1
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Maccallum F, Breen LJ, Phillips JL, Agar MR, Hosie A, Tieman J, DiGiacomo M, Luckett T, Philip J, Ivynian S, Chang S, Dadich A, Grossman CH, Gilmore I, Harlum J, Kinchin I, Glasgow N, Lobb EA. The mental health of Australians bereaved during the first two years of the COVID-19 pandemic: a latent class analysis. Psychol Med 2024; 54:1361-1372. [PMID: 38179660 DOI: 10.1017/s0033291723003227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND The COVID-19 pandemic disrupted many areas of life, including culturally accepted practices at end-of-life care, funeral rites, and access to social, community, and professional support. This survey investigated the mental health outcomes of Australians bereaved during this time to determine how these factors might have impacted bereavement outcomes. METHODS An online survey indexing pandemic and bereavement experiences, levels of grief, depression, anxiety, and health, work, and social impairment. Latent class analysis (LCA) was used to identify groups of individuals who shared similar symptom patterns. Multinomial regressions identified pandemic-related, loss-related, and sociodemographic correlates of class membership. RESULTS 1911 Australian adults completed the survey. The LCA identified four classes: low symptoms (46.8%), grief (17.3%), depression/anxiety (17.7%), and grief/depression/anxiety (18.2%). The latter group reported the highest levels of health, work, and social impairment. The death of a child or partner and an inability to care for the deceased due to COVID-19 public health measures were correlated with grief symptoms (with or without depression and anxiety). Preparedness for the person's death and levels of pandemic-related loneliness and social isolation differentiated all four classes. Unemployment was associated with depression/anxiety (with or without grief). CONCLUSIONS COVID-19 had profound impacts for the way we lived and died, with effects that are likely to ricochet through society into the foreseeable future. These lessons learned must inform policymakers and healthcare professionals to improve bereavement care and ensure preparedness during and following future predicted pandemics to prevent negative impacts.
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Affiliation(s)
- F Maccallum
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - L J Breen
- School of Population Health and enAble Institute, Curtin University, Perth, WA, Australia
| | - J L Phillips
- Faculty of Health and Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - M R Agar
- Faculty of Health, IMPACCT Centre, University of Technology Sydney, Ultimo, NSW, Australia
| | - A Hosie
- School of Nursing & Midwifery, University of Notre Dame Australia and St Vincent's Health Network Sydney, Australia
| | - J Tieman
- Research Centre for Palliative Care, Death and Dying, Flinders University, Adelaide, SA, Australia
| | - M DiGiacomo
- Faculty of Health, IMPACCT Centre, University of Technology Sydney, Ultimo, NSW, Australia
| | - T Luckett
- Faculty of Health, IMPACCT Centre, University of Technology Sydney, Ultimo, NSW, Australia
| | - J Philip
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - S Ivynian
- Faculty of Health, IMPACCT Centre, University of Technology Sydney, Ultimo, NSW, Australia
| | - S Chang
- Faculty of Health, IMPACCT Centre, University of Technology Sydney, Ultimo, NSW, Australia
| | - A Dadich
- School of Business, Western Sydney University, Penrith, NSW, Australia
| | - C H Grossman
- Calvary Health Care Bethlehem, Caulfield South, VIC, Australia
| | - I Gilmore
- Faculty of Health, IMPACCT Centre, University of Technology Sydney, Ultimo, NSW, Australia
| | - J Harlum
- District Palliative Care Service, Liverpool Hospital, Liverpool, NSW, Australia
| | - I Kinchin
- Centre for Health Policy and Management, Trinity College, the University of Dublin, Dublin, Ireland
| | - N Glasgow
- Australian National University College of Health and Medicine, Canberra, ACT, Australia
| | - E A Lobb
- Faculty of Health, IMPACCT Centre, University of Technology Sydney, Ultimo, NSW, Australia
- Department of Palliative Care, Calvary Health Care, Kogarah, NSW, Australia
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2
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Ennis HE, Lamar KT, Johnson RM, Phillips JL, Jennings JM. Comparison of Outcomes in High Versus Low Activity Level Patients After Total Joint Arthroplasty. J Arthroplasty 2024; 39:54-59. [PMID: 37380140 DOI: 10.1016/j.arth.2023.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/09/2023] [Accepted: 06/19/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Activity level (AL) recommendations following total joint arthroplasty (TJA) remain controversial. Our purpose was to compare implant survivorship of high activity (HA) and low activity (LA) patients after primary TJA. We hypothesized that there would be no difference in implant survivorship based on AL. METHODS This was a retrospective 1:1 matched cohort study after primary TJA with minimum 5-year follow-up. High activity patients were designated by the University of California and Los Angeles activity-level rating scale score ≥8 and matched to LA patients based on age (±5), sex, and body mass index (±5). There were 396 HA patients (149 knees and 48 hips) who met inclusion criteria. We analyzed revision rates, adverse events, and radiographic lucencies. RESULTS Crepitus was the most common adverse events in both HA and LA total knee arthroplasties (TKAs). Adverse events were rare in total hip arthroplasty (THA) cohorts. For both THA and TKA patients, the HA cohort did not have increased reoperations or revisions when compared to the LA cohort. No differences were noted in overall radiographic analysis between HA (16.1%) and LA (12.1%) TKA patients (P = .318), and in THA patients, more radiographic problems were noted in LA (P = .004). CONCLUSION We found no difference in minimum 5-year postoperative implant survivorship based on AL. This may change AL recommendations after TKA and THA.
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Affiliation(s)
| | | | | | | | - Jason M Jennings
- Colorado Joint Replacement, Denver, Colorado; Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado
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3
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Phillips JL, Buermeyer AB, Nguyen BD, Loehr C, Kolluri SK. Loss of the aryl hydrocarbon receptor increases tumorigenesis in p53-deficient mice. Toxicol Appl Pharmacol 2022; 454:116191. [PMID: 35926564 DOI: 10.1016/j.taap.2022.116191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/29/2022]
Abstract
The aryl hydrocarbon receptor (AhR) is a ligand-activated transcription factor that regulates cell fate via activation of a diverse set of genes. There are conflicting reports describing the role of AhR in cancer. AhR-knockout mice do not develop tumors spontaneously, yet the AhR can act as a tumor suppressor in certain contexts. Loss of tumor suppression by p53 is common in human cancer. To investigate AhR function in the absence of p53, we generated mice lacking both AhR and p53. Mice deficient for AhR and p53 had shortened lifespan, increased tumorigenesis, and an altered tumor spectrum relative to control mice lacking only p53. In addition, knockout of both AhR and p53 resulted in reduced embryonic survival and neonatal fitness. We also examined the consequences of loss of AhR in p53-heterozygous mice and observed a significantly reduced lifespan and enhanced tumor burden. These findings reveal an important role for the AhR as a tumor suppressor in the absence of p53 signaling and support the development of anti-cancer therapeutics that would promote the tumor suppressive actions of the AhR.
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Affiliation(s)
- Jessica L Phillips
- Cancer Research Laboratory, Department of Environmental & Molecular Toxicology, Oregon State University, Corvallis, OR 97331, United States of America
| | - Andrew B Buermeyer
- Department of Environmental & Molecular Toxicology, Oregon State University, Corvallis, OR 897331, United States of America; The Pacific Northwest Center for Translational Environmental Health Research, Oregon State University, Corvallis, OR 97331, USA
| | - Bach D Nguyen
- Cancer Research Laboratory, Department of Environmental & Molecular Toxicology, Oregon State University, Corvallis, OR 97331, United States of America
| | - Christiane Loehr
- Department of Biomedical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR 897331, United States of America; The Pacific Northwest Center for Translational Environmental Health Research, Oregon State University, Corvallis, OR 97331, USA
| | - Siva K Kolluri
- Cancer Research Laboratory, Department of Environmental & Molecular Toxicology, Oregon State University, Corvallis, OR 97331, United States of America; The Pacific Northwest Center for Translational Environmental Health Research, Oregon State University, Corvallis, OR 97331, USA.
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4
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Phillips JL, Raja V, Mehrotra C, Richards J, Khan J, Graham DF. Introduction of diabetic retinopathy screening into an antenatal clinic: Impact on maternal screening and diagnosis rates. Aust N Z J Obstet Gynaecol 2022; 62:906-909. [PMID: 35719012 DOI: 10.1111/ajo.13574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 06/01/2022] [Indexed: 11/27/2022]
Abstract
Pregnancy is a risk factor for the development and progression of diabetic retinopathy (DR) in women with pre-gestational diabetes. However, a minority of pregnant women with diabetes adhere to retinal screening recommendations. The introduction of an onsite retinal camera at our tertiary maternity hospital significantly increased the proportion of women who received at least one retinal screen during pregnancy (93.0% vs 54.3%, P < 0.001) and the identification of both DR and DR progression. We conclude that the use of a retinal camera in similar clinics is a feasible option to improve DR screening and diagnosis rates in pregnancy.
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Affiliation(s)
- Jessica L Phillips
- Department of Obstetric Medicine, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Vignesh Raja
- Department of Ophthalmology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Chhaya Mehrotra
- Department of Obstetrics and Gynaecology, King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Josephine Richards
- Department of Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Jane Khan
- Department of Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Dorothy F Graham
- Department of Obstetric Medicine, King Edward Memorial Hospital, Perth, Western Australia, Australia
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5
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Oishi N, Hundal T, Phillips JL, Dasari S, Hu G, Viswanatha DS, He R, Mai M, Jacobs HK, Ahmed NH, Syrbu SI, Salama Y, Chapman JR, Vega F, Sidhu J, Bennani NN, Epstein AL, Medeiros JL, Clemens MW, Miranda RN, Feldman AL. Molecular profiling reveals a hypoxia signature in breast implant-associated anaplastic large cell lymphoma. Haematologica 2021; 106:1714-1724. [PMID: 32414854 PMCID: PMC8168507 DOI: 10.3324/haematol.2019.245860] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Indexed: 01/17/2023] Open
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIAALCL) is a recently characterized T-cell malignancy that has raised significant patient safety concerns and led to worldwide impact on the implants used and clinical management of patients undergoing reconstructive or cosmetic breast surgery. Molecular signatures distinguishing BIA-ALCL from other anaplastic large cell lymphomas have not been fully elucidated and classification of BIA-ALCL as a World Health Organization entity remains provisional. We performed RNA sequencing and gene set enrichment analysis comparing BIA-ALCL to non-BIAALCL and identified dramatic upregulation of hypoxia signaling genes including the hypoxia-associated biomarker CA9 (carbonic anyhydrase- 9). Immunohistochemistry validated CA9 expression in all BIA-ALCL, with only minimal expression in non-BIA-ALCL. Growth induction in BIA-ALCL-derived cell lines cultured under hypoxic conditions was proportional to upregulation of CA9 expression, and RNA sequencing demonstrated induction of the same gene signature observed in BIAALCL tissue samples compared to non-BIA-ALCL. CA9 silencing blocked hypoxia-induced BIA-ALCL cell growth and cell cycle-associated gene expression, whereas CA9 overexpression in BIA-ALCL cells promoted growth in a xenograft mouse model. Furthermore, CA9 was secreted into BIA-ALCL cell line supernatants and was markedly elevated in human BIA-ALCL seroma samples. Finally, serum CA9 concentrations in mice bearing BIA-ALCL xenografts were significantly elevated compared to those in control serum. Together, these findings characterize BIA-ALCL as a hypoxia-associated neoplasm, likely attributable to the unique microenvironment in which it arises. These data support classification of BIA-ALCL as a distinct entity and uncover opportunities for investigating hypoxia-related proteins such as CA9 as novel biomarkers and therapeutic targets in this disease.
