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Stienstra N, Lane M, Horton J, Kumthekar A, Sathe N, Sunny C, Yadav V, Deodhar A. AB0323 DEMYELINATING DISEASE AFTER EXPOSURE TO TUMOR NECROSIS FACTOR ALPHA INHIBITORS (TNFI): LONG-TERM OUTCOMES FROM A SINGLE CENTER. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:TNFi are effective treatments for multiple immune-mediated inflammatory diseases. There are five TNFi’s approved for clinical use. Despite their acceptable safety/efficacy profile, serious side effects have been reported, including central and peripheral nervous system demyelinating diseases (DD).ͥ Causation remains controversial and there is a paucity of data on the long-term outcomes in these patients.Objectives:To assess long term outcomes in patients with DD related to TNFi use.Methods:We conducted a database search and then retrospective chart review to identify patients with potential TNFi related neurologic events at a university medical center between 2006 and 2016. 15 total patients (13 living, 2 deceased) were ultimately identified. Six were able to be contacted by phone to assess their current status. Four of these patients were able to attend a one time-visit to complete a neurologic assessment and musculoskeletal examination. Interviews over the phone or in person were used to complete multiple assessments for disability.Results:15 patients with DD were identified from among 4600 patients on TNFi’s for various indications (0.3%). Mean duration of follow-up was 6.8 years. Neurologic symptoms occurred >12 months after starting a TNFi in 8/15 (53%) patients. 47% of patients had been exposed to two or more TNFi’s. 40% received some form of treatment for their DD, including MS disease modifying therapies, IVIG and immunosuppression. No patients experienced worsening DD after stopping their TNFi except for one patient with MS who experienced a repeat flare. Two of three patients diagnosed with MS after TNFi had a first degree relative with MS. 3/15 (20%) experienced complete resolution of their symptoms. Two patients were deceased; cause of death was thought not directly related to DD on chart review.Conclusion:Prevalence of DD after TNFi exposure was low at our center, consistent with previously published data. Presentations included both central and peripheral demyelinating events. With the exception of one patient who developed MS, withdrawal of TNFi’s appeared to halt further progression or development of new neurologic symptoms. It is unclear if treatment for DD is beneficial after diagnosis and TNFi withdrawal.Patient Data:Table.Baseline characteristics and 6-month outcome of patients who have switched from originator to ABP 501AgeSexIndicationTNFi at time of eventNeurologic Presentation/DiagnosisDuration of follow-up, yearsDD status at last follow-up32FJIAEAtaxia, paresthesias, dysarthria, nystagmus, tetraparesis11Persistent despite tx58MPsAGParesthesias9Improved no tx38FASANumbness and weakness5Resolved, no tx54MPsAEParesthesias, cognitive impairment10Persistent, no tx51FASAIncontinence, paresthesias10Persistent, no tx26FCrohn’sAOptic neuritis11Resolved, no tx49MPsAAMultifocal motor neuropathy3Resolved after tx37MPsAAWeakness, spasticity, paresthesias, optic neuritis9Persistent, on tx33FPsAAOptic neuritis, transverse myelitis (MS)5Flared, no tx59FPsAETransverse myelitis (MS)9Deceased45FASITransverse myelitis7Deceased70MRAACIDP1Received treatment but lost to follow-up34FCrohn’sASmall fiber neuropathy11Persistent, no tx62FRAEOptic neuritis<1Lost to follow-up after initial visit42MUveitis, retinal vasculitisAParesthesias (MS)1Persistent, on txJuvenile idiopathic arthritis (JIA), Psoriatic arthritis (PsA), Ankylosing spondylitis (AS), Rheumatoid Arthritis (RA)Adalimumab (A), Etanercept (E), Golimumab (G), Infliximab (I)Treatment (tx)References:[1]ͥKemanetzoglou E, Andreadou E. CNS Demyelination with TNF-α Blockers.Curr Neurol Neurosci Rep. 2017;17(4):36. doi:10.1007/s11910-017-0742-1Disclosure of Interests:Nicholas Stienstra: None declared, Michael Lane: None declared, Joel Horton: None declared, Anand Kumthekar: None declared, Nishad Sathe: None declared, Christy Sunny: None declared, Vijayshree Yadav Consultant of: Alexion (one time consulting fee), Atul Deodhar Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB
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Trunnel S, Transue D, Surhigh J, Bezzaire D, Moltz K, Zacharski E, Henske J, Desai S, Frizelis K, Khan F, Sjoberg R, Allen K, Manning P, Hendry G, Taylor B, Jones S, Couch R, Danchak R, Lieberman D, Strader W, Bencomo M, Bailey T, Bedolla L, Roldan C, Moudiotis C, Vaidya B, Anning C, Bunce S, Estcourt S, Folland E, Gordon E, Harrill C, Ireland J, Piper J, Scaife L, Sutton K, Wilkins S, Costelloe M, Palmer J, Casas L, Miller C, Burgard M, Erickson C, Hallanger-Johnson J, Clark P, Taylor W, Galgani J, Banerjee S, Banda C, McEowen D, Kinman R, Lafferty A, Gillett S, Nolan C, Pathak M, Sondrol L, Hjelle T, Hafner S, Kotrba J, Hendrickson R, Cemeroglu A, Symington T, Daniel M, Appiagyei-Dankah Y, Postellon D, Racine M, Kleis L, Barnes K, Godwin S, McCullough H, Shaheen K, Buck G, Noel L, Warren M, Weber S, Parker S, Gillespie I, Nelson B, Frost C, Amrhein J, Moreland E, Hayes A, Peggram J, Aisenberg J, Riordan M, Zasa J, Cummings E, Scott K, Pinto T, Mokashi A, McAssey K, Helden E, Hammond P, Dinning L, Rahman S, Ray S, Dimicri C, Guppy S, Nielsen H, Vogel C, Ariza C, Morales L, Chang Y, Gabbay R, Ambrocio L, Manley L, Nemery R, Charlton W, Smith P, Kerr L, Steindel-Kopp B, Alamaguer M, Tabisola-Nuesca E, Pendersen A, Larson N, Cooper-Olviver H, Chan D, Fitz-Patrick D, Carreira T, Park Y, Ruhaak R, Liljenquist D. A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk. Diabetes Care 2018; 41:1887-1894. [PMID: 30002199 PMCID: PMC6105323 DOI: 10.2337/dc18-0087] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/06/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals. RESEARCH DESIGN AND METHODS We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables. RESULTS Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002). CONCLUSIONS The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.
