biopsy (n = 8/13, 62%) and anxiety related to the biopsy (n = 6/13, 46%). Of the 37/160 (23%) patients who would not consider RPOB, the most common reasons cited included pain or discomfort (n = 23/37, 62%), risk of biopsy (n = 15/37, 41%) and inconvenience of the procedure to the patient (n = 13/37, 35%).
Conclusions: The majority of patients in this study indicated they would consider research biopsies, with a larger proportion willing to consider additional biopsies; patients seen at academic hospitals were more likely to consider additional biopsies compared to those seen at community hospitals. Breast cancer patients' willingness to undergo research biopsies may be higher than generally expected by clinicians and may not be the primary barrier to obtaining research biopsies.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-16-04.
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Affiliation(s)
- DS Seah
- Dana-Farber Cancer Institute, Boston, MA; Beth Isreal Deaconness Medical Center, Boston, MA; Cancer Care of Maine, Brewer, ME; Mass General North Shore Cancer Center, Danvers, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - SM Scott
- Dana-Farber Cancer Institute, Boston, MA; Beth Isreal Deaconness Medical Center, Boston, MA; Cancer Care of Maine, Brewer, ME; Mass General North Shore Cancer Center, Danvers, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - J Najita
- Dana-Farber Cancer Institute, Boston, MA; Beth Isreal Deaconness Medical Center, Boston, MA; Cancer Care of Maine, Brewer, ME; Mass General North Shore Cancer Center, Danvers, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - T Openshaw
- Dana-Farber Cancer Institute, Boston, MA; Beth Isreal Deaconness Medical Center, Boston, MA; Cancer Care of Maine, Brewer, ME; Mass General North Shore Cancer Center, Danvers, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - KJ Krag
- Dana-Farber Cancer Institute, Boston, MA; Beth Isreal Deaconness Medical Center, Boston, MA; Cancer Care of Maine, Brewer, ME; Mass General North Shore Cancer Center, Danvers, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - E Frank
- Dana-Farber Cancer Institute, Boston, MA; Beth Isreal Deaconness Medical Center, Boston, MA; Cancer Care of Maine, Brewer, ME; Mass General North Shore Cancer Center, Danvers, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - J Sohl
- Dana-Farber Cancer Institute, Boston, MA; Beth Isreal Deaconness Medical Center, Boston, MA; Cancer Care of Maine, Brewer, ME; Mass General North Shore Cancer Center, Danvers, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - ZK Stadler
- Dana-Farber Cancer Institute, Boston, MA; Beth Isreal Deaconness Medical Center, Boston, MA; Cancer Care of Maine, Brewer, ME; Mass General North Shore Cancer Center, Danvers, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - M Garrett
- Dana-Farber Cancer Institute, Boston, MA; Beth Isreal Deaconness Medical Center, Boston, MA; Cancer Care of Maine, Brewer, ME; Mass General North Shore Cancer Center, Danvers, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - EP Winer
- Dana-Farber Cancer Institute, Boston, MA; Beth Isreal Deaconness Medical Center, Boston, MA; Cancer Care of Maine, Brewer, ME; Mass General North Shore Cancer Center, Danvers, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - S Come
- Dana-Farber Cancer Institute, Boston, MA; Beth Isreal Deaconness Medical Center, Boston, MA; Cancer Care of Maine, Brewer, ME; Mass General North Shore Cancer Center, Danvers, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - NU Lin
- Dana-Farber Cancer Institute, Boston, MA; Beth Isreal Deaconness Medical Center, Boston, MA; Cancer Care of Maine, Brewer, ME; Mass General North Shore Cancer Center, Danvers, MA; Memorial Sloan-Kettering Cancer Center, New York, NY
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Soreca I, Wallace ML, Frank E, Hasler BP, Levenson JC, Kupfer DJ. Sleep duration is associated with dyslipidemia in patients with bipolar disorder in clinical remission. J Affect Disord 2012; 141:484-7. [PMID: 22578889 PMCID: PMC3612347 DOI: 10.1016/j.jad.2012.01.046] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [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: 11/23/2011] [Revised: 01/15/2012] [Accepted: 01/30/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND The pathways to increased cardiovascular risk in bipolar disorder include health behaviors, psychosocial stress and long-term medication exposure. However, the evidence that the association between cardiovascular risk factors and bipolar disorder remains significant after controlling for these co-factors suggests that additional important risk factors have yet to be identified. Our hypothesis is that disturbances in the sleep-wake cycle are an important and under-recognized pathway through which affective disorders lead to increased cardiovascular risk. METHODS In patients with bipolar disorder type 1 in clinical remission, we: 1) explored whether sleep disturbance predicted the endorsement of NCEP ATP-III criteria for dyslipidemia, independent of other lifestyle factors and 2) tested the association between low HDL (NCEP-ATP III) and sleep duration measured with actigraphy over an eight-day period. RESULTS Median sleep duration is significantly associated with low HDL. The risk of having low HDL increases by 1.23 with every 30 minutes of reduced sleep time. LIMITATIONS Since sleep patterns in patients with bipolar disorder are variable and irregular, it is possible that other sleep characteristics, not present during the span of our study, or the variability itself may be what drives the increased cardiovascular risk. CONCLUSIONS Sleep characteristics of patients with bipolar disorder in clinical remission are associated with cardiovascular risk. More specifically, sleep duration was associated with low HDL. Clinicians should pay special attention to sleep hygiene in treating individuals with bipolar disorder, even when they are in clinical remission.
