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Zahid MU, Yang GQ, Echevarria M, Caudell JJ, Enderling H. Proliferation Saturation Index to Simulate Adaptive Radiation Fractionation in HPV-Associated Oropharyngeal Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e495-e496. [PMID: 37785561 DOI: 10.1016/j.ijrobp.2023.06.1733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) In current clinical practice for fractionated radiotherapy (RT) patients receive a fixed fractionation protocol throughout radiation course. Radiation oncology has not yet moved toward adaptive fractionation to change RT fractionation based on individual patients' response dynamics. We have previously introduced a novel mathematical and imaging biomarker, proliferation saturation index (PSI), to simulate and evaluate tumor volume dynamics during therapy. Robust tumor volume reduction was associated with lower PSI, and PSI has been utilized to select fractionation schedules for the first mathematical model informed clinical trial. Here we simulate the possibility of adapting the selection of RT fractionation on a week-by-week basis by utilizing a dynamic weekly estimation of PSI. MATERIALS/METHODS We generated a cohort of in silico patients by sampling from distributions of PSI, radiosensitivity, and growth rate parameters. These distributions were by pre-treatment and on-treatment tumor volume dynamics from a prospective clinical trial (NCT03656133), where 49 HPV+ OPC patients were treated with either 2 Gy daily fractions up to a total of 70 Gy if PS<0.75, or hyperfractionation at 1.2 Gy b.i.d. up to a total of 66 Gy for patients with PSI ≥ 0.75. We then simulated standard (2 Gy q.d.) and hyperfractionated (1.2 Gy b.i.d) for 1-8 weeks of RT to build a library of response dynamics for the different parameter combinations and treatment durations. This library was then used to estimate optimal adaptive fractionation schedules for the in silico patients that maximized tumor volume reduction and minimized total RT dose. RESULTS We found that PSI evolved towards lower values (i.e., higher proliferative fractions) over the fractionation RT treatment course. For patients that began treatment with standard fractionation, no adaption was found to be superior to uniform fractionation. For selected patients who began treatment with hyperfractionation, however, the optimal fractionation schedule included a period of upfront hyperfractionated RT followed by a switch to standard fractionation at different times during their treatment course. CONCLUSION The results of this study suggest that in addition to selecting the best initial fractionation schedule, a novel approach to personalize RT for OPC patients may include adapting the fractionation based on early treatment response dynamics. These results motivate validation in prospective clinical trials.
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Affiliation(s)
- M U Zahid
- H. Lee Moffitt Cancer Center and Research Institute, Department of Integrated Mathematical Oncology, Tampa, FL
| | - G Q Yang
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
| | - M Echevarria
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
| | - J J Caudell
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
| | - H Enderling
- H. Lee Moffitt Cancer Center and Research Institute, Department of Integrated Mathematical Oncology, Tampa, FL; H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
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Albaiges G, Papastefanou I, Rodriguez I, Prats P, Echevarria M, Rodriguez MA, Rodriguez Melcon A. External validation of Fetal Medicine Foundation competing-risks model for midgestation prediction of small-for-gestational-age neonates in Spanish population. Ultrasound Obstet Gynecol 2023; 62:202-208. [PMID: 36971008 DOI: 10.1002/uog.26210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/23/2023] [Accepted: 03/20/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To examine the external validity of the new Fetal Medicine Foundation (FMF) competing-risks model for prediction in midgestation of small-for-gestational-age (SGA) neonates. METHODS This was a single-center prospective cohort study of 25 484 women with a singleton pregnancy undergoing routine ultrasound examination at 19 + 0 to 23 + 6 weeks' gestation. The FMF competing-risks model for the prediction of SGA combining maternal factors and midgestation estimated fetal weight by ultrasound scan (EFW) and uterine artery pulsatility index (UtA-PI) was used to calculate risks for different cut-offs of birth-weight percentile and gestational age at delivery. The predictive performance was evaluated in terms of discrimination and calibration. RESULTS The validation cohort was significantly different in composition compared with the FMF cohort in which the model was developed. In the validation cohort, at a 10% false-positive rate (FPR), maternal factors, EFW and UtA-PI yielded detection rates of 69.6%, 38.7% and 31.7% for SGA < 10th percentile with delivery at < 32, < 37 and ≥ 37 weeks' gestation, respectively. The respective values for SGA < 3rd percentile were 75.7%, 48.2% and 38.1%. Detection rates in the validation cohort were similar to those reported in the FMF study for SGA with delivery at < 32 weeks but lower for SGA with delivery at < 37 and ≥ 37 weeks. Predictive performance in the validation cohort was similar to that reported in a subgroup of the FMF cohort consisting of nulliparous and Caucasian women. Detection rates in the validation cohort at a 15% FPR were 77.4%, 50.0% and 41.5% for SGA < 10th percentile with delivery at < 32, < 37 and ≥ 37 weeks, respectively, which were similar to the respective values reported in the FMF study at a 10% FPR. The model had satisfactory calibration. CONCLUSION The new competing-risks model for midgestation prediction of SGA developed by the FMF performs well in a large independent Spanish population. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- G Albaiges
- Fetal Medicine Unit, Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, University Hospital Quirón Dexeus, Barcelona, Spain
| | - I Papastefanou
- Fetal Medicine Research Institute, King's College Hospital, London, UK
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - I Rodriguez
- Epidemiological Unit, Department of Obstetrics, Gynecology and Reproductive Medicine, University Hospital Quiron Dexeus, Barcelona, Spain
| | - P Prats
- Fetal Medicine Unit, Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, University Hospital Quirón Dexeus, Barcelona, Spain
| | - M Echevarria
- Fetal Medicine Unit, Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, University Hospital Quirón Dexeus, Barcelona, Spain
| | - M A Rodriguez
- Fetal Medicine Unit, Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, University Hospital Quirón Dexeus, Barcelona, Spain
| | - A Rodriguez Melcon
- Fetal Medicine Unit, Obstetrics Service, Department of Obstetrics, Gynecology and Reproductive Medicine, University Hospital Quirón Dexeus, Barcelona, Spain
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Subramaniam RM, DeMora L, Yao M, Yom SS, Gillison M, Caudell JJ, Waldron J, Xia P, Chung CH, Truong MT, Echevarria M, Chan JW, Geiger JL, Mell L, Seaward S, Thorstad WL, Beitler JJ, Sultanem K, Blakaj D, Le QT. 18F-FDG PET/CT Prediction of Treatment Outcomes in Human Papillomavirus-Positive, Locally Advanced Oropharyngeal Cancer Patients Receiving Deintensified Therapy: Results from NRG-HN002. J Nucl Med 2023; 64:362-367. [PMID: 36215572 PMCID: PMC10071810 DOI: 10.2967/jnumed.122.264424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/24/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to determine the negative predictive value (NPV) of a 12- to 14-wk posttreatment PET/CT for 2-y progression-free survival (PFS) and locoregional control (LRC) in patients with p16-positive locoregionally advanced oropharyngeal cancer (LA-OPC). Study was a secondary endpoint in NRG-HN002, a noncomparative phase II trial in p16-positive LA-OPC, stage T1-T2, N1-N2b or T3, N0-N2b, and ≤10 pack-year smoking. Patients were randomized in a 1:1 ratio to reduced-dose intensity-modulated radiotherapy (IMRT) with or without cisplatin. Methods: PET/CT scans were reviewed centrally. Tumor response evaluations for the primary site, right neck, and left neck were performed using a 5-point ordinal scale (Hopkins criteria). Overall scores were then assigned as negative, positive, or indeterminate. Patients with a negative score for all 3 evaluation sites were given an overall score of negative. The hypotheses were NPV for PFS and LRC at 2-y posttreatment ≤ 90% versus >90% (1-sided P value, 0.10). Results: A total of 316 patients were enrolled, of whom 306 were randomized and eligible. Of these, 131 (42.8%) patients consented to a posttherapy PET/CT, and 117 (89.3%) patients were eligible for PET/CT analysis. The median time from the end of treatment to PET/CT scan was 94 d (range, 52-139 d). Estimated 2-y PFS and LRC rates in the analysis subgroup were 91.3% (95% CI, 84.6, 95.8%) and 93.8% (95% CI, 87.6, 97.5%), respectively. Posttreatment scans were negative for residual tumor for 115 patients (98.3%) and positive for 2 patients (1.7%). NPV for 2-y PFS was 92.0% (90% lower confidence bound [LCB] 87.7%; P = 0.30) and for LRC was 94.5% (90% LCB 90.6%; P = 0.07). Conclusion: In the context of deintensification with reduced-dose radiation, the NPV of a 12- to 14-wk posttherapy PET/CT for 2-y LRC is estimated to be >90%, similar to that reported for patients receiving standard chemoradiation. However, there is insufficient evidence to conclude that the NPV is >90% for PFS.