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Affiliation(s)
- Naoki Oishi
- Department of Pathology, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Tanya Hundal
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Jessica L Phillips
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Surendra Dasari
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Guangzhen Hu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - David S Viswanatha
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Rong He
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Ming Mai
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Hailey K Jacobs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Nada H Ahmed
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Sergei I Syrbu
- Department of Pathology, University of Iowa, Iowa City, IA, USA
| | - Youssef Salama
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Francisco Vega
- Department of Pathology, University of Miami, Miami, FL, USA
| | - Jagmohan Sidhu
- Department of Pathology and Laboratory Medicine, United Health Services, Binghamton, NY, USA
| | | | - Alan L Epstein
- Dept of Pathology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Jeffrey L Medeiros
- Department of Hematopathology, MD Anderson Cancer Center, Houston, TX, USA
| | - Mark W Clemens
- Department of Plastic Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Roberto N Miranda
- Department of Hematopathology, MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew L Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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6
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Singal AG, Tiro JA, Murphy CC, Blackwell JM, Kramer JR, Khan A, Liu Y, Zhang S, Phillips JL, Hernaez R. Patient-Reported Barriers Are Associated With Receipt of Hepatocellular Carcinoma Surveillance in a Multicenter Cohort of Patients With Cirrhosis. Clin Gastroenterol Hepatol 2021; 19:987-995.e1. [PMID: 32629122 PMCID: PMC7779689 DOI: 10.1016/j.cgh.2020.06.049] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [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] [Received: 03/27/2020] [Revised: 06/04/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND More than 20% of patients with cirrhosis do not receive semi-annual hepatocellular carcinoma (HCC) surveillance as recommended. Few studies have evaluated the effects of patient-level factors on surveillance receipt. METHODS We administered a telephone survey to a large cohort of patients with cirrhosis from 3 health systems (a tertiary care referral center, a safety-net health system, and Veterans Affairs) to characterize patient knowledge, attitudes, and perceived barriers of HCC surveillance. Multinomial logistic regression was performed to identify factors associated with HCC surveillance receipt (semi-annual and annual vs none) during the 12-month period preceding survey administration. RESULTS Of 2871 patients approached, 1020 (35.5%) completed the survey. Patients had high levels of concern about developing HCC and high levels of knowledge about HCC. However, patients had knowledge deficits, including believing surveillance was unnecessary when physical examination and laboratory results were normal. Nearly half of patients reported barriers to surveillance, including costs (28.9%), difficulty scheduling (24.1%), and transportation (17.8%). In the year before the survey, 745 patients (73.1%) received 1 or more surveillance examination; 281 received on-schedule, semi-annual surveillance and 464 received annual surveillance. Semi-annual HCC surveillance (vs none) was significantly associated with receipt of hepatology subspecialty care (odds ratio, 30.1; 95% CI, 17.5-51.8) and inversely associated with patient-reported barriers (odds ratio, 0.62; 95% CI, 0.41-0.94). Patterns of associations comparing annual vs no surveillance were similar although the magnitude of effects were reduced. CONCLUSIONS Patient-reported barriers such as knowledge deficits, costs, difficulty scheduling, and transportation are significantly associated with less frequent receipt of HCC surveillance, indicating a need for patient-centered interventions, such as patient navigation.
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Affiliation(s)
- Amit G Singal
- Department of Internal Medicine, UT Southwestern Medical Center and Parkland Health Hospital System, Dallas, Texas; Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, Texas; Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas.
| | - Jasmin A Tiro
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas
| | - Caitlin C Murphy
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas
| | | | - Jennifer R Kramer
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Aisha Khan
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Yan Liu
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Song Zhang
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas
| | - Jessica L Phillips
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas
| | - Ruben Hernaez
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Department of Medicine, Baylor College of Medicine, Houston, Texas
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7
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Abeykoon JP, Wu X, Nowakowski KE, Dasari S, Paludo J, Weroha SJ, Hu C, Hou X, Sarkaria JN, Mladek AC, Phillips JL, Feldman AL, Ravindran A, King RL, Boysen J, Stenson MJ, Carr RM, Manske MK, Molina JR, Kapoor P, Parikh SA, Kumar S, Robinson SI, Yu J, Boughey JC, Wang L, Goetz MP, Couch FJ, Patnaik MM, Witzig TE. Salicylates enhance CRM1 inhibitor antitumor activity by induction of S-phase arrest and impairment of DNA-damage repair. Blood 2021; 137:513-523. [PMID: 33507295 PMCID: PMC7845010 DOI: 10.1182/blood.2020009013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/30/2020] [Indexed: 01/10/2023] Open
Abstract
Chromosome region maintenance protein 1 (CRM1) mediates protein export from the nucleus and is a new target for anticancer therapeutics. Broader application of KPT-330 (selinexor), a first-in-class CRM1 inhibitor recently approved for relapsed multiple myeloma and diffuse large B-cell lymphoma, have been limited by substantial toxicity. We discovered that salicylates markedly enhance the antitumor activity of CRM1 inhibitors by extending the mechanisms of action beyond CRM1 inhibition. Using salicylates in combination enables targeting of a range of blood cancers with a much lower dose of selinexor, thereby potentially mitigating prohibitive clinical adverse effects. Choline salicylate (CS) with low-dose KPT-330 (K+CS) had potent, broad activity across high-risk hematological malignancies and solid-organ cancers ex vivo and in vivo. The K+CS combination was not toxic to nonmalignant cells as compared with malignant cells and was safe without inducing toxicity to normal organs in mice. Mechanistically, compared with KPT-330 alone, K+CS suppresses the expression of CRM1, Rad51, and thymidylate synthase proteins, leading to more efficient inhibition of CRM1-mediated nuclear export, impairment of DNA-damage repair, reduced pyrimidine synthesis, cell-cycle arrest in S-phase, and cell apoptosis. Moreover, the addition of poly (ADP-ribose) polymerase inhibitors further potentiates the K+CS antitumor effect. K+CS represents a new class of therapy for multiple types of blood cancers and will stimulate future investigations to exploit DNA-damage repair and nucleocytoplasmic transport for cancer therapy in general.
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MESH Headings
- Animals
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cell Cycle Checkpoints/drug effects
- Choline/administration & dosage
- Choline/adverse effects
- Choline/analogs & derivatives
- Choline/pharmacology
- DNA Repair/drug effects
- DNA Replication/drug effects
- DNA, Neoplasm/drug effects
- Drug Combinations
- Drug Synergism
- Gene Expression Regulation, Neoplastic/drug effects
- Humans
- Hydrazines/administration & dosage
- Hydrazines/adverse effects
- Hydrazines/pharmacology
- Karyopherins/antagonists & inhibitors
- Lymphoma, Mantle-Cell/drug therapy
- Lymphoma, Mantle-Cell/pathology
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/genetics
- Lymphoma, Non-Hodgkin/pathology
- Male
- Mice
- Mice, Inbred NOD
- Mice, SCID
- Neoplasm Proteins/antagonists & inhibitors
- Neoplasm Proteins/biosynthesis
- Neoplasm Proteins/genetics
- Phthalazines/administration & dosage
- Phthalazines/pharmacology
- Piperazines/administration & dosage
- Piperazines/pharmacology
- Random Allocation
- Receptors, Cytoplasmic and Nuclear/antagonists & inhibitors
- S Phase Cell Cycle Checkpoints/drug effects
- Salicylates/administration & dosage
- Salicylates/adverse effects
- Salicylates/pharmacology
- Triazoles/administration & dosage
- Triazoles/adverse effects
- Triazoles/pharmacology
- Tumor Cells, Cultured
- Xenograft Model Antitumor Assays
- Exportin 1 Protein
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Affiliation(s)
| | - Xiaosheng Wu
- Division of Hematology, Department of Internal Medicine
| | | | | | - Jonas Paludo
- Division of Hematology, Department of Internal Medicine
| | | | - Chunling Hu
- Department of Laboratory Medicine and Pathology
| | | | | | | | | | | | - Aishwarya Ravindran
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, and
| | - Rebecca L King
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, and
| | - Justin Boysen
- Division of Hematology, Department of Internal Medicine
| | | | | | | | | | | | | | - Shaji Kumar
- Division of Hematology, Department of Internal Medicine
| | | | | | | | | | | | - Fergus J Couch
- Department of Health Sciences Research
- Department of Laboratory Medicine and Pathology
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Gerber DE, Hamann HA, Dorsey O, Ahn C, Phillips JL, Santini NO, Browning T, Ochoa CD, Adesina J, Natchimuthu VS, Steen E, Majeed H, Gonugunta A, Lee SJC. Clinician Variation in Ordering and Completion of Low-Dose Computed Tomography for Lung Cancer Screening in a Safety-Net Medical System. Clin Lung Cancer 2020; 22:e612-e620. [PMID: 33478912 DOI: 10.1016/j.cllc.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/27/2020] [Revised: 11/19/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Less than 5% of eligible individuals in the United States undergo lung cancer screening. Variation in clinicians' participation in lung cancer screening has not been determined. PATIENTS AND METHODS We studied medical providers who ordered ≥ 1 low-dose computed tomography (LDCT) for lung cancer screening from February 2017 through February 2019 in an integrated safety-net healthcare system. We analyzed associations between provider characteristics and LDCT orders and completion using chi-square, Fisher exact, and Student t tests, as well as ANOVA and multinomial logistic regression. RESULTS Among an estimated 194 adult primary care physicians, 144 (74%) ordered at least 1 LDCT, as did 39 specialists. These 183 medical providers ordered 1594 LDCT (median, 4; interquartile range, 2-9). In univariate and multivariate models, family practice providers (P < .001) and providers aged ≥ 50 years (P = .03) ordered more LDCT than did other clinicians. Across providers, the median proportion of ordered LDCT that were completed was 67%. The total or preceding number of LDCT ordered by a clinician was not associated with the likelihood of LDCT completion. CONCLUSION In an integrated safety-net healthcare system, most adult primary care providers order LDCT. The number of LDCT ordered varies widely among clinicians, and a substantial proportion of ordered LDCT are not completed.
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Affiliation(s)
- David E Gerber
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX; Division of Hematology-Oncology, UT Southwestern Medical Center, Dallas, TX; Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX.
| | - Heidi A Hamann
- Departments of Psychology and Family and Community Medicine, University of Arizona, Tucson, AZ
| | - Olivia Dorsey
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX
| | - Chul Ahn
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX; Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX
| | - Jessica L Phillips
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX
| | - Noel O Santini
- Parkland Health and Hospital System, Dallas, TX; Division of General Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Travis Browning
- Parkland Health and Hospital System, Dallas, TX; Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | - Cristhiaan D Ochoa
- Parkland Health and Hospital System, Dallas, TX; Division of Pulmonary and Critical Care Medicine, UT Southwestern Medical Center, Dallas, TX
| | | | | | - Eric Steen
- Parkland Health and Hospital System, Dallas, TX; Division of General Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Harris Majeed
- School of Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Amrit Gonugunta
- School of Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Simon J Craddock Lee
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX; Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX
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9
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Friedman EM, Shih RA, Ahluwalia SC, Kotzias VI, Phillips JL, Siconolfi D, Saliba D. Factors Explaining State Differences in Applying for a Recent Long-Term Care Program that Promotes Aging in Place: Perspectives of Medicaid Administrators. J Appl Gerontol 2020; 40:972-979. [PMID: 32500837 DOI: 10.1177/0733464820924510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Older adults in need of assistance often prefer to remain at home rather than receive care in an institution. To meet these preferences, Medicaid invited states to apply for the Balancing Incentive Program (BIP), a program intended to "rebalance" Medicaid-financed long-term services and supports to Home- and Community-Based Services (HCBS). However, only about half of eligible states applied. We interviewed Medicaid administrators to explore why some states applied for BIP whereas others did not. Supportive state leadership and the presence of other programs supporting community-based care were positively related to BIP application. Opposing policy priorities and programs competing for similar resources were negatively related to BIP application. Because states most likely to apply already had policy goals and programs supporting HCBS, BIP may inadvertently widen disparities across states, pushing those on the margins ahead and leaving the ones that are worst off in HCBS support to fall even further behind.
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Affiliation(s)
| | | | | | | | | | | | - Debra Saliba
- RAND Corporation, Santa Monica, CA, USA.,University of California, Los Angeles, USA.,Veteran's Health Administration, Los Angeles, CA
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10
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Wilkinson EJ, Woodworth AM, Parker M, Phillips JL, Malley RC, Dickinson JL, Holloway AF. Epigenetic regulation of the ITGB4 gene in prostate cancer. Exp Cell Res 2020; 392:112055. [PMID: 32376286 DOI: 10.1016/j.yexcr.2020.112055] [Citation(s) in RCA: 9] [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] [Received: 12/11/2019] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Examination of epigenetic changes at the ITGB4 gene promoter reveals altered methylation at different stages of prostate tumour progression and these changes may, in part, explain the complex patterns of gene expression of this integrin observed. Transcriptional re-programming perturbs expression of cell adhesion molecules and underpins metastatic tumour cell behaviour. Decreasing expression of the cell adhesion molecule ITGB4, which encodes the beta subunit of the integrin, alpha6 beta4 (α6β4), has been correlated with increased tumour aggressiveness and metastasis in multiple tumour types including prostate cancer. Paradoxically, in vitro studies in tumour cell models demonstrate that ITGB4 mediates cell mobility and invasion. Herein we examined whether transcriptional re-programming by methylation influenced ITGB4 gene expression at different stages of prostate cancer progression. Bisulphite sequencing of a large CpG island in the ITGB4 gene promoter identified differentially methylated regions in prostate cancer cell lines representing a localised tumour (22Rv1), lymph node metastasis (LNCaP), and a bone metastasis (PC-3). The highest levels of methylation were observed in the CpG island surrounding the ITGB4 transcription start site in PC-3 cells, and this observation also correlated with higher gene expression of ITGB4 in these cells. Furthermore, PC-3 cells expressed two distinct transcripts, using an alternate transcription start site, which was not detected in other cell lines. In prostate tumour biopsy samples, patterns of methylation across the ITGB4 promoter were similar overall in matched primary and metastatic samples (n = 4 pairs), with a trend toward loss of methylation at specific sites in metastatic lesions.