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Affiliation(s)
- Maria J. Redondo
- Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | | | - Andrea K. Steck
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Seth Sharp
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | - John M. Wentworth
- Walter and Eliza Hall Institute of Medical Research and Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Michael N. Weedon
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | | | | | | | | | - Richard A. Oram
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
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Lisberg A, Cummings A, Goldman JW, Bornazyan K, Reese N, Wang T, Coluzzi P, Ledezma B, Mendenhall M, Hunt J, Wolf B, Jones B, Madrigal J, Horton J, Spiegel M, Carroll J, Gukasyan J, Williams T, Sauer L, Wells C, Hardy A, Linares P, Lim C, Ma L, Adame C, Garon EB. A Phase II Study of Pembrolizumab in EGFR-Mutant, PD-L1+, Tyrosine Kinase Inhibitor Naïve Patients With Advanced NSCLC. J Thorac Oncol 2018; 13:1138-1145. [PMID: 29874546 DOI: 10.1016/j.jtho.2018.03.035] [Citation(s) in RCA: 369] [Impact Index Per Article: 61.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 03/25/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Despite the significant antitumor activity of pembrolizumab in NSCLC, clinical benefit has been less frequently observed in patients whose tumors harbor EGFR mutations compared to EGFR wild-type patients. Our single-center experience on the KEYNOTE-001 trial suggested that pembrolizumab-treated EGFR-mutant patients, who were tyrosine kinase inhibitor (TKI) naïve, had superior clinical outcomes to those previously treated with a TKI. As TKI naïve EGFR-mutants have generally been excluded from pembrolizumab studies, data to guide treatment decisions in this patient population is lacking, particularly in patients with programmed death ligand 1 (PD-L1) expression ≥50%. METHODS We conducted a phase II trial (NCT02879994) of pembrolizumab in TKI naive patients with EGFR mutation-positive, advanced NSCLC and PD-L1-positive (≥1%, 22C3 antibody) tumors. Pembrolizumab was administered 200 mg every 3 weeks. The primary endpoint was objective response rate. Secondary endpoints included safety of pembrolizumab, additional pembrolizumab efficacy endpoints, and efficacy and safety of an EGFR TKI after pembrolizumab. RESULTS Enrollment was ceased due to lack of efficacy after 11 of 25 planned patients were treated. Eighty-two percent of trial patients were treatment naïve, 64% had sensitizing EGFR mutations, and 73% had PD-L1 expression ≥50%. Only 1 patient had an objective response (9%), but repeat analysis of this patient's tumor definitively showed the original report of an EGFR mutation to be erroneous. Observed treatment-related adverse events were similar to prior experience with pembrolizumab, but two deaths within 6 months of enrollment, including one attributed to pneumonitis, were of concern. CONCLUSIONS Pembrolizumab's lack of efficacy in TKI naïve, PD-L1+, EGFR-mutant patients with advanced NSCLC, including those with PD-L1 expression ≥50%, suggests that it is not an appropriate therapeutic choice in this setting.
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Affiliation(s)
- A Lisberg
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - A Cummings
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - J W Goldman
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - K Bornazyan
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - N Reese
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - T Wang
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - P Coluzzi
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - B Ledezma
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - M Mendenhall
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - J Hunt
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - B Wolf
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - B Jones
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - J Madrigal
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - J Horton
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - M Spiegel
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - J Carroll
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - J Gukasyan
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - T Williams
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - L Sauer
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - C Wells
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - A Hardy
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - P Linares
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - C Lim
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - L Ma
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - C Adame
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California
| | - Edward B Garon
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California.
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Sheng Y, Li T, Yoo S, Yin F, Blitzblau R, Horton J, Palta M, Ge Y, Wu Q. PO-0908: Developing Whole Breast Radiotherapy Automatic-Planning System using Beamlet Feature based Model. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31218-0] [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: 11/29/2022]
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Ji C, Lall R, Quinn T, Kaye C, Haywood K, Horton J, Gordon V, Deakin CD, Pocock H, Carson A, Smyth M, Rees N, Han K, Byers S, Brace-McDonnell S, Gates S, Perkins GD. Post-admission outcomes of participants in the PARAMEDIC trial: A cluster randomised trial of mechanical or manual chest compressions. Resuscitation 2017; 118:82-88. [PMID: 28689046 DOI: 10.1016/j.resuscitation.2017.06.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/26/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND The PARAMEDIC cluster randomised trial evaluated the LUCAS mechanical chest compression device, and did not find evidence that use of mechanical chest compression led to an improvement in survival at 30 days. This paper reports patient outcomes from admission to hospital to 12 months after randomisation. METHODS Information about hospital length of stay and intensive care management was obtained through linkage with Hospital Episode Statistics and the Intensive Care National Audit and Research Centre. Patients surviving to hospital discharge were approached to complete questionnaires (SF-12v2, EQ-5D, MMSE, HADS and PTSD-CL) at 90days and 12 months. The study is registered with Current Controlled Trials, number ISRCTN08233942. RESULTS 377 patients in the LUCAS arm and 658 patients in the manual chest compression were admitted to hospital. Hospital and intensive care length of stay were similar. Long term follow-up assessments were limited by poor response rates (53.7% at 3 months and 55.6% at 12 months). Follow-up rates were lower in those with worse neurological function. Among respondents, long term health related quality of life outcomes and emotional well-being was similar between groups. Cognitive function, measured by MMSE, was marginally lower in the LUCAS arm mean 26.9 (SD 3.7) compared to control mean 28.0 (SD 2.3), adjusted mean difference -1.5 (95% CI -2.6 to -0.4). CONCLUSION There were no clinically important differences identified in outcomes at long term follow-up between those allocated to the mechanical chest compression compared to those receiving manual chest compression.
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Affiliation(s)
- C Ji
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - R Lall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - T Quinn
- Kingston University and St George's University of London Joint Faculty Health, Social Care and Education, London, UK
| | - C Kaye
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - K Haywood
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - J Horton
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - V Gordon
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - C D Deakin
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, UK; NIHR Southampton Respiratory Biomedical Research Unit, Southampton, UK
| | - H Pocock
- South Central Ambulance Service NHS Foundation Trust, Otterbourne, UK
| | - A Carson
- West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK
| | - M Smyth
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK; West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK
| | - N Rees
- Welsh Ambulance Services NHS Trust, Denbighshire, Wales, UK
| | - K Han
- North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, UK
| | - S Byers
- North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - S Gates
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - G D Perkins
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK; Heart of England NHS Foundation Trust, Birmingham, UK.
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Langer JC, Rollins MD, Levitt M, Gosain A, Torre LDL, Kapur RP, Cowles RA, Horton J, Rothstein DH, Goldstein AM. Guidelines for the management of postoperative obstructive symptoms in children with Hirschsprung disease. Pediatr Surg Int 2017; 33:523-526. [PMID: 28180937 DOI: 10.1007/s00383-017-4066-7] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [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: 01/10/2017] [Indexed: 12/26/2022]
Abstract
Although most children with Hirschsprung disease ultimately do well, many experience a variety of ongoing problems after pull-through surgery. The most common include obstructive symptoms, soiling, enterocolitis and failure to thrive. The purpose of this guideline is to present a rational approach to the management of postoperative obstructive symptoms in children with Hirschsprung disease. The American Pediatric Surgical Association Board of Governors established a Hirschsprung Disease Interest Group. Group discussions, literature review and expert consensus were then used to summarize the current state of knowledge regarding causes, methods of diagnosis, and treatment approaches to children with obstructive symptoms following pull-through for Hirschsprung disease. Causes of obstructive symptoms post-pull-through include mechanical obstruction; persistent or acquired aganglionosis, hypoganglionosis, or transition zone pull-through; internal sphincter achalasia; disordered motility in the proximal intestine that contains ganglion cells; or functional megacolon caused by stool-holding behavior. An algorithm for the diagnosis and management of obstructive symptoms after a pull-through for Hirschsprung disease is presented. A stepwise, logical approach to the diagnosis and management of patients experiencing obstructive symptoms following pull-through for Hirschsprung disease can facilitate treatment. Level of evidence V.
