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Sloan RA, Kim Y, Kenyon J, Visentini-Scarzanella M, Sawada SS, Sui X, Lee IM, Myers JN, Lavie CJ. Association between Estimated Cardiorespiratory Fitness and Abnormal Glucose Risk: A Cohort Study. J Clin Med 2023; 12:jcm12072740. [PMID: 37048823 PMCID: PMC10095416 DOI: 10.3390/jcm12072740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/10/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Cardiorespiratory fitness (CRF) is a predictor of chronic disease that is impractical to routinely measure in primary care settings. We used a new estimated cardiorespiratory fitness (eCRF) algorithm that uses information routinely documented in electronic health care records to predict abnormal blood glucose incidence. METHODS Participants were adults (17.8% female) 20-81 years old at baseline from the Aerobics Center Longitudinal Study between 1979 and 2006. eCRF was based on sex, age, body mass index, resting heart rate, resting blood pressure, and smoking status. CRF was measured by maximal treadmill testing. Cox proportional hazards regression models were established using eCRF and CRF as independent variables predicting the abnormal blood glucose incidence while adjusting for covariates (age, sex, exam year, waist girth, heavy drinking, smoking, and family history of diabetes mellitus and lipids). RESULTS Of 8602 participants at risk at baseline, 3580 (41.6%) developed abnormal blood glucose during an average of 4.9 years follow-up. The average eCRF of 12.03 ± 1.75 METs was equivalent to the CRF of 12.15 ± 2.40 METs within the 10% equivalence limit. In fully adjusted models, the estimated risks were the same (HRs = 0.96), eCRF (95% CIs = 0.93-0.99), and CRF (95% CI of 0.94-0.98). Each 1-MET increase was associated with a 4% reduced risk. CONCLUSIONS Higher eCRF is associated with a lower risk of abnormal glucose. eCRF can be a vital sign used for research and prevention.
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Affiliation(s)
- Robert A Sloan
- Department of Social and Behavioral Medicine, Kagoshima University Graduate Medical School, Kagoshima 890-8520, Japan
| | - Youngdeok Kim
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Jonathan Kenyon
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Marco Visentini-Scarzanella
- Department of Social and Behavioral Medicine, Kagoshima University Graduate Medical School, Kagoshima 890-8520, Japan
| | - Susumu S Sawada
- Faculty of Sport Sciences, Waseda University, Saitama 359-1192, Japan
| | - Xuemei Sui
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - I-Min Lee
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jonathan N Myers
- Division of Cardiovascular Medicine, Veterans Affairs Palo Alto Health Care System, Stanford University, Palo Alto, CA 94304, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA 70121, USA
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Kokkinos PF, Samuel IBH, Myers JN, Vargas JD, Pittaras A, Lavie CJ, Faselis A, Gorsuch B, Karasik PE. CARDIORESPIRATORY FITNESS, STATIN THERAPY AND MORTALITY RISK IN PATIENTS WITH DM2. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02210-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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3
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Farah M, Milton DR, Gross ND, Nagarajan P, Gu J, Curry JL, Ivan D, Torres-Cabala CA, Myers JN, Prieto VG, Aung PP. Histopathologic features predictive of metastasis and survival in 230 patients with cutaneous squamous cell carcinoma of the head and neck and non-head and neck locations: a single-center retrospective study. J Eur Acad Dermatol Venereol 2022; 36:1246-1255. [PMID: 35426183 DOI: 10.1111/jdv.18147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/18/2022] [Accepted: 03/15/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Staging systems for cutaneous squamous cell carcinoma (cSCC) produce inconsistent risk stratification. OBJECTIVE The aim of this study was to identify further prognostic parameters for better stratification. METHODS We retrospectively analysed the prognostic significance of clinicopathologic parameters of 230 patients who underwent primary excision of invasive cSCC of the head and neck (n = 115) and non-head and non-neck (n = 115) locations. In addition to known high-risk features, we analysed tumour nest shape, invasion pattern, lymphoid response pattern and tumour budding. RESULTS On multivariable analysis, lymphovascular invasion (LVI) and high tumour budding predicted worse disease-specific survival, and ulceration, LVI and high tumour budding predicted worse overall survival. Only ulceration was independently associated with risk of nodal metastasis. CONCLUSION High tumour budding, LVI and ulceration are independently associated with poor outcome in cSCC and may be used to refine cSCC prognostic stratification, which is crucial to optimize clinical decision and to identify patients who are more likely to benefit from more aggressive interventions or clinical trials.
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Affiliation(s)
- M Farah
- Department of Pathology, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - D R Milton
- Department of Biostatistics, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - N D Gross
- Head and Neck Surgery, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - P Nagarajan
- Department of Pathology, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J Gu
- Cytogenetic Technology Program, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J L Curry
- Department of Pathology, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - D Ivan
- Department of Pathology, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C A Torres-Cabala
- Department of Pathology, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J N Myers
- Head and Neck Surgery, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - V G Prieto
- Department of Pathology, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - P P Aung
- Department of Pathology, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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4
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Devareddy A, Busque V, Haddad F, Myers JN, Christle J, Ashley EA, Wheeler MT. ANALYZING PROGRESSION OF DISEASE IN HYPERTROPHIC CARDIOMYOPATHY UTILIZING SEQUENTIAL CARDIOPULMONARY EXERCISE TESTING. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01232-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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5
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Pittaras AE, Faselis C, Samuel IBH, Doumas M, Grassos H, Murphy R, Myers JN, Kokkinos P. EXERCISE CAPACITY AND ATRIAL FIBRILLATION RISK IN 459,592 HYPERTENSIVE US VETERANS: A COHORT STUDY. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02977-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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6
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Wheeler MT, Olivotto I, Elliott PM, Saberi S, Owens AT, Maurer MS, Masri A, Sehnert A, Edelberg J, Li W, Florea V, Malhotra R, Wang A, Oreziak A, Jacoby D, Myers JN. THE EFFECT OF MAVACAMTEN ON CARDIOPULMONARY EXERCISE TESTING PERFORMANCE OF PATIENTS WITH OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY IN EXPLORER-HCM. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01228-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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7
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Mandal M, Kim S, Younes MN, Jasser SA, El-Naggar AK, Mills GB, Myers JN. Retraction Note to: The Akt inhibitor KP372-1 suppresses Akt activity and cell proliferation and induces apoptosis in thyroid cancer cells. Br J Cancer 2021; 124:1747. [PMID: 33603199 DOI: 10.1038/s41416-021-01299-9] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- M Mandal
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S Kim
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M N Younes
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S A Jasser
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A K El-Naggar
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G B Mills
- Department of Molecular Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J N Myers
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Sloan RA, Visentini-Scarzanella M, Sawada SS, Sui X, Myers JN, Blair SN. A Nonexercise Prediction Equation For Cardiorespiratory Fitness Without The Use Of Physical Activity. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000679132.87486.70] [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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9
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Gregg DF, Bagley JR, Machek SB, Chan KN, Lit Y, Chen Y, Tobias I, Galpin AJ, Myers JN, Rabkin R. Skeletal Muscle Fiber Type In Older Patients Receiving Maintenance Hemodialysis Treatment. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000678148.39190.6a] [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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10
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Myers JN, Bradford AJ, Hallas VS, Lawson LL, Pitcher TE, Dunham RA, Butts IAE. Channel catfish ovarian fluid differentially enhances blue catfish sperm performance. Theriogenology 2020; 149:62-71. [PMID: 32247214 DOI: 10.1016/j.theriogenology.2020.03.022] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/24/2020] [Accepted: 03/12/2020] [Indexed: 12/12/2022]
Abstract
For externally fertilizing fishes, interactions between male and female gametes have been shown to have remarkable impacts on sperm performance. Ovarian fluid (OF) and its ability to alter the swimming behavior of fish sperm makes it a determining factor of fertility. With the expansion of channel catfish (Ictalurus punctatus) ♀ × blue catfish (Ictalurus furcatus) ♂ hybrid aquaculture, it is essential to understand the impacts during fertilization and the magnitude such gametic interactions have on sperm performance and subsequent male fertility potential. This study was conducted to address the following: 1) activate blue catfish sperm with/without channel catfish OF to determine impacts on sperm performance and 2) assess if sperm behave differently when activated in the OF from individual females. Sperm (n = 4 males) were activated without OF (control) and with diluted OF from unique females (n = 6), creating 24 experimental crosses. Sperm motility (%), velocity (VCL), and longevity were analyzed using computer assisted sperm analyses software. With OF incorporated in the activation media, sperm velocity was significantly higher than the control at 10, 20, and 30 s post-activation. OF did not have an impact on motility for any females at 10 s and 20 s post-activation but became significantly higher than the control at 30 s. In all cases, OF treatments greatly increased longevity. Male × female interactions were highly significant, such that motility, velocity, and longevity were dependent on specific male-female pairs. This information shows that OF should be incorporated in aquatic media to simulate natural spawning conditions and accurately assess the fluid mechanics of sperm propulsion for each male. Additionally, there are mechanisms that drive gamete interactions that need to be explored further, which may improve selection of male-female pairs for in-vitro fertilization. On a broad scale, our results also help to shed light on the complexities of fertilization and fish reproduction overall, which may have implications for recruitment variability and recovery strategies of threatened and/or endangered freshwater species.
