1
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Ali A, Lee WF, O'Leary MP, Whealon M. Great Debates: Surgery or Watch and Wait After Total Neoadjuvant Therapy for Rectal Cancer. Am Surg 2024:31348241248812. [PMID: 38655585 DOI: 10.1177/00031348241248812] [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: 04/26/2024]
Abstract
Locally advanced rectal cancer has traditionally been treated with multimodal therapy including neoadjuvant chemoradiotherapy followed by surgical resection. More recent data suggests that in appropriate patients, total neoadjuvant treatment (TNT) makes it possible to adopt a "watch and wait" approach. Advocates for watch and wait argue that patients with a complete or near-complete clinical response to TNT have comparable overall and disease-free survival to their counterparts who undergo surgical resection, and also have a better quality of life, fewer complications, and potentially avoid a stoma. The dogma of surgery as regional curative intent therapy has been challenged by similar recurrence rates among those treated with total mesorectal excision (TME) and those treated with watch and wait. Furthermore, those who develop local recurrence in the watch and wait groups are equally salvageable, either by surgery, brachytherapy, or chemotherapy. While watch and wait is not appropriate in all patients, this manuscript highlights the benefits and drawbacks of both therapeutic modalities.
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Affiliation(s)
- Ayaa Ali
- Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Wang Fai Lee
- Department of Surgery, University of California Irvine, Irvine, CA, USA
| | - Michael P O'Leary
- Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Matthew Whealon
- Department of Surgery, University of California Irvine, Irvine, CA, USA
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2
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Yeow RY, O'Leary MP, Reddy AR, Kamdar NS, Hayek SS, de Lemos JA, Sutton NR. Survival Characteristics of Older Patients Hospitalized With COVID-19: Insights From the American Heart Association COVID-19 Cardiovascular Disease Registry. J Am Med Dir Assoc 2024; 25:348-350. [PMID: 38211937 DOI: 10.1016/j.jamda.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 01/13/2024]
Affiliation(s)
- Raymond Y Yeow
- Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Michael P O'Leary
- Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Akshay R Reddy
- Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Neil S Kamdar
- Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Salim S Hayek
- Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - James A de Lemos
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nadia R Sutton
- Division of Cardiovascular Medicine, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA.
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3
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Kabagwira J, Fuller RN, Vallejos PA, Sugiono CS, Andrianarijaona VM, Chism JB, O'Leary MP, Molina DC, Langridge W, Senthil M, Wall NR. Amplifying Curcumin's Antitumor Potential: A Heat-Driven Approach for Colorectal Cancer Treatment. Onco Targets Ther 2024; 17:63-78. [PMID: 38313386 PMCID: PMC10838088 DOI: 10.2147/ott.s448024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/25/2024] [Indexed: 02/06/2024] Open
Abstract
Introduction Peritoneal metastases from colorectal cancer (CRC) present a significant clinical challenge with poor prognosis, often unresponsive to systemic chemotherapy. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment approach for select patients. The use of curcumin, a natural compound with antitumor properties, in HIPEC is of interest due to its lower side effects compared to conventional drugs and potential for increased efficacy through direct delivery to the peritoneal cavity. Methods An in vitro hyperthermic model was developed to simulate clinical HIPEC conditions. Three colon cancer cell lines (SK-CO-1, COLO205, SNU-C1) representing different genetic mutations (p53, KRAS, BRAF) were treated with either curcumin (25 µM) or mitomycin-C (1 µM) for 1, 2, or 3 hours. Post-treatment, cells were incubated at 37°C (normothermia) or 42°C (hyperthermia). Cell viability and proliferation were assessed at 24, 48 and 72 hours post-treatment using Annexin V/PI, MTT assay, trypan blue exclusion, and Hoffman microscopy. Results Hyperthermia significantly enhanced the antitumor efficacy of curcumin, evidenced by a two-fold reduction in cell viability compared to normothermia across all cell lines. In the SNU-C1 cell line, which harbors a p53 mutation, mitomycin-C failed to significantly impact cell viability, unlike curcumin, suggesting mutation-specific differences in treatment response. Discussion The findings indicate that hyperthermia augments the antitumor effects of curcumin in vitro, supporting the hypothesis that curcumin could be a more effective HIPEC agent than traditional drugs like mitomycin-C. Mutation-associated differences in response to treatments were observed, particularly in p53 mutant cells. While further studies are needed, these preliminary results suggest that curcumin in HIPEC could represent a novel therapeutic strategy for CRC patients with peritoneal metastases. This approach may offer improved outcomes with fewer side effects, particularly in genetically distinct CRC subtypes.
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Affiliation(s)
- Janviere Kabagwira
- Department of Basic Science, Division of Biochemistry, Loma Linda University, Loma Linda, CA, USA
- Center for Health Disparities and Molecular Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Ryan N Fuller
- Department of Basic Science, Division of Biochemistry, Loma Linda University, Loma Linda, CA, USA
- Center for Health Disparities and Molecular Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Paul A Vallejos
- Department of Basic Science, Division of Biochemistry, Loma Linda University, Loma Linda, CA, USA
- Center for Health Disparities and Molecular Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Chase S Sugiono
- Department of Basic Science, Division of Biochemistry, Loma Linda University, Loma Linda, CA, USA
| | | | - Jazmine Brianna Chism
- Center for Health Disparities and Molecular Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Michael P O'Leary
- Division of Surgical Oncology, Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - David Caba Molina
- Division of Surgical Oncology, Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - William Langridge
- Department of Basic Science, Division of Biochemistry, Loma Linda University, Loma Linda, CA, USA
- Center for Health Disparities and Molecular Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Maheswari Senthil
- Division of Surgical Oncology, Department of Surgery, Irvine Medical Center, University of California, Orange, CA, USA
| | - Nathan R Wall
- Department of Basic Science, Division of Biochemistry, Loma Linda University, Loma Linda, CA, USA
- Center for Health Disparities and Molecular Medicine, Loma Linda University, Loma Linda, CA, USA
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4
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Lee D, Roman M, Newman GL, Lopez Y, Ashman ZW, O'Leary MP. Large Intestinal Obstruction and Perforation From Metastatic Merkel Cell Carcinoma: A Case Report. Cureus 2023; 15:e44467. [PMID: 37791147 PMCID: PMC10544344 DOI: 10.7759/cureus.44467] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/05/2023] Open
Abstract
Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine neoplasm of the skin that has a high propensity to metastasize. Abdominal metastases of MCC have been described previously though these are typically regional with nodal spread. We report the case of a 60-year-old man with a history of left upper extremity MCC who had resection, radiation therapy, and immunotherapy. He ultimately developed large bowel obstruction from metastatic intraperitoneal implants. A 6 cm mass at the descending colon was biopsied and proven to be metastatic MCC. The tumor eroded through the wall of the colon and perforated, requiring emergent colectomy for septic shock. Herein, we describe the first case of colonic perforation secondary to metastatic MCC. This case illustrates the importance of expedient and multifactorial management of patients with rapidly growing metastatic colonic tumors that are at risk for perforation.
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Affiliation(s)
- David Lee
- Surgery, Loma Linda University Medical Center, Loma Linda, USA
| | - Melanie Roman
- Surgery, Loma Linda University Medical Center, Loma Linda, USA
| | | | - Yamil Lopez
- Pathology, Loma Linda University Health, Murrieta, USA
| | - Zane W Ashman
- Surgery, Loma Linda University Health, Murrieta, USA
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Gonzalez L, Pawlik TM, Kibbe MR, Williams B, Vicente D, O'Leary MP, Velopulos CG, Funk LM. The 2020 Pandemics: Lessons Learned in Academic Surgery and Beyond. J Surg Res 2022; 276:A1-A6. [PMID: 35314073 PMCID: PMC8932549 DOI: 10.1016/j.jss.2022.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/08/2021] [Accepted: 01/26/2022] [Indexed: 02/08/2023]
Abstract
2020 was a significant year because of the occurrence of two simultaneous public health crises: the coronavirus pandemic and the public health crisis of racism brought into the spotlight by the murder of George Floyd. The coronavirus pandemic has affected all aspects of health care, particularly the delivery of surgical care, surgical education, and academic productivity. The concomitant public health crisis of racism and health inequality during the viral pandemic highlighted opportunities for action to address gaps in surgical care and the delivery of public health services. At the 2021 Academic Surgical Congress Hot Topics session on flexibility and leadership, we also explored how our military surgeon colleagues can provide guidance in leadership during times of crisis. The following is a summary of the issues discussed during the session and reflections on the important lessons learned in academic surgery over the past year.