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Affiliation(s)
- J C Langer
- Division of General and Thoracic Surgery, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada. .,Division of Pediatric General and Thoracic Surgery, Hospital for Sick Children, Rm 1524, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
| | - M D Rollins
- Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - M Levitt
- Department of Pediatric Surgery, Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, USA
| | - A Gosain
- Division of Pediatric Surgery, Department of Surgery, Le Bonheur Children's Hospital, Children's Foundation Research Institute, University of Tennessee Health Science Center, Memphis, TN, USA
| | - L de la Torre
- Colorectal Center for Children at Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - R P Kapur
- Department of Laboratories, Seattle Children's Hospital and University of Washington, Seattle, WA, USA
| | - R A Cowles
- Section of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - J Horton
- Madigan Army Medical Center, Tacoma, WA, USA
| | - D H Rothstein
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, NY, USA
| | - A M Goldstein
- Department of Pediatric Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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Sheng Y, Li T, Yoo S, Yin F, Blitzblau R, Horton J, Palta M, Hahn C, Ge Y, Wu Q. WE-AB-209-05: Development of an Ultra-Fast High Quality Whole Breast Radiotherapy Treatment Planning System. Med Phys 2016. [DOI: 10.1118/1.4957774] [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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Hyslop T, Alvarado M, Forero A, Golshan M, Hieken T, Horton J, Hudis C, McGuire K, Meric-Bernstam F, Nanda R, Zagar T, Hwang S. Abstract S3-06: Treatment outcomes in patients with invasive breast cancer treated with neoadjuvant systemic therapy and breast MR imaging: Results of a secondary analysis of TBCRC 017. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-s3-06] [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:Neoadjuvant chemotherapy (NCT) is used frequently to downstage locally advanced tumors and facilitate breast conservation. However, we have previously reported that achievement of radiographic complete response (rCR) or pathologic complete response (pCR) does not impact choice of surgery for many patients. This secondary analysis reports treatment outcomes across 9 NCI comprehensive cancer centers in women receiving both NCT and breast MR imaging to assess whether treatment outcomes among women receiving NCT differs according to choice of locoregional treatment.
Methods:1077 women from 9 institutions were retrospectively identified as having undergone NCT with MR imaging obtained both before and after systemic treatment. Systemic treatment regimen was not prespecified, but receipt of at least 80% of all planned cycles was required prior to final MR imaging. We performed a univariate analysis as well as a multivariable Cox proportional hazard regression to identify covariates associated with overall survival (OS), disease-free survival (DFS) and time to recurrence (TTR). rCR was defined as no residual enhancement on post-treatment breast MRI.
Results:1077 patients diagnosed and treated with NCT for stage I-III invasive breast cancer from January 1, 2002 to June 16, 2014 were analyzed for all endpoints. Median follow-up was 4.2 years, (range 0.1 to 13 years). Median age of the cohort was 50 years, (range 19-87 years). 473 (43.9%) had ER(+) and/or PR(+)/HER2(-) disease, 348 (32.3%) had HER2(+) disease, and 256 (23.8%) had ER(-)/PR(-)/HER2(-) (triple negative) disease. Mastectomy or breast conserving therapy (BCT) was recorded as the definitive surgery in 675 (62.7%) and 402 (37.3%) of patients, respectively. Radiation receipt was confirmed in 84.1% of BCT and 68.3% of mastectomy patients. Overall there were 134 recurrences, 168 disease events and 89 deaths. Among patients with pCR, there were 7/161 (7.2%) recurrences in those undergoing mastectomy and 6/143 (5.1%) in those undergoing lumpectomy (p=0.81). Among patients who achieved an rCR, there were recurrences in 5% of those undergoing mastectomy and 2.9% in those undergoing lumpectomy (p=0.53). In multivariable analysis of the entire cohort, only clinical stage, ER status and pCR remained independently associated with DFS. Notably, subset analysis showed that lumpectomy was independently associated with improved TTR (HR 0.40; 95% CI 0.17-0.97) in the triple negative group only, but this did not translate into improved DFS with lumpectomy in this group. Radiographic CR as determined by breast MRI accurately predicted presence or absence of pCR in 74% of cases, but was not independently associated with DFS, OS or TTP.
Conclusions:Among a contemporary cohort of women receiving neoadjuvant systemic therapy and breast MR imaging at 9 NCI designated cancer centers, type of surgery did not impact DFS, OS or TTP. The only exception was found in the triple negative group in which the lumpectomy group had a more favorable TTP compared to the mastectomy group. These findings provide additional evidence that in women who are appropriate candidates for lumpectomy after NCT, BCT does not compromise long-term cancer outcomes.
Citation Format: De Los Santos J, Hyslop T, Alvarado M, Forero A, Golshan M, Hieken T, Horton J, Hudis C, McGuire K, Meric-Bernstam F, Nanda R, Zagar T, Hwang S. Treatment outcomes in patients with invasive breast cancer treated with neoadjuvant systemic therapy and breast MR imaging: Results of a secondary analysis of TBCRC 017. [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 S3-06.