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Affiliation(s)
- Emma J Wilkinson
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia, 7000; Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia, 7000
| | - Alexandra M Woodworth
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia, 7000
| | - Madeline Parker
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia, 7000
| | - Jessica L Phillips
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia, 7000
| | - Roslyn C Malley
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia, 7000
| | - Joanne L Dickinson
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia, 7000.
| | - Adele F Holloway
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia, 7000
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11
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Larkey NE, Phillips JL, Jang HS, Kolluri SK, Burrows SM. Small RNA Biosensor Design Strategy To Mitigate Off-Analyte Response. ACS Sens 2020; 5:377-384. [PMID: 31942801 DOI: 10.1021/acssensors.9b01968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Several bottlenecks in the design of current sensor technologies for small noncoding RNA must be addressed. The small size of the sensors and the large number of other nucleotides that may have sequence similarity makes selectivity a real concern. Many of the current sensors have one strand with an exposed region called a toehold. The toehold serves as a place for the analyte nucleic acid strand to bind and initiate competitive displacement of sensors' secondary strands. Since the toehold region is not protected, any endogenous oligonucleotide sequences that are similar or only different by a few nucleic acids will interact with the toehold and cause false signals. To address sensor selectivity, we investigated how the toehold location in the sensor impacts the sensitivity and selectivity for the analyte of interest. We will discuss the differences in sensitivity and selectivity for a miR-146a-5p biosensor in the presence of different naturally occurring mismatch sequences. We found that altering the toehold location lowered the rate of the false signal from off-analyte microRNA by upward of 20 percentage points. Detection limits as low as 56 pM were observed when the sensor concentration was 5 nM. The findings herein are broadly applicable to other small and large RNAs as well as other types of sensing platforms.
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Affiliation(s)
- Nicholas E. Larkey
- Department of Chemistry, Oregon State University, 153 Gilbert Hall, Corvallis, Oregon 97331, United States
| | - Jessica L. Phillips
- Department of Environmental and Molecular Toxicology, Cancer Research Laboratory, Oregon State University, Corvallis, Oregon 97331, United States
| | - Hyo Sang Jang
- Department of Environmental and Molecular Toxicology, Cancer Research Laboratory, Oregon State University, Corvallis, Oregon 97331, United States
| | - Siva K. Kolluri
- Department of Environmental and Molecular Toxicology, Cancer Research Laboratory, Oregon State University, Corvallis, Oregon 97331, United States
| | - Sean M. Burrows
- Department of Chemistry, Oregon State University, 153 Gilbert Hall, Corvallis, Oregon 97331, United States
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12
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Hu G, Phillips JL, Dasari S, Jacobs HK, Luchtel RA, Oishi N, Hundal T, Ahmed NH, Satou A, Epstein AL, Bennani NN, Nowakowski GS, Murray JA, Feldman AL. Targetability of STAT3-JAK2 fusions: implications for T-cell lymphoproliferative disorders of the gastrointestinal tract. Leukemia 2019; 34:1467-1471. [PMID: 31836854 DOI: 10.1038/s41375-019-0678-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 11/07/2019] [Accepted: 11/29/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Guangzhen Hu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Jessica L Phillips
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Surendra Dasari
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Hailey K Jacobs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Rebecca A Luchtel
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Naoki Oishi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.,Department of Pathology, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Tanya Hundal
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Nada H Ahmed
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.,Department of Clinical Pathology, Suez Canal University, Ismailia, Egypt
| | - Akira Satou
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.,Department of Surgical Pathology, Aichi Medical University Hospital, Aichi, Japan
| | - Alan L Epstein
- Department of Pathology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | | | - Grzegorz S Nowakowski
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.,Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joseph A Murray
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Andrew L Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
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13
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Rao A, Zecchin R, Newton PJ, Phillips JL, DiGiacomo M, Denniss AR, Hickman LD. The prevalence and impact of depression and anxiety in cardiac rehabilitation: A longitudinal cohort study. Eur J Prev Cardiol 2019; 27:478-489. [PMID: 31597473 DOI: 10.1177/2047487319871716] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [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: 11/16/2022]
Abstract
BACKGROUND Co-morbid depression and anxiety symptoms are frequently under-recognised and under-treated in heart disease and this negatively impacts self-management. AIMS The purpose of this study was to determine the prevalence, correlates and predictors of depression and anxiety in cardiac rehabilitation programmes, the impact of cardiac rehabilitation on moderate depression, anxiety and stress symptoms, and the relationship between moderate depression, anxiety and stress symptoms and cardiac rehabilitation adherence. METHODS This was a retrospective cohort study of 5908 patients entering cardiac rehabilitation programmes from 2006-2017, across two Sydney metropolitan teaching hospitals. Variables included demographics, diagnoses, cardiovascular risk factors, medication use, participation rates, health status (Medical Outcomes Study Short Form-36) and psychological health (Depression Anxiety Stress Scales) subscale scores. RESULTS Moderate depression, anxiety or stress symptoms were prevalent in 18%, 28% and 13% of adults entering cardiac rehabilitation programmes, respectively. Adults with moderate depression (24% vs 13%), anxiety (32% vs 23%) or stress (18% vs 10%) symptoms were significantly less likely to adhere to cardiac rehabilitation compared with those with normal-mild symptoms (p < 0.001). Anxiety (odds ratio 4.395, 95% confidence interval 3.363-5.744, p < 0.001) and stress (odds ratio 4.527, 95% confidence interval 3.315-6.181, p < 0.001) were the strongest predictors of depression. Depression (odds ratio 3.167, 95% confidence interval 2.411-4.161) and stress (odds ratio 5.577, 95% confidence interval 4.006-7.765, p < 0.001) increased the risk of anxiety on entry by more than three times, above socio-demographic factors, cardiovascular risk factors, diagnoses and quality of life. CONCLUSION Monitoring depression and anxiety symptoms on entry and during cardiac rehabilitation can assist to improve adherence and may identify the need for additional psychological health support. Exploring the relevance and use of adjunct psychological support strategies within cardiac rehabilitation programmes is warranted.
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Affiliation(s)
- A Rao
- University of Technology Sydney, Australia
| | - R Zecchin
- University of Technology Sydney, Australia.,Western Sydney Local Health District (WSLHD), Australia
| | | | | | | | - A R Denniss
- Western Sydney Local Health District (WSLHD), Australia.,Western Sydney University, Australia
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14
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Sutton LP, Jeffreys SA, Phillips JL, Taberlay PC, Holloway AF, Ambrose M, Joo JHE, Young A, Berry R, Skala M, Brettingham-Moore KH. DNA methylation changes following DNA damage in prostate cancer cells. Epigenetics 2019; 14:989-1002. [PMID: 31208284 PMCID: PMC6691980 DOI: 10.1080/15592294.2019.1629231] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Many cancer therapies operate by inducing double-strand breaks (DSBs) in cancer cells, however treatment-resistant cells rapidly initiate mechanisms to repair damage enabling survival. While the DNA repair mechanisms responsible for cancer cell survival following DNA damaging treatments are becoming better understood, less is known about the role of the epigenome in this process. Using prostate cancer cell lines with differing sensitivities to radiation treatment, we analysed the DNA methylation profiles prior to and following a single dose of radiotherapy (RT) using the Illumina Infinium HumanMethylation450 BeadChip platform. DSB formation and repair, in the absence and presence of the DNA hypomethylating agent, 5-azacytidine (5-AzaC), were also investigated using γH2A.X immunofluorescence staining. Here we demonstrate that DNA methylation is generally stable following a single dose of RT; however, a small number of CpG sites are stably altered up to 14 d following exposure. While the radioresistant and radiosensitive cells displayed distinct basal DNA methylation profiles, their susceptibility to DNA damage appeared similar demonstrating that basal DNA methylation has a limited influence on DSB induction at the regions examined. Recovery from DSB induction was also similar between these cells. Treatment with 5-AzaC did not sensitize resistant cells to DNA damage, but rather delayed recruitment of phosphorylated BRCA1 (S1423) and repair of DSBs. These results highlight that stable epigenetic changes are possible following a single dose of RT and may have significant clinical implications for cancer treatment involving recurrent or fractionated dosing regimens.
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Affiliation(s)
- Laura P Sutton
- a School of Medicine, College of Health and Medicine, University of Tasmania , Hobart , Australia
| | - Sarah A Jeffreys
- a School of Medicine, College of Health and Medicine, University of Tasmania , Hobart , Australia
| | - Jessica L Phillips
- a School of Medicine, College of Health and Medicine, University of Tasmania , Hobart , Australia
| | - Phillippa C Taberlay
- a School of Medicine, College of Health and Medicine, University of Tasmania , Hobart , Australia
| | - Adele F Holloway
- a School of Medicine, College of Health and Medicine, University of Tasmania , Hobart , Australia
| | - Mark Ambrose
- a School of Medicine, College of Health and Medicine, University of Tasmania , Hobart , Australia
| | - Ji-Hoon E Joo
- b Colorectal Oncogenomics Group, Department of Clinical Pathology & University of Melbourne Centre for Cancer Research, The University of Melbourne , Parkville , Australia
| | - Arabella Young
- a School of Medicine, College of Health and Medicine, University of Tasmania , Hobart , Australia
| | - Rachael Berry
- a School of Medicine, College of Health and Medicine, University of Tasmania , Hobart , Australia
| | - Marketa Skala
- c Department of Radiation Oncology, Royal Hobart Hospital , Hobart , Australia
| | - Kate H Brettingham-Moore
- a School of Medicine, College of Health and Medicine, University of Tasmania , Hobart , Australia
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15
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Hirschhorn RM, Cadet DA, Delus R, Phillips JL, Murphy T, Haggard C, Yeargin SW. The Prevalence of Sickle Cell Trait in a Division I University Athletic Program. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000562603.94081.0c] [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: 11/21/2022]
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16
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Siconolfi D, Shih RA, Friedman EM, Kotzias VI, Ahluwalia SC, Phillips JL, Saliba D. Rural-Urban Disparities in Access to Home- and Community-Based Services and Supports: Stakeholder Perspectives From 14 States. J Am Med Dir Assoc 2019; 20:503-508.e1. [PMID: 30827892 DOI: 10.1016/j.jamda.2019.01.120] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/28/2018] [Accepted: 01/06/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Trends over time in the United States show success in rebalancing long-term services and supports (LTSS) toward increased home- and community-based services (HCBS) relative to institutionalized care. However, the diffusion and utilization of HCBS may be inequitable across rural and urban residents. We sought to identify potential disparities in rural HCBS access and utilization, and to elucidate factors associated with these disparities. DESIGN We used qualitative interviews with key informants to explore and identify potential disparities and their associated supply-side factors. SETTING AND PARTICIPANTS We interviewed 3 groups of health care stakeholders (Medicaid administrators, service agency managers and staff, and patient advocates) from 14 states (n = 40). MEASURES Interviews were conducted using a semistructured interview guide, and data were thematically coded using a standardized codebook. RESULTS Stakeholders identified supply-side factors inhibiting rural HCBS access, including limited availability of LTSS providers, inadequate transportation services, telecommunications barriers, threats to business viability, and challenges to caregiving workforce recruitment and retention. Stakeholders perceived that rural persons have a greater reliance on informal caregiving supports, either as a cultural preference or as compensation for the dearth of HCBS. CONCLUSIONS/IMPLICATIONS LTSS rebalancing efforts that limit the institutional LTSS safety net may have unintended consequences in rural contexts if they do not account for supply-side barriers to HCBS. We identified supply-side factors that (1) inhibit beneficiaries' access to HCBS, (2) affect the adequacy and continuity of HCBS, and (3) potentially impact long-term business viability for HCBS providers. Spatial isolation of beneficiaries may contribute to a perceived lack of demand and reduce chances of funding for new services. Addressing these problems requires stakeholder collaboration and comprehensive policy approaches with attention to rural infrastructure.