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Affiliation(s)
- Rathan M Subramaniam
- Otago Medical School, University of Otago, Otago, New Zealand;
- Duke University, Durham, North Carolina
| | - Lyudmila DeMora
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | - Min Yao
- University Hospitals Cleveland, Cleveland, Ohio
| | - Sue S Yom
- University of California, San Francisco, California
| | - Maura Gillison
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - John Waldron
- Princess Margaret Hospital, Toronto, Oneida, Canada
| | - Ping Xia
- Cleveland Clinic, Cleveland, Ohio
| | | | | | | | - Jason W Chan
- University of California, San Francisco, California
| | | | - Loren Mell
- UC San Diego Moores Cancer Center, San Diego, California
| | - Samantha Seaward
- Kaiser Permanente NCI Community Oncology Research Program, Vallejo, California
| | - Wade L Thorstad
- Washington University School of Medicine, St. Louis, Missouri
| | | | | | - Diagjin Blakaj
- Ohio State University Comprehensive Cancer Center, Columbus, Ohio; and
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Echevarria M, Chung C, Giuliano A, Slebos R, Yang G, Stevens P, Caudell J. Kinetics of Circulating Human Papillomavirus (cHPV) DNA in Plasma and Oral Gargles From Patients with HPV-Positive Oropharyngeal Cancer (OPC) Treated with Definitive Radiation Therapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.12.017] [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: 11/16/2022]
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Yang G, Echevarria M, Caudell J. Utility of Intermediate Risk Volumes in Human Papilloma Associated Oropharyngeal Cancer: A Pattern of Failure Analysis. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.12.044] [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: 11/30/2022]
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Yang G, Echevarria M, Caudell J. Stereotactic Body Radiation Therapy (SBRT) With or Without Daily Systemic Therapy for Re-Irradiation of Unresectable, Recurrent, Head and Neck Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Echevarria M, Chung C, Kirtane K, Kish J, Muzaffar J, Caudell J. Outcomes of Phase I Trial of Patients With Recurrent Head and Neck Squamous Cell Carcinoma Treated With Re-Irradiation With Stereotactic Body Radiation Therapy and Concurrent Cisplatin. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1092] [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: 11/27/2022]
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Echevarria M, Chung CH, Kirtane K, Muzaffar J, Kish JA, Arrington J, Farinhas J, Caudell JJ. Survival results of phase I dose escalation of stereotactic body radiation therapy and concurrent cisplatin for re-irradiation of unresectable, recurrent head and neck squamous cell carcinoma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e18020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18020 Background: Stereotactic body radiation therapy (SBRT) is a standard option for re-irradiation of recurrent or second primary cancers of the head and neck. We conducted performed a phase I clinical trial to establish a maximum tolerated dose of SBRT with concurrent cisplatin. We previously reported our safety data, and now present our secondary disease control endpoints. Methods: Major inclusion criteria were recurrence of previous squamous cell carcinoma of the head and neck in patients who had previously undergone radiotherapy to doses ≥ 45 Gy to the area of recurrence, ≥ 6 months prior to enrollment, and who were medically unfit for surgery, deemed unresectable, or refused surgery. Patients were treated with radiation therapy every other day for five fractions at three dose levels: 30 Gy, 35 Gy, and 40 Gy. Cisplatin was given prior to every SBRT fraction at a dose of 15 mg/m2. Secondary end points reported herein are locoregional control (LRC), freedom from distant metastasis (FFDM), and overall survival (OS). Results: Twenty patients were enrolled and of those 18 patients were evaluable for secondary endpoints. Nine patients had a primary tumor in the oropharynx, four patients in the oral cavity, three in the neck, one in the larynx, and one simultaneously in the larynx and neck. All patients received the planned dose of Cisplatin. Five patients received a radiation dose of 30 Gy, three patients received a dose of 35 Gy, and 9 patients received a dose of 40 Gy. Median gross tumor volume (GTV) was 11.725 cm3. With a median follow up of 9 months the 1-year OS was 38.9%. LRC at 1 year was 45.7% and FFDM at 1 year was 87.8%. There was a trend to improved OS with increasing SBRT dose, 40 Gy vs < 40 Gy (p = 0.08). There was an improved 1-year OS with a GTV ≤11.725 cm3 of 77.8% vs 0% for tumors > 11.725 cm3 (p < 0.001). For patients with a GTV < 11.725 cm3 who received 40 Gy the 1 year OS was 100% compared with 0% for tumors larger than 11.725 cm3. Conclusions: For patients with previously radiated locally or regionally recurrent head and neck cancer, SBRT up to 40 Gy given concurrently with cisplatin provides reasonable locoregional control and overall survival for patients with smaller tumors. Further evaluation in prospective trials is warranted. Clinical trial information: NCT02158234.