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Affiliation(s)
- J N Myers
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA.
| | - A J Bradford
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA.
| | - V S Hallas
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA.
| | - L L Lawson
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA.
| | - T E Pitcher
- Great Lakes Institute for Environmental Research, University of Windsor, Windsor, ON N9B 3P4, Canada; Department of Biological Sciences, University of Windsor, Windsor, ON N9B 3P4, Canada.
| | - R A Dunham
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA.
| | - I A E Butts
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, 36849, USA.
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11
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Chan KN, Chen Y, Lit Y, Massaband P, Kiratli J, Rabkin R, Myers JN. A randomized controlled trial of exercise to prevent muscle mass and functional loss in elderly hemodialysis patients: Rationale, study design, and baseline sample. Contemp Clin Trials Commun 2019; 15:100365. [PMID: 31193611 PMCID: PMC6536673 DOI: 10.1016/j.conctc.2019.100365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/06/2019] [Accepted: 04/12/2019] [Indexed: 11/02/2022] Open
Abstract
Background Elderly maintenance hemodialysis (MHD) patients exhibit muscle wasting and impaired physical function. This trial determines whether MHD patients benefit from a 12-week home-based exercise program, protein supplementation, or both. Design and Methods: This is a randomized, blinded controlled trial involving 60 elderly MHD patients with impaired exercise capacity and function. Patients are randomized into either a homebased exercise program or normal care over a 12-week period. Measures at baseline include peak VO2, strength and body composition as well as cognitive and disease-specific questionnaires. Muscle biopsies are obtained and analyzed for protein signaling, expression of IGF-1, androgen receptors, and myostatin. Results At baseline, patient characteristics in the exercise and normal care groups were similar by age, gender and anthropomorphic measures. Peak VO2 was impaired (14.7 ± 3.3 ml/kg/min), representing 55 ± 14% of the age-predicted value. Six-minute walk distance was 322 ± 71 m, and the mean 1-min sit to stand test was 18 ± 8 repetitions, representing 69 ± 16% and 55 ± 22% of the age-predicted values, respectively. Indices of muscle function, including upper and lower body and hand grip strength all indicate marked impairment. Quality of life (QoL) using the SF36, the Beeson cognitive test, and KDQOL all suggest marked impairments compared to age-expected reference values for non-MHD patients. Conclusions Patients undergoing MHD exhibit markedly reduced physical function and QoL. Thus, there are potentially significant gains to be made through a program of aerobic and resistance exercise. We anticipate this trial will demonstrate that home-based exercise improves cardiopulmonary function, protein signaling and QoL, and increases muscle mass, strength, and body composition.
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Affiliation(s)
- Khin N Chan
- Cardiology Division, Veterans Affairs Palo Alto Health Care System, United States.,Nephrology Division, Veterans Affairs Palo Alto Health Care System, United States.,Nephrology Division, Stanford University, United States
| | - Yu Chen
- Nephrology Division, Veterans Affairs Palo Alto Health Care System, United States.,Nephrology Division, Stanford University, United States
| | - Yiming Lit
- Nephrology Division, Veterans Affairs Palo Alto Health Care System, United States.,Nephrology Division, Stanford University, United States
| | - Payam Massaband
- Radiology Division, Veterans Affairs Palo Alto Health Care System, United States
| | - Jenny Kiratli
- Spinal Cord Injury Center, Veterans Affairs Palo Alto Health Care System, United States
| | - Ralph Rabkin
- Nephrology Division, Veterans Affairs Palo Alto Health Care System, United States.,Nephrology Division, Stanford University, United States
| | - Jonathan N Myers
- Cardiology Division, Veterans Affairs Palo Alto Health Care System, United States.,Cardiology Division, Stanford University, United States
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12
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Abstract
Oral squamous cell carcinoma (OSCC) is the most common type of oral cancer worldwide and in the United States. OSCC remains a major cause of morbidity and mortality in patients with head and neck cancers. Tobacco and alcohol consumption alone or with chewing betel nut are potential risk factors contributing to the high prevalence of OSCC. Multimodality therapies, including surgery, chemotherapy, biologic therapy, and radiotherapy, particularly intensity-modulated radiotherapy (IMRT), are the current treatments for OSCC patients. Despite recent advances in these treatment modalities, the overall survival remains poor over the past years. Recent data from whole-exome sequencing reveal that TP53 is commonly mutated in human papillomavirus-negative OSCC patients. Furthermore, these data stressed the importance of the TP53 gene in suppressing the development and progression of OSCC. Clinically, TP53 mutations are largely associated with poor survival and tumor resistance to radiotherapy and chemotherapy in OSCC patients, which makes the TP53 mutation status a potentially useful molecular marker prognostic and predictive of clinical response in these patients. Several forms of DNA damage have been shown to activate p53, including those generated by ionizing radiation and chemotherapy. The DNA damage stabilizes p53 in part via the DNA damage signaling pathway that involves sensor kinases, including ATM and ATR and effector kinases, such as Chk1/2 and Wee1, which leads to posttranscriptional regulation of a variety of genes involved in DNA repair, cell cycle control, apoptosis, and senescence. Here, we discuss the link of TP53 mutations with treatment outcome and survival in OSCC patients. We also provide evidence that small-molecule inhibitors of critical proteins that regulate DNA damage repair and replication stress during the cell cycle progression, as well as other molecules that restore wild-type p53 activity to mutant p53, can be exploited as novel therapeutic approaches for the treatment of OSCC patients bearing p53 mutant tumors.
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Affiliation(s)
- A Lindemann
- 1 Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - H Takahashi
- 1 Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A A Patel
- 1 Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A A Osman
- 1 Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J N Myers
- 1 Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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13
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Narayan P, Doumas M, Kumar A, Faselis CJ, Myers JN, Pittaras A, Kokkinos PF. Impact of Cardiorespiratory Fitness on Mortality in Black Male Veterans With Resistant Systemic Hypertension. Am J Cardiol 2017; 120:1568-1571. [PMID: 28886854 DOI: 10.1016/j.amjcard.2017.07.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/12/2017] [Accepted: 07/21/2017] [Indexed: 11/27/2022]
Abstract
Patients with resistant systemic hypertension have poorer outcomes than nonresistant hypertensives. The purpose of this study was to evaluate the association between cardiorespiratory fitness and all-cause mortality in black male Veterans with resistant systemic hypertension. Patients were identified from a cohort undergoing exercise tolerance test at the department of Veterans Affairs Medical Center in Washington, DC. Patients were divided into 4 cardiorespiratory fitness categories based on age-specific peak metabolic equivalents achieved on a standard Bruce protocol. Multivariate Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality across all fitness categories. A total of 1,276 patients out of 9,068 hypertensives had resistant hypertension defined as systolic and/or diastolic blood pressure >140 and/or >90 mm Hg, respectively, on 3 antihypertensive medications, one of which was a diuretic or use of >4 antihypertensive medications. During a follow-up of 9.5 ± 4.2 years, an inverse association was observed between cardiorespiratory fitness and all-cause mortality in patients with resistant hypertension. Compared with the least-fit group, mortality was reduced by 21% in the low-fit group (HR 0.79, CI 0.60 to 1.05; p value: 0.280), 36% in the moderate-fit group (HR 0.64, CI 0.48 to 0.87; p value 0.001), and 62% in the high-fit group (HR 0.38, CI 0.25 to 0.56; p value <0.001). In conclusion, an inverse association was observed between the level of cardiorespiratory fitness and all-cause mortality in patients with resistant systemic hypertension. Compared with the least-fit referent group, the high-fit group had a significant 62% lower risk of all-cause mortality.