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Affiliation(s)
- T Hyslop
- University of Alabama at Birmingham, Birmingham, AL; Duke Cancer Institute, Durham, NC; University of California San Francisco, San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University School of Medicine, Durham, NC; Memorial Sloan Kettering Cancer Center, NY, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Chicago Medicine, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - M Alvarado
- University of Alabama at Birmingham, Birmingham, AL; Duke Cancer Institute, Durham, NC; University of California San Francisco, San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University School of Medicine, Durham, NC; Memorial Sloan Kettering Cancer Center, NY, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Chicago Medicine, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - A Forero
- University of Alabama at Birmingham, Birmingham, AL; Duke Cancer Institute, Durham, NC; University of California San Francisco, San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University School of Medicine, Durham, NC; Memorial Sloan Kettering Cancer Center, NY, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Chicago Medicine, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - M Golshan
- University of Alabama at Birmingham, Birmingham, AL; Duke Cancer Institute, Durham, NC; University of California San Francisco, San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University School of Medicine, Durham, NC; Memorial Sloan Kettering Cancer Center, NY, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Chicago Medicine, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - T Hieken
- University of Alabama at Birmingham, Birmingham, AL; Duke Cancer Institute, Durham, NC; University of California San Francisco, San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University School of Medicine, Durham, NC; Memorial Sloan Kettering Cancer Center, NY, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Chicago Medicine, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - J Horton
- University of Alabama at Birmingham, Birmingham, AL; Duke Cancer Institute, Durham, NC; University of California San Francisco, San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University School of Medicine, Durham, NC; Memorial Sloan Kettering Cancer Center, NY, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Chicago Medicine, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - C Hudis
- University of Alabama at Birmingham, Birmingham, AL; Duke Cancer Institute, Durham, NC; University of California San Francisco, San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University School of Medicine, Durham, NC; Memorial Sloan Kettering Cancer Center, NY, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Chicago Medicine, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - K McGuire
- University of Alabama at Birmingham, Birmingham, AL; Duke Cancer Institute, Durham, NC; University of California San Francisco, San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University School of Medicine, Durham, NC; Memorial Sloan Kettering Cancer Center, NY, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Chicago Medicine, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - F Meric-Bernstam
- University of Alabama at Birmingham, Birmingham, AL; Duke Cancer Institute, Durham, NC; University of California San Francisco, San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University School of Medicine, Durham, NC; Memorial Sloan Kettering Cancer Center, NY, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Chicago Medicine, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - R Nanda
- University of Alabama at Birmingham, Birmingham, AL; Duke Cancer Institute, Durham, NC; University of California San Francisco, San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University School of Medicine, Durham, NC; Memorial Sloan Kettering Cancer Center, NY, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Chicago Medicine, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - T Zagar
- University of Alabama at Birmingham, Birmingham, AL; Duke Cancer Institute, Durham, NC; University of California San Francisco, San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University School of Medicine, Durham, NC; Memorial Sloan Kettering Cancer Center, NY, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Chicago Medicine, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - S Hwang
- University of Alabama at Birmingham, Birmingham, AL; Duke Cancer Institute, Durham, NC; University of California San Francisco, San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University School of Medicine, Durham, NC; Memorial Sloan Kettering Cancer Center, NY, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Chicago Medicine, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
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Adamson J, Chang Z, Cai J, Palta M, Horton J, Yin F, Blitzblau R. SU-E-J-223: A BOLD Contrast Imaging Sequence to Evaluate Oxygenation Changes Due to Breath Holding for Breast Radiotherapy: A Pilot Study. Med Phys 2015. [DOI: 10.1118/1.4924309] [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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Xie Y, Wang C, Horton J, Chang Z. TU-F-CAMPUS-J-02: Evaluation of Textural Feature Extraction for Radiotherapy Response Assessment of Early Stage Breast Cancer Patients Using Diffusion Weighted MRI and Dynamic Contrast Enhanced MRI. Med Phys 2015. [DOI: 10.1118/1.4925807] [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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Horton J, Hudak K, Scroggins B, Chung E, White A, Citrin D. Il-13 is a Critical Mediator of Radiation-Induced Pulmonary Fibrosis. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Horton J, Hudak K, Scroggins B, Chung E, White A, Citrin D. Mitigation of Radiation Induced Pulmonary Injury With Systemic Delivery of Mesenchymal Stem Cells. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wang C, Horton J, Yin F, Blitzblau R, Palta M, Chang Z. SU-E-J-182: A Feasibility Study Evaluating Automatic Identification of Gross Tumor Volume for Breast Cancer Radiotherapy Using Dynamic Contrast-Enhanced MR Imaging. Med Phys 2014. [DOI: 10.1118/1.4888235] [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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Mahaffey KW, Horton J, Alexander JH, Tricoci P, Harrington RA, Wallentin L. Intracranial hemorrhage in acute coronary syndrome: incidence, predictors, and outcomes from APPRAISE-2, PLATO, and TRACER. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ziem JB, Kettenis IMJ, Bayita A, Brienen EAT, Dittoh S, Horton J, Olsen A, Magnussen P, Polderman AM. The short-term impact of albendazole treatment onOesophagostomum bifurcumand hookworm infections in northern Ghana. Annals of Tropical Medicine & Parasitology 2013; 98:385-90. [PMID: 15228719 DOI: 10.1179/000349804225003370] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In November-December 2002, stool samples from a random sample of the human population (N = 190) in the Garu area of northern Ghana were checked for intestinal helminths, using a single Kato smear and duplicate coprocultures for each subject. All 190 subjects were subsequently treated with a single, 400-mg dose of albendazole and 146 of them were successfully re-examined 21-28 days post-treatment. Prior to treatment, 75.5% of the Kato smears were found to contain 'hookworm-like' eggs (with a geometric mean egg count among the positives of 578 eggs/g faeces), and the third-stage larvae of Oesophagostomum bifurcum and hookworm were found in the cultures of stools from 34.2% and 77.4% of the subjects, respectively. Among the subjects who had positive Kato smears before treatment, albendazole treatment led to a cure 'rate' of 79.0% and an egg-reduction 'rate' of 73.5%. The results from the coprocultures indicated cure 'rates' of 98.0% for O. bifurcum but only 51.3% for hookworm. Only one subject was still positive for O. bifurcum after treatment. Among those still positive for hookworm after treatment, the larva-reduction 'rate' was 79.8%. The egg-/larva-reduction 'rates' among those with heavy infections prior to treatment were >90%, whether the data analysed came from the Kato smears or the coprocultures. It may be concluded that a single dose of albendazole is very likely to cure an O. bifurcum infection and to reduce greatly the intensity (but not the prevalence) of any hookworm infections.
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Affiliation(s)
- J B Ziem
- Department of Parasitology, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, The Netherlands
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Chang Z, Yin F, Yoo S, Horton J. SU-E-CAMPUS-J-04: Evaluating Radiation-Induced Changes with Diffusion Weighted MRI and Dynamic Contrast Enhanced MRI in Patients with Early Stage Breast Cancer Treated with Stereotactic Body Radiotherapy: Initial Results. Med Phys 2013. [DOI: 10.1118/1.4815176] [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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Davison JE, Kearney S, Horton J, Foster K, Peet AC, Hendriksz CJ. Intellectual and neurological functioning in Morquio syndrome (MPS IVa). J Inherit Metab Dis 2013; 36:323-8. [PMID: 22231379 DOI: 10.1007/s10545-011-9430-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [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] [Received: 07/11/2011] [Revised: 11/18/2011] [Accepted: 11/22/2011] [Indexed: 12/26/2022]
Abstract
Mucopolysaccharidosis type IVa (MPS IVa, Morquio syndrome OMIM #253000) is a lysosomal storage disease caused by deficiency in N-acetylgalactosamine-6-sulfatase (GALNS, EC 3.1.6.4; encoded by GALNS gene at 16q24.3). Unlike other MPS disorders involving excessive heparan and dermatan sulfate, Morquio syndrome has not been associated with neurological involvement nor with intellectual impairment as this disorder of keratan sulfate has been described as a purely visceral and skeletal disorder. Neurocognitive assessment was undertaken of MPS IVa patients with age appropriate intellectual tests as well as a Child Behaviour Checklist as part of clinical follow up. Available neuroimaging studies (MRI and MR spectroscopy) were reviewed. Whilst more than half of the overall IQ scores fell in the average range, scores for 3/8 children fell below average. A number of behavioural problems were highlighted, including anxiety/depression, attention and somatic complaints. Subtle neuroimaging abnormalities were demonstrated in over half of the children. These findings present a challenge to existing assumptions about the nature of Morquio A syndrome. A hypothesis regarding the potential role of calcium signalling is explored.