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Affiliation(s)
| | | | | | | | | | | | - Debra Saliba
- RAND Corporation, Arlington, VA; Borun Center, UCLA Division of Geriatrics, Los Angeles, CA; Veterans Health Administration, Los Angeles, CA
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17
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Rao A, Zecchin R, Newton PJ, Digiacomo M, Phillips JL, Hickman LD. P5438Who drops out of cardiac rehabilitation programs (2007–2017)? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Rao
- University of Technology Sydney, Faculty of Health, IMPACCT, Sydney, Australia
| | - R Zecchin
- Western Sydney Local Health District, Cardiac Education and Assessment Program, Sydney, Australia
| | - P J Newton
- Western Sydney University, Nursing & Midwifery Research Centre, Sydney, Australia
| | - M Digiacomo
- University of Technology Sydney, Faculty of Health, IMPACCT, Sydney, Australia
| | - J L Phillips
- University of Technology Sydney, Faculty of Health, IMPACCT, Sydney, Australia
| | - L D Hickman
- University of Technology Sydney, Faculty of Health, IMPACCT, Sydney, Australia
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18
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Clark K, Lam L, Talley NJ, Watts G, Phillips JL, Byfieldt NJ, Currow DC. A pragmatic comparative study of palliative care clinician's reports of the degree of shadowing visible on plain abdominal radiographs. Support Care Cancer 2018; 26:3749-3754. [PMID: 29736868 DOI: 10.1007/s00520-018-4238-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 04/26/2018] [Indexed: 11/28/2022]
Abstract
The assessment of constipation symptoms is based on history and physical examination. However, the experience is highly subjective perhaps explaining why palliative medicine doctors continue to use plain abdominal radiographs as part of routine assessment of constipation. Previous studies have demonstrated poor agreement between clinicians with this work in palliative care, limited further by disparity of clinicians' experience and training. The aim of this work was to explore whether there was less variation in the assessments of faecal shadowing made by more experienced clinicians compared to their less experienced colleagues. This pragmatic study was conducted across six palliative care services in Sydney (NSW, Australia). Doctors of varying clinical experience were asked to independently report their opinions of the amount of shadowing seen on 10 plain abdominal radiographs all taken from cancer patients who self-identified themselves as constipated. There were 46 doctors of varying clinical experience who participated including qualified specialists, doctors in specialist training and lastly, doctors in their second- and third post-graduate years. Poor agreement was seen between the faecal shadowing scores allocated by doctors of similar experience and training (Fleiss's kappa (FK): RMO 0.05; registrar 0.06; specialist 0.11). Further, when the levels of agreement between groups were considered, no statistically significant differences were observed. Although the doctors did not agree on the appearance of the film, the majority felt they were able to extrapolate patients' experiences from the radiograph's appearance. As it remains challenging in palliative care to objectively assess and diagnose constipation by history and imaging, uniform and objective assessment and diagnostic criteria are required. It is likely that any agreed criteria will include a combination of imaging and history. The results suggest the use of radiographs alone to diagnose and assess constipation in palliative care represents low value care.
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Affiliation(s)
- Katherine Clark
- Northern Sydney Local Health District Cancer and Palliative Care Network, Royal North Shore Hospital, Reserve Rd, St Leonards, NSW, 2065, Australia. .,The University of Sydney, Sydney, NSW, Australia.
| | - L Lam
- The University of Technology, Sydney, NSW, Australia
| | - N J Talley
- The University of Newcastle, Newcastle, NSW, Australia
| | - G Watts
- The University of Newcastle, Newcastle, NSW, Australia.,Calvary Mater Newcastle, Newcastle, NSW, Australia
| | - J L Phillips
- The University of Technology, Sydney, NSW, Australia
| | - N J Byfieldt
- Calvary Mater Newcastle, Newcastle, NSW, Australia
| | - D C Currow
- The University of Technology, Sydney, NSW, Australia
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19
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Rondon AJ, Tan TL, Greenky MR, Goswami K, Shohat N, Phillips JL, Purtill JJ. Who Goes to Inpatient Rehabilitation or Skilled Nursing Facilities Unexpectedly Following Total Knee Arthroplasty? J Arthroplasty 2018; 33:1348-1351.e1. [PMID: 29325725 DOI: 10.1016/j.arth.2017.12.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 11/08/2017] [Revised: 12/09/2017] [Accepted: 12/12/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Inpatient rehabilitation facilities (IRFs) and skilled nursing facilities (SNFs) represent a significant portion of post-operative expenses of bundled payments for total knee arthroplasty (TKA). Although many surgeons no longer routinely send patients to IRFs or SNFs, some patients are unable to be discharged directly home. This study identified patient factors for discharge to post-acute care facilities with an institutional protocol of discharging TKA patients home. METHODS A retrospective review of patients undergoing primary unilateral TKA at a single institution from 2012 to 2017 was performed. All surgeons discharged patients home as a routine protocol. An electronic query followed by manual review identified discharge disposition, demographic factors, co-morbidities, and other patient factors. In total, 2281 patients were identified, with 9.6% discharged to SNFs or IRFs and 90.4% discharged home. Univariate and multivariate analyses were conducted to create 2 predictive models for patient discharge: pre-operative visit and hospital course. RESULTS Among 43 variables studied, 6 were found to be significant pre-operative risk factors for a discharge disposition other than home. In descending order, age 75 or greater, female, non-Caucasian race, Medicare status, history of depression, and Charlson Comorbidity Index were predictors for patients going to IRFs. In addition, any in-hospital complications led to a higher likelihood of being discharged to IRFs and SNFs. Both models had excellent predictive assessments with area under curve values of 0.79 and 0.80 for pre-operative visit and hospital course. CONCLUSION This study identifies pre-operative and in-hospital factors that predispose patients to non-routine discharges, which allow surgeons to better predict patient post-operative disposition.
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Affiliation(s)
- Alexander J Rondon
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Timothy L Tan
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Max R Greenky
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Karan Goswami
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Noam Shohat
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Jessica L Phillips
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - James J Purtill
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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20
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Rondon AJ, Schlitt PK, Tan TL, Phillips JL, Greenky MR, Purtill JJ. Survivorship and Outcomes in Patients With Multiple Sclerosis Undergoing Total Joint Arthroplasty. J Arthroplasty 2018; 33:1024-1027. [PMID: 29174408 DOI: 10.1016/j.arth.2017.10.056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 07/26/2017] [Revised: 10/24/2017] [Accepted: 10/30/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Patients with multiple sclerosis (MS) frequently require total joint arthroplasty (TJA). The outcomes of TJA in patients with MS, who are frequently on immunomodulatory medications and physically deconditioned, remain largely unknown. The aim of this study is to elucidate the survivorship and reasons for failure in this patient population. METHODS A single-institution retrospective review of 108 TJAs (46 knees and 62 hips) was performed from 2000 to 2016. An electronic chart query based on MS medications and International Classification of Diseases, Ninth Revision codes was used to identify this population followed by a manual review to confirm the diagnosis. Outcomes were then assessed using revision for any reason as the primary end point. Functional outcomes were assessed using Short Form 12 scores. Survivorship curves were generated using the Kaplan-Meier method. RESULTS At an average follow-up of 6.2 years, 19.4% (21/108) of patients required a revision surgery. Instability (5.6%, P = .0278) and periprosthetic joint infection (4.6%, P = .0757) were among the most common reasons for revision. The overall survivorship of TJA at years 2, 5, and 7, respectively, was 96.5% (95% confidence interval [CI], 92.6-100), 86.3% (95% CI, 77.7-94.5), and 75.3% (95% CI, 63.5-87.0). Functional score improvement was less in MS cohort than patients without MS. CONCLUSION Patients with MS are at increased risk of complications, particularly instability and periprosthetic joint infection. Despite this increased risk of complications, patients with MS can demonstrate improved functional outcomes, but not as much as patients without MS. Patients with MS should be counseled appropriately before undergoing TJA.
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Affiliation(s)
- Alexander J Rondon
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Patrick K Schlitt
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Timothy L Tan
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jessica L Phillips
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Max R Greenky
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - James J Purtill
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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21
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Rondon AJ, Tan TL, Schlitt PK, Greenky MR, Phillips JL, Purtill JJ. Total Joint Arthroplasty in Patients With Parkinson's Disease: Survivorship, Outcomes, and Reasons for Failure. J Arthroplasty 2018; 33:1028-1032. [PMID: 29199060 DOI: 10.1016/j.arth.2017.11.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 08/21/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Gait instability and muscle rigidity are known characteristics of Parkinson's disease (PD), putting PD patients at risk for complications following total joint arthroplasty (TJA). The outcomes of Parkinson's patients undergoing TJA are largely unknown. This study evaluated the outcomes of TJA in this population. METHODS A single institution retrospective cohort of 123 TJAs (52 hips, 71 knees) from 2000 to 2016 was reviewed. An electronic chart query was performed using International Classification of Diseases, Ninth revision codes to identify this population. A manual chart review was performed to confirm the diagnosis of PD, survivorship, and reason for failure. A control cohort was matched 2:1 based on age, body mass index, joint, and comorbidities. Outcomes were assessed using revision for any reason as the primary endpoint. Functional outcomes were assessed using Short-Form 12 scores. RESULTS At an average follow-up of 5.3 years, 23.6% of patients required revision surgery. The most common reasons for revision for total knee arthroplasty (TKA) were periprosthetic infection and for total hip arthroplasty (THA) were periprosthetic fracture and dislocation. Overall survivorship of TJA at years 2, 5, and 10 respectively were 94.9%, 87.9%, and 72.3%. The survivorship of TKA was 95.2%, 89.8%, and 66.2%. THA implant survivorship was 94.3%, 85.3%, and 78.7%. Functional score improvement was less in PD cohort than the control. CONCLUSION Patients with PD are at increased risk for complications, particularly periprosthetic infection following TKA and periprosthetic fracture and dislocation following THA. Despite this increased risk of complications, patients with PD can demonstrate improved functional outcomes but not as high as patients without PD. Patients with PD should be counseled appropriately prior to undergoing TJA.
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Affiliation(s)
- Alexander J Rondon
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Timothy L Tan
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Patrick K Schlitt
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Max R Greenky
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jessica L Phillips
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - James J Purtill
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Vongmany J, Luckett T, Lam L, Phillips JL. Family behaviours that have an impact on the self-management activities of adults living with Type 2 diabetes: a systematic review and meta-synthesis. Diabet Med 2018; 35:184-194. [PMID: 29150863 DOI: 10.1111/dme.13547] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2017] [Indexed: 12/27/2022]
Abstract
AIMS To identify family behaviours that adults with Type 2 diabetes' perceive as having an impact on their diabetes self-management. BACKGROUND Research suggests that adults with Type 2 diabetes perceive that family members have an important impact on their self-management; however, it is unclear which family behaviours are perceived to influence self-management practices. METHODS This meta-synthesis identified and synthesized qualitative studies from the databases EMBASE, Medline and CINAHL published between the year 2000 and October 2016. Studies were eligible if they provided direct quotations from adults with Type 2 diabetes, describing the influence of families on their self-management. This meta-synthesis adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. RESULTS Of the 2606 studies screened, 40 were included. This meta-synthesis identified that adults with Type 2 diabetes perceive family behaviours to be either: 1) facilitators of diabetes self-management; 2) barriers to diabetes self-management; or 3) equivocal behaviours with the potential to both support and/or impede diabetes self-management. Seven sub-themes were identified within these themes, including: four facilitator sub-themes ('positive care partnerships'; 'family watchfulness'; 'families as extrinsic motivator' and 'independence from family'); two barrier sub-themes ('obstructive behaviours' and 'limited capacity for family support'); and one equivocal behaviours subtheme ('regular reminders and/or nagging'). CONCLUSION While most family behaviours are unambiguously perceived by adults with Type 2 diabetes to act as facilitators of or barriers to self-management, some behaviours were perceived as being neither clear facilitators nor barriers; these were termed 'equivocal behaviours'. If the concept of 'equivocal behaviours' is confirmed, it may be possible to encourage the adult living with Type 2 diabetes to reframe these behaviours so that they are perceived as enabling their diabetes self-management.