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Affiliation(s)
- Michelle Echevarria
- Department of Radiation Oncology, Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL
| | | | | | | | - Julie Ann Kish
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - John Arrington
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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Echevarria M, Chung CH, Kirtane K, Muzaffar J, Arrington J, Farinhas J, Caudell JJ. Phase I dose escalation of stereotactic body radiation therapy and concurrent cisplatin for re-irradiation of unresectable, recurrent head and neck squamous cell carcinoma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6543 Background: For patients with unresectable, previously radiated, locoregionally recurrent head and neck cancer, stereotactic body radiation therapy (SBRT) has become an attractive option. The use of high daily doses of radiotherapy may overcome the inherent radioresistance of these recurrent cancers. Given the resistant and advanced nature of many of these cancers, the addition of chemotherapy to radiotherapy is typically recommended as a radiosensitizer. We therefore performed a phase I clinical trial in order to establish a maximum tolerated dose of SBRT with concurrent chemotherapy in locoregionally recurrent head and neck cancer. Methods: Major inclusion criteria were recurrence of previous squamous cell carcinoma of the head and neck in patients who had previously undergone radiotherapy to doses ≥ 45 Gy to the area of recurrence, ≥ 6 months prior to enrollment, and who were medically unfit for surgery, deemed unresectable, or refused surgery. Patients were treated with radiation therapy every other day for five fractions at three dose levels; 30 Gy, 35 Gy, and 40 Gy. Cisplatin was given prior to every SBRT fraction at a dose of 15 mg/m2. Patients were monitored for safety and tolerability for any grade 4 or greater toxicity (per CTCAE v4.0) that occurred within 3 months from the start of SBRT. Primary end point was maximum tolerated dose (MTD). Results: Twenty patients were enrolled and of those 17 patients were evaluable for the primary endpoint. Nine patients had a primary tumor in the oropharynx, four patients in the oral cavity, three in the neck, one in the larynx, and one simultaneously in the larynx and neck. Of the three patients that were not evaluable two withdrew consent, and one patient in the 30 Gy dose level died of unknown causes two weeks following completion of treatment. Due to safety concerns the 30 Gy dose level was expanded an additional three patients, and no further dose limiting toxicities (DLTs) were observed. At the 35 Gy and 40 Gy dose level there were no reported grade 4 or 5 adverse events (per CTCAE v4.0). There were 5 (27%) reported grade 3 toxicities and 12 (66%) grade 2 toxicities. Conclusions: This phase I study demonstrates that 40 Gy SBRT with concurrent cisplatin at a dose of 15mg/m2 is feasible, safe, and well tolerated. Patients continue to be followed for secondary outcomes of local control and overall survival. Clinical trial information: NCT02158234 .
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Affiliation(s)
- Michelle Echevarria
- Department of Radiation Oncology, Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL
| | | | | | | | - John Arrington
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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Echevarria M, Yang G, Giuliano A, Caudell J. Correlation of Standard Clinical p16/HPV Testing with Highly Sensitive HPV Subtype Testing, and Association of HPV Subtypes with Outcomes in Oropharyngeal Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.126] [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: 11/16/2022]
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Echevarria M, Caudell J. Balancing Risks and Benefits of Dose and Volume of Radiation Therapy in a Neck Recurrence From Tongue Cancer. Int J Radiat Oncol Biol Phys 2020; 106:902-903. [DOI: 10.1016/j.ijrobp.2019.09.028] [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] [Received: 09/08/2019] [Revised: 09/08/2019] [Accepted: 09/13/2019] [Indexed: 11/30/2022]
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Martin-Gomez L, Giuliano AR, Fulp WJ, Caudell J, Echevarria M, Sirak B, Abrahamsen M, Isaacs-Soriano KA, Hernandez-Prera JC, Wenig BM, Vorwald K, McMullen CP, Wadsworth JT, Slebos RJ, Chung CH. Human Papillomavirus Genotype Detection in Oral Gargle Samples Among Men With Newly Diagnosed Oropharyngeal Squamous Cell Carcinoma. JAMA Otolaryngol Head Neck Surg 2020; 145:460-466. [PMID: 30920604 DOI: 10.1001/jamaoto.2019.0119] [Citation(s) in RCA: 11] [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] [Indexed: 12/20/2022]
Abstract
Importance The most common cause of oropharyngeal squamous cell carcinoma is human papillomavirus (HPV) infection, and currently the standard of care to determine the HPV infection status in this type of carcinoma is to use p16 immunohistochemistry as a surrogate marker of high-risk HPV infection. Although p16 immunohistochemistry is limited by the inability to determine the specific HPV genotypes, oral gargle samples may be a readily available source of HPV DNA for genotyping. Objective To determine the specific HPV genotypes present in both oral gargle samples and tumor specimens. Design, Setting, and Participants This prospective, biomarker cohort study conducted at a single specialized cancer hospital in Florida screened approximately 800 potentially eligible participants from May 2014 through October 2017. To be eligible for participation, patients had to meet all of the following criteria: 18 years of age or older, male sex, newly diagnosed as having stage I to IV cancer of the oropharynx, a squamous cell carcinoma diagnosis, treatment naive or at least 4 weeks after chemoradiation or surgical treatment of other diseases, fully understand the study procedures and risks involved, and voluntarily agree to participate by signing an informed consent statement. Main Outcomes and Measures Detection rate of HPV infection and HPV genotypes in oral gargle samples and tumor specimens. Results A cohort of 204 male participants with newly diagnosed oropharyngeal squamous cell carcinoma was assessed in this prospective collection of comprehensive clinical data and oral gargle samples. Most study participants (190 [93.1%]) were white and ever smokers (114, 55.9%), with a median age of 61 years (range, 35-87 years). The HPV infection status could be assessed in 203 of 204 participants (99.5%) using oral gargle samples: 35 samples (17.2%) were negative for HPV infection, whereas 168 samples (82.8%) were positive for HPV infection. The detection rate of HPV genotypes was 93.0% in tumor specimens (160 specimens) and 82.8% (168 samples) in oral gargle samples. The oral gargle samples frequently had low-risk HPV genotypes that were not detected in tumors, but these low-risk genotypes were always a coinfection with high-risk genotypes. Conclusions and Relevance Oral gargle samples can be used to detect the majority of clinically relevant HPV genotypes found in oropharyngeal squamous cell carcinoma, but the interpretation of HPV detected in these samples should be assessed with caution for general cancer risk assessment given that sensitive assays can concomitantly detect low-risk genotypes.