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14
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Cheng XS, Myers JN, Chertow GM, Rabkin R, Chan KN, Chen Y, Tan JC. Prehabilitation for kidney transplant candidates: Is it time? Clin Transplant 2017; 31. [DOI: 10.1111/ctr.13020] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2017] [Indexed: 12/27/2022]
Affiliation(s)
- Xingxing S. Cheng
- Division of Nephrology; Department of Medicine; Stanford University; Palo Alto CA USA
| | - Jonathan N. Myers
- Division of Cardiology; Veterans Affairs Palo Alto Health Care System; Palo Alto CA USA
- Research Service; Veterans Administration Health Care System; Palo Alto CA USA
| | - Glenn M. Chertow
- Division of Nephrology; Department of Medicine; Stanford University; Palo Alto CA USA
| | - Ralph Rabkin
- Division of Nephrology; Department of Medicine; Stanford University; Palo Alto CA USA
- Research Service; Veterans Administration Health Care System; Palo Alto CA USA
| | - Khin N. Chan
- Division of Cardiology; Veterans Affairs Palo Alto Health Care System; Palo Alto CA USA
| | - Yu Chen
- Research Service; Veterans Administration Health Care System; Palo Alto CA USA
| | - Jane C. Tan
- Division of Nephrology; Department of Medicine; Stanford University; Palo Alto CA USA
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Abstract
In recent years, a growing body of research has demonstrated that an individual's fitness level is a strong and independent marker of risk for cardiovascular and all-cause mortality. In addition, modest improvements in fitness through exercise intervention have been associated with considerable health outcome benefits. These studies have generally assessed fitness as a baseline marker in traditional epidemiological cohorts. However, there has been a recent recognition that fitness powerfully predicts outcomes associated with a wide range of surgical interventions. The concept of 'prehabilitation' is based on the principle that patients with higher functional capability will better tolerate a surgical intervention, and studies have shown that patients with higher fitness have reduced postoperative complications and demonstrate better functional, psychosocial, and surgery-related outcomes. This review focuses on the impact of fitness on surgical outcomes and provides a rationale in support of routine application of prehabilitation in the management of patients undergoing surgery.
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Affiliation(s)
- Jonathan N Myers
- 1Division of Cardiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; 2Stanford University, Stanford, CA
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16
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Müller J, Chan K, Myers JN. Association Between Exercise Capacity and Late Onset of Dementia, Alzheimer Disease, and Cognitive Impairment. Mayo Clin Proc 2017; 92:211-217. [PMID: 28082018 DOI: 10.1016/j.mayocp.2016.10.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 10/19/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To address the association between exercise capacity and the onset of dementia, Alzheimer disease, and cognitive impairment. PATIENTS AND METHODS For 6104 consecutive veteran patients (mean ± SD age: 59.2±11.4 years) referred for treadmill exercise testing, the combined end point of dementia, Alzheimer disease, and cognitive impairment was abstracted from the Veterans Affairs computerized patient record system. RESULTS After mean ± SD follow-up of 10.3±5.5 years, 353 patients (5.8%) developed the composite end point at a mean ± SD age of 76.7±10.3 years. After correction for confounders in multivariate Cox proportional hazards regression, higher age at exercise testing (hazard ratio [HR]=1.08; 95% CI, 1.07-1.09; P<.001), current smoking (HR=1.44; 95% CI, 1.08-1.93; P=.01), and exercise capacity (HR=0.92; 95% CI, 0.89-0.96; P<.001) emerged as predictors of cognitive impairment. Each 1-metabolic equivalent increase in exercise capacity conferred a nearly 8% reduction in the incidence of cognitive impairment. Meeting the recommendations for daily activity was not associated with a delay in onset of cognitive impairment (HR=1.07; 95% CI, 0.86-1.32; P=.55). CONCLUSION Exercise capacity is strongly associated with cognitive function; the inverse association between fitness and cognitive impairment provides an additional impetus for health care providers to promote physical activity.
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Affiliation(s)
- Jan Müller
- Institute of Preventive Pediatrics, Technische Universität München, München, Germany; Division of Cardiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Stanford University School of Medicine, Stanford, CA.
| | - Khin Chan
- Division of Cardiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Jonathan N Myers
- Division of Cardiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Stanford University School of Medicine, Stanford, CA
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Fitzgerald AL, Osman AA, Xie TX, Patel A, Skinner H, Sandulache V, Myers JN. Reactive oxygen species and p21Waf1/Cip1 are both essential for p53-mediated senescence of head and neck cancer cells. Cell Death Dis 2015; 6:e1678. [PMID: 25766317 PMCID: PMC4385922 DOI: 10.1038/cddis.2015.44] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [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: 10/07/2014] [Revised: 12/11/2014] [Accepted: 12/12/2014] [Indexed: 12/15/2022]
Abstract
Treatment of head and neck squamous cell carcinoma, HNSCC, often requires multimodal therapy, including radiation therapy. The efficacy of radiotherapy in controlling locoregional recurrence, the most frequent cause of death from HNSCC, is critically important for patient survival. One potential biomarker to determine radioresistance is TP53 whose alterations are predictive of poor radiation response. DNA-damaging reactive oxygen species (ROS) are a by-product of ionizing radiation that lead to the activation of p53, transcription of p21(cip1/waf1) and, in the case of wild-type TP53 HNSCC cells, cause senescence. The expression of p21 and production of ROS have been associated with the induction of cellular senescence, but the intricate relationship between p21 and ROS and how they work together to induce senescence remains elusive. For the first time, we show that persistent exposure to low levels of the ROS, hydrogen peroxide, leads to the long-term expression of p21 in HNSCC cells with a partially functional TP53, resulting in senescence. We conclude that the level of ROS is crucial in initiating p53's transcription of p21 leading to senescence. It is p21's ability to sustain elevated levels of ROS, in turn, that allows for a long-term oxidative stress, and ensures an active p53-p21-ROS signaling loop. Our data offer a rationale to consider the use of either ROS inducing agents or therapies that increase p21 expression in combination with radiation as approaches in cancer therapy and emphasizes the importance of considering TP53 status when selecting a patient's treatment options.