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Affiliation(s)
- Lorena Gonzalez
- Department of Surgery, City of Hope National Medical Center, Duarte, California,Corresponding author. City of Hope South Bay, 5215 Torrance Blvd, Torrance, CA 90503. Tel.: 310-750-1715; fax: 310-939-0934
| | - Timothy M. Pawlik
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Melina R. Kibbe
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Brian Williams
- Department of Surgery, The University of Chicago Medicine & Biological Sciences, Chicago, Illinois
| | - Diego Vicente
- Uniformed Service University of the Health Sciences, Bethesda, Maryland
| | - Michael P. O'Leary
- Department of Surgery, Loma Linda University Medical Center, Loma Linda, California
| | | | - Luke M. Funk
- Department of Surgery, Wisconsin Surgical Outcomes Research Program (WiSOR), University of Wisconsin–Madison, Madison, Wisconsin,Department of Surgery, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
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Bhasin S, Lincoff AM, Basaria S, Bauer DC, Boden WE, Cunningham GR, Davey D, Dubcenco E, Fukumoto S, Garcia M, Granger CB, Kalahasti V, Khera M, Miller MG, Mitchell LM, O'Leary MP, Pencina KM, Snyder PJ, Thompson IM, Travison TG, Wolski K, Nissen SE. Effects of long-term testosterone treatment on cardiovascular outcomes in men with hypogonadism: Rationale and design of the TRAVERSE study. Am Heart J 2022; 245:41-50. [PMID: 34871580 DOI: 10.1016/j.ahj.2021.11.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Testosterone exerts some effects on the cardiovascular system that could be considered beneficial; some other effects may potentially increase the risk of cardiovascular (CV) events. Neither the long-term efficacy nor safety of testosterone treatment has been studied in an adequately-powered randomized trial. METHODS The Testosterone Replacement therapy for Assessment of long-term Vascular Events and efficacy ResponSE in hypogonadal men (TRAVERSE) study is a randomized, double-blind, placebo-controlled, parallel group, non-inferiority, multicenter study. Eligible participants are men, 45 to 80 years, with serum testosterone concentration <300 ng/dL and hypogonadal symptoms, who have evidence pre-existing CV disease or increased risk of CV disease. Approximately 6,000 subjects will be randomized to either 1.62% transdermal testosterone gel or a matching placebo gel daily for an anticipated duration of up to 5 years. The primary outcome is CV safety defined by the major adverse CV event composite of nonfatal myocardial infarction, nonfatal stroke, or death due to CV causes. The trial will continue until at least 256 adjudicated major adverse CV event endpoints have occurred to assess whether the 95% (2-sided) upper confidence limit for a hazard ratio of 1.5 can be ruled out. Secondary endpoints include prostate safety defined as the incidence of adjudicated high grade prostate cancer and efficacy in domains of sexual function, bone fractures, depression, anemia, and diabetes. RESULTS As of July 1, 2021, 5,076 subjects had been randomized. CONCLUSIONS The TRAVERSE study will determine the CV safety and long-term efficacy of testosterone treatment in middle-aged and older men with hypogonadism with or at increased risk of CV disease.
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Affiliation(s)
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- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Nguyen AH, O'Leary MP, De Andrade JP, Ituarte PG, Warner SG, Melstrom LG, Kessler J, Fong Y, Li D, Singh G. Presentation and survival of gastro-entero-pancreatic neuroendocrine tumors in young adults versus older patients. Am J Surg 2021; 223:939-944. [PMID: 34474917 DOI: 10.1016/j.amjsurg.2021.08.030] [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: 06/08/2021] [Revised: 08/02/2021] [Accepted: 08/16/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND A minority of patients with gastro-entero-pancreatic neuroendocrine tumors (GEP-NETs) is diagnosed at younger age. This population-based study explores the broad clinical and pathologic features of the youngest 5% of adult patients with GEP-NETs. METHODS A retrospective study of the National Cancer Database (NCDB) of patients with a primary GEP-NET was performed. Patients were stratified by age. Kaplan-Meier and multivariate Cox proportional hazards analyses were performed. RESULTS We identified 31,983 patients with a diagnosis of a GEP-NET and only 5% of patients were under the age of 35. Young patients were found to have greater proportions of localized, well differentiated disease. On multivariate analysis, young age, well differentiated histology, early stage, and surgical intervention were associated with lower risk of mortality. CONCLUSIONS Young patients with GEP-NETs tend to have earlier stage of presentation and well differentiated tumors, which may be most amenable to surgical intervention.
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Affiliation(s)
- Andrew H Nguyen
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Michael P O'Leary
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - James P De Andrade
- Department of Surgery, University of Iowa Health Care, 200 Hawkins Drive, Iowa City, IA, USA
| | - Philip G Ituarte
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Susanne G Warner
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Laleh G Melstrom
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Jonathan Kessler
- Department of Radiology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Daneng Li
- Department of Medical Oncology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Gagandeep Singh
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA.
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De Andrade JP, Wong P, O'Leary MP, Parekh V, Amini A, Schoellhammer HF, Margolin KA, Afkhami M, Melstrom LG. Multidisciplinary Care for Melanoma of Unknown Primary: Experience in the Era of Molecular Profiling. Ann Surg Oncol 2020; 27:5240-5247. [PMID: 32909128 DOI: 10.1245/s10434-020-09112-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/14/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Melanoma of unknown primary (MUP) accounts for approximately 3% of melanoma diagnoses. This study sought to evaluate treatment and outcomes for a modern MUP cohort. METHODS A retrospective review of MUP was performed at a tertiary referral cancer center. RESULTS Of 815 melanoma patients, 67 (8.2%) had MUP. Men were more likely to have MUP than women (67% vs. 55%; p = 0.04). The most common sites of MUP were lymph nodes (28%), visceral solid organs (25%), brain (16%), and skin/subcutaneous tissues (10%). Of the patients who underwent tumor genomic profiling, 52% harbored pathogenic BRAF mutations. Of the 24 patients who underwent multi-gene panel testing, all had pathogenic mutations and 21 (88%) had mutations in addition to or exclusive of BRAF, including 11 patients (46%) with telomerase reverse transcriptase promoter mutations. Checkpoint inhibitors (39%) and BRAF-MEK inhibitors (7%) were the most common first-line treatments. Upfront surgical resection was used for 25% of the MUP patients, and 12 of these resections were for curative intent. During a median follow-up period of 22.1 months, the median overall survival (OS) was not met for the patients with MUP isolated to lymph nodes. At 56.8 months, 75% of these patients were alive. The median OS was 37.4 months for skin/soft tissue MUP, 33.3 months for single solid organ viscera MUP, and 29.8 months for metastatic brain MUP. CONCLUSION Multigene panel testing identified pathogenic mutations in all tested MUP patients and frequently identified targets outside BRAF. Despite advanced stage, aggressive multimodal therapy for MUP can be associated with 5-year OS and should be pursued for appropriate candidates.
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Affiliation(s)
- James P De Andrade
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Paul Wong
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Michael P O'Leary
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Vishwas Parekh
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Hans F Schoellhammer
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Kim A Margolin
- Division of Medical Oncology, Department of Medicine, City of Hope National Medical Center, Duarte, CA, USA
| | - Michelle Afkhami
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Laleh G Melstrom
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.
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Affiliation(s)
- Lawrence Ku
- Division of Gastroenterology, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Marco A Paez
- Division of Gastroenterology, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Michael P O'Leary
- Department of Surgery, Division of Surgical Oncology, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Danielle M Hari
- Department of Surgery, Division of Surgical Oncology, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Sofiya Reicher
- Division of Gastroenterology, Harbor-UCLA Medical Center, Torrance, California, USA
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10
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Warner SG, Kim SI, Chaurasiya S, O'Leary MP, Lu J, Sivanandam V, Woo Y, Chen NG, Fong Y. A Novel Chimeric Poxvirus Encoding hNIS Is Tumor-Tropic, Imageable, and Synergistic with Radioiodine to Sustain Colon Cancer Regression. Mol Ther Oncolytics 2019; 13:82-92. [PMID: 31061881 PMCID: PMC6495072 DOI: 10.1016/j.omto.2019.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 04/04/2019] [Indexed: 12/11/2022]
Abstract
Colon cancer has a high rate of recurrence even with good response to modern therapies. Novel curative adjuncts are needed. Oncolytic viral therapy has shown preclinical promise against colon cancer but lacks robust efficacy in clinical trials and raises regulatory concerns without real-time tracking of viral replication. Novel potent vectors are needed with adjunctive features to enhance clinical efficacy. We have thus used homologous recombination and high-throughput screening to create a novel chimeric poxvirus encoding a human sodium iodide symporter (hNIS) at a redundant tk locus. The resulting virus (CF33-hNIS) consistently expresses hNIS and demonstrates replication efficiency and immunogenic cell death in colon cancer cells in vitro. Tumor-specific CF33-hNIS efficacy against colon cancer results in tumor regression in vivo in colon cancer xenograft models. Early expression of hNIS by infected cells makes viral replication reliably imageable via positron emission tomography (PET) of I-124 uptake. The intensity of I-124 uptake mirrors viral replication and tumor regression. Finally, systemic delivery of radiotherapeutic I-131 isotope following CF33-hNIS infection of colon cancer xenografts enhances and sustains tumor regression compared with virus treatment alone in HCT116 xenografts, demonstrating synergy of oncolytic viral therapy with radioablation in vivo.
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Affiliation(s)
- Susanne G Warner
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA.,Center for Gene Therapy, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Sang-In Kim
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Shyambabu Chaurasiya
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Michael P O'Leary
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Jianming Lu
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Venkatesh Sivanandam
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Yanghee Woo
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Nanhai G Chen
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA.,Center for Gene Therapy, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Yuman Fong
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA.,Center for Gene Therapy, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA
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11
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O'Leary MP, Beckord BJ, Mock KE, Venegas RJ, Yeh JJ, Dauphine CE, Ozao-Choy JJ. A new era of neoadjuvant treatment with Pertuzumab: Should the 10-lymph node guideline for axillary lymph node dissection in breast cancer be revised? Cancer Rep (Hoboken) 2018; 1:e1132. [PMID: 32729253 DOI: 10.1002/cnr2.1132] [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: 03/22/2018] [Revised: 06/26/2018] [Accepted: 07/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pertuzumab has improved pathologic complete response rates when compared with other chemotherapeutics in the treatment of HER-2 positive breast cancer patients. AIMS We sought to determine if axillary lymph node dissections (ALNDs) yielding at least the national standard of 10 lymph nodes is lower in patients who received neoadjuvant pertuzumab. METHODS AND RESULTS A retrospective database identified patients who underwent ALND for breast cancer. We compared the axillary lymph node retrieval rates in those who received or did not receive neoadjuvant pertuzumab. Of 139 breast cancer patients who underwent ALND, fewer than 10 axillary lymph nodes were found in 41.7% of patients who received neoadjuvant pertuzumab (P < 0.01) and 18.6% of patients who received neoadjuvant therapy without pertuzumab (P = 0.01). CONCLUSION Neoadjuvant chemotherapy was associated with a significantly lower rate of "adequate" ALNDs as defined by current guidelines. The patient subset that received neoadjuvant pertuzumab was more likely to have fewer than 10 axillary lymph nodes retrieved.