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Affiliation(s)
- Laura Martin-Gomez
- Center for Immunization and Infection Research in Cancer, Tampa, Florida
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Tampa, Florida
| | - William J Fulp
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Jimmy Caudell
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | | | - Bradley Sirak
- Center for Immunization and Infection Research in Cancer, Tampa, Florida
| | - Martha Abrahamsen
- Center for Immunization and Infection Research in Cancer, Tampa, Florida
| | | | | | - Bruce M Wenig
- Department of Pathology, Moffitt Cancer Center, Tampa, Florida
| | - Kathryn Vorwald
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Caitlin P McMullen
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida
| | - J Trad Wadsworth
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Robbert J Slebos
- Center for Immunization and Infection Research in Cancer, Tampa, Florida.,Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Christine H Chung
- Center for Immunization and Infection Research in Cancer, Tampa, Florida.,Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida
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Echevarria M, Giuliano A, Sirak B, Abrahamsen M, Isaacs-Soriano K, Caudell J. Prospective Evaluation of HPV Subtypes in Oropharyngeal Cancer and Association Standard Clinical Testing and with Outcomes. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1519] [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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Echevarria M, Harrison L, Trotti A, Caudell J. EP-1197 Pattern, timing, and detection of recurrence in HPV positive oropharyngeal cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31617-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Echevarria M, Naghavi A, Abuodeh Y, Kilinski K, Pow-Sang J, Johnstone P, Fernandez D, Parikh N, Gage K, Yamoah K. MRI Heterogeneity in Prostate Cancer Predicts for Aggressive Pathology. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1151] [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: 10/18/2022]
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Abuodeh Y, Naghavi AO, Echevarria M, DeMarco M, Tonner B, Feygelman V, Stevens CW, Perez BA, Dilling TJ. Quantitatively Excessive Normal Tissue Toxicity and Poor Target Coverage in Postoperative Lung Cancer Radiotherapy Meta-analysis. Clin Lung Cancer 2017; 19:e123-e130. [PMID: 29107487 DOI: 10.1016/j.cllc.2017.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/16/2017] [Accepted: 06/20/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND A previous meta-analysis (MA) found postoperative radiotherapy (PORT) in lung cancer patients to be detrimental in N0/N1 patients and equivocal in the N2 setting. We hypothesized that treatment plans generated using MA protocols had worse dosimetric outcomes compared to modern plans. PATIENTS AND METHODS We retrieved plans for 13 patients who received PORT with modern planning. A plan was recreated for each patient using the 8 protocols included in MA. Dosimetric values were then compared between the modern and simulated MA plans. RESULTS A total of 104 MA plans were generated. Median prescribed dose was 50.4 (range, 50-60) Gy in the modern plans and 53.2 (30-60) Gy in the MA protocols. Median planning volume coverage was 96% (93%-100%) in the modern plans, versus 58% (0%-100%) in the MA plans (P < .001). Internal target volume coverage was 100% (99%-100%) versus 65% (0%-100%), respectively (P < .001). Organs at risk received the following doses: spinal cord maximum dose, 36.8 (4.6-50.4) Gy versus 46.8 (2.9-74.0) Gy (P < .001); esophageal mean dose, 22.9 (5.5-35) Gy versus 30.5 (11.1-52.5) Gy (P = .003); heart V30 (percentage of volume of an organ receiving at least a dose of 30 Gy), 16% (0%-45%) versus 35% (0%-79%) (P = .047); mean lung dose, 12.4 (3.4-24.3) Gy versus 14.8 (4.1-27.4) Gy (P = .008); and lung V20, 18% (4%-34%) versus 25% (8%-67%) (P = .023). CONCLUSION We quantitatively confirm the inferiority of the techniques used in the PORT MA. Our analysis showed a lower therapeutic ratio in the MA plans, which may explain the poor outcomes in the MA. The findings of the MA are not relevant in the era of modern treatment planning.
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Affiliation(s)
- Yazan Abuodeh
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Arash O Naghavi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Michelle Echevarria
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - MaryLou DeMarco
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Brian Tonner
- Department of Radiation Oncology, Eastern Carolina University, Greenville, NC
| | - Vladimir Feygelman
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Craig W Stevens
- Department of Radiation Oncology, William Beaumont Cancer Institute, Detroit, MI
| | - Bradford A Perez
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Thomas J Dilling
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
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Kilinski K, Naghavi A, Abuodeh YA, Echevarria M, Yamoah K. The impact of pretreatment MRI on genitourinary and gastrointestinal toxicity after radiation therapy in patients with localized prostate cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
119 Background: MRI has several advantages relative to other imaging modalities in evaluating, diagnosing, and planning treatment for prostate cancer yet it is rarely ordered for localized disease. While the diagnostic abilities have been studied, little has been done to associate clinical outcomes with prostate cancer patients who received MRI. We evaluated the effect of pre-treatment MRI on genitourinary (GU) and gastrointestinal (GI) toxicity in prostate cancer patients who received definitive radiation treatment. Methods: We retrospectively analyzed prostate cancer patients who underwent definitive radiation treatment at our facility between January 01, 1999 and July 31, 2014. All patients who underwent MRI of the pelvis or prostate within 5 years prior to treatment were included in the MRI cohort. The American Urological Symptom Score (AUA) and Rectal Assessment Scale (RAS) were used to measure GU and GI toxicity, respectively. We compared the toxicity profile of patients in our MRI cohort to a comparable cohort of patients who did not receive pre-treatment MRI. Results: 1085 patients (211 with MRI) were analyzed. Median follow-up was 30 months. Mean increase from baseline in AUA scores at 6 months was 3.58 for the MRI cohort and 5.04 for the comparison cohort (p = 0.017). RAS scores were not significantly different between the MRI and comparison cohorts at 6 months (mean increase: 0.62 vs. 0.77, p = 0.662). AUA scores returned to baseline after 6 months in the MRI cohort and after 12 months in the comparison cohort. RAS scores returned to baseline after 12 months in the MRI cohort but never returned to baseline in the comparison cohort. Biochemical failure rates were not significantly different between the MRI cohort and comparison cohort (86.3% vs. 91.1%, p = 0.083). Conclusions: Pre-treatment MRI was associated with significantly less GU and GI toxicity. These results may be influenced by more advanced disease and higher use of hormonal therapy in the MRI cohort. Future prospective studies in a risk-matched cohort are required to validate these findings.
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Affiliation(s)
- Kyle Kilinski
- University of South Florida Morsani College of Medicine, Tampa, FL
| | - Arash Naghavi
- Department of Radiation Oncology, Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL
| | - Yazan Asad Abuodeh
- Department of Radiation Oncology, Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL
| | - Michelle Echevarria
- Department of Radiation Oncology, Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL
| | - Kosj Yamoah
- Department of Radiation Oncology, Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL
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Abuodeh Y, Ahmed K, Echevarria M, Naghavi A, Grass GD, Robinson TJ, Tomblyn M, Shah B, Chavez J, Bello C, El-Haddad G, Harrison L, Kim S. Priming radioimmunotherapy with external beam radiation in patients with relapsed low grade non-Hodgkin lymphoma. Ther Adv Hematol 2017; 8:129-138. [PMID: 28491264 DOI: 10.1177/2040620717693574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate the outcomes of priming salvage radioimmunotherapy (RIT) with a low dose of external beam radiotherapy (EBRT) in patients with relapsed low grade non-Hodgkin lymphoma (LG-NHL). METHODS Patients who received salvage RIT with or without 2 × 2 Gy EBRT between March 2009 and February 2013 were retrospectively reviewed at a single institution. Planning target volume (PTV) for EBRT was created by adding a 1-2 cm expansion to the gross tumor volume depending on the anatomical location. Kaplan-Meier method via log-rank was employed to analyze the endpoints freedom from progression (FFP) and overall survival (OS). RESULTS We identified 22 patients who received salvage RIT without chemotherapy with a median follow up of 34 months. Of these, 9 (41%) patients were treated with EBRT immediately prior to RIT, and 13 (59%) received salvage RIT alone. Median FFP was not reached in patients who underwent combination treatment, while it was 9 months for patients treated with RIT alone (p = 0.02). OS for all patients at 36 months was 80.3% with no significant difference between the two groups (p = 0.88). On univariate analysis, the addition of EBRT was associated with improved FFP [hazard ratio (HR) = 4.17; 95% confidence interval (CI), 1.24-19.1; p = 0.02)]. No long term toxicities were reported in both groups. CONCLUSIONS RIT outcomes and effects were improved with addition of low-dose EBRT immediately prior to it, in the treatment of relapsed LG-NHL with no additional toxicity. This study is hypothesis-generating and the findings should be validated in prospective studies.