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Affiliation(s)
- I Soreca
- University of Pittsburgh, School of Medicine, Department of Psychiatry, USA.
| | - ML Wallace
- University of Pittsburgh, Department of Statistics
| | - E Frank
- University of Pittsburgh School of Medicine, Department of Psychiatry
| | - BP Hasler
- University of Pittsburgh School of Medicine, Department of Psychiatry
| | - JC Levenson
- University of Pittsburgh School of Medicine, Department of Psychiatry
,University of Pittsburgh, Department of Psychology
| | - DJ Kupfer
- University of Pittsburgh School of Medicine, Department of Psychiatry
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Abstract
Due to photobleaching and phototoxicity induced by high-intensity excitation light, the number of fluorescence images that can be obtained in live cells is always limited. This limitation becomes particularly prominent in multidimensional recordings when multiple Z-planes are captured at every time point. Here we present a simple technique, termed predictive-focus illumination (PFI), which helps to minimize cells' exposure to light by decreasing the number of Z-planes that need to be captured in live-cell 3D time-lapse recordings. PFI utilizes computer tracking to predict positions of objects of interest (OOIs) and restricts image acquisition to small dynamic Z-regions centred on each OOI. Importantly, PFI does not require hardware modifications and it can be easily implemented on standard wide-field and spinning-disc confocal microscopes.
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Affiliation(s)
- Z. Schilling
- Department of Electrical, Computer, and Systems Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - E. Frank
- Department of Electrical, Computer, and Systems Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - V. Magidson
- Department of Mechanical, Aerospace, and Nuclear Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - J. Wason
- Department of Electrical, Computer, and Systems Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - J. Lončarek
- Wadsworth Center, NY State Dept. of Health, Albany, NY, USA
| | - K. Boyer
- Department of Electrical, Computer, and Systems Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - J. Wen
- Department of Electrical, Computer, and Systems Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
- Department of Mechanical, Aerospace, and Nuclear Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - A. Khodjakov
- Wadsworth Center, NY State Dept. of Health, Albany, NY, USA
- Department of Biology, Rensselaer Polytechnic Institute, Troy, NY, USA
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Rayego-Mateos S, Rodrigues-Diez R, Rodrigues-Diez RR, Lavoz-Barria C, Alique M, Mas S, Pato J, Keri G, Egido J, Ortiz A, Ruiz-Ortega M, Ying L, Tepel M, Frank E, Florian T, Gregor T, Boye J, Maik G, Teng B, Gu C, Haller H, Sever S, Schiffer M, Worthmann K, Leitges M, Dittrich-Breiholz O, Kracht M, Haller H, Schiffer M, Peired A, Angelotti ML, Ronconi E, Lazzeri E, Sisti A, Lasagni L, Romagnani P. Mechanisms and targets of glomerular damage. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs229] [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: 11/13/2022] Open
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Frank E, Kupfer DJ, Rucci P, Lotz-Wallace M, Levenson J, Fournier J, Kraemer HC. Simultaneous evaluation of the harms and benefits of treatments in randomized clinical trials: demonstration of a new approach. Psychol Med 2012; 42:865-873. [PMID: 21861951 PMCID: PMC3516402 DOI: 10.1017/s0033291711001619] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND One aim of personalized medicine is to determine which treatment is to be preferred for an individual patient, given all patient information available. Particularly in mental health, however, there is a lack of a single objective, reliable measure of outcome that is sensitive to crucial individual differences among patients. METHOD We examined the feasibility of quantifying the total clinical value provided by a treatment (measured by both harms and benefits) in a single metric. An expert panel was asked to compare 100 pairs of patients, one from each treatment group, who had participated in a randomized clinical trial (RCT) involving interpersonal psychotherapy (IPT) and escitalopram, selecting the patient with the preferred outcome considering both benefits and harms. RESULTS From these results, an integrated preference score (IPS) was derived, such that the differences between any two patients' IPSs would predict the clinicians' preferences. This IPS was then computed for all patients in the RCT. A second set of 100 pairs was rated by the panel. Their preferences were highly correlated with the IPS differences (r=0.84). Finally, the IPS was used as the outcome measure comparing IPT and escitalopram. The 95% confidence interval (CI) for the effect size comparing treatments indicated clinical equivalence of the treatments. CONCLUSIONS A metric that combines benefits and harms of treatments could increase the value of RCTs by making clearer which treatments are preferable and, ultimately, for whom. Such methods result in more precise estimation of effect sizes, without increasing the required sample size.