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Affiliation(s)
- J E Davison
- School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, UK
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Citrin D, Horton J, White A, Hudak K, Scroggins B, Chung E. Bone Marrow Mesenchymal Stromal Cell Infusion Improves Radiation-induced Cutaneous Fibrosis in a Murine Model. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.175] [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: 12/01/2022]
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Palta M, Palta P, Horton J, Blitzblau R. Use of Adjuvant Radiation Therapy in Elderly Patients With Early Stage Breast Cancer: Changes in Practice Patterns After Publication of Cancer and Leukemia Group B (CALGB) 9343. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.665] [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: 10/27/2022]
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Metra M, Chiswell K, Fiuzat M, Lazzarini V, Horton J, Davison B, Cleland J, Ponikowski P, Teerlink J, Voors A, Givertz M, Mansoor G, Massie B, Cotter G, O'Connor C. Age, Clinical Characteristics and Outcomes of Patients With Acute Decompensated Heart Failure: Insights from the PROTECT Trial. J Card Fail 2012. [DOI: 10.1016/j.cardfail.2012.06.484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Stewardson D, Creanor S, Thornley P, Bigg T, Bromage C, Browne A, Cottam D, Dalby D, Gilmour J, Horton J, Roberts E, Westoby L, Burke T. The survival of Class V restorations in general dental practice: part 3, five-year survival. Br Dent J 2012; 212:E14. [DOI: 10.1038/sj.bdj.2012.367] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2012] [Indexed: 01/10/2023]
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Affiliation(s)
- P. Krustrup
- Sport and Health Sciences, University of Exeter, United Kingdom
- Institute of Exercise and Sport Sciences, University of Copenhagen, Denmark
| | - M. Randers
- Institute of Exercise and Sport Sciences, University of Copenhagen, Denmark
| | - J. Horton
- Institute of Exercise and Sport Sciences, University of Copenhagen, Denmark
| | - J. Brito
- Faculty of Sport - Centre of Research, Education, Innovation and Intervention in Sport, University of Porto, Portugal
| | - A. Rebelo
- Faculty of Sport - Centre of Research, Education, Innovation and Intervention in Sport, University of Porto, Portugal
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De LSJ, Cantor A, Mcguire K, Golshan M, Meric-Bernstam F, Horton J, Nanda R, Amos K, Forero A, Hudis C, Meszoely I, Hwang S. P2-08-02: Magnetic Resonance Imaging as a Predictor of Pathologic Response in Patients Treated with Neoadjuvant Systemic Treatment for Operable Breast Cancer (TBCRC 017). Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p2-08-02] [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: Increased pathologic complete response (pCR) rates observed with neoadjuvant chemotherapy for invasive breast cancer has prompted interest in whether patients with pCR can be identified preoperatively and potentially spared the morbidity of surgery. This multicenter retrospective study was performed to determine the accuracy of preoperative MRI in predicting pCR in the breast and whether MRI performance differs by molecular subtype, histology, and treatment regimen.
Methods: 770 women from 8 institutions were retrospectively identified as having received neoadjuvant systemic therapy with MRI obtained at baseline and after completion of systemic treatment. Tumor phenotypes were defined on the basis of estrogen and progesterone receptor (ER/PR or HR) and HER2 receptor status. Univariate and multivariate analyses of factors influencing radiographic complete response (rCR) and pCR were recorded, with rCR defined as resolution of any abnormal enhancement, mass, or distortion on MRI, and pCR defined as resolution of both invasive disease and DCIS.
Results: rCR and pCR for the total group were 182/746 (24%) and 179/746 (24%), respectively, with the highest rate of pCR seen among the triple-negative (TN; 57/155; 37%) and HR-/HER2+ (38/101; 38%) subtypes. Covariates significantly associated with rCR included T stage (p=0.0002), tumor grade (p=0.005), IHC phenotype (p=0.005), and chemotherapy regimen (p<0.0001). On multivariate analysis, only tumor phenotype was independently associated with likelihood of rCR, with both TN (OR = 2.00, 95% CI 1.20−3.33) and HR-HER2+ (OR=2.30, 95% CI 1.09–4.83) more likely to achieve rCR than HR+HER- (reference group). Overall accuracy of MRI for prediction of pCR was 74%. Sensitivity, NPV, PPV, and accuracy differed significantly among tumor subtypes, with the greatest NPV in the HR-/HER2+ and TN subtypes (table1). Among patients with rCR, ER- status (OR=6.4, 95% CI 1.1 to 35.6), PR- status (OR=3.8, 95% CI 1.2 to 11.4), and tumor grade of 3 vs 1 or 2 (OR=2.49, 95% CI 1.22−5.07) were independently associated with likelihood of pCR. Discussion: MRI performance for predicting pCR in patients with invasive breast cancer receiving neoadjuvant systemic therapy differed significantly among breast cancer subtypes; however this difference is likely due to subtype differences in frequency of pCR and not to intrinsically better or worse MRI detection. The relatively low NPV of MRI following neoadjuvant systemic therapy does not support using MRI rCR alone to accurately identify those patients that can safely avoid surgery.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-08-02.