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Affiliation(s)
- Michael P O'Leary
- Department of Surgery, Division of Surgical Oncology, Harbor UCLA Medical Center, Torrance, CA, USA
| | - Brian J Beckord
- Department of Surgery, Division of Surgical Oncology, Harbor UCLA Medical Center, Torrance, CA, USA
| | - Kyle E Mock
- Department of Surgery, Division of Surgical Oncology, Harbor UCLA Medical Center, Torrance, CA, USA
| | - Rose J Venegas
- Department of Pathology, Division of Cytopathology, Harbor UCLA Medical Center, Torrance, CA, USA
| | - James J Yeh
- Department of Medicine, Division of Medical Oncology, Harbor UCLA Medical Center, Torrance, CA, USA
| | - Christine E Dauphine
- Department of Surgery, Division of Surgical Oncology, Harbor UCLA Medical Center, Torrance, CA, USA
| | - Junko J Ozao-Choy
- Department of Surgery, Division of Surgical Oncology, Harbor UCLA Medical Center, Torrance, CA, USA
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12
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Eng OS, Raoof M, O'Leary MP, Lew MW, Wakabayashi MT, Paz IB, Melstrom LG, Lee B. Hypothermia Is Associated with Surgical Site Infection in Cytoreductive Surgery with Hyperthermic Intra-Peritoneal Chemotherapy. Surg Infect (Larchmt) 2018; 19:618-621. [DOI: 10.1089/sur.2018.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Oliver S. Eng
- Department of Surgery, City of Hope National Medical Center, Duarte, California
| | - Mustafa Raoof
- Department of Surgery, City of Hope National Medical Center, Duarte, California
| | - Michael P. O'Leary
- Department of Surgery, City of Hope National Medical Center, Duarte, California
| | - Michael W. Lew
- Department of Anesthesiology, City of Hope National Medical Center, Duarte, California
| | - Mark T. Wakabayashi
- Department of Surgery, City of Hope National Medical Center, Duarte, California
| | - I. Benjamin Paz
- Department of Surgery, City of Hope National Medical Center, Duarte, California
| | - Laleh G. Melstrom
- Department of Surgery, City of Hope National Medical Center, Duarte, California
| | - Byrne Lee
- Department of Surgery, City of Hope National Medical Center, Duarte, California
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13
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O'Leary MP, Choi AH, Kim SI, Chaurasiya S, Lu J, Park AK, Woo Y, Warner SG, Fong Y, Chen NG. Novel oncolytic chimeric orthopoxvirus causes regression of pancreatic cancer xenografts and exhibits abscopal effect at a single low dose. J Transl Med 2018; 16:110. [PMID: 29699566 PMCID: PMC5918769 DOI: 10.1186/s12967-018-1483-x] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 04/17/2018] [Indexed: 02/07/2023] Open
Abstract
Background Pancreatic ductal adenocarcinoma (PDAC) has been increasing by 0.5% per year in the United States. PDAC portends a dismal prognosis and novel therapies are needed. This study describes the generation and characterization of a novel oncolytic chimeric orthopoxvirus for the treatment of pancreatic cancer. Methods After chimerization and high-throughput screening, CF33 was chosen from 100 new chimeric orthopoxvirus isolates for its ability to kill pancreatic cancer cells. In vitro cytotoxicity was assayed in six pancreatic cancer cell lines. In vivo efficacy and toxicity were evaluated in PANC-1 and MIA PaCa-2 xenograft models. Results CF33 caused rapid killing of six pancreatic cancer cells lines in vitro, releasing damage-associated molecular patterns, and regression of PANC-1 injected and non-injected distant xenografts in vivo after a single low intratumoral dose of 103 plaque-forming units. Using luciferase imaging, CF33 was noted to preferentially replicate in tumors which corresponds to the low viral titers found in solid organs. Conclusion The low dose of CF33 required to treat pancreatic cancer in this preclinical study may ease the manufacturing and dosing challenges currently facing oncolytic viral therapy.
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Affiliation(s)
- Michael P O'Leary
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, 1500 Duarte Rd., Duarte, CA, 91010, USA
| | - Audrey H Choi
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, 1500 Duarte Rd., Duarte, CA, 91010, USA
| | - Sang-In Kim
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, 1500 Duarte Rd., Duarte, CA, 91010, USA
| | - Shyambabu Chaurasiya
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, 1500 Duarte Rd., Duarte, CA, 91010, USA
| | - Jianming Lu
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, 1500 Duarte Rd., Duarte, CA, 91010, USA
| | - Anthony K Park
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, 1500 Duarte Rd., Duarte, CA, 91010, USA
| | - Yanghee Woo
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, 1500 Duarte Rd., Duarte, CA, 91010, USA
| | - Susanne G Warner
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, 1500 Duarte Rd., Duarte, CA, 91010, USA
| | - Yuman Fong
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, 1500 Duarte Rd., Duarte, CA, 91010, USA.,Center for Gene Therapy, Department of Hematologic and Hematopoietic Cell Transplantation, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Nanhai G Chen
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, 1500 Duarte Rd., Duarte, CA, 91010, USA. .,Center for Gene Therapy, Department of Hematologic and Hematopoietic Cell Transplantation, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, 91010, USA. .,Gene Editing and Viral Vector Core, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA, 91010, USA.
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14
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O'Leary MP, Warner SG, Kim SI, Chaurasiya S, Lu J, Choi AH, Park AK, Woo Y, Fong Y, Chen NG. A Novel Oncolytic Chimeric Orthopoxvirus Encoding Luciferase Enables Real-Time View of Colorectal Cancer Cell Infection. Mol Ther Oncolytics 2018; 9:13-21. [PMID: 29988502 PMCID: PMC6026443 DOI: 10.1016/j.omto.2018.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/19/2018] [Indexed: 01/23/2023]
Abstract
This study hypothesizes that a novel oncolytic chimeric orthopoxvirus CF33-Fluc is imageable and targets colorectal cancer cells (CRCs). A novel chimeric orthopoxvirus (CF33) was constructed. The thymidine kinase locus was replaced with firefly luciferase (Fluc) to yield a recombinant virus—CF33-Fluc. In vitro cytotoxicity and viral replication assays were performed. In vivo CRC flank xenografts received single doses of intratumoral or intravenous CF33-Fluc. Viral biodistribution was analyzed via luciferase imaging and organ titers. CF33-Fluc infects, replicates in, and kills CRCs in vitro in a dose-dependent manner. CF33 has superior secretion of extracellular-enveloped virus versus all but one parental strain. Rapid tumor regression or stabilization occurred in vivo at a low dose over a short time period, regardless of the viral delivery method in the HCT-116 colorectal tumor xenograft model. Rapid luciferase expression in virus-infected tumor cells was associated with treatment response. CRC death occurs via necroptotic pathways. CF33-Fluc replicates in and kills colorectal cancer cells in vitro and in vivo regardless of delivery method. Expression of luciferase enables real-time tracking of viral replication. Despite the chimerism, CRC death occurs via standard poxvirus-induced mechanisms. Further studies are warranted in immunocompetent models.
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Affiliation(s)
- Michael P O'Leary
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Susanne G Warner
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA.,Center for Gene Therapy, Department of Hematologic and Hematopoietic Cell Transplantation, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Sang-In Kim
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Shyambabu Chaurasiya
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Jianming Lu
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Audrey H Choi
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Anthony K Park
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Yanghee Woo
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Yuman Fong
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA.,Center for Gene Therapy, Department of Hematologic and Hematopoietic Cell Transplantation, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Nanhai G Chen
- Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA.,Center for Gene Therapy, Department of Hematologic and Hematopoietic Cell Transplantation, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA.,Gene Editing and Viral Vector Core, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA
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15
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O'Leary MP, Ayabe RI, Dauphine CE, Hari DM, Ozao-Choy JJ. Building a Single-Site Robotic Cholecystectomy Program in a Public Teaching Hospital: Is It Safe for Patients and Feasible for Residents to Participate?. Am Surg 2018. [DOI: 10.1177/000313481808400223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Single-site robotic cholecystectomy (SSRC) accounts for most of the robotic surgery cases performed by general surgeons at our institution since acquiring the da Vinci Si Surgical SystemTM (Intuitive Surgical, Inc., Sunnyvale, CA) in 2014. We sought to determine whether a SSRC program is safe to start in a public teaching hospital and to determine whether resident participation in this procedure is feasible. Data on age, gender, race, BMI, total operative time, length of stay, comorbidities, and conversion from laparoscopic to open surgery were examined for elective SSRC and laparoscopic cholecystectomies (LCs) performed by two faculty surgeons between February 2015 and August 2015. Thirty-eight patients underwent elective SSRC, whereas 27 patients underwent LC. Residents participated as operating surgeons for some portion of the case in 15 SSRC cases and in all LC cases. There were no significant differences in operative time, length of stay, or 30-day readmission rates, regardless of resident involvement. Patients in the SSRC group had a significantly lower BMI (25.8 vs 33.7, P = 0.008). This study suggests that resident participation does not increase complications or total operative time and that SSRC is a safe procedure to start in a public teaching hospital after proper faculty and resident training.