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Affiliation(s)
- E Frank
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Troxel W, Kupfer D, Reynolds C, Frank E, Thase M, Miewald J, Buysse D. Insomnia and objectively measured sleep disturbances predict treatment outcome in depressed patients treated with psychotherapy or psychotherapy-pharmacotherapy combinations. J Clin Psychiatry 2012; 73:478-85. [PMID: 22152403 PMCID: PMC3310298 DOI: 10.4088/jcp.11m07184] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 10/14/2011] [Indexed: 10/15/2022]
Abstract
OBJECTIVE Insomnia and objectively measured sleep disturbances predict poor treatment outcomes in patients with major depressive disorder (MDD). However, prior research has utilized individual clinical trials with relatively small sample sizes and has focused on insomnia symptoms or objective measures, but not both. The present study is a secondary analysis that examines the degree to which insomnia, objective sleep disturbances, or their combination predicts depression remission following pharmacotherapy and/or psychotherapy treatment. METHOD Participants were 711 depressed (DSM criteria) patients drawn from 6 clinical trials. Remission status, defined as a score of ≤ 7 on the Hamilton Depression Rating Scale (HDRS) over 2 consecutive months, served as the primary outcome. Insomnia was assessed via the 3 sleep items on the HDRS. Objectively measured short sleep duration (total sleep time ≤ 6 hours) and prolonged sleep latency (> 30 minutes) or wakefulness after sleep onset (> 30 minutes) were derived from in-laboratory polysomnographic sleep studies. Logistic regression predicted the odds of nonremission according to insomnia, each of the objective sleep disturbances, or their combination, after adjusting for age, sex, treatment modality, and baseline depressive symptoms. RESULTS Prolonged sleep latency alone (OR = 3.53; 95% CI, 1.28-9.73) or in combination with insomnia (OR = 2.11; 95% CI, 1.13-3.95) predicted increased risk of nonremission. In addition, insomnia and sleep duration individually and in combination were each associated with a significantly increased risk of nonremission (P values < .05). CONCLUSIONS Findings suggest that objectively measured prolonged sleep latency and short sleep duration independently or in conjunction with insomnia are risk factors for poor depression treatment outcome.
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Affiliation(s)
- W.M. Troxel
- University of Pittsburgh, Department of Psychiatry and Psychology
| | - D.J. Kupfer
- University of Pittsburgh School of Medicine, Department of Psychiatry
| | - C.F. Reynolds
- University of Pittsburgh School of Medicine, Department of Psychiatry
| | - E. Frank
- University of Pittsburgh, Department of Psychiatry and Psychology
| | - M. Thase
- University of Pennsylvania, Department of Psychiatry
| | - J. Miewald
- University of Pittsburgh School of Medicine, Department of Psychiatry
| | - D.J. Buysse
- University of Pittsburgh School of Medicine, Department of Psychiatry
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Frank E, Frank S. Chairside dental imaging processing with DentalMagic. Int J Comput Dent 2012; 15:327-334. [PMID: 23457902] [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: 06/01/2023]
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Frank E, Frank S. Computer-assisted periodontal diagnostics using the pa-on periometer and the byzzParo software. Int J Comput Dent 2012; 15:227-235. [PMID: 23252222] [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: 06/01/2023]
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Frank E, Frank S. Bite registration in Cerec and in lab. Int J Comput Dent 2012; 15:149-158. [PMID: 22891418] [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: 06/01/2023]
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Filiou MD, Teplytska L, Gormanns P, Reckow S, Zhang Y, Frank E, Kessler MS, Nussbaumer M, Maccarrone G, Landgraf R, Turck CW. Anxiety and mitochondria: Insights from the -omics world. Pharmacopsychiatry 2011. [DOI: 10.1055/s-0031-1292470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abe K, Abgrall N, Ajima Y, Aihara H, Albert JB, Andreopoulos C, Andrieu B, Aoki S, Araoka O, Argyriades J, Ariga A, Ariga T, Assylbekov S, Autiero D, Badertscher A, Barbi M, Barker GJ, Barr G, Bass M, Bay F, Bentham S, Berardi V, Berger BE, Bertram I, Besnier M, Beucher J, Beznosko D, Bhadra S, Blaszczyk FDMM, Blondel A, Bojechko C, Bouchez J, Boyd SB, Bravar A, Bronner C, Brook-Roberge DG, Buchanan N, Budd H, Calvet D, Cartwright SL, Carver A, Castillo R, Catanesi MG, Cazes A, Cervera A, Chavez C, Choi S, Christodoulou G, Coleman J, Coleman W, Collazuol G, Connolly