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Affiliation(s)
- J Vongmany
- Centre for Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - T Luckett
- Centre for Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - L Lam
- Centre for Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - J L Phillips
- Centre for Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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Wang H, Robinson RD, Phillips JL, Ryon A, Simpson S, Ford JR, Umejiego J, Duane TM, Putty B, Zenarosa NR. Traumatic Abdominal Solid Organ Injury Patients Might Benefit From Thromboelastography-Guided Blood Component Therapy. J Clin Med Res 2017; 9:433-438. [PMID: 28392864 PMCID: PMC5380177 DOI: 10.14740/jocmr3005w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Thromboelastography (TEG) has been utilized for the guidance of blood component therapy (BCT). We aimed to investigate the association between emergent TEG-guided BCT and clinical outcomes in patients with traumatic abdominal solid organ (liver and/or spleen) injuries. METHODS A single center retrospective study of patients who sustained traumatic liver and/or spleen injuries receiving emergent BCT was conducted. TEG was ordered in all these patients. Patient demographics, general injury information, outcomes, BCT, and TEG parameters were analyzed and compared in patients receiving TEG-guided BCT versus those without. RESULTS A total of 166 patients were enrolled, of whom 52% (86/166) received TEG-guided BCT. A mortality of 12% was noted among patients with TEG-guided BCT when compared with 19% of mortality in patients with non-TEG-guided BCT (P > 0.05). An average of 4 units of packed red blood cell (PRBC) was received in patients with TEG-guided BCT when compared to an average of 9 units of PRBC received in non-TEG-guided BCT patients (P < 0.01). A longer hospital length of stay (LOS, 19 ± 16 days) was found among non-TEG-guided BCT patients when compared to the TEG-guided BCT group (14 ± 12 days, P < 0.05). TEG-guided BCT showed as an independent factor associated with hospital LOS after other variables were adjusted (coefficiency: 5.44, 95% confidence interval: 0.69 - 10.18). CONCLUSIONS Traumatic abdominal solid organ injury patients receiving blood transfusions might benefit from TEG-guided BCT as indicated by less blood products needed and less hospitalization stay among the cohort.
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Affiliation(s)
- Hao Wang
- Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Richard D Robinson
- Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Jessica L Phillips
- Research Institute, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Andrew Ryon
- Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Scott Simpson
- Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Jonathan R Ford
- Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Johnbosco Umejiego
- Research Institute, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Therese M Duane
- Department of General Surgery, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Bradley Putty
- Department of General Surgery, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Nestor R Zenarosa
- Department of Emergency Medicine, Integrative Emergency Services Physician Group, John Peter Smith Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA
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Mark JM, Gandhi RR, Price EL, Phillips JL, Collyer M, Duane TM. Pan-Scanning for Ground Level Falls in the Elderly: Really? J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.06.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Chalouhi N, Daou B, Kung D, Zanaty M, Phillips JL, Tjoumakaris S, Starke RM, Hasan D, Polifka A, Salas S, Rosenwasser RH, Jabbour PM. Fate of the Ophthalmic Artery After Treatment With the Pipeline Embolization Device. Neurosurgery 2016; 77:581-4; discussion 584. [PMID: 26191974 DOI: 10.1227/neu.0000000000000887] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Flow diverters have emerged as a major tool in the treatment of cerebral aneurysms. A crucial issue with the use of flow diverters is the patency of side branches covered by the device, most importantly the ophthalmic artery (OA). OBJECTIVE To assess the patency of the OA after coverage with the pipeline embolization device (PED). METHODS All patients who had a PED covering the OA and in whom angiographic follow-up was available were included in the study. The patency of the OA at follow-up was systematically evaluated by 2 authors who were not involved in the procedure. RESULTS Of 95 treated patients, the OA was covered by 1 PED in 81 patients (85%) and by 2 PEDs in 14 patients (15%). Mean angiographic follow-up was 7.5 months, ranging from 3 to 24 months. At the latest follow-up, the OA remained patent in 85 patients (89%), showed diminished flow in 4 patients (4%), and was occluded in 6 patients (7%). Only 1 patient had clinical symptoms related to OA occlusion. In multivariable analysis, larger aneurysm size predicted OA occlusion (P = .04). There was also a strong trend for younger age (P = .06) and coverage by more than 1 device (P = .07). CONCLUSION Treatment of internal carotid artery aneurysms with the PED preserves the patency of the OA in most cases. The occlusion of the OA in the few cases where it occurs is usually a clinically irrelevant event. Minimizing the number of PEDs across the OA is crucial to preserve its patency.
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Affiliation(s)
- Nohra Chalouhi
- *Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania; ‡Department of Neurosurgery, University of Iowa, Iowa City, Iowa
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Qadi AA, Taberlay PC, Phillips JL, Young A, West AC, Brettingham-Moore KH, Dickinson JL, Holloway AF. The Leukemia Inhibitory Factor Receptor Gene Is a Direct Target of RUNX1. J Cell Biochem 2015; 117:49-58. [DOI: 10.1002/jcb.25246] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 05/29/2015] [Indexed: 12/15/2022]
Affiliation(s)
- Abeer A. Qadi
- Menzies Institute for Medical Research; University of Tasmania; Hobart Tasmania 7000 Australia
| | - Phillippa C. Taberlay
- Genomics and Epigenetics Division; The Garvan Institute of Medical Research; Darlinghurst New South Wales 2010 Australia
| | - Jessica L. Phillips
- Menzies Institute for Medical Research; University of Tasmania; Hobart Tasmania 7000 Australia
| | - Arabella Young
- Menzies Institute for Medical Research; University of Tasmania; Hobart Tasmania 7000 Australia
| | - Alison C. West
- Menzies Institute for Medical Research; University of Tasmania; Hobart Tasmania 7000 Australia
| | | | - Joanne L. Dickinson
- Menzies Institute for Medical Research; University of Tasmania; Hobart Tasmania 7000 Australia
| | - Adele F. Holloway
- School of Medicine; University of Tasmania; Hobart Tasmania 7000 Australia
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Young A, Berry R, Holloway AF, Blackburn NB, Dickinson JL, Skala M, Phillips JL, Brettingham-Moore KH. RNA-seq profiling of a radiation resistant and radiation sensitive prostate cancer cell line highlights opposing regulation of DNA repair and targets for radiosensitization. BMC Cancer 2014; 14:808. [PMID: 25369795 PMCID: PMC4233036 DOI: 10.1186/1471-2407-14-808] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 10/21/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Radiotherapy is a chosen treatment option for prostate cancer patients and while some tumours respond well, up to 50% of patients may experience tumour recurrence. Identification of functionally relevant predictive biomarkers for radioresponse in prostate cancer would enable radioresistant patients to be directed to more appropriate treatment options, avoiding the side-effects of radiotherapy. METHODS Using an in vitro model to screen for novel biomarkers of radioresistance, transcriptome analysis of a radioresistant (PC-3) and radiosensitive (LNCaP) prostate cancer cell line was performed. Following pathway analysis candidate genes were validated using qRT-PCR. The DNA repair pathway in radioresistant PC-3 cells was then targeted for radiation sensitization using the PARP inhibitor, niacinimide. RESULTS Opposing regulation of a DNA repair and replication pathway was observed between PC-3 and LNCaP cells from RNA-seq analysis. Candidate genes BRCA1, RAD51, FANCG, MCM7, CDC6 and ORC1 were identified as being significantly differentially regulated post-irradiation. qRT-PCR validation confirmed BRCA1, RAD51 and FANCG as being significantly differentially regulated at 24 hours post radiotherapy (p-value =0.003, 0.045 and 0.003 respectively). While the radiosensitive LNCaP cells down-regulated BRCA1, FANCG and RAD51, the radioresistant PC-3 cell line up-regulated these candidates to promote cell survival post-radiotherapy and a similar trend was observed for MCM7, CDC6 and ORC1. Inhibition of DNA repair using niacinamide sensitised the radioresistant cells to irradiation, reducing cell survival at 2 Gy from 66% to 44.3% (p-value =0.02). CONCLUSIONS These findings suggest that the DNA repair candidates identified via RNA-seq hold potential as both targets for radiation sensitization and predictive biomarkers in prostate cancer.
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Punj S, Kopparapu P, Jang HS, Phillips JL, Pennington J, Rohlman D, O’Donnell E, Iversen PL, Kolluri SK, Kerkvliet NI. Benzimidazoisoquinolines: a new class of rapidly metabolized aryl hydrocarbon receptor (AhR) ligands that induce AhR-dependent Tregs and prevent murine graft-versus-host disease. PLoS One 2014; 9:e88726. [PMID: 24586378 PMCID: PMC3929365 DOI: 10.1371/journal.pone.0088726] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 01/09/2014] [Indexed: 12/22/2022] Open
Abstract
The aryl hydrocarbon receptor (AhR) is a ligand-activated transcription factor that plays multiple roles in regulation of immune and inflammatory responses. The ability of certain AhR ligands to induce regulatory T cells (Tregs) has generated interest in developing AhR ligands for therapeutic treatment of immune-mediated diseases. To this end, we designed a screen for novel Treg-inducing compounds based on our understanding of the mechanisms of Treg induction by the well-characterized immunosuppressive AhR ligand, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). We screened a ChemBridge small molecule library and identified 10-chloro-7H-benzimidazo[2,1-a]benzo[de]Iso-quinolin-7-one (10-Cl-BBQ) as a potent AhR ligand that was rapidly metabolized and not cytotoxic to proliferating T cells. Like TCDD,10-Cl-BBQ altered donor CD4+ T cell differentiation during the early stages of a graft versus host (GVH) response resulting in expression of high levels of CD25, CTLA-4 and ICOS, as well as several genes associated with Treg function. The Treg phenotype required AhR expression in the donor CD4+ T cells. Foxp3 was not expressed in the AhR-induced Tregs implicating AhR as an independent transcription factor for Treg induction. Structure-activity studies showed that unsubstituted BBQ as well as 4, 11-dichloro-BBQ were capable of inducing AhR-Tregs. Other substitutions reduced activation of AhR. Daily treatment with 10-Cl-BBQ during the GVH response prevented development of GVH disease in an AhR-dependent manner with no overt toxicity. Together, our data provide strong support for development of select BBQs that activate the AhR to induce Tregs for treatment of immune-mediated diseases.
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Affiliation(s)
- Sumit Punj
- Department of Environmental & Molecular Toxicology, Oregon State University, Corvallis, Oregon, United States of America
| | - Prasad Kopparapu
- Department of Environmental & Molecular Toxicology, Oregon State University, Corvallis, Oregon, United States of America
| | - Hyo Sang Jang
- Department of Environmental & Molecular Toxicology, Oregon State University, Corvallis, Oregon, United States of America
| | - Jessica L. Phillips
- Department of Environmental & Molecular Toxicology, Oregon State University, Corvallis, Oregon, United States of America
| | - Jamie Pennington
- Department of Environmental & Molecular Toxicology, Oregon State University, Corvallis, Oregon, United States of America
| | - Diana Rohlman
- Department of Environmental & Molecular Toxicology, Oregon State University, Corvallis, Oregon, United States of America
| | - Edmond O’Donnell
- Department of Environmental & Molecular Toxicology, Oregon State University, Corvallis, Oregon, United States of America
| | - Patrick L. Iversen
- Department of Environmental & Molecular Toxicology, Oregon State University, Corvallis, Oregon, United States of America
| | - Siva Kumar Kolluri
- Department of Environmental & Molecular Toxicology, Oregon State University, Corvallis, Oregon, United States of America
- Environmental Health Sciences Center, Oregon State University, Corvallis, Oregon, United States of America
| | - Nancy I. Kerkvliet
- Department of Environmental & Molecular Toxicology, Oregon State University, Corvallis, Oregon, United States of America
- Environmental Health Sciences Center, Oregon State University, Corvallis, Oregon, United States of America
- * E-mail:
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29
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Phillips JL, Wassersug RJ, McLeod DL. Systemic bias in the medical literature on androgen deprivation therapy and its implication to clinical practice. Int J Clin Pract 2012; 66:1189-96. [PMID: 23163498 DOI: 10.1111/ijcp.12025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND LHRH agonists are used for androgen deprivation therapy (ADT) to treat prostate cancer, but have many side effects that reduce of the quality of life of prostate cancer patients and their partners. Patients are poorly informed about the side effects of these drugs and how to manage them. AIM To test the hypothesis that there is bias in the peer-reviewed literature on ADT that correlates with an association between authors and the luteinising hormone-releasing hormone (LHRH) agonists pharmaceutical industry. METHODS We assessed 155 articles on ADT published in English-language peer-reviewed journals in terms of how comprehensive they were in acknowledging LHRH agonists' side effects. RESULTS Although the literature regarding ADT is substantial, the vast majority of articles failed to acknowledge many of the more stressful side effects of ADT for patients and their partners. Articles most likely to acknowledge the psychosocial impact of ADT were significantly less likely to have had industrial support than those articles that did not mention those side effects. Alternative treatments to the LHRH agonists were rarely mentioned. Authors who indicated some association with a pharmaceutical company tended to minimise the side effects of LHRH agonists and not acknowledge alternatives to the LHRH agonists for ADT. CONCLUSION Industrial support is associated with a proliferation of articles published in the peer-reviewed literature directed at practising physicians. Such flooding of the literature may, in part, limit physicians' knowledge of the side effects of these drugs and, in turn, account for the poor knowledge that patients on LHRH agonists have about the drugs they are taking and ways to manage their side effects.