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Affiliation(s)
- Los Santos J De
- 1University of Alabama at Birmingham, Birmingham, AL; University of North Carolina Chapel Hill, Chapel Hill, NC; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; MD Anderson Cancer Center, Houston, TX; Vanderbilt University, Nashville, TN; University of Chicago, Chicago, IL; University of California at San Francisco, San Francisco, CA
| | - A Cantor
- 1University of Alabama at Birmingham, Birmingham, AL; University of North Carolina Chapel Hill, Chapel Hill, NC; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; MD Anderson Cancer Center, Houston, TX; Vanderbilt University, Nashville, TN; University of Chicago, Chicago, IL; University of California at San Francisco, San Francisco, CA
| | - K Mcguire
- 1University of Alabama at Birmingham, Birmingham, AL; University of North Carolina Chapel Hill, Chapel Hill, NC; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; MD Anderson Cancer Center, Houston, TX; Vanderbilt University, Nashville, TN; University of Chicago, Chicago, IL; University of California at San Francisco, San Francisco, CA
| | - M Golshan
- 1University of Alabama at Birmingham, Birmingham, AL; University of North Carolina Chapel Hill, Chapel Hill, NC; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; MD Anderson Cancer Center, Houston, TX; Vanderbilt University, Nashville, TN; University of Chicago, Chicago, IL; University of California at San Francisco, San Francisco, CA
| | - F Meric-Bernstam
- 1University of Alabama at Birmingham, Birmingham, AL; University of North Carolina Chapel Hill, Chapel Hill, NC; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; MD Anderson Cancer Center, Houston, TX; Vanderbilt University, Nashville, TN; University of Chicago, Chicago, IL; University of California at San Francisco, San Francisco, CA
| | - J Horton
- 1University of Alabama at Birmingham, Birmingham, AL; University of North Carolina Chapel Hill, Chapel Hill, NC; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; MD Anderson Cancer Center, Houston, TX; Vanderbilt University, Nashville, TN; University of Chicago, Chicago, IL; University of California at San Francisco, San Francisco, CA
| | - R Nanda
- 1University of Alabama at Birmingham, Birmingham, AL; University of North Carolina Chapel Hill, Chapel Hill, NC; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; MD Anderson Cancer Center, Houston, TX; Vanderbilt University, Nashville, TN; University of Chicago, Chicago, IL; University of California at San Francisco, San Francisco, CA
| | - K Amos
- 1University of Alabama at Birmingham, Birmingham, AL; University of North Carolina Chapel Hill, Chapel Hill, NC; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; MD Anderson Cancer Center, Houston, TX; Vanderbilt University, Nashville, TN; University of Chicago, Chicago, IL; University of California at San Francisco, San Francisco, CA
| | - A Forero
- 1University of Alabama at Birmingham, Birmingham, AL; University of North Carolina Chapel Hill, Chapel Hill, NC; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; MD Anderson Cancer Center, Houston, TX; Vanderbilt University, Nashville, TN; University of Chicago, Chicago, IL; University of California at San Francisco, San Francisco, CA
| | - C Hudis
- 1University of Alabama at Birmingham, Birmingham, AL; University of North Carolina Chapel Hill, Chapel Hill, NC; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; MD Anderson Cancer Center, Houston, TX; Vanderbilt University, Nashville, TN; University of Chicago, Chicago, IL; University of California at San Francisco, San Francisco, CA
| | - I Meszoely
- 1University of Alabama at Birmingham, Birmingham, AL; University of North Carolina Chapel Hill, Chapel Hill, NC; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; MD Anderson Cancer Center, Houston, TX; Vanderbilt University, Nashville, TN; University of Chicago, Chicago, IL; University of California at San Francisco, San Francisco, CA
| | - S Hwang
- 1University of Alabama at Birmingham, Birmingham, AL; University of North Carolina Chapel Hill, Chapel Hill, NC; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; MD Anderson Cancer Center, Houston, TX; Vanderbilt University, Nashville, TN; University of Chicago, Chicago, IL; University of California at San Francisco, San Francisco, CA
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Yoo S, O'Daniel J, Horton J, Blitzblau R, Yin F. A Dual-Isocenter Technique for Image Guidance of Prone-Breast Radiation Therapy. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.1454] [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: 11/25/2022]
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Zagar T, Palta M, Catalano S, O′Neill L, Yoo S, Leonard P, Horton J. Dosimetric Comparison Of Radiotherapy For Left Sided Breast Cancer: Breath-hold versus Free Breathing. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.1209] [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: 11/28/2022]
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Yoo S, Wu Q, O'Daniel J, Horton J, Yin F. Breast Cancer Radiation Treatment Planning: A Comparison of Anisotropic Analytical Algorithm (AAA) and Pencil Beam Convolution (PBC) Algorithm. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.574] [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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Yoo S, O'Daniel J, Horton J, Wu Q, Yin F. SU-GG-T-583: Dosimetric Comparison of Anisotropic Analytical and Pencil Beam Convolution Algorithms in Breast Cancer Radiation Treatment Planning. Med Phys 2010. [DOI: 10.1118/1.3468984] [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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Stewardson D, Thornley P, Bigg T, Bromage C, Browne A, Cottam D, Dalby D, Gilmour J, Horton J, Roberts E, Westoby L, Dietrich T, Burke T. The survival of Class V restorations in general dental practice. Part 1, baseline data. Br Dent J 2010; 208:E17; discussion 406-7. [DOI: 10.1038/sj.bdj.2010.445] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2009] [Indexed: 11/09/2022]
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Abstract
The history of the development of ivermectin and diethylcarbamazine for the treatment of human filarial infections is relatively well known and documented. The story of how albendazole became involved in the global elimination programmes is, however, less well known. This review examines the thinking and the processes behind the development of albendazole, from the first ideas in the mid 1980s to the establishment of the Global Programme to Eliminate Lymphatic Filariasis. Throughout, the approaches were essentially different from those of traditional drug development and, in the end, there was a recommendation for a particular public-health use that was not formally approved by the regulatory authorities. While there is no doubt about the efficacy of albendazole for the treatment of many helminth diseases, as a single agent it could never be recommended for filariasis.
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Affiliation(s)
- J Horton
- Tropical Projects, 24 The Paddock, Hitchin SG4 9EF, UK.
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Finucane FM, Sharp SJ, Purslow LR, Horton K, Horton J, Savage DB, Brage S, Besson H, De Lucia Rolfe E, Sleigh A, Martin HJ, Aihie Sayer A, Cooper C, Ekelund U, Griffin SJ, Wareham NJ. The effects of aerobic exercise on metabolic risk, insulin sensitivity and intrahepatic lipid in healthy older people from the Hertfordshire Cohort Study: a randomised controlled trial. Diabetologia 2010; 53:624-31. [PMID: 20052455 DOI: 10.1007/s00125-009-1641-z] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [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] [Received: 08/11/2009] [Accepted: 11/30/2009] [Indexed: 12/27/2022]
Abstract
AIMS/HYPOTHESIS We sought to determine the effect of an aerobic exercise intervention on clustered metabolic risk and related outcomes in healthy older adults in a single-centre, explanatory randomised controlled trial. METHODS Participants from the Hertfordshire Cohort Study (born 1931-1939) were randomly assigned to 36 supervised 1 h sessions on a cycle ergometer over 12 weeks or to a non-intervention control group. Randomisation and group allocation were conducted by the study co-ordinator, using a software programme. Those with prevalent diabetes, unstable ischaemic heart disease or poor mobility were excluded. All data were collected at our clinical research facility in Cambridge. Components of the metabolic syndrome were used to derive a standardised composite metabolic risk score (zMS) as the primary outcome. Trial status: closed to follow-up. RESULTS We randomised 100 participants (50 to the intervention, 50 to the control group). Mean age was 71.4 (range 67.4-76.3) years. Overall, 96% of participants attended for follow-up measures. There were no serious adverse events. Using an intention-to-treat analysis, we saw a non-significant reduction in zMS in the exercise group compared with controls (0.07 [95% CI -0.03, 0.17], p = 0.19). However, the exercise group had significantly decreased weight, waist circumference and intrahepatic lipid, with increased aerobic fitness and a 68% reduction in prevalence of abnormal glucose metabolism (OR 0.32 [95% CI 0.11-0.92], p = 0.035) compared with controls. Results were similar in per-protocol analyses. CONCLUSIONS/INTERPRETATION Enrolment in a supervised aerobic exercise intervention led to weight loss, increased fitness and improvements in some but not all metabolic outcomes. In appropriately screened older individuals, such interventions appear to be safe. TRIAL REGISTRATION Controlled-trials.com ISRCTN60986572 FUNDING Medical Research Council.