K, Curioni A, Dabrowska A, Danko I, Das R, Davies GS, Davis S, Day M, De Rosa G, de André JPAM, de Perio P, Delbart A, Densham C, Di Lodovico F, Di Luise S, Dinh Tran P, Dobson J, Dore U, Drapier O, Dufour F, Dumarchez J, Dytman S, Dziewiecki M, Dziomba M, Emery S, Ereditato A, Escudero L, Esposito LS, Fechner M, Ferrero A, Finch AJ, Frank E, Fujii Y, Fukuda Y, Galymov V, Gannaway FC, Gaudin A, Gendotti A, George MA, Giffin S, Giganti C, Gilje K, Golan T, Goldhaber M, Gomez-Cadenas JJ, Gonin M, Grant N, Grant A, Gumplinger P, Guzowski P, Haesler A, Haigh MD, Hamano K, Hansen C, Hansen D, Hara T, Harrison PF, Hartfiel B, Hartz M, Haruyama T, Hasegawa T, Hastings NC, Hastings S, Hatzikoutelis A, Hayashi K, Hayato Y, Hearty C, Helmer RL, Henderson R, Higashi N, Hignight J, Hirose E, Holeczek J, Horikawa S, Hyndman A, Ichikawa AK, Ieki K, Ieva M, Iida M, Ikeda M, Ilic J, Imber J, Ishida T, Ishihara C, Ishii T, Ives SJ, Iwasaki M, Iyogi K, Izmaylov A, Jamieson B, Johnson RA, Joo KK, Jover-Manas GV, Jung CK, Kaji H, Kajita T, Kakuno H, Kameda J, Kaneyuki K, Karlen D, Kasami K, Kato I, Kearns E, Khabibullin M, Khanam F, Khotjantsev A, Kielczewska D, Kikawa T, Kim J, Kim JY, Kim SB, Kimura N, Kirby B, Kisiel J, Kitching P, Kobayashi T, Kogan G, Koike S, Konaka A, Kormos LL, Korzenev A, Koseki K, Koshio Y, Kouzuma Y, Kowalik K, Kravtsov V, Kreslo I, Kropp W, Kubo H, Kudenko Y, Kulkarni N, Kurjata R, Kutter T, Lagoda J, Laihem K, Laveder M, Lee KP, Le PT, Levy JM, Licciardi C, Lim IT, Lindner T, Litchfield RP, Litos M, Longhin A, Lopez GD, Loverre PF, Ludovici L, Lux T, Macaire M, Mahn K, Makida Y, Malek M, Manly S, Marchionni A, Marino AD, Marteau J, Martin JF, Maruyama T, Maryon T, Marzec J, Masliah P, Mathie EL, Matsumura C, Matsuoka K, Matveev V, Mavrokoridis K, Mazzucato E, McCauley N, McFarland KS, McGrew C, McLachlan T, Messina M, Metcalf W, Metelko C, Mezzetto M, Mijakowski P, Miller CA, Minamino A, Mineev O, Mine S, Missert AD, Mituka G, Miura M, Mizouchi K, Monfregola L, Moreau F, Morgan B, Moriyama S, Muir A, Murakami A, Murdoch M, Murphy S, Myslik J, Nakadaira T, Nakahata M, Nakai T, Nakajima K, Nakamoto T, Nakamura K, Nakayama S, Nakaya T, Naples D, Navin ML, Nelson B, Nicholls TC, Nishikawa K, Nishino H, Nowak JA, Noy M, Obayashi Y, Ogitsu T, Ohhata H, Okamura T, Okumura K, Okusawa T, Oser SM, Otani M, Owen RA, Oyama Y, Ozaki T, Pac MY, Palladino V, Paolone V, Paul P, Payne D, Pearce GF, Perkin JD, Pettinacci V, Pierre F, Poplawska E, Popov B, Posiadala M, Poutissou JM, Poutissou R, Przewlocki P, Qian W, Raaf JL, Radicioni E, Ratoff PN, Raufer TM, Ravonel M, Raymond M, Retiere F, Robert A, Rodrigues PA, Rondio E, Roney JM, Rossi B, Roth S, Rubbia A, Ruterbories D, Sabouri S, Sacco R, Sakashita K, Sánchez F, Sarrat A, Sasaki K, Scholberg K, Schwehr J, Scott M, Scully DI, Seiya Y, Sekiguchi T, Sekiya H, Shibata M, Shimizu Y, Shiozawa M, Short S, Siyad M, Smith RJ, Smy M, Sobczyk JT, Sobel H, Sorel M, Stahl A, Stamoulis P, Steinmann J, Still B, Stone J, Strabel C, Sulak LR, Sulej R, Sutcliffe P, Suzuki A, Suzuki K, Suzuki S, Suzuki SY, Suzuki Y, Suzuki Y, Szeglowski T, Szeptycka M, Tacik R, Tada M, Takahashi S, Takeda A, Takenaga Y, Takeuchi Y, Tanaka K, Tanaka HA, Tanaka M, Tanaka MM, Tanimoto N, Tashiro K, Taylor I, Terashima A, Terhorst D, Terri R, Thompson LF, Thorley A, Toki W, Tomaru T, Totsuka Y, Touramanis C, Tsukamoto T, Tzanov M, Uchida Y, Ueno K, Vacheret A, Vagins M, Vasseur G, Wachala T, Walding JJ, Waldron AV, Walter CW, Wanderer PJ, Wang J, Ward MA, Ward GP, Wark D, Wascko MO, Weber A, Wendell R, West N, Whitehead LH, Wikström G, Wilkes RJ, Wilking MJ, Wilson JR, Wilson RJ, Wongjirad T, Yamada S, Yamada Y, Yamamoto A, Yamamoto K, Yamanoi Y, Yamaoka H, Yanagisawa C, Yano T, Yen S, Yershov N, Yokoyama M, Zalewska A, Zalipska J, Zambelli L, Zaremba K, Ziembicki M, Zimmerman ED, Zito M, Żmuda J. Indication of electron neutrino appearance from an accelerator-produced off-axis muon neutrino beam. Phys Rev Lett 2011; 107:041801. [PMID: 21866992 DOI: 10.1103/physrevlett.107.041801] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Indexed: 05/31/2023]
Abstract
The T2K experiment observes indications of ν(μ) → ν(e) appearance in data accumulated with 1.43×10(20) protons on target. Six events pass all selection criteria at the far detector. In a three-flavor neutrino oscillation scenario with |Δm(23)(2)| = 2.4×10(-3) eV(2), sin(2)2θ(23) = 1 and sin(2)2θ(13) = 0, the expected number of such events is 1.5±0.3(syst). Under this hypothesis, the probability to observe six or more candidate events is 7×10(-3), equivalent to 2.5σ significance. At 90% C.L., the data are consistent with 0.03(0.04) < sin(2)2θ(13) < 0.28(0.34) for δ(CP) = 0 and a normal (inverted) hierarchy.