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Affiliation(s)
- Michael P. O'Leary
- Department of Surgery, Division of Surgical Oncology, Harbor UCLA Medical Center, Torrance, California
| | - Reed I. Ayabe
- Department of Surgery, Division of Surgical Oncology, Harbor UCLA Medical Center, Torrance, California
| | - Christine E. Dauphine
- Department of Surgery, Division of Surgical Oncology, Harbor UCLA Medical Center, Torrance, California
| | - Danielle M. Hari
- Department of Surgery, Division of Surgical Oncology, Harbor UCLA Medical Center, Torrance, California
| | - Junko J. Ozao-Choy
- Department of Surgery, Division of Surgical Oncology, Harbor UCLA Medical Center, Torrance, California
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16
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Choi AH, O'Leary MP, Chaurasiya S, Lu J, Kim SI, Fong Y, Chen NG. Novel chimeric parapoxvirus CF189 as an oncolytic immunotherapy in triple-negative breast cancer. Surgery 2017; 163:336-342. [PMID: 29174433 DOI: 10.1016/j.surg.2017.09.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/13/2017] [Accepted: 09/16/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Triple-negative breast cancer is an aggressive subtype of breast cancer with high recurrence rate and poor prognosis. Here we describe a novel, genetically engineered parapoxvirus that efficiently kills triple-negative breast cancer. METHODS A novel chimeric parapoxvirus (CF189) was generated via homologous recombination and identified through high-throughput screening. Cytotoxicity was assayed in vitro in 4 triple-negative breast cancer cell lines. Viral replication was examined through standard plaque assay. Orthotopic triple-negative breast cancer xenografts were generated by MDA-MB-468 implantation into the 2nd and 4th mammary fat pads of athymic nude mice and treated with the virus. RESULTS Chimeric parapoxvirus (CF189) demonstrated dose-dependent cytotoxicity at low multiplicity of infection, with > 80% cell death 6 days after treatment. Significant reductions in tumor size were observed 2 weeks after intratumoral injection at doses as low as 103 plaque-forming units (PFU) compared with control (P < 0.01). In addition, abscopal effect (shrinkage of noninjected remote tumors) was clearly demonstrated. CONCLUSION Chimeric parapoxvirus (CF189) demonstrated efficient cytotoxicity in vitro and potent antitumor effect in vivo at doses as low as 103 PFU. These are data encouraging of clinical development for this highly potent agent against triple-negative breast cancer.
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Affiliation(s)
- Audrey H Choi
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Michael P O'Leary
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | | | - Jianming Lu
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Sang-In Kim
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center, Duarte, CA; Center for Gene Therapy, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA
| | - Nanhai G Chen
- Department of Surgery, City of Hope National Medical Center, Duarte, CA; Center for Gene Therapy, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA.
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17
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Abstract
PURPOSE OF REVIEW The present review will highlight recent advances in the clinical application of oncolytic viral therapy. RECENT FINDINGS Until recently, oncolytic viral researchers saw the immune system as an enemy that would clear the virus from the bloodstream. However, researchers now understand that sustained responses are seen in those patients with more robust antitumor immune responses. Much of the current focus in oncolytic viral research is trained on manipulation of the immune system to affect cancer cell killing in the tumor microenvironment and to facilitate durable systemic antitumor immunity. Many investigators have demonstrated synergistic effects of checkpoint inhibition and other immune therapies with viral administration. At the same time, insertion of various markers enables noninvasive deep tissue imaging. Finally, following regulatory approval in the United States and Europe, unbridled clinical use of T-VEC for patients with metastatic melanoma is also generating large volumes of patient data that will help elucidate strengths and weaknesses of oncolytic viral therapy. Perhaps the most telling sign of the field's future is a seismic shift in clinical trials with more investigators combining virus and immunotherapies. SUMMARY This article reviews the current state of therapeutic oncolytic viruses in clinical use, and explores future directions of the field.
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Affiliation(s)
- Susanne G Warner
- aDivision of Surgical Oncology bDepartment of Surgery, City of Hope National Medical Center, Duarte, California, USA
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18
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O'Leary MP, Goldner BS, Abboy S, Mercado PD, Plurad HY. A single visit multidisciplinary model for managing patients with mutations in moderate and high-risk genes in a community practice setting. Fam Cancer 2017; 17:175-178. [PMID: 28600699 DOI: 10.1007/s10689-017-0010-1] [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] [Indexed: 11/30/2022]
Abstract
The introduction of screening for multiple high and moderate risk mutations in genes has resulted in a complex approach to patient care involving multiple disciplines. We sought to describe the feasibility of a single visit multidisciplinary approach to the management of patients with an identified high/moderate risk gene mutation. Patients who presented to our community hospital over a 1-year period who were found to have a high/moderate risk genetic mutation on a screening panel were referred to the High Risk Genetic Clinic. Thirty-five patients were included. The majority were female [34 (97.1%)], Hispanic [22 (62.9%)], with a family history of cancer [21 (60%)]. Mean age was 40.3 years. Most of the participants had a BRCA1 gene mutation [10 (28.6%)]. Patients were seen at the High Risk Genetic Clinic within a mean of 41.9 days from the day of genetic mutation diagnosis. Four patients did not show and were significantly younger (19.3 vs. 39.6 years, p = 0.014). In this community setting, we provided coordinated care within multiple disciplines related to a genetic mutation in a single clinic visit. Increased efforts at coordinating early care should be directed towards patients diagnosed at a younger age.
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Affiliation(s)
- Michael P O'Leary
- Department of Surgery, Kaiser Permanente, 1011 Baldwin Park Blvd, Baldwin Park, CA, 91706, USA.,Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Bryan S Goldner
- Department of Surgery, Kaiser Permanente, 1011 Baldwin Park Blvd, Baldwin Park, CA, 91706, USA.,Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Sridevi Abboy
- Department of Medical Genetics, Kaiser Permanente, Baldwin Park, CA, USA
| | - Philip D Mercado
- Department of Surgery, Kaiser Permanente, 1011 Baldwin Park Blvd, Baldwin Park, CA, 91706, USA.,Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Hong Yoon Plurad
- Department of Surgery, Kaiser Permanente, 1011 Baldwin Park Blvd, Baldwin Park, CA, 91706, USA. .,Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA.
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19
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Whealon MD, Gahagan JV, Sujatha-Bhaskar S, O'Leary MP, Selleck M, Dumitra S, Lee B, Senthil M, Pigazzi A. Erratum to: Is Fecal Diversion Needed in Pelvic Anastomoses During Hyperthermic Intraperitoneal Chemotherapy (HIPEC)? Ann Surg Oncol 2017; 24:690. [PMID: 28547561 DOI: 10.1245/s10434-017-5893-4] [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: 11/18/2022]
Affiliation(s)
- Matthew D Whealon
- Department of Surgery, University of California Irvine, Orange, CA, USA
| | - John V Gahagan
- Department of Surgery, University of California Irvine, Orange, CA, USA
| | | | - Michael P O'Leary
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Matthew Selleck
- Department of Surgery, Loma Linda University, Loma Linda, CA, USA
| | - Sinziana Dumitra
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Byrne Lee
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | | | - Alessio Pigazzi
- Department of Surgery, University of California Irvine, Orange, CA, USA.
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20
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Choi AH, O'Leary MP, Merchant SJ, Sun V, Chao J, Raz DJ, Kim JY, Kim J. Complications of Feeding Jejunostomy Tubes in Patients with Gastroesophageal Cancer. J Gastrointest Surg 2017; 21:259-265. [PMID: 27785689 PMCID: PMC5568416 DOI: 10.1007/s11605-016-3297-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 10/03/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Feeding jejunostomy tubes (FJT) in patients undergoing resection of gastroesophageal cancers facilitate perioperative nutrition. Data regarding FJT use and complications are limited. STUDY DESIGN A single institution review was performed for patients who underwent perioperative FJT placement for gastrectomy or esophagogastrectomy from 2007 to 2015. FJT-related and unrelated complications were evaluated. RESULTS FJTs were inserted for total/completion gastrectomy (n = 49/117, 41.9 %), proximal gastrectomy (n = 7/117, 6.0 %), or esophagogastrectomy (n = 61/117, 52.1 %). Ninety percent (n = 106/117) of patients used an FJT at some time point. Although the majority of patients (75.2 %) used FJTs after discharge, 8.5 % (n = 10/117) never used the FJT and 10.3 % (n = 12/117) used the FJT only during hospitalization. Overall, 44.4 % (n = 52/117) had FJT-related complications, including dislodgement (n = 22), clogging (n = 13), and leakage (n = 6). The majority of FJT complications were resolved by telephone triage (13.5 %) or bedside/clinic intervention (57.7 %), but 3.4 % required operative intervention for small bowel obstruction (n = 3) and hemorrhage (n = 1). FJT complications were more common with gastrectomy than esophagogastrectomy (53.6 vs. 36.0 %), perhaps related to longer FJT use in gastrectomy patients (71 vs. 38 days). CONCLUSIONS FJT-related complications are common, occurring more frequently after gastrectomy than esophagogastrectomy. In most patients, complications can be managed by simple measures, rarely requiring operative intervention. Nevertheless, the need for FJTs should be carefully considered to balance nutritional benefits with the risks of insertion and usage.
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Affiliation(s)
- Audrey H Choi
- Department of Surgery, City of Hope, Duarte, CA, USA
| | | | - Shaila J Merchant
- Department of Surgery, Queen's University, Kingston, Ontario, Canada
| | - Virginia Sun
- Division of Nursing Research and Education, City of Hope, Duarte, CA, USA
| | - Joseph Chao
- Department of Medical Oncology, City of Hope, Duarte, CA, USA
| | - Dan J Raz
- Department of Surgery, City of Hope, Duarte, CA, USA
| | - Jae Y Kim
- Department of Surgery, City of Hope, Duarte, CA, USA
| | - Joseph Kim
- Department of Surgery, SUNY Stony Brook, Stony Brook, NY, USA.
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21
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O'Leary MP, Neville AL, Keeley JA, Kim DY, de Virgilio C, Plurad DS. Predictors of Ischemic Bowel in Patients with Small Bowel Obstruction. Am Surg 2016; 82:992-994. [PMID: 27779991] [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: 06/06/2023]
Abstract
Preoperative diagnosis of ischemic bowel in patients with small bowel obstruction (SBO) is a clinical challenge. The aim of this study was to identify preoperative variables associated with ischemic bowel found at operative exploration. We performed a 5-year retrospective review of patients admitted to a university affiliated, county funded hospital who underwent exploratory laparoscopy or laparotomy for SBO. Patients were excluded if they had a known preoperative malignancy or hernia on physical examination. Multivariate logistic regression was used to determine factors independently associated with bowel ischemia or ischemic perforation. One hundred and sixteen patients underwent exploratory surgery for SBO. Mean age was 52 ± 14 years and most were male [64 (55.2%)]. Adhesions [92 (79.3%)] were the most common etiology of obstruction. Leukocytosis (P = 0.304) and acidosis (P = 0.151) were not significantly associated with ischemia or ischemic perforation. In addition, history of prior SBO (P = 0.618), tachycardia (P = 0.111), fever (P = 0.859), and time from admission to operation (P = 0.383) were not predictive of ischemic bowel. However, hyponatremia (≤134 mmol/L) and CT scan findings of wall thickening or a suspected closed loop were independently associated with bowel ischemia. Awareness of these predictors should heighten the concern for ischemic bowel in patients presenting with SBO.