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Affiliation(s)
- A L Fitzgerald
- Graduate School of Biomedical Sciences, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - A A Osman
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - T-X Xie
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - A Patel
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - H Skinner
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - V Sandulache
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX
| | - J N Myers
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
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Maranhao Neto GA, Oliveira RB, Myers JN, Farinatti PTV. Prediction of peak oxygen pulse (O2Ppeak) without exercise testing in older adults. Arch Gerontol Geriatr 2014; 59:562-7. [PMID: 25085231 DOI: 10.1016/j.archger.2014.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 01/27/2014] [Accepted: 07/10/2014] [Indexed: 10/25/2022]
Abstract
Peak oxygen pulse has been considered a surrogate of cardiovascular function and an independent predictor of all cause mortality. However, O2P(peak) depends on maximal volitional effort which may limit its utility in older subjects. The aim of this study was to develop a model to estimate O2P(peak) without exercise in an elderly sample. This cross-sectional study enrolled 67 community-dwelling older adults (69.4±7.1 years; 41 men) for the non-exercise model development and 30 community-dwelling older adults (67.7±6.4 years; n=30; 17 men) for cross-validation. The non-exercise model was derived through hierarchical regression model and cross-validated by means of PRESS statistics and comparison against an independent sample. Classification accuracy of the model for tertiles of estimated and actual O2P(peak) was tested by gamma (γ) nonparametric correlation. The following prediction equation was generated: -3.416+0.137 × weight (kg)+1.226 × Veterans Specific Activity Questionnaire (VSAQ) (metabolic equivalents, METs)+1.987 × gender (0=women, 1=men)-2.045 × β-Blockers use (0=no, 1=yes)-0.044 × resting heart rate (HR) (R(2)=0.83; standard error of estimate (SEE)=1.68 mL beat(-1)). Correlation in cross-validation group was 0.80 (P<0.001). A high probability was observed for the model to rank the values in the same tertile in validation and cross-validation groups (γ=0.98; γ=0.92, respectively, P<0.05). In conclusion, O2P(peak) can be estimated with reasonable precision without exercise testing, providing an alternative for elder subjects not capable to perform maximal effort.
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Affiliation(s)
| | | | | | - Paulo T V Farinatti
- Salgado de Oliveira University, Niteroi, RJ, Brazil; Rio de Janeiro State University, RJ, Brazil.
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Jagoda A, Myers JN, Kaminsky LA, Whaley MH. Heart rate response at the onset of exercise in an apparently healthy cohort. Eur J Appl Physiol 2014; 114:1367-75. [DOI: 10.1007/s00421-014-2867-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 03/02/2014] [Indexed: 10/25/2022]
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Pickering CR, Shah K, Ahmed S, Rao A, Frederick MJ, Zhang J, Unruh AK, Wang J, Ginsberg LE, Kumar AJ, Myers JN, Hamilton JD. CT imaging correlates of genomic expression for oral cavity squamous cell carcinoma. AJNR Am J Neuroradiol 2013; 34:1818-22. [PMID: 23764725 DOI: 10.3174/ajnr.a3635] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE Imaging correlates of genetic expression have been found for prognostic and predictive biomarkers of some malignant diseases, including breast and brain tumors. This study tests the hypothesis that imaging findings correlate with relevant genomic biomarkers in oral cavity squamous cell carcinoma. MATERIALS AND METHODS Surplus frozen tissue from 27 untreated patients with oral cavity squamous cell carcinoma who underwent preoperative CT imaging was analyzed for gene expression. A team of neuroradiologists blinded to the genomic analysis results reviewed an extensive list of CT findings. The imaging correlated with genomic expression for cyclin D1, angiogenesis-related genes (vascular endothelial growth factor receptors and ligands), which relate to enhancement on the basis of other tumor types; and epidermal growth factor receptor, which may relate to proliferation and mass effect. RESULTS Expression of vascular endothelial growth factor receptors 1 and 2 correlated with the enhancement of the primary tumor (P = .018 and P = .025, respectively), whereas the epidermal growth factor receptor correlated with mass effect (P = .03). Other exploratory correlations included epidermal growth factor receptor to perineural invasion (P = .05), and certain vascular endothelial growth factor receptors and ligands to mass effect (P = .03) and increased (P = .01) or decreased (P = .02) primary tumor size. CONCLUSIONS We report that CT imaging correlates with gene expression in untreated oral cavity squamous cell carcinoma. Enhancement of the primary tumor and degree of mass effect correlate with relevant genomic biomarkers, which are also potential drug targets. Eventually, treatment decisions may be aided by combining imaging findings into meaningful phenotypes that relate directly to genomic biomarkers.
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Hamilton JD, Ahmed S, Sandulache VC, Daram SP, Ow TJ, Skinner HD, Rao A, Ginsberg LE, Kumar AJ, Myers JN. Improving imaging diagnosis of persistent nodal metastases after definitive therapy for oropharyngeal carcinoma: specific signs for CT and best performance of combined criteria. AJNR Am J Neuroradiol 2013; 34:1637-42. [PMID: 23471023 DOI: 10.3174/ajnr.a3461] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND PURPOSE Criteria for detection of persistent nodal metastases in treated oropharyngeal tumors are sensitive but nonspecific, leading to unnecessary nodal dissections. Developing specific imaging criteria for persistent nodal metastases could improve diagnosis while decreasing patient morbidity. MATERIALS AND METHODS Patients with oropharyngeal squamous cell carcinoma with nodal metastases treated by definitive radiation therapy and subsequent nodal dissection were retrospectively evaluated. One hundred thirty-eight patients had pre- and posttherapy contrast-enhanced CTs evaluated by radiologists blinded to the status of pathologically proved hemineck persistent nodal metastases. Composite scoring criteria for CT, combined from individual parameters, were compared with radiologists' opinions, previous multiparameter criteria, and outcome data. RESULTS New low-attenuation areas and a lack of size change (<20% cross sectional area) were both highly specific for persistent nodal metastases (99%; P = .0004). Extranodal disease on pretherapy imaging was moderately specific (86%; P = .001). The CSC correctly placed 29 patients in a low-risk category compared with 14 by previously reported criteria and radiologist reports. With good second-rater reliability, the CSC cutoff values stratified patients at highest risk of persistent nodal metastases, thereby improving specificity while maintaining sensitivity. CONCLUSIONS Comparing pre- and posttherapy examinations improves specificity by discriminating focal findings and size change compared with a single time point. The CSC can categorize the risk of persistent nodal metastases more accurately than previous CT methods. This finding has the potential to improve resource use and reduce surgical morbidity.
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Affiliation(s)
- J D Hamilton
- Neuroradiology Section, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Arena R, Myers JN, de Souza CR, Borghi Silva A, Guazzi M, Chase P, Bensimhon D, Ann Peberdy M, Ashley E, West E, Cahalin L, Forman D. A NEURAL NETWORK APPROACH TO PREDICTING OUTCOMES IN HEART FAILURE USING CARDIOPULMONARY EXERCISE TESTING. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61415-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lanier GM, Zheng Q, Wagman G, Tseng CH, Myers JN, Vittorio TJ. Simple prediction formula for peak oxygen consumption in patients with chronic heart failure. J Exerc Sci Fit 2012. [DOI: 10.1016/j.jesf.2012.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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McAuley PA, Artero EG, Sui X, Lee DC, Church TS, Lavie CJ, Myers JN, España-Romero V, Blair SN. The obesity paradox, cardiorespiratory fitness, and coronary heart disease. Mayo Clin Proc 2012; 87:443-51. [PMID: 22503065 PMCID: PMC3538467 DOI: 10.1016/j.mayocp.2012.01.013] [Citation(s) in RCA: 189] [Impact Index Per Article: 15.8] [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: 11/15/2011] [Revised: 01/11/2012] [Accepted: 01/16/2012] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate associations of cardiorespiratory fitness (CRF) and different measures of adiposity with cardiovascular disease (CVD) and all-cause mortality in men with known or suspected coronary heart disease (CHD). PATIENTS AND METHODS We analyzed data from 9563 men (mean age, 47.4 years) with documented or suspected CHD in the Aerobics Center Longitudinal Study (August 13, 1977, to December 30, 2002) using baseline body mass index (BMI) and CRF (quantified as the duration of a symptom-limited maximal treadmill exercise test). Waist circumference (WC) and percent body fat (BF) were measured using standard procedures. RESULTS There were 733 deaths (348 of CVD) during a mean follow-up of 13.4 years. After adjustment for age, examination year, and multiple baseline risk factors, men with low fitness had a higher risk of all-cause mortality in the BMI categories of normal weight (hazard ratio [HR], 1.60; 95% confidence interval [CI], 1.24-2.05), obese class I (HR, 1.38; 95% CI, 1.04-1.82), and obese class II/III (HR, 2.43; 95% CI, 1.55-3.80) but not overweight (HR, 1.09; 95% CI, 0.88-1.36) compared with the normal-weight and high-fitness reference group. We observed a similar pattern for WC and percent BF tertiles and for CVD mortality. Among men with high fitness, there were no significant differences in CVD and all-cause mortality risk across BMI, WC, and percent BF categories. CONCLUSION In men with documented or suspected CHD, CRF greatly modifies the relation of adiposity to mortality. Using adiposity to assess mortality risk in patients with CHD may be misleading unless fitness is considered.