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Affiliation(s)
- K Abe
- University of Tokyo, Institute for Cosmic Ray Research, Kamioka Observatory, Kamioka, Japan
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Rucci P, Frank E, Scocco P, Calugi S, Miniati M, Fagiolini A, Cassano G. Treatment-emergent suicidal ideation during 4 months of acute management of unipolar major depression with SSRI pharmacotherapy or interpersonal psychotherapy in a randomized clinical trial. Depress Anxiety 2011; 28:303-9. [PMID: 21308882 PMCID: PMC3079416 DOI: 10.1002/da.20758] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [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: 07/01/2010] [Revised: 09/11/2010] [Accepted: 09/13/2010] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND To date, few randomized controlled trials (RCTs) of major depression have examined suicidal ideation as an outcome measure. Our aim is to determine the incidence of treatment-emergent suicidal ideation (ESI) and behaviors during the acute phase of treatment with an SSRI antidepressant or interpersonal psychotherapy (IPT) in patients with unipolar major depression. METHODS In a two-site RCT, 291 adult outpatients with nonpsychotic major depression and a Hamilton Depression Rating Scale (HDRS) score ≥15 were randomly allocated to IPT or SSRI. Participants who did not remit with monotherapy received augmentation with the other treatment. ESI was defined as a post-baseline HDRS suicidality item score ≥2 or a post-baseline Quick Inventory of Depressive Symptomatology (QIDS) score ≥2 in patients with a baseline score ≤1. RESULTS Of the 231 participants who had no suicidal ideation at baseline, 32 (13.8%) subsequently exhibited ESI on at least one post-baseline visit. Time to suicidal ideation was significantly longer in patients allocated to SSRI compared to those allocated to IPT (HR = 2.21, 95% CI 1.04-4.66, P = .038), even after controlling for treatment augmentation, benzodiazepine use, and comorbidity with anxiety disorders. Worsening of suicidal ideation occurred in 7/60 patients who had suicidal ideation at baseline. In the large majority of cases, suicidal ideation was successfully managed with the study protocol. CONCLUSIONS In the context of careful monitoring and frequent contact, selective serotonin reuptake inhibitor (SSRI) was associated with a lower risk of ESI than IPT and both SSRI and IPT appeared to be safe treatments for patients with past suicide attempts, none of whom exhibited ESI during the study.
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Affiliation(s)
- P Rucci
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - E Frank
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - P. Scocco
- Mental Health Department, ULSS 16, Padova, Italy
| | - S. Calugi
- Department of Psychiatry, Neurobiology, Pharmacology, Biotechnology, University of Pisa, Pisa, Italy
| | - M. Miniati
- Department of Psychiatry, Neurobiology, Pharmacology, Biotechnology, University of Pisa, Pisa, Italy
| | - A. Fagiolini
- Department of Neuroscience, University of Siena School of Medicine, Siena, Italy
| | - G.B. Cassano
- Department of Psychiatry, Neurobiology, Pharmacology, Biotechnology, University of Pisa, Pisa, Italy
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Calugi S, Cassano GB, Litta A, Rucci P, Benvenuti A, Miniati M, Lattanzi L, Mantua, Lombardi, Fagiolini A, Frank E. Does psychomotor retardation define a clinically relevant phenotype of unipolar depression? J Affect Disord 2011; 129:296-300. [PMID: 20833434 PMCID: PMC3387566 DOI: 10.1016/j.jad.2010.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Revised: 08/03/2010] [Accepted: 08/03/2010] [Indexed: 12/17/2022]
Abstract
BACKGROUND The recognition and assessment of psychomotor retardation may have implications for better definition of the clinical phenotypes of depression. The aim of this study was to assess the clinical correlates of psychomotor retardation endorsed at any time during the patients' lifetime (LPR). METHODS The study sample included 291 patients with non-psychotic major depressive disorder (MDD) participating in the clinical trial, "Depression: The Search for Treatment-Relevant Phenotypes." Psychomotor retardation was measured using a factor derived from the Mood Spectrum Self-Report (MOODS-SR) assessment. Using a pre-defined cut-off score on the lifetime psychomotor retardation (LPR) factor of the MOODS-SR, participants were classified into high and low scorers. Logistic regression analysis was used to evaluate the relationship between LPR and subthreshold bipolarity. RESULTS Compared to low scorers, participants with high scores on the LPR factor had greater severity of depression and more bipolarity indicators. CONCLUSIONS The MOODS-SR appears to be helpful to identify clinical phenotypes of unipolar depression and to highlight the usefulness of a lifetime approach to the assessment of psychopathology in the characterisation of patients with unipolar depression.