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22
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Abstract
Preoperative diagnosis of ischemic bowel in patients with small bowel obstruction (SBO) is a clinical challenge. The aim of this study was to identify preoperative variables associated with ischemic bowel found at operative exploration. We performed a 5-year retrospective review of patients admitted to a university affiliated, county funded hospital who underwent exploratory laparoscopy or laparotomy for SBO. Patients were excluded if they had a known preoperative malignancy or hernia on physical examination. Multivariate logistic regression was used to determine factors independently associated with bowel ischemia or ischemic perforation. One hundred and sixteen patients underwent exploratory surgery for SBO. Mean age was 52 ± 14 years and most were male [64 (55.2%)]. Adhesions [92 (79.3%)] were the most common etiology of obstruction. Leukocytosis ( P = 0.304) and acidosis ( P = 0.151) were not significantly associated with ischemia or ischemic perforation. In addition, history of prior SBO ( P = 0.618), tachycardia ( P = 0.111), fever ( P = 0.859), and time from admission to operation ( P = 0.383) were not predictive of ischemic bowel. However, hyponatremia (≤134 mmol/L) and CT scan findings of wall thickening or a suspected closed loop were independently associated with bowel ischemia. Awareness of these predictors should heighten the concern for ischemic bowel in patients presenting with SBO.
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Affiliation(s)
| | | | | | - Dennis Y. Kim
- From the Harbor-UCLA Medical Center, Torrance, California
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23
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O'Leary MP, Parrish AB, Tom CM, MacLaughlin BW, Petrie BA. Staging Rectal Cancer: The Utility of Chest Radiograph and Chest Computed Tomography. Am Surg 2016; 82:1005-1008. [PMID: 27779994] [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: 06/06/2023]
Abstract
The National Comprehensive Cancer Network recommends that patients who are newly diagnosed with rectal cancer undergo staging CT scan of the chest. It is unclear whether posteroanterior and lateral chest radiography (X-ray) alone would provide adequate staging for most of these patients. A retrospective review was performed on all patients who had a two-view chest X-ray along with a chest CT for rectal cancer staging from 2007 to 2015. A total of 74 patients had both modalities. Sixty-three (85%) had a normal chest X-ray and 11 (15%) had an abnormal chest X-ray. Of the 63 patients with a normal chest X-ray, 40 (63%) had a corresponding normal chest CT and 23 (37%) had a lesion only noted on chest CT. Four patients (17%) in the latter group had metastatic cancer to the lung at the time of workup and four out of five of the tumors found to metastasize were within 5 cm from the anal verge. Our data suggest that a staging chest X-ray is unlikely to diagnose metastatic lungs lesions from a primary rectal cancer. Conversely, staging chest CT will accurately stage metastatic disease but will also reveal benign lung lesions in this patient population.
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Affiliation(s)
- Michael P O'Leary
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California, USA
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24
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Abstract
The National Comprehensive Cancer Network recommends that patients who are newly diagnosed with rectal cancer undergo staging CT scan of the chest. It is unclear whether posteroanterior and lateral chest radiography (X-ray) alone would provide adequate staging for most of these patients. A retrospective review was performed on all patients who had a two-view chest X-ray along with a chest CT for rectal cancer staging from 2007 to 2015. A total of 74 patients had both modalities. Sixty-three (85%) had a normal chest X-ray and 11 (15%) had an abnormal chest X-ray. Of the 63 patients with a normal chest X-ray, 40 (63%) had a corresponding normal chest CT and 23 (37%) had a lesion only noted on chest CT. Four patients (17%) in the latter group had metastatic cancer to the lung at the time of workup and four out of five of the tumors found to metastasize were within 5 cm from the anal verge. Our data suggest that a staging chest X-ray is unlikely to diagnose metastatic lungs lesions from a primary rectal cancer. Conversely, staging chest CT will accurately stage metastatic disease but will also reveal benign lung lesions in this patient population.
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Affiliation(s)
- Michael P. O'Leary
- From the Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Aaron B. Parrish
- From the Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Cynthia M. Tom
- From the Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Brian W. Maclaughlin
- From the Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Beverley A. Petrie
- From the Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
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25
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O'Leary MP, Keeley JA, Yule A, Suruki C, Plurad DS, Moazzez A, Neville AL, Putnam BA, Kim DY. Clinical predictors of early acute respiratory distress syndrome in trauma patients. Am J Surg 2016; 212:1096-1100. [PMID: 27780558 DOI: 10.1016/j.amjsurg.2016.09.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 09/06/2016] [Accepted: 09/06/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The objectives of this study were to examine the incidence and severity of early acute respiratory distress syndrome (ARDS) according to the Berlin Definition and to identify risk factors associated with the development of early post-traumatic ARDS. METHODS A 2.5-year retrospective database of adult trauma patients who required mechanical ventilation for greater than 48 hours at a level 1 trauma center was analyzed for variables predictive of early (<48 hours after injury), mild, moderate, and severe ARDS and in-hospital mortality. RESULTS Of 305 patients, 59 (19.3%) developed early ARDS: mild, 27 (45.8%); moderate, 26 (44.1%); and severe, 6 (10.1%). Performance of an emergent thoracotomy, blunt mechanism, and fresh frozen plasma administration were independently associated with the development of early ARDS. ARDS was not predictive of mortality. CONCLUSIONS Trauma patients with blunt mechanism, who receive fresh frozen plasma, or undergo thoracotomy, are at risk of developing early ARDS.
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Affiliation(s)
- Michael P O'Leary
- Harbor-UCLA Medical Center, Department of Surgery, 1000 West Carson Street Box 461, Torrance, CA 90502, USA
| | - Jessica A Keeley
- Harbor-UCLA Medical Center, Department of Surgery, 1000 West Carson Street Box 461, Torrance, CA 90502, USA
| | - Arthur Yule
- Harbor-UCLA Medical Center, Department of Surgery, 1000 West Carson Street Box 461, Torrance, CA 90502, USA
| | - Caitlyn Suruki
- Harbor-UCLA Medical Center, Department of Surgery, 1000 West Carson Street Box 461, Torrance, CA 90502, USA
| | - David S Plurad
- Harbor-UCLA Medical Center, Department of Surgery, 1000 West Carson Street Box 461, Torrance, CA 90502, USA
| | - Ashkan Moazzez
- Harbor-UCLA Medical Center, Department of Surgery, 1000 West Carson Street Box 461, Torrance, CA 90502, USA
| | - Angela L Neville
- Harbor-UCLA Medical Center, Department of Surgery, 1000 West Carson Street Box 461, Torrance, CA 90502, USA
| | - Brant A Putnam
- Harbor-UCLA Medical Center, Department of Surgery, 1000 West Carson Street Box 461, Torrance, CA 90502, USA
| | - Dennis Y Kim
- Harbor-UCLA Medical Center, Department of Surgery, 1000 West Carson Street Box 461, Torrance, CA 90502, USA.
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Choi AH, O'Leary MP, Fong Y, Chen NG. From Benchtop to Bedside: A Review of Oncolytic Virotherapy. Biomedicines 2016; 4:biomedicines4030018. [PMID: 28536385 PMCID: PMC5344257 DOI: 10.3390/biomedicines4030018] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [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] [Received: 06/30/2016] [Revised: 07/28/2016] [Accepted: 07/29/2016] [Indexed: 12/14/2022] Open
Abstract
Oncolytic viruses (OVs) demonstrate the ability to replicate selectively in cancer cells, resulting in antitumor effects by a variety of mechanisms, including direct cell lysis and indirect cell death through immune-mediate host responses. Although the mechanisms of action of OVs are still not fully understood, major advances have been made in our understanding of how OVs function and interact with the host immune system, resulting in the recent FDA approval of the first OV for cancer therapy in the USA. This review provides an overview of the history of OVs, their selectivity for cancer cells, and their multifaceted mechanism of antitumor action, as well as strategies employed to augment selectivity and efficacy of OVs. OVs in combination with standard cancer therapies are also discussed, as well as a review of ongoing human clinical trials.
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Affiliation(s)
- Audrey H Choi
- Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, USA.
| | - Michael P O'Leary
- Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, USA.
| | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, USA.
- Center for Gene Therapy, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA.
| | - Nanhai G Chen
- Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, USA.
- Center for Gene Therapy, Department of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA 91010, USA.
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Mendoza AS, O'Leary MP, Peng SK, Petrie BA, Li AI, French SW. Low-grade fibromyxoid sarcoma of the sigmoid colon. Exp Mol Pathol 2015; 98:300-3. [DOI: 10.1016/j.yexmp.2015.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 02/16/2015] [Indexed: 10/24/2022]
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Mahal BA, Ziehr DR, Hyatt AS, Neubauer-Sugar EH, O'Farrell DA, O'Leary MP, Steele GS, Niedermayr TR, Beard CJ, Martin NE, Orio PF, D'Amico AV, Devlin PM, Nguyen PL. Use of a rectal spacer with low-dose-rate brachytherapy for treatment of prostate cancer in previously irradiated patients: Initial experience and short-term results. Brachytherapy 2014; 13:442-9. [DOI: 10.1016/j.brachy.2014.05.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 02/19/2014] [Accepted: 05/01/2014] [Indexed: 11/16/2022]
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Heller HT, Oliff MC, Doubilet PM, O'Leary MP, Benson CB. Testicular microlithiasis: prevalence and association with primary testicular neoplasm. J Clin Ultrasound 2014; 42:423-426. [PMID: 24585495 DOI: 10.1002/jcu.22144] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 08/12/2013] [Accepted: 01/31/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE To assess the prevalence of testicular microlithiasis and its association with primary testicular neoplasm. METHODS Evaluated were 6,002 patients undergoing scrotal ultrasound at our institution. Data recorded included age, ultrasound date, presence of microlithiasis, presence of testicular mass on ultrasound, and pathologic diagnosis for those who had subsequent orchiectomy. RESULTS Four hundred fifty-six of 6,002 patients (7.6%) demonstrated testicular microlithiasis. The prevalence increased from 4.6% for those examined before 2001 to 9.02% for those examined since 2001 (p < 0.001). The prevalence of primary testicular neoplasm in patients without microlithiasis was 1.5% (84/5,546), whereas in those with microlithiasis it was 12% (53/456) (p < 0.001). The prevalence of pure seminoma was 39% (33/84) in the nonmicrolithiasis group with tumor versus 64% (34/53) in the microlithiasis group with tumor (p < 0.001). Germ cell tumors made up 98% of neoplasms in patients with microlithiasis, but only 85% in patients without microlithiasis (p = 0.009). CONCLUSIONS Advances in ultrasound technology have led to an increased detection of testicular microlithiasis. We observed an eight-fold increased prevalence of primary testicular neoplasm in patients with microlithiasis than in those without as well as an increased prevalence of germ cell tumors, particularly pure seminoma. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 42:423-426, 2014.