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Key Words
- acls, aerobics center longitudinal study
- bf, body fat
- bmi, body mass index
- chd, coronary heart disease
- ci, confidence interval
- crf, cardiorespiratory fitness
- cvd, cardiovascular disease
- dm, diabetes mellitus
- hr, hazard ratio
- htn, hypertension
- wc, waist circumference
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Affiliation(s)
- Paul A McAuley
- Department of Human Performance and Sport Sciences, Winston-Salem State University, NC 27110, USA.
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Myers JN, Oliveira R, Guazzi M, Chase P, Bensimhon D, Ashley E, Forman D, Peberdy MA, West E, Arena R. VALIDATION OF A CARDIOPULMONARY EXERCISE TEST SCORE IN HEART FAILURE. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61946-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Cardiorespiratory fitness as an explanation for the obesity paradox warrants further examination. We evaluated independent and joint associations of cardiorespiratory fitness and adiposity with all-cause mortality in 811 middle-aged (age, 53.3 ± 7.2 years) male never smokers without documented cardiopulmonary disease or diabetes from the Veterans Exercise Testing Study (VETS). Cardiorespiratory fitness was quantified in metabolic equivalents (METs) using final treadmill speed and grade achieved on a maximal exercise test. Subjects were grouped for analysis by METs: unfit (lowest third) and fit (upper two-thirds); and by body mass index (kg/m(2)): nonobese (18.5-29.9) and obese (≥30.0). Associations of baseline fitness and adiposity measures with all-cause mortality were determined by Cox proportional hazards analysis adjusted for age, ethnicity, hypertension, hypercholesterolemia, family history of coronary artery disease, and cardiovascular medication use. In multivariate analysis, mortality risk for obese/fit men did not differ significantly from the nonobese/fit reference group. However, compared to the reference group, nonobese and obese unfit men were 2.2 (P = 0.01) and 1.9 (P = 0.03) times more likely to die, respectively. Cardiorespiratory fitness altered the obesity paradox such that mortality risk was lower for both obese and nonobese men who were fit.
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Affiliation(s)
- Paul A. McAuley
- Department of Human Performance and Sport Sciences, Winston-Salem State University, C024 Anderson, 601 S Martin Luther King Jr Drive, Winston-Salem, NC 27110, USA
- *Paul A. McAuley:
| | - Nancy S. Smith
- Department of Physical Therapy, Winston-Salem State University, Winston-Salem, NC 27110, USA
| | - Brian T. Emerson
- Department of Physical Therapy, Winston-Salem State University, Winston-Salem, NC 27110, USA
| | - Jonathan N. Myers
- Department of Cardiology, Division of Cardiovascular Medicine, Veterans Affairs Palo Alto Health Care System, Stanford University, Palo Alto, CA 94304, USA
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Yom SS, Garden AS, Staerkel GA, Ginsberg LE, Morrison WH, Sturgis EM, Rosenthal DI, Myers JN, Edeiken-Monroe BS. Sonographic examination of the neck after definitive radiotherapy for node-positive oropharyngeal cancer. AJNR Am J Neuroradiol 2011; 32:1532-8. [PMID: 21757532 DOI: 10.3174/ajnr.a2545] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Radiographic determination of viable disease in cervical adenopathy following RT for head and neck cancer can be challenging. The purpose of this study was to evaluate the utility of US, with or without FNA, in regard to the postradiotherapy effects on documented metastatic adenopathy in patients with oropharyngeal cancer. MATERIALS AND METHODS This study included 133 patients with node-positive oropharyngeal cancer who were irradiated from 1998 to 2004. Sonographic evaluation was performed within 6 months of completion of radiation. Posttreatment US results were compared with pretreatment CT images and were recorded as the following: progression, suspicious, indeterminate, posttreatment change, or regression (positive) versus nonsuspicious or benign (negative). FNAC was classified as nondiagnostic, negative, indeterminate, or positive. Results of US and US-guided FNAC were correlated with findings at neck dissection and disease outcome. RESULTS Of 203 sonographic examinations, 90% were technically feasible and yielded a nonequivocal imaging diagnosis. Of 87 US-guided FNAs, 71% yielded a nonequivocal tissue diagnosis. The PPV and NPV of initial posttreatment US were 11% and 97%. Sensitivity and specificity were 92% and 28%. The PPV and NPV of US-guided FNA were 33% and 95%, and the sensitivity and specificity were 75% and 74%. On serial sonographic surveillance, of 33 patients with nonsuspicious findings, only 1 (3%) had neck recurrence. Of 22 patients with questionable findings on CT and negative findings on US, none had a neck recurrence. CONCLUSIONS In experienced hands, serial US is an inexpensive noninvasive reassuring follow-up strategy after definitive head and neck RT, even when CT findings are equivocal.
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Affiliation(s)
- S S Yom
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, 77030, USA
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Myers JN, Gujja P, Neelagaru S, Hsu L, Burkhoff D. Noninvasive measurement of cardiac performance in recovery from exercise in heart failure patients. Clinics (Sao Paulo) 2011; 66:649-56. [PMID: 21655761 PMCID: PMC3386648 DOI: 10.1590/s1807-59322011000400021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Accepted: 01/27/2011] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To examine the association between cardiac performance during recovery and the severity of heart failure, as determined by clinical and cardiopulmonary exercise test responses. METHODS As part of a retrospective cohort study, 46 heart failure patients and 13 normal subjects underwent cardiopulmonary exercise testing while cardiac output was measured using a noninvasive device. Cardiac output in recovery was expressed as the slope of a single exponential relationship between cardiac output and time; the recovery-time constant was assessed in relation to indices of cardiac function, along with clinical, functional, and cardiopulmonary exercise responses. RESULTS The recovery time constant was delayed in patients with heart failure compared with normal subjects (296.7 ± 238 vs. 110.1 ±27 seconds, p <0.01), and the slope of the decline of cardiac output in recovery was steeper in normal subjects compared with heart failure patients (p<0.001). The slope of the decline in cardiac output recovery was inversely related to peak VO(2) (r = -0.72, p<0.001) and directly related to the VE/VCO(2) slope (r = 0.57, p,0.001). Heart failure patients with abnormal recovery time constants had lower peak VO(2), lower VO(2) at the ventilatory threshold, lower peak cardiac output, and a heightened VE/VCO(2) slope during exercise. CONCLUSIONS Impaired cardiac output recovery kinetics can identify heart failure patients with more severe disease, lower exercise capacity, and inefficient ventilation. Estimating cardiac output in recovery from exercise may provide added insight into the cardiovascular status of patients with heart failure.
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Chaudhry S, Arena RA, Hansen JE, Lewis GD, Myers JN, Sperling LS, Labudde BD, Wasserman K. The utility of cardiopulmonary exercise testing to detect and track early-stage ischemic heart disease. Mayo Clin Proc 2010; 85:928-32. [PMID: 20884826 PMCID: PMC2947965 DOI: 10.4065/mcp.2010.0183] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Evidence demonstrating the potential value of noninvasive cardiopulmonary exercise testing (CPET) to accurately detect exercise-induced myocardial ischemia is emerging. This case-based concept report describes CPET abnormalities in an asymptomatic at-risk man with suspected early-stage ischemic heart disease. When CPET was repeated 1 year after baseline assessment, his cardiovascular function had worsened, and an anti-atherosclerotic regimen was initiated. When the patient was retested after 3.3 years, the diminished left ventricular function had reversed with pharmacotherapy directed at decreasing cardiovascular events in patients with coronary artery disease. Thus, in addition to identifying appropriate patients in need of escalating therapy for atherosclerosis, CPET was useful in monitoring progression and reversal of abnormalities of the coronary circulation in a safe and cost-effective manner without the use of radiation. Serial CPET parameters may be useful to track changes marking the progression and/or regression of the underlying global ischemic burden.