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Affiliation(s)
- S Calugi
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa
| | - GB Cassano
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa
| | - A Litta
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa
| | - P Rucci
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - A Benvenuti
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa
| | - M Miniati
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa
| | - L Lattanzi
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa
| | - Mantua
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa
| | - Lombardi
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa
| | - A Fagiolini
- Department of Neuroscience, University of Siena School of Medicine
| | - E Frank
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Frank E. Input devices in the dental environment. Int J Comput Dent 2011; 14:273-280. [PMID: 22141236] [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: 05/31/2023]
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Frank E, Frank S. Dental e-learning. Int J Comput Dent 2011; 14:155-162. [PMID: 21877382] [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: 05/31/2023]
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Frank E, Cassano GB, Rucci P, Thompson WK, Kraemer HC, Fagiolini A, Maggi L, Kupfer DJ, Shear MK, Houck PR, Calugi S, Grochocinski VJ, Scocco P, Buttenfield J, Forgione RN. Predictors and moderators of time to remission of major depression with interpersonal psychotherapy and SSRI pharmacotherapy. Psychol Med 2011; 41:151-162. [PMID: 20380782 PMCID: PMC3275416 DOI: 10.1017/s0033291710000553] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [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: 12/17/2022]
Abstract
BACKGROUND Although many studies suggest that, on average, depression-specific psychotherapy and antidepressant pharmacotherapy are efficacious, we know relatively little about which patients are more likely to respond to one versus the other. We sought to determine whether measures of spectrum psychopathology are useful in deciding which patients with unipolar depression should receive pharmacotherapy versus depression-specific psychotherapy. METHOD A total of 318 adult out-patients with major depression were randomly assigned to escitalopram pharmacotherapy or interpersonal psychotherapy (IPT) at academic medical centers at Pittsburgh, Pennsylvania and Pisa, Italy. Our main focus was on predictors and moderators of time to remission on monotherapy at 12 weeks. RESULTS Participants with higher scores on the need for medical reassurance factor of the Panic-Agoraphobic Spectrum Self-Report (PAS-SR) had more rapid remission with IPT and those with lower scores on the psychomotor activation factor of the Mood Spectrum Self-Report (MOODS-SR) experienced more rapid remission with selective serotonin reuptake inhibitor (SSRI) pharmacotherapy. Non-specific predictors of longer time to remission with monotherapy included several panic spectrum and mood spectrum factors and the Social Phobia Spectrum (SHY) total score. Higher baseline scores on the 17- and 25-item Hamilton Depression Rating Scales (HAMD-17 and HAMD-25) and the Work and Social Adjustment Scale (WSAS) also predicted a longer time to remission, whereas being married predicted a shorter time to remission. CONCLUSIONS This exploratory study identified several non-specific predictors but few moderators of psychotherapy versus pharmacotherapy outcome. It offers useful indicators of the characteristics of patients that are generally difficult to treat, but only limited guidance as to who benefits from IPT versus SSRI pharmacotherapy.
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Affiliation(s)
- E Frank
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213, USA.
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Perlmutter J, Frank E, LeStage B, Esserman L. Abstract P5-07-02: I-SPY 2 Clinical Trial: Advocate Involvement in Protocol, Informed Consent and Patient Support Materials Development. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p5-07-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: I-SPY 2 is an innovative collaboration to assess 8-12 investigational agents and numerous biomarkers in an adaptive, neoadjuvant clinical trial for patients with locally advanced breast cancer and a high likelihood of recurrence. The first site opened in March 2010, and the trial will eventually open in up to 20 sites and enroll 800 patients. Helping patients understand complex clinical trials and make informed decisions about participating in them continues to be a challenge. In the interest of meeting regulatory requirements and protecting participating institutions, informed consent documents often confuse potential patients rather than inform them. I-SPY 2 investigators engaged advocates to ensure that informed consent documents were as patient friendly as possible, and to provide supplementary materials to assist patients obtain the information a way that meets their individual learning styles and information needs. Methods: A network of over 170 advocates from around the US have been informed about the I-SPY 2 trial through presentations at SABCS, webinars, a website and monthly email updates. About 25 of these advocates, including novice and experienced advocates, provided input into the protocol, informed consent documents and/or patient support materials. A virtual process (email and teleconferences) was used to plan, develop and finalize patient support materials and to review multiple versions of all documents. A survey to assess this collaboration was conducted once the trial launched. It was distributed to 25 advocates and 8 staff/investigators. This survey captured: 1) key contributions made by the advocates; 2) amount of time spent on various activities; and 3) perceptions about success of the process.