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Affiliation(s)
- F M Finucane
- MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Box 285, Hills Road, Cambridge CB2 0QQ, UK.
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Zhang Y, Tiruveedhula P, Sincich L, Horton J, Roorda A. Adaptive optics scanning laser ophthalmoscope (AOSLO) for precise visual stimulus presentation. J Vis 2010. [DOI: 10.1167/7.15.116] [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: 11/24/2022] Open
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32
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Horton J, Sincich L, Adams D. Complete Pattern of Ocular Dominance Columns in Human Striate Cortex. J Vis 2010. [DOI: 10.1167/7.15.22] [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: 11/24/2022] Open
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Polderman A, Eberhard M, Baeta S, Gasser RB, van Lieshout L, Magnussen P, Olsen A, Spannbrucker N, Ziem J, Horton J. The Rise and Fall of Human Oesophagostomiasis. ADVANCES IN PARASITOLOGY 2010. [DOI: 10.1016/s0065-308x(10)71002-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ross LL, Rouse E, Gerondelis P, DeJesus E, Cohen C, Horton J, Ha B, Lanier ER, Elion R. Low-abundance HIV species and their impact on mutational profiles in patients with virological failure on once-daily abacavir/lamivudine/zidovudine and tenofovir. J Antimicrob Chemother 2009; 65:307-15. [PMID: 20008905 PMCID: PMC2809245 DOI: 10.1093/jac/dkp419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background HIV clonal genotypic analysis (CG) was used to investigate whether a more sensitive analysis method would detect additional low-abundance mutations compared with population genotyping (PG) in antiretroviral-naive patients who experienced virological failure (VF) during treatment with abacavir/lamivudine/zidovudine and tenofovir. Methods HIV was analysed by PG and CG (771 baseline and 657 VF clones) from subjects with VF (confirmed HIV RNA ≥ 400 copies/mL at 24–48 weeks). Results Fourteen of 123 subjects (11%) met VF criteria; their median baseline HIV RNA was 5.4 log10 copies/mL, and 4.0 log10 copies/mL at VF. By baseline PG, 2/14 had HIV-1 with nucleoside reverse transcriptase inhibitor (NRTI) or non-NRTI mutations. By baseline CG, 9/14 had HIV-1 with NNRTI and/or NRTI mutations; 7/9 had study drug-associated mutations. By PG at VF, 10/14 had selected for resistance mutations [2, K65R; 1, M184V; and 7, thymidine analogue mutations (TAMs) ± M184V]. By CG at VF, for subjects with TAMs, T215F was more commonly detected (5/14 samples) than T215Y (2/14). For one subject who selected K65R at VF, both K65R-containing clones and TAM-containing clones (both T215A and T215F) were observed independently but not conjunctively in the same clone in a post-VF sample. Conclusions The majority of subjects with VF had major and minor mutations detected at VF; CG detected additional low-abundance variants at baseline and VF that could have influenced mutation selection pathways. Both PG and CG data suggest TAMs, not K65R selection, are the preferred resistance route, biased towards 215F selection. No HIV clone contained both K65R and T215F/Y mutations, suggesting in vivo antagonism between the two mutations. The once-daily zidovudine usage and high baseline viraemia may also have contributed to rapid selection of HIV with multiple mutations in VFs.
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Affiliation(s)
- L L Ross
- GlaxoSmithKline, 5 Moore Drive, Research Triangle Park, NC 27709, USA.
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Horton J, Jacobson I, Smith B, Ryan M, Boyko E, Smith T. Occupational, Physical, and Mental Health Characteritistics Associated with Supplement Use in a Large Military Cohort. Ann Epidemiol 2009. [DOI: 10.1016/j.annepidem.2009.07.029] [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: 11/29/2022]
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Cortés V, Agarwal A, Garg A, Horton J. Abstract: 147 CHREBP MEDIATES THE DEVELOPMENT OF HEPATIC STEATOSIS IN THE APGAT2 DEFICIENT MICE. ATHEROSCLEROSIS SUPP 2009. [DOI: 10.1016/s1567-5688(09)70254-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ortiz J, Horton J, Bingaman A, Palma J, Foster P, Wright F, Membreno F. CAMPATH 1-H INDUCTION AND STEROID-FREE MAINTENANCE IMMUNOSUPPRESSION IN HEPATITIS C POSITIVE KIDNEY RECIPIENTS. Transplantation 2008. [DOI: 10.1097/01.tp.0000330450.48043.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Leow L, Sinclair P, Horton J. Plaque-like dermatofibroma with satellitosis. Australas J Dermatol 2007. [DOI: 10.1111/j.1440-0960.2007.00408_1.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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McIlleron H, Norman J, Kanyok TP, Fourie PB, Horton J, Smith PJ. Elevated gatifloxacin and reduced rifampicin concentrations in a single-dose interaction study amongst healthy volunteers. J Antimicrob Chemother 2007; 60:1398-401. [DOI: 10.1093/jac/dkm393] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gifford K, Kirsner S, Horton J, Wareing T, Mourtada F. TU-C-AUD-06: Calculation of the Dose Distribution Around a Commercially Available 125I Brachytherapy Source Via a Multi-Group Discrete Ordinates Method. Med Phys 2007. [DOI: 10.1118/1.2761355] [Citation(s) in RCA: 2] [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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Wareing T, Vassiliev O, Failla G, Davis I, McGhee J, Barnett D, Horton J, Mourtada F. TU-EE-A1-01: Validation of a Prototype Deterministic Solver for Photon Beam Dose Calculations On Acquired CT Data in the Presence of Narrow Beams and Heterogeneities. Med Phys 2007. [DOI: 10.1118/1.2761416] [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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Jones A, Focht A, Horton J, Kline J. Clinical Effectiveness of Implementing Early Goal Directed Therapy in the Emergency Department Care of Severe Sepsis and Septic Shock: A Prospective Study. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.1237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Ziem JB, Olsen A, Magnussen P, Horton J, Spannbrucker N, Yelifari L, Nana Biritwum K, Polderman AM. Annual mass treatment with albendazole might eliminate human oesophagostomiasis from the endemic focus in northern Ghana. Trop Med Int Health 2007; 11:1759-63. [PMID: 17054757 DOI: 10.1111/j.1365-3156.2006.01730.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
As a follow-up to the study by Ziem et al., in this issue, efforts to control human oesophagostomiasis and hookworm infections in northern Ghana were pursued, and the results evaluated in collaboration with the Lymphatic Filariasis Elimination Programme. This phase of evaluation of the impact of mass treatment was no longer limited to a small-scale research setting: it was done both in the context of an operationally viable national control programme and as a continuation of the Oesophagostomum Intervention Research Project (OIRP). The methods of evaluation included classical stool examination with Kato thick smears, stool culture and ultrasound examination of the colon wall. The results showed that yearly population-based albendazole-ivermectin treatment in 11 villages scattered over north-eastern Ghana, with a treatment coverage of 70-75%, resulted in a reduction of Oesophagostomum prevalence from about 20% pre-intervention to less than 1% after 2 years of mass treatment. Simultaneously, hookworm prevalence went down from 70% to approximately 15%. The data, however, cannot be readily compared with those of Ziem et al. because of the relatively crude diagnostic (single stool cultures) screening system that had to be used for the evaluation of the large-scale control programme. In the research area of the OIRP, interruption of mass treatment resulted in a rising hookworm prevalence. The Oesophagostomum prevalence, on the other hand, continued to go down. Transmission of human oesophagostomiasis appears interruptible and small numbers of persistent cases of Oesophagostomum infection were shown insufficient to serve as a nucleus of renewed spread of the infection. The data suggest that both the infection with and the pathology due to human oesophagostomiasis can be eliminated and that elimination is likely to be achieved through operationally feasible albendazole-ivermectin treatment as used by the Global Alliance for the Elimination of Lymphatic Filariasis.