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Affiliation(s)
- J L Phillips
- Department of Anatomy and Neurobiology, Dalhousie University, Halifax, NS, Canada
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McGlothlin JW, Jawor JM, Greives TJ, Casto JM, Phillips JL, Ketterson ED. Hormones and honest signals: males with larger ornaments elevate testosterone more when challenged. J Evol Biol 2007; 21:39-48. [PMID: 18034801 DOI: 10.1111/j.1420-9101.2007.01471.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
When male investment in mating varies with quality, reliable sexual signals may evolve. In many songbirds, testosterone mediates mating investment, suggesting that signals should be linked to testosterone production. However, because testosterone may change rapidly during behaviour such as territorial aggression and courtship, efforts to establish such a relationship have proved challenging. In a population of dark-eyed juncos, we measured individual variation in the production of short-term testosterone increases by injecting gonadotropin-releasing hormone (GnRH). We found a positive correlation between the magnitude of these increases and the size of a plumage ornament ('tail white') previously shown to be important for female choice and male-male competition. We then measured naturally elevated testosterone levels produced during male-male competition and found that they covaried with those induced by GnRH. We suggest that the association between tail white and testosterone increases may allow conspecifics to assess potential mates and competitors reliably using tail white.
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Affiliation(s)
- J W McGlothlin
- Department of Biology and Center for the Integrative Study of Animal Behavior, Indiana University, Bloomington, IN, USADepartment of Biological Sciences, The University of Southern Mississippi, Hattiesburg, MS, USADepartment of Biological Sciences, Illinois State University, Normal, IL, USABiology Department, The College of William & Mary, Williamsburg, VA, USA
| | - J M Jawor
- Department of Biology and Center for the Integrative Study of Animal Behavior, Indiana University, Bloomington, IN, USADepartment of Biological Sciences, The University of Southern Mississippi, Hattiesburg, MS, USADepartment of Biological Sciences, Illinois State University, Normal, IL, USABiology Department, The College of William & Mary, Williamsburg, VA, USA
| | - T J Greives
- Department of Biology and Center for the Integrative Study of Animal Behavior, Indiana University, Bloomington, IN, USADepartment of Biological Sciences, The University of Southern Mississippi, Hattiesburg, MS, USADepartment of Biological Sciences, Illinois State University, Normal, IL, USABiology Department, The College of William & Mary, Williamsburg, VA, USA
| | - J M Casto
- Department of Biology and Center for the Integrative Study of Animal Behavior, Indiana University, Bloomington, IN, USADepartment of Biological Sciences, The University of Southern Mississippi, Hattiesburg, MS, USADepartment of Biological Sciences, Illinois State University, Normal, IL, USABiology Department, The College of William & Mary, Williamsburg, VA, USA
| | - J L Phillips
- Department of Biology and Center for the Integrative Study of Animal Behavior, Indiana University, Bloomington, IN, USADepartment of Biological Sciences, The University of Southern Mississippi, Hattiesburg, MS, USADepartment of Biological Sciences, Illinois State University, Normal, IL, USABiology Department, The College of William & Mary, Williamsburg, VA, USA
| | - E D Ketterson
- Department of Biology and Center for the Integrative Study of Animal Behavior, Indiana University, Bloomington, IN, USADepartment of Biological Sciences, The University of Southern Mississippi, Hattiesburg, MS, USADepartment of Biological Sciences, Illinois State University, Normal, IL, USABiology Department, The College of William & Mary, Williamsburg, VA, USA
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Abstract
Endocast analysis of the brain Homo floresiensis by Falk et al. (Reports, 8 April 2005, p. 242) implies that the hominid is an insular dwarf derived from H. erectus, but its tiny cranial capacity cannot result from normal dwarfing. Consideration of more appropriate microcephalic syndromes and specimens supports the hypothesis of modern human microcephaly.
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Affiliation(s)
- R D Martin
- Field Museum, Chicago, IL 60605-2496, USA
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Phillips JL, Hayward SW, Wang Y, Vasselli J, Pavlovich C, Padilla-Nash H, Pezullo JR, Ghadimi BM, Grossfeld GD, Rivera A, Linehan WM, Cunha GR, Ried T. The consequences of chromosomal aneuploidy on gene expression profiles in a cell line model for prostate carcinogenesis. Cancer Res 2001; 61:8143-9. [PMID: 11719443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Here we report the genetic characterization of immortalized prostate epithelial cells before and after conversion to tumorigenicity using molecular cytogenetics and microarray technology. We were particularly interested to analyze the consequences of acquired chromosomal aneuploidies with respect to modifications of gene expression profiles. Compared with nontumorigenic but immortalized prostate epithelium, prostate tumor cell lines showed high levels of chromosomal rearrangements that led to gains of 1p, 5, 11q, 12p, 16q, and 20q and losses of 1pter, 11p, 17, 20p, 21, 22, and Y. Of 5700 unique targets on a 6.5K cDNA microarray, approximately 3% were subject to modification in expression levels; these included GRO-1, -2, IAP-1,- 2, MMP-9, and cyclin D1, which showed increased expression, and TRAIL, BRCA1, and CTNNA, which showed decreased expression. Thirty % of expression changes occurred in regions the genomic copy number of which remained balanced. Of the remainder, 42% of down-regulated and 51% of up-regulated genes mapped to regions present in decreased or increased genomic copy numbers, respectively. A relative gain or loss of a chromosome or chromosomal arm usually resulted in a statistically significant increase or decrease, respectively, in the average expression level of all of the genes on the chromosome. However, of these genes, very few (e.g., 5 of 101 genes on chromosome 11q), and in some instances only two genes (MMP-9 and PROCR on chromosome 20q), were overexpressed by > or =1.7-fold when scored individually. Cluster analysis by gene function suggests that prostate tumorigenesis in these cell line models involves alterations in gene expression that may favor invasion, prevent apoptosis, and promote growth.
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Affiliation(s)
- J L Phillips
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, NIH, 10 Center Drive, Bethesda, MD 20817, USA.
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Phillips JL, Pavlovich CP, Walther M, Ried T, Linehan WM. The genetic basis of renal epithelial tumors: advances in research and its impact on prognosis and therapy. Curr Opin Urol 2001; 11:463-9. [PMID: 11493766 DOI: 10.1097/00042307-200109000-00003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The genetics of renal cell carcinoma continues to elucidate the pathways of kidney tumorigenesis. The relationship between the VHL gene and clear cell carcinoma, MET and papillary carcinoma, and the families of genes that they regulate, continues to be unraveled. New hereditary kidney cancer syndromes, like familial oncocytoma and the Birt-Hogg-Dubé syndrome, have been identified and the search for the genes that cause them is under way. Researching the genetics of these disorders is essential for an understanding of sporadic kidney cancer genetics. This chapter will review the current knowledge of the hereditary kidney cancer syndromes, the genes that cause them, new advances in genetic research and techniques, and how this information impacts upon diagnostic, prognostic, and therapeutic methods of the future.
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Affiliation(s)
- J L Phillips
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.
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Phillips JL, Ghadimi BM, Wangsa D, Padilla-Nash H, Worrell R, Hewitt S, Walther M, Linehan WM, Klausner RD, Ried T. Molecular cytogenetic characterization of early and late renal cell carcinomas in von Hippel-Lindau disease. Genes Chromosomes Cancer 2001; 31:1-9. [PMID: 11284029 DOI: 10.1002/gcc.1111] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [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: 11/06/2022] Open
Abstract
Deletions of 3p25, gains of chromosomes 7 and 10, and isochromosome 17q are known cytogenetic aberrations in sporadic renal cell carcinoma (RCC). In addition, a majority of RCCs have loss of heterozygosity (LOH) of the Von Hippel-Lindau (VHL) gene located at chromosome band 3p25. Patients who inherit a germline mutation of the VHL gene can develop multifocal RCCs and other solid tumors, including malignancies of the pancreas, adrenal medulla, and brain. VHL tumors follow the two-hit model of tumorigenesis, as LOH of VHL, a classic tumor suppressor gene, is the critical event in the development of the neoplastic phenotype. In an attempt to define the cytogenetic aberrations from early tumors to late RCC further, we applied spectral karyotyping (SKY) to 23 renal tumors harvested from 6 unrelated VHL patients undergoing surgery. Cysts and low-grade solid lesions were near-diploid and contained 1-2 reciprocal translocations, dicentric chromosomes, and/or isochromosomes. A variety of sole numerical aberrations included gains of chromosomes 1, 2, 4, 7, 10, 13, 21, and the X chromosome, although no tumors had sole numerical losses. Three patients shared a breakpoint at 2p21-22, and three others shared a dicentric chromosome 9 or an isochromosome 9q. In contrast to the near-diploidy of the low-grade lesions, a high-grade lesion and its nodal metastasis were markedly aneuploid, revealed loss of VHL by fluorescence in situ hybridization (FISH), and contained recurrent unbalanced translocations and losses of chromosome arms 2q, 3p, 4q, 9p, 14q, and 19p as demonstrated by comparative genomic hybridization (CGH). By combining SKY, CGH, and FISH of multiple tumors from the same VHL kidney, we have begun to identify chromosomal aberrations in the earliest stages of VHL-related renal cell tumors. Our current findings illustrate the cytogenetic heterogeneity of different VHL lesions from the same kidney, which supports the multiclonal origins of hereditary RCCs. Published 2001 Wiley-Liss, Inc.
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Affiliation(s)
- J L Phillips
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.
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Phillips JL, Walther MM, Pezzullo JC, Rayford W, Choyke PL, Berman AA, Linehan WM, Doppman JL, Gill JR. Predictive value of preoperative tests in discriminating bilateral adrenal hyperplasia from an aldosterone-producing adrenal adenoma. J Clin Endocrinol Metab 2000; 85:4526-33. [PMID: 11134103 DOI: 10.1210/jcem.85.12.7086] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In primary hyperaldosteronism, discriminating bilateral adrenal hyperplasia (BAH) from an aldosterone-producing adenoma (APA) is important because adrenalectomy, which is usually curative in APA, is seldom effective in BAH. We analyzed the results from our most recent 7-yr series to evaluate the predictive value of preoperative noninvasive tests compared with adrenal vein sampling (AVS). Forty-eight patients with hypertensive hyperaldosteronism underwent bedside testing, computed tomography (CT) imaging, and AVS. Those in whom the results of AVS indicated APA underwent adrenalectomy. Twelve (30%) and 14 (34%) of 41 patients with APA had paradoxical falls with ambulation in plasma aldosterone concentration (PAC) and 18-hydroxycorticosterone (18-OH-B), respectively. Twenty-nine (70%) and 26 (65%) APA patients had a rise in PAC and 18-OH-B, respectively, as did all 8 BAH patients. Significant identifiers of BAH were supine PAC values less than 15 ng/dL (P: = 0.04), an increase greater than 60% (P: = 0.02) in PAC with ambulation, and supine 18-OH-B values less than 60 ng/dL (P: = 0.04). CT imaging alone was not predictive for BAH or APA. In our population, patients with a positive bedside test result (e.g. a fall in PAC and/or 18-OH-B) and a unilateral adrenal nodule on CT (10 of 41 patients) could have proceeded directly to adrenalectomy for APA. However, a positive bedside test result with a negative CT or a negative bedside test result regardless of CT findings required AVS to confirm the diagnosis and site of disease.
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Affiliation(s)
- J L Phillips
- Urologic Oncology Branch/National Cancer Institute, National Cancer Institute, Bethesda, MD 20892-1501, USA
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Ivaschuk OI, Jones RA, Ishida-Jones T, Haggren W, Adey WR, Phillips JL. Exposure of nerve growth factor-treated PC12 rat pheochromocytoma cells to a modulated radiofrequency field at 836.55 MHz: effects on c-jun and c-fos expression. Bioelectromagnetics 2000; 18:223-9. [PMID: 9096840 DOI: 10.1002/(sici)1521-186x(1997)18:3<223::aid-bem4>3.0.co;2-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.4] [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: 02/04/2023]
Abstract
Rat PC12 pheochromocytoma cells have been treated with nerve growth factor and then exposed to athermal levels of a packet-modulated radiofrequency field at 836.55 MHz. This signal was produced by a prototype time-domain multiple-access (TDMA) transmitter that conforms to the North American digital cellular telephone standard. Three slot average power densities were used: 0.09, 0.9, and 9 mW/cm2. Exposures were for 20, 40, and 60 min and included an intermittent exposure regimen (20 min on/20 min off), resulting in total incubation times of 20, 60, and 100 min, respectively. Concurrent controls were sham exposed. After extracting total cellular RNA, Northern blot analysis was used to assess the expression of the immediate early genes, c-fos and c-jun, in all cell populations. No change in c-fos transcript levels were detected after 20 min exposure at each field intensity (20 min was the only time period at which c-fos message could be detected consistently). Transcript levels for c-jun were altered only after 20 min exposure to 9 mW/cm2 (average 38% decrease).