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Affiliation(s)
- Yazan Abuodeh
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kamran Ahmed
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Michelle Echevarria
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Arash Naghavi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - G Daniel Grass
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Timothy J Robinson
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Bijal Shah
- Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Julio Chavez
- Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Celeste Bello
- Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Ghassan El-Haddad
- Department of Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Louis Harrison
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Sungjune Kim
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
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Naghavi A, Echevarria M, Strom T, Abuodeh Y, Ahmed K, Venkat P, Trotti A, Harrison L, Green B, Yamoah K, Caudell J. Race Is Associated With Poor Outcomes in Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Echevarria M, Ahmed K, Patel B, Abuodeh Y, Naghavi A, Sarangkasiri S, Johnstone P, Etame A, Yu H. Clinical Outcomes of Combined BRAF and MEK Inhibition With Stereotactic Radiation for BRAF Mutant Melanoma Brain Metastases. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.882] [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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Naghavi A, Gonzalez R, Scott J, Abuodeh Y, Echevarria M, Mullinax J, Ahmed K, Harrison L, Fernandez D. Staged Reconstruction Brachytherapy Has Lower Overall Cost in Recurrent Soft Tissue Sarcoma. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Naghavi A, Strom T, Abuodeh Y, Echevarria M, Russell J, Kish J, Balducci L, Trotti A, Harrison L, Caudell J. Concurrent Chemotherapy in Elderly Patients With Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Echevarria M, Naghavi A, Abuodeh Y, Chevere C, Yamoah K. Low-Dose-Rate Brachytherapy for Prostate Cancer in Low Resource Settings. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1655] [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: 11/30/2022]
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Abuodeh Y, Ahmed K, Echevarria M, Naghavi A, Grass G, Tomblyn M, Harrison L, Kim S. Priming Radioimmunotherapy With External Beam Radiation in Patients With Relapsed Low-Grade Non-Hodgkin Lymphoma. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.414] [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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Turmo M, Echevarria M, Rubio P, Almeida C. Development of chronic pain after episiotomy. Rev Esp Anestesiol Reanim 2015; 62:436-442. [PMID: 25555717 DOI: 10.1016/j.redar.2014.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 06/09/2014] [Revised: 10/04/2014] [Accepted: 10/10/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To analyze the incidence of chronic pain 5 months after episiotomy, as well as potential prognostic factors. METHODS A prospective cohort observational study was conducted on pregnant women age≥18 years who had undergone an episiotomy. The presence of pain was evaluated in the area of episiotomy at 24 and 48 h of delivery using a structured face-to-face questionnaire, and by telephone questionnaire at 5 months. The primary endpoint was the presence of persistent pain at 5 months. A record was made of the presence of pain at delivery, and its intensity, the presence or absence of epidural analgesia, instrumental delivery, perineal tear, and pain when episiotomy was performed, as well as the presence of dyspareunia and urinary incontinence at 5 months post-episiotomy. RESULTS A total of 87 parturient patients were included, of whom 78 completed the study. Of the patients who completed the study, 12.8% reported chronic episiotomy pain. Epidural analgesia was associated with a higher incidence of instrumental delivery and less pain at the time of episiotomy and expulsion (P<.0005, P<.02, and P<.01, respectively). Chronic pain is associated with operative delivery (P<.017), and with the presence of pain at rest at 24 and 48 h (P<.01), of wound complications (P<.026), and of dyspareunia (P<.001). CONCLUSION An incidence of 12.8% of women developing chronic pain after delivery with episiotomy suggests a health problem. More studies are needed to confirm our results.
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Affiliation(s)
- M Turmo
- Servicio de Anestesiología y Reanimación, Unidad de Investigación, Hospital de Valme, Sevilla, España
| | - M Echevarria
- Servicio de Anestesiología y Reanimación, Unidad de Investigación, Hospital de Valme, Sevilla, España.
| | - P Rubio
- Servicio de Anestesiología y Reanimación, Unidad de Investigación, Hospital de Valme, Sevilla, España
| | - C Almeida
- Servicio de Anestesiología y Reanimación, Unidad de Investigación, Hospital de Valme, Sevilla, España
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Echevarria M, Ramos P, Caba F, López J, Almeida C, Cortes Gonzalez C. [Factors determining patient satisfaction with the pre-anaesthesia consultation]. ACTA ACUST UNITED AC 2015; 30:215-9. [PMID: 26260378 DOI: 10.1016/j.cali.2015.06.003] [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: 08/07/2014] [Revised: 06/08/2015] [Accepted: 06/23/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To analyse patient satisfaction with care provided in the pre-anaesthetic consultation and its determining factors. MATERIAL AND METHOD An anonymous questionnaire was randomly distributed to patients attending a pre-anaesthesia clinic, which included 4 questions with 5 possible answers on a (very dissatisfied, dissatisfied, fairly satisfied, satisfied and very satisfied) categorical graduated scale related to punctuality, understanding of the information received, respectful treatment, and overall satisfaction. The fifth question was about the knowledge or the name of the anaesthesiologist who attended them. A binary logistic regression model was used, which identified the predictors of satisfaction, calculated the odds ratios, and their respective 95% confidence intervals. RESULTS A total of 4006 questionnaires were analysed, in which 99.2% (3966) of users rated as satisfied/very satisfied the question about the respectful treatment, 98.4% (3937) of the information received and understanding, 77.4% (3096) punctuality in attending, and 97, 6% (3909) overall satisfaction. Almost three-quarters (71%, 2844) did not know the name of the anaesthesiologist. Regression analysis associated the more satisfied with their treatment (OR 17.44; P<.0005) and the information received (OR 14.94, P<.0005), while punctuality (OR 5 40; P<.0005) was the factor that contributed less to the result. CONCLUSION In our population satisfaction in pre-anaesthesia consultation is due mainly to the communication skills of the anaesthesiologist.
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Affiliation(s)
- M Echevarria
- Servicio de Anestesiología y Reanimación, Hospital de Valme, Sevilla, España.