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Affiliation(s)
- J B Ziem
- Department of Parasitology, Leiden, Leiden University Medical Centre, The Netherlands
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Price M, Mourtada F, Gifford K, Horton J, Eifel P. 2869. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.1288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Moulder SL, Valkov N, Minton S, Munster P, Gump J, Lacevic M, Rocha-Lima C, Horton J, Lush R, Sullivan D. A single arm phase II trial of gemcitabine (G) and irinotecan (I) in metastatic breast cancer: Can localization of topoisomerase I (topo I) predict response to topo I inhibitors? J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.661] [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: 11/20/2022] Open
Abstract
661 Background: The incorporation of G into DNA enhances cleavage complexes in vitro when combined with a topo I inhibitor. Topo I poisons require enzyme interaction with DNA to exert activity. Methods: Two stage accrual design, primary endpoint: response (RR) using RECIST criteria. Inclusion criteria: male and female patients (pts) with MBC, prior anthracycline therapy, measurable disease, ECOG PS of ≤ 2, adequate organ function, and ≤ 3 prior chemotherapy regimens for MBC. 51 eligible pts received therapy with G at 1000mg/m2 and I at 100mg/m2 on days 1 and 8 of a 21-day cycle. Optional tumor biopsies were obtained in 9 pts (18%) prior to therapy to determine localization of topo I using immunofluorescence. PK: Irinotecan: A validated limited sampling strategy was used. Gemcitabine: Serial blood samples were collected over 24 hrs following the first dose. Intracellular nucleotides were quantitated in PBMCs. Results: 45 pts have been evaluated with a RR of 27% (CR=0, PR=12; 95% CI 13–37%). 4 pts had SD for ≥6 months for a clinical benefit rate (PR+SD) of 36%. 3 pts received < 1 cycle of therapy before protocol withdrawal and were not evaluable for RR. RR for the final 3 patients will be available at the time of presentation. 7/9 tissue biopsies were assessable for topo I with results listed below. PK and toxicity data will be available at presentation.Conclusion: GI is active in MBC. Topo I localization can be measured in MBC. In this limited data set, the two lowest nuclear to cytoplasmic (N/C) ratios were associated with lack of response to irinotecan. Further validation is needed. [Table: see text] [Table: see text]
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Affiliation(s)
- S. L. Moulder
- UT M. D. Anderson Cancer Center, Houston, TX; H. Lee Moffitt Cancer Center, Tampa, FL; University of Miami Sylvester Cancer Center, Miami, FL
| | - N. Valkov
- UT M. D. Anderson Cancer Center, Houston, TX; H. Lee Moffitt Cancer Center, Tampa, FL; University of Miami Sylvester Cancer Center, Miami, FL
| | - S. Minton
- UT M. D. Anderson Cancer Center, Houston, TX; H. Lee Moffitt Cancer Center, Tampa, FL; University of Miami Sylvester Cancer Center, Miami, FL
| | - P. Munster
- UT M. D. Anderson Cancer Center, Houston, TX; H. Lee Moffitt Cancer Center, Tampa, FL; University of Miami Sylvester Cancer Center, Miami, FL
| | - J. Gump
- UT M. D. Anderson Cancer Center, Houston, TX; H. Lee Moffitt Cancer Center, Tampa, FL; University of Miami Sylvester Cancer Center, Miami, FL
| | - M. Lacevic
- UT M. D. Anderson Cancer Center, Houston, TX; H. Lee Moffitt Cancer Center, Tampa, FL; University of Miami Sylvester Cancer Center, Miami, FL
| | - C. Rocha-Lima
- UT M. D. Anderson Cancer Center, Houston, TX; H. Lee Moffitt Cancer Center, Tampa, FL; University of Miami Sylvester Cancer Center, Miami, FL
| | - J. Horton
- UT M. D. Anderson Cancer Center, Houston, TX; H. Lee Moffitt Cancer Center, Tampa, FL; University of Miami Sylvester Cancer Center, Miami, FL
| | - R. Lush
- UT M. D. Anderson Cancer Center, Houston, TX; H. Lee Moffitt Cancer Center, Tampa, FL; University of Miami Sylvester Cancer Center, Miami, FL
| | - D. Sullivan
- UT M. D. Anderson Cancer Center, Houston, TX; H. Lee Moffitt Cancer Center, Tampa, FL; University of Miami Sylvester Cancer Center, Miami, FL
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Aragaki C, Barber R, Purdue G, Arnoldo B, Hunt J, Chang E, Horton J. Increased Innate Immune Genetic Burden Impacts Severe Sepsis Risk in Burn Trauma Patients. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s71-b] [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: 11/14/2022] Open
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Bryant K, Powell S, Camp L, Horton J. Integrating Oral Care into a Process for Prevention of Pneumonia in Patients with Artificial Airways. Am J Infect Control 2006. [DOI: 10.1016/j.ajic.2006.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Price M, Gifford K, Horton J, Eifel P, Mourtada F. TU-EE-A1-01: Capabilities of a CT-Suitable, Patient-Adaptive HDR/PDR Intracavitary Brachytherapy Applicator for the Treatment of Cervical Cancer. Med Phys 2006. [DOI: 10.1118/1.2241586] [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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Wareing T, Failla G, Vassiliev O, Barnett A, McGhee J, Titt U, Horton J, Mourtada F. TH-E-224C-02: Performance Assessment of a Deterministic Method Incorporating Coupled Photon-Electron Transport for Photon Beam Dose Calculations On Acquired CT Data. Med Phys 2006. [DOI: 10.1118/1.2241957] [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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