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Affiliation(s)
- Howard T Heller
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115
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Niedermayr TR, Nguyen PL, Murciano-Goroff YR, Kovtun KA, Neubauer Sugar E, Cail DW, O'Farrell DA, Hansen JL, Cormack RA, Buzurovic I, Wolfsberger LT, O'Leary MP, Steele GS, Devlin PM, Orio PF. Placement of empty catheters for an HDR-Emulating LDR Prostate Brachytherapy technique: Comparison to standard intraoperative planning. Brachytherapy 2014; 13:375-9. [DOI: 10.1016/j.brachy.2014.01.009] [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] [Received: 12/10/2013] [Revised: 01/17/2014] [Accepted: 01/28/2014] [Indexed: 10/25/2022]
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Abstract
INTRODUCTION The rectum is particularly sensitive to radiation and it represents the dose limiting structure during radiation therapy for prostate cancer. Transperineally inserted rectal hydrogel spacers were proposed as a technique to limit the rectal radiation dose and rectal toxicity during prostate radiation therapy. METHODS Different spacing materials, including hyaluronic acid, polyethylene glycol and human collagen, have been tested as potential rectal spacing agents to reduce radiation exposure to the rectum and limit rectal toxicity. RESULTS Early results from studies in which 1 to 48 patients received rectal spacers demonstrate that rectal spacers during prostate radiation therapy appear to be feasible and tolerable, and are not associated with significant side effects. The published literature shows a median or mean space achieved between the rectum and prostate that typically ranges from 1.0 to 2.0 cm, significant reductions in rectal radiation dose, a low rate of acute gastrointestinal toxicity and short-term quality of life benefits when comparing men who receive rectal spacers during prostate radiation therapy to those who do not. CONCLUSIONS Rectal spacers could potentially allow for greater dose escalation and hypofractionation while reducing rectal toxicity or protecting against increased rectal toxicity. This could theoretically lead to better tumor control, decreased toxicity and health care costs, and improved patient and provider satisfaction. Although short-term results based on the small cohort studies summarized in this review are encouraging, longer followup and larger, randomized trials are needed to determine the impact of rectal spacers on tumor control and late rectal toxicity.
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Affiliation(s)
| | - Michael P. O'Leary
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paul L. Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Nguyen PL, Devlin PM, Beard CJ, Orio PF, O'Leary MP, Wolfsberger LD, O'Farrell DA, Sweeney CM, Hadaschik BA, Hohenfellner M, Hatiboglu G. High-dose-rate brachytherapy for prostate cancer in a previously radiated patient with polyethylene glycol hydrogel spacing to reduce rectal dose: Case report and review of the literature. Brachytherapy 2013; 12:77-83. [DOI: 10.1016/j.brachy.2012.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 03/13/2012] [Indexed: 10/28/2022]
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Nnedu ON, O'Leary MP, Mutua D, Mutai B, Kalantari-Dehaghi M, Jasinskas A, Nakajima-Sasaki R, John-Stewart G, Otieno P, Liang X, Waitumbi J, Kimani F, Camerini D, Felgner PL, Walson JL, Vigil A. Humoral immune responses to Plasmodium falciparum among HIV-1-infected Kenyan adults. Proteomics Clin Appl 2012; 5:613-23. [PMID: 21956928 DOI: 10.1002/prca.201100021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Humoral immune responses play a pivotal role in naturally acquired immunity to malaria. Understanding which humoral responses are impaired among individuals at higher risk for malaria may improve our understanding of malaria immune control and contribute to vaccine development. METHODS We compared humoral responses with 483 Plasmodium falciparum antigens between adults in, Kisumu (high, year-long malaria transmission leading to partial immunity), and adults in Kisii (low, seasonal malaria transmission). Then within each site, we compared malaria-specific humoral responses between those at higher risk for malaria (CD4(+) ≤500) and those at lower risk for malaria (CD4(+) >500). A protein microarray chip containing 483 P. falciparum antigens and 71 HIV antigens was used. Benjamini-Hochberg adjustments were made to control for multiple comparisons. RESULTS Fifty-seven antigens including CSP, MSP1, LSA1 and AMA1 were identified as significantly more reactive in Kisumu than in Kisii. Ten of these antigens had been identified as protective in an earlier study. CD4(+) T-cell count did not significantly impact humoral responses. CONCLUSION Protein microarrays are a useful method to screen multiple humoral responses simultaneously. This study provides useful clues for potential vaccine candidates. Modest decreases in CD4 counts may not significantly impact malaria-specific humoral immunity.
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Affiliation(s)
- Obinna N Nnedu
- Department of Medicine, Section of Infectious Diseases, Tulane University, New Orleans, LO, USA.
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O'Rourke DJ, DiJohnson DA, Caiazzo RJ, Nelson JC, Ure D, O'Leary MP, Richie JP, Liu BCS. Autoantibody signatures as biomarkers to distinguish prostate cancer from benign prostatic hyperplasia in patients with increased serum prostate specific antigen. Clin Chim Acta 2011; 413:561-7. [PMID: 22146597 DOI: 10.1016/j.cca.2011.11.027] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 11/07/2011] [Accepted: 11/23/2011] [Indexed: 01/26/2023]
Abstract
BACKGROUND Serum prostate specific antigen (PSA) concentrations lack the specificity to differentiate prostate cancer from benign prostate hyperplasia (BPH), resulting in unnecessary biopsies. We identified 5 autoantibody signatures to specific cancer targets which might be able to differentiate prostate cancer from BPH in patients with increased serum PSA. METHODS To identify autoantibody signatures as biomarkers, a native antigen reverse capture microarray platform was used. Briefly, well-characterized monoclonal antibodies were arrayed onto nanoparticle slides to capture native antigens from prostate cancer cells. Prostate cancer patient serum samples (n=41) and BPH patient samples (collected starting at the time of initial diagnosis) with a mean follow-up of 6.56 y without the diagnosis of cancer (n=39) were obtained. One hundred micrograms of IgGs were purified and labeled with a Cy3 dye and incubated on the arrays. The arrays were scanned for fluorescence and the intensity was quantified. Receiver operating characteristic curves were produced and the area under the curve (AUC) was determined. RESULTS Using our microarray platform, we identified autoantibody signatures capable of distinguishing between prostate cancer and BPH. The top 5 autoantibody signatures were TARDBP, TLN1, PARK7, LEDGF/PSIP1, and CALD1. Combining these signatures resulted in an AUC of 0.95 (sensitivity of 95% at 80% specificity) compared to AUC of 0.5 for serum concentration PSA (sensitivity of 12.2% at 80% specificity). CONCLUSION Our preliminary results showed that we were able to identify specific autoantibody signatures that can differentiate prostate cancer from BPH, and may result in the reduction of unnecessary biopsies in patients with increased serum PSA.
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Affiliation(s)
- Dennis J O'Rourke
- Molecular Urology Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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Kupelian V, Wei JT, O'Leary MP, Norgaard JP, Rosen RC, McKinlay JB. Nocturia and quality of life: results from the Boston area community health survey. Eur Urol 2011; 61:78-84. [PMID: 21945718 DOI: 10.1016/j.eururo.2011.05.065] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 08/29/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Nocturia, a common complaint in aging men and women, is frequently cited as the cause of nocturnal awakenings leading to sleep loss, daytime fatigue, and reduced quality of life (QOL). OBJECTIVE Investigate the association of nocturia with QOL and depressive symptoms among men and women. DESIGN, SETTING, AND PARTICIPANTS A population-based epidemiologic survey of urologic symptoms among persons aged 30-79 yr. A multistage stratified cluster sample design was used to randomly sample 5503 residents of Boston, MA, USA. MEASUREMENTS Nocturia was defined as a self-report of two or more voiding episodes nightly or having to get up to urinate more than once nightly "fairly often," "usually," or "almost always." QOL was assessed using the physical and mental health component scores of the 12-Item Short-Form Survey (SF-12). Depression was assessed using the Center for Epidemiological Studies Depression Scale. Multiple linear and logistic regression methods were used to model the nocturia and QOL association and to control for confounders. RESULTS AND LIMITATIONS Nocturia was associated with decreased SF-12 scores for both the physical and mental health components after multivariate adjustment. Nocturia was also associated with increased odds of depressive symptoms (men: adjusted odds ratio [OR]: 2.79; 95% confidence interval [CI], 1.81-4.31; women: adjusted OR: 1.80; 95% CI, 1.29-2.51). Among women who reported sleep interference due to urologic symptoms, nocturia was associated with a threefold increase in odds of depression. In this cross-sectional analysis, the temporal sequence of causality of the nocturia and depression association could not be assessed. CONCLUSIONS Nocturia is associated with decreased QOL and with an increased prevalence of depressive symptoms in both men and women.