Discussion: Seventeen advocates responses were received, with nine of the seventeen involved in each of the three components—protocol, informed consent, and patient support materials. A majority of the advocates spent between 5 and 9 hours reviewing documents plus between 2 and 9 hours on teleconferences. Both advocates and staff believed that a majority of advocates’ suggestions were incorporated into the final material. However, several of the advocate recommendations were rejected by IRBs, although concerns varied by site. Both investigators and advocates felt the process was a successful collaboration that will improve patient experiences and are likely to improve accrual and compliance. In addition to changing the documents themselves, advocate suggestions led to several changes in the trial procedures. For example, the trial uses a two stage consent process—one to obtain tissue for screening and randomization, and a second to enroll in the treatment phase of the trial. Also, procedures have been defined for collecting data about specific reasons patients decline to participate, and informing patients who are found ineligible for the trial and when investigational agents are removed from the trial. Details from the survey provide information about: 1) the types of contributions re likely to result from involving advocates; and 2) how to structure the collaboration to maximize satisfaction and contribution. Future research will assess patients reactions to the materials developed for I-SPY 2.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-07-02.
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Affiliation(s)
- J Perlmutter
- Gemini Group, Ann Arbor, MI; Dana Farber Cancer Center, Boston, MA; Independent Advocate, MA; University of California, San Francisco
| | - E Frank
- Gemini Group, Ann Arbor, MI; Dana Farber Cancer Center, Boston, MA; Independent Advocate, MA; University of California, San Francisco
| | - B LeStage
- Gemini Group, Ann Arbor, MI; Dana Farber Cancer Center, Boston, MA; Independent Advocate, MA; University of California, San Francisco
| | - L. Esserman
- Gemini Group, Ann Arbor, MI; Dana Farber Cancer Center, Boston, MA; Independent Advocate, MA; University of California, San Francisco
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Gilbert A, Olino TM, Houck P, Fagiolini A, Kupfer D, Frank E. Self-reported cognitive problems predict employment trajectory in patients with bipolar I disorder. J Affect Disord 2010; 124:324-8. [PMID: 19942294 PMCID: PMC2888870 DOI: 10.1016/j.jad.2009.11.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [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: 06/25/2009] [Revised: 11/03/2009] [Accepted: 11/12/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cognitive impairment in bipolar disorder has been associated with poor functional outcomes. We examined the relation of self-reported cognitive problems to employment trajectory in patients diagnosed with bipolar I disorder. METHODS 154 bipolar I disorder patients were followed for 15-43months at the Bipolar Disorders Center for Pennsylvanians. Using a multinomial logistic regression we examined predictors of employment group including self-reported cognitive problems, mood symptoms, education and age. Cognitive functioning was measured via 4 self-report items assessing memory/concentration at baseline and termination. Employment status was recorded at baseline and termination. Employment was categorized as working (full-time, part-time, homemaker, volunteer) or not working (leave of absence, disability, unemployed, no longer volunteering) at each time point. Patients were categorized as good stable, improving, worsening and poor stable. RESULTS Baseline self-reported concentration problems and years of education significantly predicted employment trajectory. LIMITATIONS Post-hoc analyses of existing clinical data. CONCLUSIONS Self-reported concentration problems assessed in the context of specific areas of functioning may serve as a sensitive predictor of functional outcome in patients diagnosed with bipolar I disorder.
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Affiliation(s)
- A.M. Gilbert
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania,Department of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, New York,Corresponding Author: Alison Gilbert, Ph.D., Zucker Hillside Hospital, 75-59 263rd Street, Glen Oaks, NY 11004, ph: 718.470.8773, fax: 718.343.1659
| | - T. M. Olino
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania
| | - P. Houck
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania
| | - A. Fagiolini
- University of Siena, Department of Neuroscience, Siena Italy
| | - D.J. Kupfer
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania
| | - E. Frank
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania
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Ditzen C, Varadarajulu J, Czibere L, Gonik M, Targosz BS, Hambsch B, Bettecken T, Kessler MS, Frank E, Bunck M, Teplytska L, Erhardt A, Holsboer F, Müller-Myhsok B, Landgraf R, Turck CW. Proteomic-based genotyping in a mouse model of trait anxiety exposes disease-relevant pathways. Mol Psychiatry 2010; 15:702-11. [PMID: 19139748 DOI: 10.1038/mp.2008.146] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In our biomarker identification efforts, we have reported earlier on a protein that differs in its electrophoretic mobility between mouse lines bred either for high or low trait anxiety. The altered electrophoretic behavior of enolase phosphatase (EP) is now identified to be caused by two single-nucleotide polymorphisms. In both cases, the genetic polymorphism introduces an amino acid change in the protein's sequence resulting in differential mobility on SDS gels. This was shown by recombinantly expressing the two EP isoforms. Functional studies indicate that the EP isoform from the high anxiety mouse line has a lower enzymatic activity than does its low anxiety mouse counterpart. EP is a member of the methionine salvage pathway that is responsible for the synthesis of S-adenosyl-L-methionine, a natural compound with potential antidepressant activities. In addition, it is linked to the polyamine pathway whose members have functions in anxiety/depression-related behaviors. In a freely-segregating F2 panel, both single-nucleotide polymorphisms were significantly associated with locomotion-independent trait anxiety, further supporting a functional role of EP for this phenotype. The study shows that proteomic analysis can reveal genotypic differences relevant for the phenotype. The identified protein alterations, in turn, can expose metabolic pathways pertinent to the behavioral phenotype.