| | - P Ramos
- Servicio de Anestesiología y Reanimación, Hospital de Valme, Sevilla, España
| | - F Caba
- Servicio de Anestesiología y Reanimación, Hospital de Valme, Sevilla, España
| | - J López
- Servicio de Anestesiología y Reanimación, Hospital de Valme, Sevilla, España
| | - C Almeida
- Servicio de Anestesiología y Reanimación, Hospital de Valme, Sevilla, España
| | - C Cortes Gonzalez
- Servicio de Anestesiología y Reanimación, Hospital de Valme, Sevilla, España
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Eschrich SA, Fulp WJ, Pawitan Y, Foekens JA, Smid M, Martens JWM, Echevarria M, Kamath V, Lee JH, Harris EE, Bergh J, Torres-Roca JF. Validation of a radiosensitivity molecular signature in breast cancer. Clin Cancer Res 2012; 18:5134-43. [PMID: 22832933 DOI: 10.1158/1078-0432.ccr-12-0891] [Citation(s) in RCA: 145] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE Previously, we developed a radiosensitivity molecular signature [radiosensitivity index (RSI)] that was clinically validated in 3 independent datasets (rectal, esophageal, and head and neck) in 118 patients. Here, we test RSI in radiotherapy (RT)-treated breast cancer patients. EXPERIMENTAL DESIGN RSI was tested in 2 previously published breast cancer datasets. Patients were treated at the Karolinska University Hospital (n = 159) and Erasmus Medical Center (n = 344). RSI was applied as previously described. RESULTS We tested RSI in RT-treated patients (Karolinska). Patients predicted to be radiosensitive (RS) had an improved 5-year relapse-free survival when compared with radioresistant (RR) patients (95% vs. 75%, P = 0.0212), but there was no difference between RS/RR patients treated without RT (71% vs. 77%, P = 0.6744), consistent with RSI being RT-specific (interaction term RSI × RT, P = 0.05). Similarly, in the Erasmus dataset, RT-treated RS patients had an improved 5-year distant metastasis-free survival over RR patients (77% vs. 64%, P = 0.0409), but no difference was observed in patients treated without RT (RS vs. RR, 80% vs. 81%, P = 0.9425). Multivariable analysis showed RSI is the strongest variable in RT-treated patients (Karolinska, HR = 5.53, P = 0.0987, Erasmus, HR = 1.64, P = 0.0758) and in backward selection (removal α of 0.10), RSI was the only variable remaining in the final model. Finally, RSI is an independent predictor of outcome in RT-treated ER(+) patients (Erasmus, multivariable analysis, HR = 2.64, P = 0.0085). CONCLUSIONS RSI is validated in 2 independent breast cancer datasets totaling 503 patients. Including prior data, RSI is validated in 5 independent cohorts (621 patients) and represents, to our knowledge, the most extensively validated molecular signature in radiation oncology.
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Affiliation(s)
- Steven A Eschrich
- Department of Bioinformatics, H Lee Moffitt Cancer Center, Tampa, Florida 33612, USA
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Leonard A, Wolff J, Sengupta R, Marassa J, Piwnica-Worms D, Rubin J, Pollack I, Jakacki R, Butterfield L, Okada H, Fangusaro J, Warren KE, Mullins C, Jurgen P, Julia S, Friedrich CC, Keir S, Saling J, Roskoski M, Friedman H, Bigner D, Moertel C, Olin M, Dahlheimer T, Gustafson M, Sumstad D, McKenna D, Low W, Nascene D, Dietz A, Ohlfest J, Sturm D, Witt H, Hovestadt V, Quan DAK, Jones DTW, Konermann C, Pfaff E, Korshunov A, Rizhova M, Milde T, Witt O, Zapatka M, Collins VP, Kool M, Reifenberger G, Lichter P, Lindroth AM, Plass C, Jabado N, Pfister SM, Pizer B, Salehzadeh A, Brodbelt A, Mallucci C, Brassesco M, Pezuk J, Morales A, de Oliveira J, Roberto G, Umezawa K, Valera E, Rego E, Scrideli C, Tone L, Veringa SJE, Van Vuurden DG, Wesseling P, Vandertop WP, Noske DP, Wurdinger T, Kaspers GJL, Hulleman E, Wright K, Broniscer A, Bendel A, Bowers D, Crawford J, Fisher P, Hassall T, Armstrong G, Baker J, Qaddoumi I, Robinson G, Wetmore C, Klimo P, Boop F, Onar-Thomas A, Ellison D, Gajjar A, Cruz O, de Torres C, Sunol M, Rodriguez E, Alonso L, Parareda A, Cardesa T, Salvador H, Celis V, Guillen A, Garcia G, Muchart J, Trampal C, Martin ML, Rebollo M, Mora J, Piotrowski A, Kowalska A, Coyle P, Smith S, Rogers H, Macarthur D, Grundy R, Puccetti D, Salamat S, Kennedy T, Fangusaro J, Patel N, Bradley K, Casey K, Iskandar B, Nakano Y, Okada K, Osugi Y, Yamasaki K, Fujisaki H, Fukushima H, Inoue T, Matsusaka Y, Sakamoto H, Hara J, De Vleeschouwer S, Ardon H, Van Calenbergh F, Sciot R, Wilms G, Van Loon J, Goffin J, Van Gool S, Puccetti D, Salamat S, Rusinak D, Patel N, Bradley K, Casey K, Knight P, Onel K, Wargowski D, Stettner A, Iskandar B, Al-Ghafari A, Punjaruk W, Coyle B, Kerr I, Xipell E, Rodriguez M, Gonzalez-Huarriz M, Tunon MT, Zazpe I, Tejada-Solis S, Diez-Valle R, Fueyo J, Gomez-Manzano C, Alonso MM, Pastakia D, McCully C, Murphy R, Bacher J, Thomas M, Steffen-Smith E, Saleem K, Waldbridge S, Widemann B, Warren K, Miele E, Buttarelli F, Arcella A, Begalli F, Po A, Baldi C, Carissimo G, Antonelli M, Donofrio V, Morra I, Nozza P, Gulino A, Giangaspero F, Ferretti E, Elens I, De Vleeschouwer S, Pauwels F, Van Gool S, Fritzell S, Eberstal S, Sanden E, Visse E, Darabi A, Siesjo P, McDonald P, Wrogemann J, Krawitz S, Del Bigio M, Eisenstat D, Wolff J, Kwiecien R, Pietsch T, Faldum A, Kortmann RD, Warmuth-Metz M, Rutkowski S, Slavc I, Kramm CM, Uparkar U, Geyer R, Ermoian R, Ellenbogen R, Leary S, Triscott J, Hu K, Fotovati A, Yip S, Kast R, Toyota B, Dunn S, Hegde M, Corder A, Chow K, Mukherjee M, Ashoori A, Brawley V, Heslop H, Gottschalk S, Yvon E, Ahmed N, Wong TT, Yang FY, Lu M, Liang HF, Wang HE, Liu RS, Teng MC, Yen CC, Agnihotri S, Ternamian C, Jones C, Zadeh G, Rutka J, Hawkins C, Filipek I, Drogosiewicz M, Perek-Polnik M, Swieszkowska E, Baginska BD, Jurkiewicz E, Perek D, Kuehn A, Falkenstein F, Wolff J, Kwiecien R, Pietsch T, Gnekow A, Kramm C, Brooks MD, Jackson E, Piwnica-Worms D, Mitra RD, Rubin JB, Liu XY, Korshunov A, Schwartzentruber J, Jones DTW, Pfaff E, Sturm D, Fontebasso AM, Quang DAK, Albrecht S, Kool M, Dong Z, Siegel P, Von Diemling A, Faury D, Tabori U, Lichter P, Plass C, Majewski J, Pfister SM, Jabado N, Lulla R, Echevarria M, Alden T, DiPatri A, Tomita T, Goldman S, Fangusaro J, Qaddoumi I, Lin T, Merchant TE, Kocak M, Panandiker AP, Armstrong GT, Wetmore C, Gajjar A, Broniscer A, Gielen GH, Muehlen AZ, Kramm C, Pietsch T, Hubert C, Ding Y, Toledo C, Paddison P, Olson J, Nandhabalan M, Bjerke L, Bax D, Carvalho D, Bajrami I, Ashworth A, Lord C, Hargrave D, Reis R, Workman P, Jones C, Little S, Popov S, Jury A, Burford A, Doey L, Al-Sarraj S, Jurgensmeier J, Jones C, Carvalho D, Bjerke L, Bax D, Chen L, Kozarewa I, Baker S, Grundy R, Ashworth A, Lord C, Hargrave D, Reis R, Jones C, Bjerke L, Perryman L, Burford A, Bax D, Jury A, Popov S, Box G, Raynaud F, Hargrave D, Eccles S, Jones C, Viana-Pereira M, Pereira M, Burford A, Jury A, Popov S, Perryman L, Bax D, Forshew T, Tatevossian R, Sheer D, Pimental J, Pires M, Reis R, Jones C, Sarkar C, Jha P, Patrick IRP, Somasundaram K, Pathak P, Sharma MC, Suri V, Suri A, Gerges N, Haque T, Nantel A, Faury D, Jabado N, Lee C, Fotovati A, Triscott J, Chen J, Venugopal C, Singhal A, Dunham C, Kerr J, Verreault M, Yip S, Wakimoto H, Jones C, Jayanthan A, Narendran A, Singh S, Dunn S, Giraud G, Holm S, Gustavsson B, Van Gool S, Kizyma R, Kizyma Z, Dvornyak L, Kotsay B, Epari S, Sharma P, Gurav M, Gupta T, Shetty P, Moiyadi A, Kane S, Jalali R. HIGH GRADE GLIOMAS. Neuro Oncol 2012; 14:i56-i68. [PMCID: PMC3483348 DOI: 10.1093/neuonc/nos102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