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Nickel JC, O'Leary MP, Lepor H, Caramelli KE, Thomas H, Hill LA, Hoel GE. Silodosin for men with chronic prostatitis/chronic pelvic pain syndrome: results of a phase II multicenter, double-blind, placebo controlled study. J Urol 2011; 186:125-31. [PMID: 21571345 DOI: 10.1016/j.juro.2011.03.028] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Indexed: 12/16/2022]
Abstract
PURPOSE We evaluated the efficacy and safety of 2 doses of silodosin vs placebo in men with moderate to severe abacterial chronic prostatitis/chronic pelvic pain syndrome who had not been treated previously with α-blockers for chronic prostatitis/chronic pelvic pain syndrome. MATERIALS AND METHODS In this multicenter, randomized, double-blind, phase II study, men 18 years old or older with chronic prostatitis/chronic pelvic pain syndrome, a total National Institutes of Health Chronic Prostatitis Symptom Index score of 15 or greater and a National Institutes of Health Chronic Prostatitis Symptom Index pain score of 8 or greater received 4 or 8 mg silodosin, or placebo once daily for 12 weeks. The primary efficacy end point was change from baseline to week 12 in National Institutes of Health Chronic Prostatitis Symptom Index total score. RESULTS Of 151 patients (mean age 48 years) 52 received 4 mg silodosin, 45 received 8 mg silodosin and 54 received placebo. Silodosin 4 mg was associated with a significant decrease in total National Institutes of Health Chronic Prostatitis Symptom Index score (mean ± SD change -12.1 ± 9.3) vs placebo (-8.5 ± 7.2, p = 0.0224), including a decrease in urinary symptom (-2.2 ± 2.7, placebo -1.3 ± 3.0, p = 0.0102) and quality of life (-4.1 ± 3.1, placebo -2.7 ± 2.5, p = 0.0099) subscores. The 4 mg dose of silodosin also significantly increased Medical Outcomes Study Short Form 12 physical component scores (4.2 ± 8.1, placebo 1.7 ± 9.0, p = 0.0492). During global response assessment 56% of patients receiving 4 mg silodosin vs 29% receiving placebo reported moderate or marked improvement (p = 0.0069). Increasing the dose of silodosin to 8 mg resulted in no incremental treatment effects. CONCLUSIONS Silodosin 4 mg relieved symptoms and improved quality of life in men with chronic prostatitis/chronic pelvic pain syndrome but its efficacy requires confirmation in additional studies.
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Angalakuditi M, Seifert RF, Hayes RP, O'Leary MP, Viktrup L. Measurement properties of the benign prostatic hyperplasia impact index in tadalafil studies. Health Qual Life Outcomes 2010; 8:131. [PMID: 21073697 PMCID: PMC2998470 DOI: 10.1186/1477-7525-8-131] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 11/12/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To assess the measurement properties of the Benign Prostatic Hyperplasia Impact Index (BII) for use in men with Lower Urinary Tract Symptoms (LUTS) secondary to Benign Prostatic Hyperplasia (BPH) treated with tadalafil. METHODS Data from a dose-titration (Study 1) and a dose-finding placebo-controlled (Study 2) tadalafil studies of men 45 years of age or older with moderate to severe LUTS (N = 281; N = 1053) were included in this post-hoc analysis. Measures included the BII, International Prostate Symptom Score (IPSS), IPSS Quality of Life Index (IPSS-QoL), LUTS Global Assessment Question, uroflowmetry measure peak flow rate (Qmax) and postvoid residual volume (PVR). Spearman rank and Pearson correlation coefficients were computed between the BII score and the other measures at each visit. Wilcoxin two-sample tests, t-tests and general linear modeling compared BII scores of subjects with global ratings of improvement versus no improvement, and subjects taking tadalafil versus placebo. Effect size, standardized response mean and Guyatt's responsiveness statistic were calculated for BII and IPSS change scores. RESULTS There were high correlations between BII and IPSS & IPSS-QoL and low correlations between BII and Qmax & PVR at each visit. There were significant differences in BII at the End-of-Study Visit between subjects reporting improvement versus subjects reporting no improvement (Studies 1 and 2, P < .0001) and subjects taking tadalafil versus subjects taking placebo (Study 1, P = .0045; Study 2, P = .0064). The BII and IPSS were both responsive to change. CONCLUSIONS Results show that the BII is reliable, shows responsiveness to change in patients with BPH-LUTS, and demonstrates construct validity.
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Sullivan KF, Barqawi A, Crawford ED, O'Leary MP, O'Donnell CI, Maroni PD. A REDUCED AMERICAN UROLOGICAL ASSOCIATION SYMPTOM SCORE. J Urol 2009. [DOI: 10.1016/s0022-5347(09)61676-1] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pontari MA, Krieger JN, Litwin MS, White PC, Anderson RU, McNaughton-Collins M, Nickel JC, Shoskes DA, Alexander RB, Nadler RB, O'Leary MP, Zeitlin S, Chuai S, Landis JR, Kusek JW, Nyberg LM, Schaeffer AJ. A RANDOMIZED PLACEBO-CONTROLLED MULTICENTER TRIAL OF PREGABALIN FOR THE TREATMENT OF MEN WITH CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME. J Urol 2009. [DOI: 10.1016/s0022-5347(09)60354-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rosen RC, Link CL, Mollon P, Aiyer LP, O'Leary MP, Giuliano F. LOWER URINARY TRACT SYMPTOMS (LUTS) AND SEXUAL HEALTH: THE ROLE OF GENDER, LIFESTYLE AND MEDICAL CO-MORBIDITIES. J Urol 2009. [DOI: 10.1016/s0022-5347(09)60463-8] [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: 11/15/2022]
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Abstract
BACKGROUND Interstitial cystitis is characterized by over 6 months of chronic pain, pressure and discomfort felt in the lower pelvis or bladder. It is often relieved with voiding, along with daytime frequency and nocturia in the absence of a urinary tract infection. Interstitial cystitis occurs primarily in females including adolescents and its diagnosis is still one of exclusion. It is now recognized as a serious medical condition associated with significant disability. OBJECTIVE The aim of this paper was to review the pathogenesis and treatment of interstitial cystitis with emphasis on new pathogenetic trends and therapeutic modalities. METHODS About 713 mostly original papers were reviewed in Medline from 1990 to August. 2008. All authors independently reviewed the literature. Large, double-blind, placebo-controlled, clinical trials were few and the medical histories of the patients used varied considerably making conclusions difficult. Promising pilot trials turned out mostly negative on follow-up. RESULTS Increasing evidence of co-morbid diseases, neurogenic inflammation and the effect of stress are promising as new targets for pathophysiology. No new effective treatments have emerged. Oral pentosanpolysulfate, amitriptyline, hydroxyzine and quercetin, as well as intravesical heparin/bicarbonate/lidocaine solutions, are still used with variable success. Some pilot open-label trials presented encouraging findings. CONCLUSION Interstitial cystitis contributes substantially to chronic pelvic pain and to poor quality of life. Oral or intravesical administration of solutions containing sodium hyaluronate, chondroitin sulfate and quercetin to both reduce bladder inflammation and 'replenish' the glycosaminoglycan layer should be tried. There is a clear need for therapeutic modalities. New potential translational research areas are suggested.
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Affiliation(s)
- Theoharis C Theoharides
- Tufts University School of Medicine, Department of Pharmacology and Experimental Therapeutics, Experimental Therapeutics 136 Harrison Avenue, Boston, MA 02111, USA.
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Nickel JC, Alexander RB, Anderson R, Berger R, Comiter CV, Datta NS, Fowler JE, Krieger JN, Landis JR, Litwin MS, McNaughton-Collins M, O'Leary MP, Pontari MA, Schaeffer AJ, Shoskes DA, White P, Kusek J, Nyberg L. Category III chronic prostatitis/chronic pelvic pain syndrome: insights from the National Institutes of Health Chronic Prostatitis Collaborative Research Network studies. Curr Urol Rep 2009; 9:320-7. [PMID: 18765132 DOI: 10.1007/s11934-008-0055-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic prostatitis/chronic pelvic pain syndrome remains an enigmatic medical condition. Creation of the National Institutes of Health-funded Chronic Prostatitis Collaborative Research Network (CPCRN) has stimulated a renewed interest in research on and clinical aspects of chronic prostatitis/chronic pelvic pain syndrome. Landmark publications of the CPCRN document a decade of progress. Insights from these CPCRN studies have improved our management of chronic prostatitis/chronic pelvic pain syndrome and offer hope for continued progress.
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Affiliation(s)
- J Curtis Nickel
- Department of Urology, Queen's University, Kingston General Hospital, Kingston, Ontario K7L 2V7, Canada.
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Abstract
PURPOSE To evaluate the performance characteristics of computed tomographic (CT) urography for the detection of bladder cancer in patients at risk for the disease. MATERIALS AND METHODS Institutional review board approval was obtained for this retrospective HIPAA-compliant review of medical records of 2600 consecutive patients undergoing CT urography. Of these, 838 CT urograms in 779 patients (449 men, mean age of 62 years, range of 27-92 years; 330 women, mean age of 56 years, range of 18-86 years) evaluated for hematuria or a history of urothelial cancer, who had undergone cystoscopy within 6 months of the CT urogram, were included in the study. Clinical reports of CT urograms containing a bladder lesion interpreted as suspicious for malignancy were classified as positive. All others were classified as negative. Cystoscopy reports were classified as positive if a lesion underwent biopsy or was resected or negative if no lesion was detected. Performance characteristics for both CT urography and cystoscopy were determined by using pathologic findings or clinical follow-up as the reference standard. Ninety-five percent confidence intervals were estimated for each test characteristic. RESULTS The overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value (NPV) for bladder cancer detection were 79% (117 of 149), 94% (649 of 689), 91% (766 of 838), 75% (117 of 157), and 95% (649 of 681) for CT urography and 95% (142 of 149), 92% (634 of 689), 93% (776 of 838), 72% (142 of 197), and 99% (634 of 641) for cystoscopy. The NPV of CT urography was higher in patients evaluated for hematuria alone (98%, 589 of 603). However, the accuracy of CT urography was considerably lower in patients with a prior urothelial malignancy (78%, 123 of 158). CONCLUSION CT urography is an accurate noninvasive test for detecting bladder cancer in patients at risk for the disease. The high NPV of CT urography in patients with hematuria may obviate cystoscopy in selected patients.