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Affiliation(s)
- O I Ivaschuk
- Jerry L. Pettis Memorial Veterans Administration Medical Center, Loma Linda, CA 92357, USA
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Hundahl SA, Phillips JL, Menck HR. The National Cancer Data Base Report on poor survival of U.S. gastric carcinoma patients treated with gastrectomy: Fifth Edition American Joint Committee on Cancer staging, proximal disease, and the "different disease" hypothesis. Cancer 2000. [PMID: 10679663 DOI: 10.1002/(sici)1097-0142(20000215)88:4<921::aid-cncr24>3.0.co;2-s] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND A high proportion of U.S. patients with gastric carcinoma do not receive surgical treatment. To sharpen staging criteria and facilitate comparisons with surgical series, an analysis of patients whose treatment included gastrectomy was undertaken. In addition, to evaluate the "different disease" hypothesis as an explanation for superior Japanese results, outcomes for Japanese Americans were examined. METHODS Data were obtained from National Cancer Data Base (NCDB) reports of 50,169 gastric carcinoma cases diagnosed during the years 1985-1996 and treated with gastrectomy. In addition to demographic and treatment information, 5-year and 10-year relative survival rates are presented, with stage defined according to fifth edition American Joint Committee on Cancer (AJCC) staging procedures. RESULTS Stage-stratified 5-year and 10-year relative survival rates were as follows: Stage IA, 78%/65%; Stage IB, 58%/42%; Stage II, 34%/26%; Stage IIIA, 20%/14%; Stage IIIB, 8%/3%; and Stage IV, 7%/5%. Stage-stratified survival for Japanese Americans was higher. Males had a poorer prognosis than females, and the male-to-female ratio for Japanese Americans was lower. Proximal tumors were associated with a worse prognosis than distal tumors; the proportion of Japanese Americans with proximal disease was less than in the overall patient group. Japanese Americans underwent resection of adjacent organs less frequently. In this series, adjuvant therapy did not substantially affect survival. Overall, 20% were 10-year survivors; of these, 67% were lymph node negative and 98% had </= 8 involved lymph nodes. Five-year stage-stratified survival increased for cases with >/= 15 lymph nodes analyzed. Stage migration was evident in cases with </= 15 nodes examined. CONCLUSIONS The current AJCC/International Union Against Cancer TNM staging system fails to accommodate the effect of proximal location on prognosis. Largely because Japanese Americans present with fewer proximal tumors, have a lower male-to-female ratio, and undergo adjacent organ resection less frequently, stage- stratified survival for Japanese Americans appears to be superior. In the U.S., surgical undertreatment of patients with this disease appears to be a problem.
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Affiliation(s)
- S A Hundahl
- Department of Surgery, The Queen's Medical Center, Honolulu, Hawaii, USA
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Hundahl SA, Phillips JL, Menck HR. The National Cancer Data Base Report on poor survival of U.S. gastric carcinoma patients treated with gastrectomy: Fifth Edition American Joint Committee on Cancer staging, proximal disease, and the "different disease" hypothesis. Cancer 2000. [PMID: 10679663 DOI: 10.1002/(sici)1097-0142(20000215)88] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND A high proportion of U.S. patients with gastric carcinoma do not receive surgical treatment. To sharpen staging criteria and facilitate comparisons with surgical series, an analysis of patients whose treatment included gastrectomy was undertaken. In addition, to evaluate the "different disease" hypothesis as an explanation for superior Japanese results, outcomes for Japanese Americans were examined. METHODS Data were obtained from National Cancer Data Base (NCDB) reports of 50,169 gastric carcinoma cases diagnosed during the years 1985-1996 and treated with gastrectomy. In addition to demographic and treatment information, 5-year and 10-year relative survival rates are presented, with stage defined according to fifth edition American Joint Committee on Cancer (AJCC) staging procedures. RESULTS Stage-stratified 5-year and 10-year relative survival rates were as follows: Stage IA, 78%/65%; Stage IB, 58%/42%; Stage II, 34%/26%; Stage IIIA, 20%/14%; Stage IIIB, 8%/3%; and Stage IV, 7%/5%. Stage-stratified survival for Japanese Americans was higher. Males had a poorer prognosis than females, and the male-to-female ratio for Japanese Americans was lower. Proximal tumors were associated with a worse prognosis than distal tumors; the proportion of Japanese Americans with proximal disease was less than in the overall patient group. Japanese Americans underwent resection of adjacent organs less frequently. In this series, adjuvant therapy did not substantially affect survival. Overall, 20% were 10-year survivors; of these, 67% were lymph node negative and 98% had </= 8 involved lymph nodes. Five-year stage-stratified survival increased for cases with >/= 15 lymph nodes analyzed. Stage migration was evident in cases with </= 15 nodes examined. CONCLUSIONS The current AJCC/International Union Against Cancer TNM staging system fails to accommodate the effect of proximal location on prognosis. Largely because Japanese Americans present with fewer proximal tumors, have a lower male-to-female ratio, and undergo adjacent organ resection less frequently, stage- stratified survival for Japanese Americans appears to be superior. In the U.S., surgical undertreatment of patients with this disease appears to be a problem.
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Affiliation(s)
- S A Hundahl
- Department of Surgery, The Queen's Medical Center, Honolulu, Hawaii, USA
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Abstract
BACKGROUND Primary lung cancer accounts for approximately 14% of all new cancers and 28% of cancer deaths in the U.S. Previous reviews have shown limited progress in the management or outcome of this devastating disease. METHODS Reports described in the current study were 713,043 primary lung malignancies diagnosed between 1985 and 1995 and submitted to the National Cancer Data Base. Demographic, tumor, and treatment patterns for 1995 were compared with those for 1985-1987, 1988-1991, and 1992-1994. Ten-year relative survival rates were presented for selected demographic and histologic groups and 5-year relative survival rates were presented by stage and dominant treatment modalities for major carcinoma histologies. RESULTS Previously observed demographic trends were evident, with increasing proportions of patients being older, female, and African American, and more cases reported to be adenocarcinomas. There was a substantial shift toward more complete staging but no change in the distribution of staged cases. Compared with earlier patients, fewer 1995 patients received cancer-directed treatment. More surgical patients underwent lymph node dissection, and radiation treatment was supplemented more often with chemotherapy. The overall 10-year relative survival rate was 7%. The 5-year survival for American Joint Committee on Cancer Stage I surgical patients was >50% for all nonsmall cell histologic groups. CONCLUSIONS Recent shifts in treatment, although minimal, are consistent with current literature concerning the effectiveness of lung carcinoma treatment. The authors believe that the overall poor survival of lung carcinoma patients points to a continuing need for improved prevention and treatment measures. The comparatively superior survival of Stage I nonsmall cell lung carcinoma surgical patients indicates that a substantial number of patients have the potential to be treated successfully.
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Affiliation(s)
- W A Fry
- Department of Clinical Surgery, Northwestern University Medical School and Section of Thoracic Surgery, Evanston Northwestern Healthcare, Evanston, Illinois, USA
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Adey WR, Byus CV, Cain CD, Higgins RJ, Jones RA, Kean CJ, Kuster N, MacMurray A, Stagg RB, Zimmerman G, Phillips JL, Haggren W. Spontaneous and nitrosourea-induced primary tumors of the central nervous system in Fischer 344 rats chronically exposed to 836 MHz modulated microwaves. Radiat Res 1999; 152:293-302. [PMID: 10453090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
We have tested an 836.55 MHz field with North American Digital Cellular (NADC) modulation in a 2-year animal bioassay that included fetal exposure. In offspring of pregnant Fischer 344 rats, we tested both spontaneous tumorigenicity and the incidence of induced central nervous system (CNS) tumors after a single dose of the carcinogen ethylnitrosourea (ENU) in utero, followed by intermittent digital-phone field exposure for 24 months. Far-field exposures began on gestational day 19 and continued until weaning at age 21 days. Near-field exposures began at 35 days and continued for the next 22 months, 4 consecutive days weekly, 2 h/day. SAR levels simulated localized peak brain exposures of a cell phone user. Of the 236 original rats, 182 (77%) survived to the termination of the whole experiment and were sacrificed at age 709-712 days. The 54 rats (23%) that died during the study ("preterm rats") formed a separate group for some statistical analyses. There was no evidence of tumorigenic effects in the CNS from exposure to the TDMA field. However, some evidence of tumor-inhibiting effects of TDMA exposure was apparent. Overall, the TDMA field-exposed animals exhibited trends toward a reduced incidence of spontaneous CNS tumors (P < 0. 16, two-tailed) and ENU-induced CNS tumors (P < 0.16, two-tailed). In preterm rats, where primary neural tumors were determined to be the cause of death, fields decreased the incidence of ENU-induced tumors (P < 0.03, two-tailed). We discuss a possible approach to evaluating with greater certainty the possible inhibitory effects of TDMA-field exposure on tumorigenesis in the CNS.
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Affiliation(s)
- W R Adey
- Department of Biochemistry, University of California, Riverside, California 92521, USA
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Abstract
BACKGROUND Vulvar melanoma is a very rare form of cancer. The purpose of this study was to describe practice patterns for the management of vulvar melanoma. STUDY DESIGN The National Cancer Data Base was reviewed from 1985 through 1994 for patient reports submitted with a diagnosis of vulvar melanoma. RESULTS Five hundred sixty-nine patients with vulvar melanoma were identified. A substantial number of patients were older; during the latter period of this study (1990 to 1994), 50% were 70 years old or older. Surgery was used in more than 90% of patients with stages 0 to III. Local excision was used mainly in early-stage (0 and I) disease. Adjuvant therapy was used infrequently. Lymph node evaluation was performed in more than half of the patients, with greater frequency for patients who had advanced disease. The overall 5-year relative survival rate was 62%. If the lymph nodes contained metastases, survival was poor. Patients with recurrent disease also had poor survival. CONCLUSIONS Surgery remains the mainstay of therapy for vulvar melanoma. The use of excision and radical operations remained constant during the 10 years of the study.
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Affiliation(s)
- W T Creasman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, USA
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Geevarghese SK, Flakoll P, Bradley AL, Wright JK, Chapman WC, Van Buren D, Sika M, Blair KT, Jabbour K, Williams PE, Hutchins CH, Phillips JL, Pinson CW. The effect of nutritional and hormonal supplementation on protein synthesis immediately after liver transplantation. J Surg Res 1999; 81:196-200. [PMID: 9927540 DOI: 10.1006/jsre.1998.5509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We have previously shown that immediately after liver transplantation (LT) the porcine recipient exhibits elevated plasma glucagon, increased fractional synthetic rate (FSR) of fibrinogen, and decreased FSR of fixed or structural liver proteins. The purpose of this study was to evaluate the effect of nutritional and hormonal supplementation on these observations 24 h after LT. Two groups of nine pigs were studied 1 day after LT using radioisotopic and arteriovenous difference techniques. A control group underwent LT with saline infusion and a supplemented group underwent LT with infusion of glucose, amino acids (6 and 1.06 mg/kg. min, respectively), and intraportal insulin (0.6 mU/kg. min) and glucagon (1.3 ng/kg. min). Primed constant infusions of [3H]leucine were used to determine leucine flux, an estimate of whole body protein breakdown, and fractional synthetic rates (FSR). The following changes were noted with supplementation: elevated plasma insulin (6 +/- 1 versus 29 +/- 4 microU/ml, control versus supplemented, respectively, P < 0.05), decreased glucagon to normal levels (323 +/- 65 versus 102 +/- 12 pg/ml, P < 0.05), decreased fibrinogen FSR (108 +/- 15 versus 70 +/- 6%/day, P < 0.025), and increased fixed liver protein FSR (8 +/- 1 versus 13 +/- 2%/day, P < 0.05, respectively). Albumin FSR was unaltered by supplementation (8 +/- 2 versus 6 +/- 1%/day, respectively). Nutritional and hormonal supplementation immediately after LT restored the measured protein synthesis in the allograft to near normal levels 1 day after transplantation.