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Affiliation(s)
- Sundeep Chaudhry
- Research and Development Department, MET-TEST, Atlanta, GA, USA.
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Myers JN, White J, Dalman R. Exercise Training In Patients With Abdominal Aortic Aneurysm: Preliminary Results From The AAA Stop Trial. Med Sci Sports Exerc 2010. [DOI: 10.1249/01.mss.0000386706.68019.23] [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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32
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Myers JN, Powell A, Smith K, Dalman R. Cardiopulmonary Exercise Testing In Abdominal Aortic Aneurysm: Profile, Safety, And Mortality Estimates. Med Sci Sports Exerc 2010. [DOI: 10.1249/01.mss.0000386107.72400.92] [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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Abstract
OBJECTIVE To evaluate the influence of cardiorespiratory fitness (fitness) on the obesity paradox in middle-aged men with known or suspected coronary artery disease. PATIENTS AND METHODS This study consists of 12,417 men aged 40 to 70 years (44% African American) who were referred for exercise testing at the Veterans Affairs Medical Centers in Washington, DC, or Palo Alto, CA (between January 1, 1983, and June 30, 2007). Fitness was quantified as metabolic equivalents achieved during a maximal exercise test and was categorized for analysis as low, moderate, and high (defined as <5, 5-10, and >10 metabolic equivalents, respectively). Adiposity was defined by body mass index (BMI) according to standard clinical guidelines. Separate and combined associations of fitness and adiposity with all-cause mortality were assessed by Cox proportional hazards analyses. RESULTS We recorded 2801 deaths during a mean+/-SD follow-up of 7.7+/-5.3 years. Multivariate hazard ratios (95% confidence interval) for all-cause mortality, with normal weight (BMI, 18.5-24.9 kg/m2) used as the reference group, were 1.9 (1.5-2.3), 0.7 (0.7-0.8), 0.7 (0.6-0.7), and 1.0 (0.8-1.1) for BMIs of less than 18.5, 25.0 to 29.9, 30.0 to 34.9, and 35.0 or more kg/m2, respectively. Compared with highly fit normal-weight men, underweight men with low fitness had the highest (4.5 [3.1-6.6]) and highly fit overweight men the lowest (0.4 [0.3-0.6]) mortality risk of any subgroup. Overweight and obese men with moderate fitness had mortality rates similar to those of the highly fit normal-weight reference group. CONCLUSION Fitness altered the obesity paradox. Overweight and obese men had increased longevity only if they registered high fitness.
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Affiliation(s)
- Paul A McAuley
- Department of Human Performance and Sport Sciences, Winston-Salem State University, 601 S Martin Luther King Jr Dr, Anderson C 24-E, Winston-Salem, NC 27110, USA.
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Kupferman ME, Jiffar T, El-Naggar A, Yilmaz T, Zhou G, Xie T, Feng L, Wang J, Holsinger FC, Yu D, Myers JN. TrkB induces EMT and has a key role in invasion of head and neck squamous cell carcinoma. Oncogene 2010; 29:2047-59. [PMID: 20101235 DOI: 10.1038/onc.2009.486] [Citation(s) in RCA: 148] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Head and neck squamous cell carcinoma (HNSCC) remains a significant public health problem, accounting for over 5% of all cancer-related deaths, and these deaths primarily result from metastatic disease. The molecular processes involved in HNSCC pathogenesis and progression are poorly understood, and here we present experimental evidence for a direct role of the cell surface receptor tyrosine kinase, TrkB, in HNSCC tumor progression. Using immunohistochemical analysis and transcriptional profiling of archival HNSCC tumor specimens, we found that TrkB and its secreted ligand, brain-derived neurotrophic factor (BDNF), are expresses in greater than 50% of human HNSCC tumors, but not in normal upper aerodigestive tract (UADT) epithelia. Studies with HNSCC cell lines reveal that in vitro stimulation with BDNF, the ligand for TrkB, upregulates the migration and invasion of HNSCC cells, and both transient and stable suppressions of TrkB result in significant abrogation of constitutive and ligand-mediated migration and invasion. Furthermore, enforced overexpression of TrkB results in altered expression of molecular mediators of epithelial-to-mesenchymal transition (EMT), including downregulation of E-cadherin and upregulation of Twist. Using an in vivo mouse model of HNSCC, we were able to show that downregulation of TrkB suppresses tumor growth. These results directly implicate TrkB in EMT and the invasive behavior of HNSCC, and correlate with the in vivo overexpression of TrkB in human HNSCC. Taken together, these data suggest that the TrkB receptor may be a critical component in the multi-step tumor progression of HNSCC, and may be an attractive target for much needed new therapies for this disease.
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Affiliation(s)
- M E Kupferman
- Department of Head and Neck Surgery, Houston TX, USA.
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Hadley DM, Dewey FE, Freeman JV, Myers JN, Froelicher VF. Prediction of cardiovascular death using a novel heart rate recovery parameter. Med Sci Sports Exerc 2008; 40:1072-9. [PMID: 18460999 DOI: 10.1249/mss.0b013e318167665a] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Reassertion of vagal tone after exercise is an important component in mediating heart rate recovery (HRR), and both vagal tone and HRR have been associated with mortality. HRR is strongly related to the increase in HR from resting to peak exercise. We hypothesized that a score normalized for HR increase would better isolate the vagal influences in recovery from the sympathetic influences supporting maximal exercise. METHODS HRR data from 1959 veterans were analyzed. During a mean follow-up of 5.3 years, 187 (9.5%) subjects died-70 (37%) due to cardiovascular (CV) causes. A method was developed to compare HRR curve shapes normalized for differences in HR increase. Differences in the slopes of the normalized curves over the range 50-70 s were observed between the survivors and nonsurvivors, and a prognostic measurement, HRRS50-70, was developed. The incremental increases in predictive power and discriminative accuracy provided by Duke Treadmill Score (DTS), clinical parameters, HR increase, recovery variables, and HRRS50-70 were assessed. RESULTS In the age-adjusted Cox analysis, the only significant exercise indices associated with CV mortality were HR increase (P < 0.0001), HRRS50-70 (P = 0.01), and DTS (P < 0.001). The increased risk for patients in the lowest tertile for all three indices, relative to those with normal scores, was 22 (95% CI, 7.9-63; P < 0.0001). CONCLUSIONS HRRS50-70 is independent of and complementary to HR increase and DTS. Patients with abnormal HRRS50-70 and abnormal DTS and/or HR increase are at substantially increased risk of CV mortality.
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Abstract
The development of oral squamous cell carcinoma (OSCC) is a multistep process requiring the accumulation of multiple genetic alterations, influenced by a patient's genetic predisposition as well as by environmental influences, including tobacco, alcohol, chronic inflammation, and viral infection. Tumorigenic genetic alterations consist of two major types: tumor suppressor genes, which promote tumor development when inactivated; and oncogenes, which promote tumor development when activated. Tumor suppressor genes can be inactivated through genetic events such as mutation, loss of heterozygosity, or deletion, or by epigenetic modifications such as DNA methylation or chromatin remodeling. Oncogenes can be activated through overexpression due to gene amplification, increased transcription, or changes in structure due to mutations that lead to increased transforming activity. This review focuses on the molecular mechanisms of oral carcinogenesis and the use of biologic therapy to specifically target molecules altered in OSCC. The rapid progress that has been made in our understanding of the molecular alterations contributing to the development of OSCC is leading to improvements in the early diagnosis of tumors and the refinement of biologic treatments individualized to the specific characteristics of a patient's tumor.