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Affiliation(s)
- Cheryl A Sadow
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
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O'Leary MP, Wei JT, Roehrborn CG, Miner M. Correlation of the International Prostate Symptom Score bother question with the Benign Prostatic Hyperplasia Impact Index in a clinical practice setting. BJU Int 2008; 101:1531-5. [PMID: 18445080 DOI: 10.1111/j.1464-410x.2008.07574.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the association between the International Prostate Symptom Score (IPSS) bother question (BQ) and a validated disease-specific quality-of-life questionnaire, the Benign Prostatic Hyperplasia (BPH) Impact Index (BPH-II), using the BPH Registry and Patient Survey database. PATIENTS AND METHODS The BPH Registry and Patient Survey is a multicentre, longitudinal, observational database of management practices and patient outcomes in a population of patients with BPH in the USA, managed with watchful waiting or pharmacotherapy. Men enrolled in the BPH Registry who completed the IPSS BQ and the four-item BPH-II at enrolment were identified. The association between the IPSS BQ score and the BPH Impact Index was assessed using Spearman rank correlation. RESULTS At baseline (enrolment visit), 6439 men (mean age 66 years) completed the IPSS BQ and the BPH-II. The mean (sd) score of the IPSS BQ was 2.5 (1.4) and of the BPH-II was 2.8 (2.8). Based on responses to the BPH-II, at least half the men reported that their urinary symptoms were associated with physical discomfort, worry about their health, and bothersomeness. The IPSS BQ score was significantly correlated (P < 0.001) with the BPH-II (r = 0.68) and each of its four questions (physical discomfort, r = 0.52; worry about health, r = 0.53; bothersomeness of trouble with urination, r = 0.67; and time kept from usual activities, r = 0.44). CONCLUSIONS The IPSS BQ score has a strong and positive correlation with the BPH-II among men enrolled in the BPH Registry. The IPSS BQ is a convenient tool for assessing disease-specific quality of life when determining treatment strategies and evaluating treatment outcomes in men with BPH.
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Affiliation(s)
- Michael P O'Leary
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Dallal RM, Smith JA, O'Leary MP, Harkaway RC, Sawh SL. PROFOUND SEXUAL DYSFUNCTION IS COMMON IN THE MORBIDLY OBESE MALE AND IS REVERSED AFTER GASTRIC BYPASS SURGERY. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61186-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Prasad SM, Ferreira M, Prasad MM, Lipsitz SR, Richie JP, Loughlin KR, O'Leary MP, Doyle CJ, Steele GS, Gawande AA, Hu JC. SURGICAL APGAR: PERIOPERATIVE RISK ASSESSMENT FOR RADICAL CYSTECTOMY. J Urol 2008. [DOI: 10.1016/s0022-5347(08)60013-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nickel JC, Tripp DA, Chuai S, Litwin MS, McNaughton-Collins M, Landis JR, Alexander RB, Schaeffer AJ, O'Leary MP, Pontari MA, White P, Mullins C, Nyberg L, Kusek J. Psychosocial variables affect the quality of life of men diagnosed with chronic prostatitis/chronic pelvic pain syndrome. BJU Int 2007; 101:59-64. [PMID: 17924985 DOI: 10.1111/j.1464-410x.2007.07196.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine interactions between demographic, pain, urinary, psychological and environmental predictors of quality of life (QOL) in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). PATIENTS AND METHODS In all, 253 men previously enrolled in the National Institutes of Health Chronic Prostatitis Cohort study in North American tertiary-care clinical centres (six in the USA and one in Canada) self-reported with validated instruments, including the QOL subscales of the Short Form-12 (physical, SF12-PCS; and mental, SF12-MCS), demographics, urinary symptoms, depression, current pain, pain coping, 'catastrophizing' (catastrophic thinking about pain), pain control, social support and solicitous responses from a partner. Data were collected through a one-time survey. Covariates determined to be significant were entered into a multivariable regression model predicting SF12-PCS and SF12-MCS. RESULTS Adjusting for covariates, regression models showed that poorer SF12-PCS scores were predicted by worse urinary function (P < 0.001) and increased use of pain-contingent resting as a coping strategy (P = 0.026). Further, poorer SF12-MCS scores were predicted by greater pain catastrophizing (P = 0.002) and lower perceptions of social support (P< 0.001). In separate follow-up analyses, helplessness was the significant catastrophizing subscale (P < 0.001), while support from family and friends were the significant social support subscales (P = 0.002 and <0.001). CONCLUSIONS These data suggest that specific coping and environmental factors (i.e. catastrophizing, pain-contingent resting, social support) are significant in understanding how patients with CP/CPPS adjust. These data can be used to develop specific cognitive-behavioural programmes for men with CP/CPPS who are refractory to standard medical therapy.
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Affiliation(s)
- J Curtis Nickel
- Department of Urology, Queen's University, Kingston, Ontario, Canada.
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Cappelleri JC, Althof SE, O'Leary MP, Glina S, King R, Stecher VJ, Carlsson M, Siegel RL. Clinically meaningful improvement on the Self-Esteem And Relationship questionnaire in men with erectile dysfunction. Qual Life Res 2007; 16:1203-10. [PMID: 17616836 DOI: 10.1007/s11136-007-9232-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Accepted: 06/04/2007] [Indexed: 11/25/2022]
Abstract
PURPOSE To estimate the minimal clinically meaningful improvement (MCMI) on the Self-Esteem And Relationship (SEAR) questionnaire. METHODS Using combined data from the 2 pivotal SEAR trials of men treated with sildenafil for erectile dysfunction (ED), MCMIs were estimated as the lower limit of the 2-sided 95% confidence intervals of SEAR mean change scores (from baseline to end of study) for 2 anchor groups: (1) men who improved 1 ED severity category on the Erectile Function domain of the International Index of Erectile Function, and (2) men who improved 5-60% (inclusive) on these erectile function scores. RESULTS Both anchors gave comparable results. A 10-point MCMI was proposed because the estimates of 95% lower bounds centered on around 10 points for most SEAR components (Sexual Relationship, Confidence, Self-Esteem, Overall Score). An exception was the Overall Relationship whose 95% lower bounds were too low to recommend them as an MCMI. CONCLUSIONS Two anchor-based approaches suggest that a change of about 10 points represents an MCMI on most components of the SEAR questionnaire.
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Affiliation(s)
- Joseph C Cappelleri
- Pfizer Inc, Global Research & Development, MS 8260-2222, Eastern Point Road, Groton, CT 06340-8030, USA.
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O'Leary MP, Roehrborn CG, Black L. Dutasteride significantly improves quality of life measures in patients with enlarged prostate. Prostate Cancer Prostatic Dis 2007; 11:129-33. [PMID: 17592479 DOI: 10.1038/sj.pcan.4500990] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of this study was to determine the effect of dutasteride on quality of life of men with lower urinary tract symptoms associated with enlarged prostate or benign prostatic hyperplasia (BPH) as measured by symptom problem index (SPI), BPH-specific interference with activities (BSIA), BPH-specific psychological well-being (BPWB) and BPH-specific lifestyle adaptations (BSLA). Data were derived from three randomized, double-blind studies conducted in 4325 men treated with placebo or dutasteride (0.5 mg/day). Primary analyses included changes from baseline in mean SPI, BSIA, BPWB and BSLA scores. Men treated with dutasteride showed significant improvements in SPI, BSIA, BPWB and BSLA scores compared with placebo.
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Affiliation(s)
- M P O'Leary
- Brigham and Women's Hospital, Boston, MA 02115, USA.
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Litman HJ, Bhasin S, O'Leary MP, Link CL, McKinlay JB. An investigation of the relationship between sex-steroid levels and urological symptoms: results from the Boston Area Community Health survey. BJU Int 2007; 100:321-6. [PMID: 17506868 DOI: 10.1111/j.1464-410x.2007.06938.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [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: 11/30/2022]
Abstract
OBJECTIVES To investigate whether circulating levels of sex hormones are associated with urological symptoms, using data from the Boston Area Community Health (BACH) Survey. SUBJECTS AND METHODS BACH used a multistage stratified-cluster approach to randomly sample 5506 adults aged 30-79 years in Boston, MA, USA. Anthropometric measures, lifestyle and psychosocial factors, comorbidities and urological symptoms were obtained using a questionnaire administered by an interviewer. Serum testosterone, sex hormone-binding globulin (SHBG), dehydroepiandrosterone sulphate (DHEAS), dihydrotestosterone (DHT) and oestradiol (E2) levels were measured, and bioavailable testosterone (BT) was calculated in 1899 men (538 Black, 651 Hispanic and 710 White). Regression analysis was used to investigate the relationships between androgen levels and American Urological Association symptom index (AUA-SI), lower urinary tract symptoms (LUTS) (> or = 8 on the AUA-SI), urinary incontinence (UI), dribble and hesitancy. RESULTS Of all subjects, 19% reported LUTS, 6% UI, 9% dribble and 4% hesitancy. Testosterone, BT and DHEAS levels were inversely related to the AUA-SI (P = 0.009, <0.001 and <0.001, respectively); SHBG values and the AUA-SI were positively correlated (P < 0.001). Adjusting for age, BT and DHEAS levels had negative relationships with the AUA-SI; BT and DHEAS levels were negatively related to LUTS and SHBG was positively related to LUTS (both P < 0.001); after age adjustment, only LUTS and DHEAS remained related, and only the relationship between dribble and E2 remained significant; no hormone levels were related to hesitancy. CONCLUSIONS Circulating levels of sex hormones are generally not significant predictors of urological symptoms in men after adjusting for age. The pathophysiology of LUTS is complex and probably includes factors other than circulating sex steroid levels.
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