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Gabriel CC, Echevarria M, Rodríguez I, Serra B. Analysis of quality of nuchal translucency measurements: its role in prenatal diagnosis. ScientificWorldJournal 2011; 2012:482832. [PMID: 22649294 PMCID: PMC3353280 DOI: 10.1100/2012/482832] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 12/08/2011] [Indexed: 11/17/2022] Open
Abstract
Objective. Quantitative analysis of the quality of nuchal translucency (NT) measurements. Methods. First-trimester combined screening for Down syndrome was performed to all pregnant women attended in our Department from October 2003 to November 2009. NT was measured according to the Fetal Medicine Foundation (FMF) criteria by 20 trained obstetricians. The performance of NT measurements was retrospectively analyzed with regard to several quality control standards. Accuracy according to experience, professional profile, crown rump length (CRL) values, and FMF certification was statistically tested. Results. A total of 14978 NT measurements were assessed. (1) The mean operator-specific median NT-MoM values was 0,98. (2) Mean percentage of cases >95th and <5th centiles were 5,0% and 4,2%, respectively. (3) Logarithmic mean and SD of the NT MoM values were 0,00 and 0,13, respectively. (4) The DR for trisomy 21 at screening time was 90,7% for a FPR of 6,7% for standard screening strategy. (5) According to Cumulative SUM (CUSUM) figures, the performance was more acceptable in FMF-certified operators. Conclusion. Overall, quality standards show optimal NT measurements in our unit. Operator experience, a dedicated profile to fetal medicine, CRL over 60 mm, and FMF certification have a significant positive impact on the quality standards.
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Affiliation(s)
- Carmen Comas Gabriel
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Institut Universitari Dexeus, Gran Vía Carles III 71-75, 08028 Barcelona, Spain.
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Echevarria M, Hachero A, Martinez A, Ramallo E, García-Bernal D, Ramos M, Fernández A. Spinal anaesthesia with 0.5% isobaric bupivacaine in patients with diabetes mellitus: the influence of CSF composition on sensory and motor block. Eur J Anaesthesiol 2008; 25:1014-1019. [PMID: 18990259 DOI: 10.1017/s0265021508004729] [Citation(s) in RCA: 12] [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: 05/27/2023]
Abstract
BACKGROUND AND OBJECTIVE We investigated cerebrospinal fluid characteristics in patients with and without diabetes mellitus and the influences that changes in these characteristics have on sensory and motor block when spinal anaesthesia is performed. METHODS We included 44 patients in each study group. All received spinal administration of 15 mg of 0.5% isobaric bupivacaine. Blood and cerebrospinal fluid were analysed for glucose, total protein, urea, albumin, immunoglobulin G, sodium, chloride, potassium, calcium, magnesium and osmolarity as well as the performance of the local anaesthetic from establishment until complete regression of sensory and motor block. RESULTS The cerebrospinal fluid of the two groups differed significantly (P < 0.05) in the levels of total protein, albumin, immunoglobulin G, glucose and osmolarity. Sensory and motor block was established more rapidly in the diabetic group (P < 0.05), and the total duration from maximum block until regression to two dermatomes was greater (P < 0.05), as was the complete regression from sensory and motor block (P < 0.05). CONCLUSION This study shows that diabetes mellitus has an influence on sensory and motor block after the administration of spinal isobaric bupivacaine.
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Affiliation(s)
- M Echevarria
- Valme University Hospital, Departament of Anaesthesiology, Seville, Spain.
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Venero JL, Vizuete ML, Ilundáin AA, Machado A, Echevarria M, Cano J. Detailed localization of aquaporin-4 messenger RNA in the CNS: preferential expression in periventricular organs. Neuroscience 1999; 94:239-50. [PMID: 10613514 DOI: 10.1016/s0306-4522(99)00182-7] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We have performed a detailed in situ hybridization study of the distribution of aquaporin-4 messenger RNA in the CNS. Contrary to expectation, we demonstrate that aquaporin-4 is ubiquitously expressed in the CNS. Strong hybridization labeling was detected in multiple olfactory areas, cortical cells, medial habenular nucleus, bed nucleus of the stria terminalis, tenia tecta, pial surface, pontine nucleus, hippocampal formation and multiple thalamic and hypothalamic areas. A low but significant hybridization signal was found, among others, in the choroid plexus of the lateral ventricles, ependymal cells, dorsal raphe and cerebellum. Overall, a preferential distribution of aquaporin-4 messenger RNA-expressing cells was evident in numerous periventricular organs. From the distribution study, the presence of aquaporin-4 messenger RNA-expressing cells in neuronal layers was evident in neuronal layers including the CA1 -CA3 hippocampal pyramidal cells, granular dentate cells and cortical cells. Further evidence of neuronal expression comes from the semicircular arrangement of aquaporin-4 messenger RNA-expressing cells in the bed nucleus of the stria terminalis and medial habenular nucleus exhibiting Nissl-stained morphological features typical of neurons. Combined glial fibrillary acidic protein immunohistochemistry and aquaporin-4 messenger RNA in situ hybridization demonstrated that aquaporin-4 messenger RNA is expressed by glial fibrillary acidic protein-lacking cells. We conclude that aquaporin-4 messenger RNA is present in a collection of structures typically involved in the regulation of water and sodium intake and that aquaporin-4 water channels could be the osmosensor mechanism responsible for detecting changes in cell volume by these cells.