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Affiliation(s)
- S Choi
- Department of Head and Neck Surgery, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 441, [corrected] Houston, TX 77030-4009, USA
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Abstract
OBJECTIVE To demonstrate the relation of exercise capacity and BMI to mortality in a population of male veterans with type 2 diabetes. RESEARCH DESIGN AND METHODS After excluding two underweight patients (BMI <18.5 kg/m2), the study population comprised 831 consecutive patients with type 2 diabetes (mean age 61 +/- 9 years) referred for exercise testing for clinical reasons between 1995 and 2006. Exercise capacity was determined from a maximal exercise test and measured in metabolic equivalents (METs). Patients were classified both according to BMI category (18.5-24.9, 25.0-29.9, and > or =30 kg/m2) and by exercise capacity (<5.0 or > or =5.0 maximal METs). The association among exercise capacity, BMI, other clinical variables, and all-cause mortality was assessed by Cox proportional hazards. Study participants were followed for mortality up to 30 June 2006. RESULTS During a mean follow-up of 4.8 +/- 3.0 years, 112 patients died, for an average annual mortality rate of 2.2%. Each 1-MET increase in exercise capacity conferred a 10% survival benefit (hazard ratio 0.90 [95% CI 0.82-0.98]; P = 0.01), but BMI was not significantly associated with mortality. After adjustment for age, ethnicity, examination year, BMI, presence of cardiovascular disease (CVD), and CVD risk factors, diabetic patients achieving <5 maximal METs were 70% more likely to die (1.70 [1.13-2.54]) than those achieving > or =5 maximal METs. CONCLUSIONS There was a strong inverse association between exercise capacity and mortality in this cohort of men with documented diabetes, and this relationship was independent of BMI.
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Affiliation(s)
- Paul A McAuley
- Cardiology Division, VA Palo Alto Health Care System/Stanford University, Palo Alto, California 94304, USA.
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Myers JN. Predicting Outcomes in Cardiovascular Disease. Med Sci Sports Exerc 2007. [DOI: 10.1249/01.mss.0000272275.35891.ca] [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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Atwood JE, Myers JN, Tang XC, Reda DJ, Singh SN, Singh BN. Exercise capacity in atrial fibrillation: a substudy of the Sotalol-Amiodarone Atrial Fibrillation Efficacy Trial (SAFE-T). Am Heart J 2007; 153:566-72. [PMID: 17383295 DOI: 10.1016/j.ahj.2006.12.020] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Accepted: 12/17/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND Therapy for chronic atrial fibrillation (AF) focuses on rate versus rhythm control, but little is known about the effects of common therapeutic interventions on exercise tolerance in AF. METHODS Six hundred fifty-five patients with chronic AF underwent maximal exercise testing at baseline and 8 weeks, 6 months, and 1 year after randomization to sotalol, amiodarone, or placebo therapy and attempted direct current cardioversion. Analyses of baseline determinants of exercise capacity, predictors of change in exercise capacity at 6 months and 1 year, and the short- and long-term effects of cardioversion on exercise capacity were made. RESULTS Age, obesity, and presence of symptoms accompanying AF were inversely associated with baseline exercise capacity, but these factors accounted for only 10% of the variance in exercise capacity. Patients most likely to benefit from cardioversion were those most limited initially, younger, not obese or hypertensive, and with an uncontrolled ventricular rate at baseline. Conversion to sinus rhythm (SR) resulted in significant reductions in resting (approximately 25 beat/min) and peak exercise (approximately 40 beat/min) heart rates at 6 months and 1 year (P < .001). Successful cardioversion improved exercise capacity by 15% at 8 weeks, and these improvements were maintained throughout the year. This improvement was observed both among those who maintained SR and those with intermittent AF. CONCLUSION Cardioversion resulted in a sustained improvement in exercise capacity over the course of 1 year, and this improvement was similar between those in SR and those with SR and recurrent AF. Patients most likely to improve with treatment tended to be younger and nonobese and have the greatest limitations initially.
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Affiliation(s)
- J Edwin Atwood
- Cardiology Division, Walter Reed Army Medical Center, 6900 Georgia Ave NW, Washington, DC 20307, USA.
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Myers JN, Froelicher VF. Rehabilitation of the Patient with Cardiovascular Disease. Cardiovasc Ther 2007. [DOI: 10.1016/b978-1-4160-3358-5.50055-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Abraham WT, Abrams J, Aklog L, Albert MA, Antman EM, Anyanwu A, Arora R, Bakris GL, Bates ER, Bermudez EA, Cabell CH, Calhoun DA, Califf RM, Callans DJ, Chrysant G, Cohn JN, Colucci WS, Couper GS, Dangas GD, Danik JS, Davidson MH, DiMarco JP, Drexler H, Dzau VJ, Ellis SG, Falk RH, Falkner B, Fang JC, Ferguson JD, Forbess LW, Fox KA, Freedman J, Frisch DR, Frishman WH, Froelicher VF, Gaasch WH, Gehr TW, Giugliano RP, Givertz MM, Gordon BR, Gulliver GA, Hoit BD, Hsue PY, Hudgins LC, Jacobson JT, Kadish AH, Karha J, Katakam R, Khosla N, Krousel-Wood M, Kupersmith J, Kushner FG, Landzberg MJ, Lincoff AM, Maisel WH, Mangrum JM, Martucci G, Materson BJ, Mathier MA, McManus K, Meadows J, Melo LG, Mullany CJ, Mullen M, Muni NI, Murali S, Myers JN, Napolitano C, Nattel S, Newby DE, Nishizaka MK, Ooi OC, Oparil S, Peterson GE, Priori SG, Reimold SC, Rihal CS, Sacks FM, Saltman AE, Schroeder J, Schwartz GL, Shirazi F, Sica DA, Stevenson LW, Stone NJ, Sweitzer NK, Townsend RR, Umans JG, Velazquez EJ, Ward CA, Washam JB, Waters DD, Weber MA, Whelton PK, Wiviott SD, Wollert KC, Woosley RL, Young WF, Zimetbaum P, Zuckerman BD. Contributors. Cardiovasc Ther 2007. [DOI: 10.1016/b978-1-4160-3358-5.50003-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Jackson-Bernitsas DG, Ichikawa H, Takada Y, Myers JN, Lin XL, Darnay BG, Chaturvedi MM, Aggarwal BB. Evidence that TNF-TNFR1-TRADD-TRAF2-RIP-TAK1-IKK pathway mediates constitutive NF-κB activation and proliferation in human head and neck squamous cell carcinoma. Oncogene 2006; 26:1385-97. [PMID: 16953224 DOI: 10.1038/sj.onc.1209945] [Citation(s) in RCA: 160] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Constitutively activated nuclear factor-kappaB (NF-kappaB) has been associated with a variety of aggressive tumor types, including head and neck squamous cell carcinoma (HNSCC); however, the mechanism of its activation is not fully understood. Therefore, we investigated the molecular pathway that mediates constitutive activation of NF-kappaB in a series of HNSCC cell lines. We confirmed that NF-kappaB was constitutively active in all HNSCC cell lines (FaDu, LICR-LON-HN5 and SCC4) examined as indicated by DNA binding, immunocytochemical localization of p65, by NF-kappaB-dependent reporter gene expression and its inhibition by dominant-negative (DN)-inhibitory subunit of NF-kappaB (IkappaBalpha), the natural inhibitor of NF-kappaB. Constitutive NF-kappaB activation in HNSCC was found to be due to constitutive activation of IkappaBalpha kinase (IKK); and this correlated with constitutive expression of phosphorylated forms of IkappaBalpha and p65 proteins. All HNSCC showed the expression of p50, p52, p100 and receptor-interacting protein; all linked with NF-kappaB activation. The expression of constitutively active NF-kappaB in HNSCC is mediated through the tumor necrosis factor (TNF) signaling pathway, as NF-kappaB reporter activity was inhibited by DN-TNF receptor-associated death domain (TRADD), DN-TNF receptor-associated factor (TRAF)2, DN-receptor-interacting protein (RIP), DN-transforming growth factor-beta-activated kinase 1 (TAK1), DN-kappa-Ras, DN-AKT and DN-IKK but not by DN-TRAF5 or DN-TRAF6. Constitutive NF-kappaB activation was also associated with the autocrine expression of TNF, TNF receptors and receptor-activator of NF-kappaB and its ligand in HNSCC cells but not interleukin (IL)-1beta. All HNSCC cell lines expressed IL-6, a NF-kappaB-regulated gene product. Furthermore, treatment of HNSCC cells with anti-TNF antibody downregulated constitutively active NF-kappaB, and this was associated with inhibition of IL-6 expression and cell proliferation. Our results clearly demonstrate that constitutive activation of NF-kappaB is mediated through the TRADD-TRAF2-RIP-TAK1-IKK pathway, making TNF a novel target in the treatment of head and neck cancer.