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Affiliation(s)
- C Ditzen
- Max Planck Institute of Psychiatry, Munich, Germany
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Adrian GP, Blumenstock T, Fischer H, Frank E, Gulde T, Oelhaf H, Thomas P, Trieschmann O. Column Amounts and Some Information on the Vertical Distribution of Trace Gases in the Late North Polar Winter 1990. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/bbpc.19920960308] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Levenson JC, Frank E, Cheng Y, Rucci P, Janney CA, Houck P, Forgione RN, Swartz HA, Cyranowski JM, Fagiolini A. Comparative outcomes among the problem areas of interpersonal psychotherapy for depression. Depress Anxiety 2010; 27:434-40. [PMID: 20099274 PMCID: PMC4228685 DOI: 10.1002/da.20661] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Although interpersonal psychotherapy (IPT) is an efficacious treatment for acute depression, the relative efficacy of treatment in each of the four IPT problem areas (grief, role transitions, role disputes, interpersonal deficits) has received little attention. We evaluated the specificity of IPT by comparing treatment success among patients whose psychotherapy focused on each problem area. Moreover, we sought to understand how the patient characteristics and interpersonal problems most closely linked to the onset of a patient's current depression contributed to IPT success. METHODS Patients meeting DSM-IV criteria for an episode of major depressive disorder (n=182) were treated with weekly IPT. Remission was defined as an average Hamilton Rating Scale for Depression 17-item score of 7 or below over 3 weeks. Personality disorders were diagnosed using the Structured Clinical Interview for DSM-IV Personality Disorders. RESULTS Contrary to our prediction that patients whose treatment was focused on interpersonal deficits would take longer to remit, survival analyses indicated that patients receiving treatment focused on each of the four problem areas did not differ in their times to remission. Nor were patients in the interpersonal deficits group more likely to have an Axis II diagnosis. Patients whose treatment focused on role transitions remitted faster than those whose treatment focused on role disputes, after controlling for covariates. CONCLUSION With skillful use of IPT strategies and tactics and with careful medication management where appropriate, patients in this study whose treatment focused on each problem area were treated with equal success by trained IPT clinicians.
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Affiliation(s)
- J. C. Levenson
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - E. Frank
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Y. Cheng
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Department of Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - P. Rucci
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - C. A. Janney
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - P. Houck
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - H. A. Swartz
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - J. M. Cyranowski
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - A. Fagiolini
- Department of Neuroscience, University of Siena School of Medicine, Siena, Italy
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Miniati M, Rucci P, Benvenuti A, Frank E, Buttenfield J, Giorgi G, Cassano G. Clinical characteristics and treatment outcome of depression in patients with and without a history of emotional and physical abuse. J Psychiatr Res 2010; 44:302-9. [PMID: 19800634 PMCID: PMC2836419 DOI: 10.1016/j.jpsychires.2009.09.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [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: 01/07/2009] [Revised: 08/28/2009] [Accepted: 09/08/2009] [Indexed: 11/29/2022]
Abstract
Clinical features and treatment outcome were compared in depressed outpatients with and without a history of emotional and physical abuse (EPA), including childhood maltreatment. Patients were initially randomized to IPT or SSRI and then augmented with the second treatment if they did not remit with monotherapy. Assessments included the SCID-I, the SCID-II for DSM-IV diagnoses, the HRSD, the QIDS and the Mood Spectrum Self-Report (MOODS-SR). Seventy-eight (25%) patients reported a history of EPA; 60 (76.9%) were women. Patients with a history of EPA did not differ from those without on HRSD scores at baseline, but showed an earlier age at onset of depression and a longer duration of illness. The two groups differed on several mood spectrum factors, namely: 'depressivemood' (15.6+/-4.9 vs. 13.5+/-5.4; p<0.004), 'psychomotorretardation' (11.7+/-4.5 vs. 9.6+/-4.7; p<0.001), 'drugandillness-relateddepression' (1.3+/-1.3 vs. 0.6+/-1.0; p<0.0001), and 'neurovegetativesymptoms' (8.3+/-2.6 vs. 6.9+/-2.9; p<0.0001). Patients with EPA had also a significantly longer time to remission (89 vs. 67days, log-rank test, p=0.035). The need for augmentation treatment was significantly more frequent among patients with EPA than in those without. The present study suggests that patients with a history of EPA show a subtype of depression characterized by poor treatment response and more severe neurovegetative and psychomotor symptoms.
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Affiliation(s)
- M. Miniati
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa
| | - P. Rucci
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - A. Benvenuti
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa
| | - E. Frank
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - J. Buttenfield
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - G. Giorgi
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa
| | - G.B. Cassano
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa
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Frank E, Kleinjung T, Burger J, Landgrebe M, Eichhammer P, Hajak G, Langguth B. transcranial Direct Current Stimulation (tDCS) in the treatment of chronic tinnitus – results of a pilot study. KLIN NEUROPHYSIOL 2010. [DOI: 10.1055/s-0030-1250967] [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: 10/19/2022]
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