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Affiliation(s)
- S K Geevarghese
- Division of Hepatobiliary Surgery and Liver Transplantation and Section of Surgical Sciences, Vanderbilt University Medical Center. Nashville, TN, USA
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Abstract
BACKGROUND Although the incidence of uterine carcinoma is lower among African-American women compared with white women, the mortality rates are higher for African-American patients. This report is part of an ongoing series on gynecologic malignancies in African-American women. METHODS Hospital registry reports collected by the National Cancer Data Base were used to describe some of the differences in case presentation and management characteristics of endometrial carcinoma in these two groups. The cases represented 52,307 Non-Hispanic white and 3226 African-American women diagnosed with primary carcinoma of the endometrium between 1988-1994. RESULTS More African-American patients were diagnosed with less favorable histologies than white patients, at more advanced stages of disease, and with less tumor differentiation. Income had no effect on stage or grade. African-American patients were treated less often for their tumor at every stage of diagnosis compared with white women. Income generally had no effect on whether treatment was provided, but limited income was associated with a lack of treatment in African-American patients with American Joint Committee on Cancer Stage IV tumors. African-American women were less frequently treated surgically and, among surgically treated patients at advanced stages of disease, they received adjuvant radiotherapy less often and chemotherapy more often than white patients. Five-year survival was poorer for African-American women, even for patients with the more favorable Stage I adenocarcinoma who were treated surgically. CONCLUSIONS All patients, regardless of race, should be treated appropriately as dictated by medical and prognostic factors and not by race. Although no screening methods currently exist for endometrial carcinoma, the development of procedures for identifying patients at risk for the prognostic factors that lead to a poor outcome should be a primary focus.
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Affiliation(s)
- M L Hicks
- Department of Obstetrics and Gynecology, Henry Ford Hospital, Detroit, Michigan, USA
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Campbell-Beachler M, Ishida-Jones T, Haggren W, Phillips JL. Effect of 60 Hz magnetic field exposure on c-fos expression in stimulated PC12 cells. Mol Cell Biochem 1998; 189:107-11. [PMID: 9879660 DOI: 10.1023/a:1006872309385] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Rat pheochromocytoma PC12 cells have been treated with nerve growth factor (NGF) at final concentrations of 2, 4, 8, and 16 ng/ml, and then were exposed to 60-Hz, sinusoidal magnetic fields (MF) of 12.5, 25, 50, and 100 microT (rms) for 30 min. Transcript levels for both c-fos and glyceraldehyde-3 -phosphate dehydrogenase were determined by Northern blot analysis using 32P-labeled cDNA probes. No change in c-fos expression was measured at any condition employed. Treatment of PC12 cells with a combination of agents (NGF, forskolin, and tetradecanoylphorbol acetate [TPA]) increased c-fos expression over that detected with NGF alone. MF exposure of cells treated with the three-agent regimen produced two outcomes, either no change or a doubling of c-fos expression. In subsequent experiments, cells were treated with NGF, NGF + forskolin + TPA, or pre-treated with anisomycin and then treated with NGF + forskolin + TPA. It was determined that MF exposure, like superinduction with anisomycin, increased c-fos expression only in cultures which were not yet exhibiting maximal c-fos expression. It is hypothesized that MF exposure, like anisomycin, may alter the activity of key intracellular protein kinases.
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Beers GJ, Phillips JL, Prato FS, Nair I. Biologic effects of low-level electromagnetic fields: current issues and controversies. Magn Reson Imaging Clin N Am 1998; 6:749-74. [PMID: 9799854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
There is uncertainty and controversy about the extent to which low level electromagnetic fields may cause deleterious effects, but even experts who are skeptical about many supposed hazards are willing to agree that electromagnetic fields even weaker than those in the MR environment can have effects under certain conditions. In order that readers can familiarize themselves enough with the subject to make an informed independent assessment, discuss it knowledgeably in public, and have the means with which to evaluate new developments and avoid experimental pitfalls if planning their own research in the area, they are provided with some of the most recent finding of in vitro and in vivo research from outside the MR literature as well as some of the results and controversies coming from recent epidemiological studies.
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Affiliation(s)
- G J Beers
- Jerry L. Pettis VA Medical Center, Loma Linda, California, USA
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Creasman WT, Phillips JL, Menck HR. The National Cancer Data Base report on cancer of the vagina. Cancer 1998; 83:1033-40. [PMID: 9731908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND This study was conducted to determine practice patterns in the management of vaginal malignancy. METHODS The National Cancer Data Base (NCDB), a large central registry of hospital case data, was reviewed for the 10-year period 1985-1994 for patients registered with a primary diagnosis of vaginal cancer. Patients with a prior history of malignancy were excluded. RESULTS Between 1985-1994 4885 cases of vaginal cancer were submitted to NCDB. More than 90% were epithelial neoplasia with approximately 25% of these in situ lesions only. Squamous carcinoma was more common as the age of the patient progressed. Adenocarcinomas represented nearly all the carcinomas in the group of patients age < 20 years and were observed less frequently with advanced age. Relative survival at 5 years was stage-related: Stage 0: 96%; Stage I: 73%; Stage II: 58%; and Stages III-IV: 36%. Melanoma had an extremely poor prognosis with a 5-year survival rate of only 14%. A significant number of sarcomas occurred in children for whom chemotherapy played a major role in treatment. Chemotherapy was used less frequently in the older patients. Survival was better in the younger patients (90% vs. 30% in the older patients). CONCLUSIONS Although vaginal cancer is the rarest of genital malignancies, it appears that treatment and results from the NCDB reported from multiple institutions followed prescribed treatment guidelines.
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Affiliation(s)
- W T Creasman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, USA
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Abstract
BACKGROUND The development of nasopharyngeal carcinoma reflects interactions of genetics, diet, and viral agents. It is more common in Asians than non-Asians, with different characteristic histologic types. This study examined nasopharyngeal carcinoma in the U.S. as a function of patient origin and histology. METHODS The data were from the National Cancer Data Base (NCDB). The 5069 nasopharyngeal carcinoma cases were grouped by histologic type: keratinizing squamous cell, nonkeratinizing, and undifferentiated carcinoma. Patient origin was derived from race, Hispanic ethnicity, and place of birth. RESULTS World Health Organization (WHO) type 1 keratinizing squamous cell carcinomas comprised 75% of the U.S. nasopharyngeal carcinoma cases and were found most often in U.S.-born, non-Hispanic whites. WHO-2 nonkeratinizing and WHO-3 undifferentiated carcinomas of the nasopharnyx comprised the remaining 25% of nasopharyngeal carcinomas and were more common in Asians. Histologic composition varied for each of the 12 patient origin groups in the study and correlated with survival after treatment with ionizing radiation. Asians had the highest proportion of radioresponsive WHO-2 nonkeratinizing and WHO-3 undifferentiated carcinomas of the nasopharynx and better survival than African-Americans and Hispanic and non-Hispanic whites, who had the greatest number of the less radioresponsive keratinizing squamous cell carcinomas of the nasopharynx. The 5-year relative survival was 65% for the nonkeratinizing and undifferentiated carcinomas of the nasopharynx and 37% for the keratinizing variety. CONCLUSIONS The survival rate of the patient origin groups correlated with the histologic composition of their nasopharyngeal carcinomas. Those with the highest proportion of radioresponsive nonkeratinizing and undifferentiated carcinomas had the best survival.
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Affiliation(s)
- J E Marks
- Department of Radiation Oncology, Missouri Baptist Medical Center, St. Louis, USA
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Wadia JS, Chalmers-Redman RM, Ju WJ, Carlile GW, Phillips JL, Fraser AD, Tatton WG. Mitochondrial membrane potential and nuclear changes in apoptosis caused by serum and nerve growth factor withdrawal: time course and modification by (-)-deprenyl. J Neurosci 1998; 18:932-47. [PMID: 9437015 PMCID: PMC6792769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Studies in non-neural cells have suggested that a fall in mitochondrial membrane potential (DeltaPsiM) is one of the earliest events in apoptosis. It is not known whether neural apoptosis caused by nerve growth factor (NGF) and serum withdrawal involves a decrease in DeltaPsiM. We used epifluorescence and laser confocal microscopy with the mitochondrial potentiometric dyes chloromethyl-tetramethylrosamine methyl ester and 5,5',6, 6'-tetrachloro-1,1',3,3'-tetraethybenzimidazol carbocyanine iodide to estimate DeltaPsiM. PC12 cells were differentiated in media containing serum and NGF for 6 d before withdrawal of trophic support. After washing, the cells were incubated with media containing serum and NGF (M/S+N), media without serum and NGF, or media with the "trophic-like" monoamine oxidase B inhibitor, (-)-deprenyl. Mitochondria in cells without trophic support underwent a progressive shift to lower DeltaPsiM values that was significant by 3 hr after washing. The percentages of cells with nuclear chromatin condensation or nuclear DNA fragmentation were not significantly increased above those for cells in M/S+N until 6 hr after washing. Replacement of cells into M/S+N or treatment with (-)-deprenyl markedly reduced the proportion of mitochondria with decreased DeltaPsiM. Measurements of cytoplasmic peroxyl radical levels with 2',7'-dihydrodichlorofluorescein fluorescence and intramitochondrial Ca2+ with dihydro-rhodamine-2-acetylmethyl ester indicated that cytoplasmic peroxyl radical levels were not increased until after 6 hr, whereas increases in intramitochondrial Ca2+ paralleled the decreases in DeltaPsiM. (-)-Deprenyl appeared to alter the relationship between intramitochondrial Ca2+ levels and DeltaPsiM, possibly through its reported capacity to increase the synthesis of proteins such as BCL-2.
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Affiliation(s)
- J S Wadia
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada M55 1A8
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Phillips JL, Holdengreber V, Ben-Shaul Y, Zhang J, Tolan DR, Hausman RE. Developmental localization of retina cognin synthesis by in situ hybridization. Brain Res Dev Brain Res 1997; 104:143-52. [PMID: 9466717 DOI: 10.1016/s0165-3806(97)00172-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Retina cognin (R-cognin) is a 50 kDa protein involved in cell recognition and neuronal differentiation during development of the embryonic chick retina. Initial characterization of a partial cDNA encoding R-cognin revealed a striking similarity to the cDNA encoding protein disulfide isomerase (PDI), a 57 kDa multifunctional protein. The exact nature of the relationship between R-cognin and PDI is not known; however, both proteins appear to be encoded by the same gene. In the present study, we developed cRNA probes to examine the expression of R-cognin and PDI transcripts in embryonic chick retina and liver. In the retina, the amount of transcript decreased with embryonic age, in parallel to a similar decrease in R-cognin protein. In the liver, where PDI is prominently expressed, the amount of transcript was not developmentally regulated. The spatial and temporal pattern of expression of the R-cognin-encoding retinal transcript was examined by in situ hybridization. R-cognin mRNA was expressed in cells across the retina early in retinogenesis, but became restricted to the cells of the inner retina later in development. This pattern of expression was the same as the developmental pattern of R-cognin protein [Dobi et al., Invest. Ophthalmol. Vis. Sci. 27, (1986) p. 323-329], thus, demonstrating that this secreted protein functions at the surface of the cells where it is transcribed.
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Affiliation(s)
- J L Phillips
- Department of Biology, Boston University, MA 02215, USA
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Fleming ID, Phillips JL, Menck HR, Murphy GP, Winchester DP. The National Cancer Data Base report on recent hospital cancer program progress toward complete American Joint Committee on Cancer/TNM staging. Cancer 1997; 80:2305-10. [PMID: 9404708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND American Joint Committee on Cancer (AJCC) staging procedures were first published in 1977. Since 1991 the Commission on Cancer (COC) has required AJCC staging of all nonpediatric cancers. The National Cancer Data Base (NCDB) encouraged recording of AJCC staging through analyses of selected aspects of staging completeness. We reviewed the trend toward the adoption of routine AJCC staging by hospitals for the 5-year period 1990-1994. METHODS NCDB reports for nearly 2 million stageable cancers diagnosed from 1990 through 1994 were examined with emphasis on the hospital cancer program environment. Staging was complete if the hospital submitted stage codes for > or =90% of stageable cases or absent if stage codes were submitted for <5%. Hospitals were classified by ownership and type of cancer program. Regional staging practices also were reviewed. RESULTS Overall staging increased from 78% to 88%, with increases for every site except carcinomas of the skin, cancers of the extrahepatic bile ducts and urethra, melanoma of the eyelid, and retinoblastoma The percent of hospitals staging completely increased from 49% to 61%, and the percent not routinely staging decreased from 6% to 3%. Complete staging increased in all hospital categories except For-Profit. The trend toward complete staging was uneven among states and regions. CONCLUSIONS Hospital staging policies were affected by activities of the AJCC, COC, NCDB, clinical protocol procedures, and state policies. The varied completeness of staging at the hospital level by state, region, and type of hospital indicates that the adoption of routine staging is ongoing.
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Affiliation(s)
- I D Fleming
- American Joint Committee on Cancer, University of Tennessee Center for Health Sciences, Memphis, USA
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