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Affiliation(s)
- D G Jackson-Bernitsas
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Myers JN. Tutorial Lecture – Cardiopulmonary Exercise Testing in the Heart Failure Population. Med Sci Sports Exerc 2006. [DOI: 10.1249/00005768-200605001-00797] [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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Myers JN, Tan SY, Abella J, Abrol N, Kishorenath S, Sridhara V, Froelicher V. Comparison of Lifetime vs. Recent Recreational Activity in Predicting All-Cause Mortality. Med Sci Sports Exerc 2006. [DOI: 10.1249/00005768-200605001-02677] [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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Maruya SI, Myers JN, Weber RS, Rosenthal DI, Lotan R, El-Naggar AK. ICAM-5 (telencephalin) gene expression in head and neck squamous carcinoma tumorigenesis and perineural invasion! Oral Oncol 2005; 41:580-8. [PMID: 15975520 DOI: 10.1016/j.oraloncology.2005.01.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2004] [Accepted: 01/11/2005] [Indexed: 01/30/2023]
Abstract
ICAM-5 (telencephalin) is an intercellular adhesion molecule reported to be expressed only in the somatodendritic membrane of telencephalic neurons. We recently identified high ICAM-5 expression in a cDNA array study of head and neck neoplasms with a propensity for perineural invasion. To determine the association of this gene in tumorigenesis and perineural invasion, we analyzed the expression and functional status of ICAM-5 mRNA transcripts in 30 different human cancer cell lines and 25 head and neck squamous carcinoma specimens by reverse-transcriptase polymerase chain reaction (cell lines and specimens) and in vitro functional assays (cell lines). ICAM-5 transcripts were detected in 28 (93%) of 30 cell lines derived from primary head and neck, colon, thyroid, cervical, pancreatic, skin, and adenoid cystic carcinomas. In cell lines, small interfering RNA blocked ICAM-5 expression and inhibited cell proliferation. Treatment with the phosphatidylinositol 3'-kinase (PBK) inhibitor LY294002 resulted in ICAM-5 down-regulation. In tissue specimens, none of the 25 histologically normal oral mucosal specimens had detectable ICAM-5 level, whereas 16 (64%) of the 25 matched primary squamous carcinomas showed expression. Carcinoma specimens high ICAM-5 expression had a high incidence of perineural invasion. Our study indicates that ICAM-5 may play a role in tumorigenesis and perineural invasion, most likely through the P13K/Akt-signaling pathway.
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Affiliation(s)
- S I Maruya
- Department of Pathology, Unit 85, The University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030-4009, USA
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Mandal M, Kim S, Younes MN, Jasser SA, El-Naggar AK, Mills GB, Myers JN. The Akt inhibitor KP372-1 suppresses Akt activity and cell proliferation and induces apoptosis in thyroid cancer cells. Br J Cancer 2005; 92:1899-905. [PMID: 15870708 PMCID: PMC2361761 DOI: 10.1038/sj.bjc.6602595] [Citation(s) in RCA: 73] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The phosphatidylinositol 3′ kinase (PI3K)/phosphatase and tensin homologue deleted on chromosome ten/Akt pathway, which is a critical regulator of cell proliferation and survival, is mutated or activated in a wide variety of cancers. Akt appears to be a key central node in this pathway and thus is an attractive target for targeted molecular therapy. We demonstrated that Akt is highly phosphorylated in thyroid cancer cell lines and human thyroid cancer specimens, and hypothesised that KP372-1, an Akt inhibitor, would block signalling through the PI3K pathway and inhibit cell proliferation while inducing apoptosis of thyroid cancer cells. KP372-1 blocked signalling downstream of Akt in thyroid tumour cells, leading to inhibition of cell proliferation and increased apoptosis. As thyroid cancer consistently expresses phosphorylated Akt and KP372-1 effectively blocks Akt signalling, further preclinical evaluation of this compound for treatment of thyroid cancer is warranted.
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Affiliation(s)
- M Mandal
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S Kim
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M N Younes
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S A Jasser
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A K El-Naggar
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G B Mills
- Department of Molecular Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J N Myers
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Head and Neck Surgery, Unit 441, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. E-mail:
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Abstract
This study evaluated the accuracy of heart rate calibrated from a maximum exercise test for predicting energy expenditure during five activities of daily living (ADL) in participants with spinal cord injury (SCI). Thirteen individuals with SCI underwent maximum exercise testing, followed by portable heart rate and metabolic testing during five ADL. A regression equation was developed from heart rate and oxygen uptake responses during the maximum exercise test for each subject. Based on this individualized equation, heart rate measured during the ADL was used to estimate energy expenditure for each participant. Predicted energy expenditure from heart rate was compared with that measured by indirect calorimetry with the use of oxygen uptake. Heart rate derived from the individualized regression equations explained 55% of the variance in measured energy expenditure, compared with only 8.3% from heart rate alone. However, calibrated heart rate consistently overestimated the actual kilocalories used; on average, the estimated energy expenditure was roughly 25% higher than that measured by oxygen uptake. Heart rate can be used as a gross estimate of energy expenditure during higher-intensity ADL in people with SCI when individual calibration of heart rate from maximum exercise testing is used.
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Affiliation(s)
- Amy M Hayes
- Spinal Cord Injury Center, Department of Veterans Affairs Palo Alto Health Care System (VAPAHCS), Palo Alto, CA 94304, USA
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Abstract
BACKGROUND While the beneficial effect of exercise capacity on mortality is well-accepted, its effect on health-care costs remains uncertain. This study investigates the relationship between exercise capacity and health-care costs. METHODS The Veterans Affairs Health Care System recently implemented a Decision Support System that provides data on patterns of care, patient outcomes, workload, and costs. Total inpatient and outpatient costs were derived from existing administrative and clinical data systems, were adjusted for relative value units, and were expressed in relative cost units. We used univariable and multivariable analyses to evaluate the 1-year total costs in the year following a standard exercise test. Costs were compared with exercise capacity estimated in metabolic equivalents (METs), other test results, and clinical variables for 881 consecutive patients who were referred for clinical reasons for treadmill testing at the Palo Alto Veterans Affairs Health Care System facility between October 1, 1998, and September 30, 2000. RESULTS The patients had a mean age of 59 years, 95% were men, and 74% were white. Eight patients (< 1%) died during the year of follow-up. Exercise testing showed an average maximum heart rate of 138 beats/min, 8.2 METs, and a peak Borg scale of 17. In unadjusted analysis, costs were incrementally lower by an average of 5.4% per MET increase (p < 0.001). In a multivariable analysis adjusting for demographic variables, treadmill test performance and results, and clinical history, METs were found to be the most significant predictor of cost (F-statistic, 21.8; p < 0.001). CONCLUSION These findings are consistent with the hypothesis that exercise capacity is inversely associated with health-care costs.
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Affiliation(s)
- J Peter Weiss
- Division of Cardiovascular Medicine, Stanford University Medical Center and Veterans Affairs Health Care System, Palo Alto, CA 94304, USA
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Piña IL, Apstein CS, Balady GJ, Belardinelli R, Chaitman BR, Duscha BD, Fletcher BJ, Fleg JL, Myers JN, Sullivan MJ. Exercise and heart failure: A statement from the American Heart Association Committee on exercise, rehabilitation, and prevention. Circulation 2003; 107:1210-25. [PMID: 12615804 DOI: 10.1161/01.cir.0000055013.92097.40] [Citation(s) in RCA: 708] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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