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Affiliation(s)
- J L Venero
- Departamento de Bioquimica, Bromatologia y Toxicologia, Facultad de Farmacia, Universidad de Sevilla, Spain
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Abstract
Three aquaporins (AQP) are present in the membrane of the principal collecting duct cells. On the apical side, the levels of AQP2 protein are increased in response to both arginine vasopressin and water deprivation. However, whether this change parallels changes in the abundance of AQP3 and AQP4 in the basolateral membrane is less well known. This study evaluates the effect of either dehydration or water loading on the rat kidney mRNA expression of AQP2, AQP3, and AQP4. Poly(A+)RNA was prepared from renal cortex and medulla of control, water-deprived, well hydrated, and water-deprived rats treated with OPC31260, a V2 receptor antagonist. Northern blots were done and mRNA levels were quantified using a PhosphorImager system. Relative to control, water deprivation increased the expression of cortical AQP2, -3, and -4, whereas water loading decreased the cortical and medullar expression of AQP2, -3, and -4. Therefore, in addition to AQP2 and -3, AQP4 expression is also regulated by water intake. Treatment with OPC31260 (40 mg/kg of weight per d) inhibited up to 20 to 30% the upregulation of AQP-mRNA induced by water deprivation. Blood values of arginine vasopressin and aldosterone were significantly increased by water deprivation, whereas they were unchanged by water overloading. Taken together, these results indicate that renal AQP2, -3, and -4 expression is regulated in a coordinated manner. Simultaneous up- or downregulation of the three transcripts occurred upon either water deprivation or water loading of animals, respectively. However, the signaling mechanism for the two long-term adaptive processes may be different, and, in addition to arginine vasopressin, other factors may be involved in the transcriptional regulatory processes.
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Affiliation(s)
- M I Murillo-Carretero
- Departamento de Fisiología y Biologia Animal, Facultad de Farmacia, Universidad de Sevilla, Spain
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33
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Abstract
BACKGROUND AND OBJECTIVES We performed a preliminary study to analyze the influence of the menstrual cycle on the incidence of postdural puncture headache (PDPH). METHODS One hundred sixty female patients with regular menstrual cycles who received spinal anesthesia were observed. Based on the day within the menstrual cycle that they received the puncture, the patients were classified into period A (perimenstrual) or period B (postmenstrual). The possible relationship among headaches, lifestyle habits, and anesthetic technique, and the presence of PDPH were analyzed, as were the levels of female sex hormones with PDPH in comparison with a control group. RESULTS Seven cases of PDPH (4.3%) were observed--one within the perimenstrual group and six in the postmenstrual group. No significant differences were observed between the two periods or were there any differences in relating PDPH to the other variables analyzed. CONCLUSIONS According to our results, the menstrual cycle and hormonal levels may not have any influence on the appearance of PDPH in female patients, although a larger series is required to validate these results.
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Affiliation(s)
- M Echevarria
- Servicio de Anestesiología y Reanimación, Hospital de Valme, Sevilla, Spain
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Mulders SM, Olde Weghuis D, van Boxtel JA, van Kessel AG, Echevarria M, van Os CH, Deen PM. Localization of the human gene for aquaporin 3 (AQP3) to chromosome 9, region p21-->p12, using fluorescent in situ hybridization. Cytogenet Cell Genet 1996; 72:303-5. [PMID: 8641135 DOI: 10.1159/000134209] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The chromosome location of the gene encoding aquaporin 3 (AQP3), which functions as a channel for water and small polar solutes in the basolateral membrane of the collecting duct of the kidney, was determined. In situ hybridization on metaphase chromosomes allowed the assignment of human AQP3 to chromosome 9p21-->p12.
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Affiliation(s)
- S M Mulders
- Department of Cell Physiology, University of Nijmegen, The Netherlands.
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35
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Caba F, Echevarria M. [Current situation of anesthesiology research in Andalucia and Extremadura. Comparative study with the rest of Spain]. Rev Esp Anestesiol Reanim 1995; 42:420-3. [PMID: 8789526] [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] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To examine the quality and quantity of scientific research in anesthesiology in Andalucia and Extremadura, comparing them with the rest of Spain. MATERIAL AND METHODS We conducted a retrospective study of publications (original research articles and clinical notes) by spanish authors whose abstracts appeared in the MEDLINE data base from 1990 to 1994. Quality of research design was assessed with the classification system of Fletcher and Fletcher, who categorize works and being either descriptive or analytical. Comparative analysis was in reference to the total number of anesthesiologists. RESULTS Anesthesiologists working in Andalucía and Extremadura make up 21.7% of the total number in Spain, yet fewer publications came from these regions (17%). The proportion of analytical designs, however, was significantly higher (60% versus 44%; p = 0.05). Publications were similar in other ways, though there was a higher proportion of articles from non-anesthesiologists in Andalucía and Extremadura (p = 0.02). Most publications adressed clinical questions. CONCLUSIONS Although there is less scientific publication coming from Andalucía and Extremadura in the field of anesthesiology, its quality is acceptable and seems to be improving.
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Affiliation(s)
- F Caba
- Servicio de Anestesiologia y Reanimación, Hospital Universitario de Valme, Sevilla
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36
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Ecelbarger CA, Terris J, Frindt G, Echevarria M, Marples D, Nielsen S, Knepper MA. Aquaporin-3 water channel localization and regulation in rat kidney. Am J Physiol 1995; 269:F663-72. [PMID: 7503232 DOI: 10.1152/ajprenal.1995.269.5.f663] [Citation(s) in RCA: 176] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The aquaporins are a family of water channels expressed in several water-transporting tissues, including the kidney. We have used a peptide-derived, affinity-purified polyclonal antibody to aquaporin-3 (AQP-3) to investigate its localization and regulation in the kidney. Immunoblotting experiments showed expression in both renal cortex and medulla, with greatest expression in the base of the inner medulla. Subcellular fractionation of membranes, using progressively higher centrifugation speeds, revealed that AQP-3 is present predominantly in the 4,000 and 17,000 g pellets and, in contrast to AQP-2, is virtually absent in the high-speed (200,000 g) pellet that contains small intracellular vesicles. Immunocytochemistry and immunofluorescence studies revealed that labeling is restricted to the cortical, outer medullary, and inner medullary collecting ducts. Within the collecting duct, principal cells were labeled, whereas intercalated cells were unlabeled. Consistent with previous immunofluorescence studies (K. Ishibashi, S. Sasaki, K. Fushimi, S. Uchida, M. Kuwahara, H. Saito, T. Furukawa, K. Nakajima, Y. Yamaguchi, T. Gojobori, and F. Marumo. Proc. Natl. Acad. Sci. USA 91: 6269-6273, 1994; T. Ma, A. Frigeri, H. Hasegawa, and A. S. Verkman. J. Biol. Chem. 269: 21845-21849, 1994), the labeling was confined to the basolateral domain. Immunoelectron microscopy, using the immunogold technique in ultrathin cryosections, demonstrated a predominant labeling of the basolateral plasma membranes. In contrast to previous findings with AQP-2, there was only limited AQP-3 labeling of intracellular vesicles, suggesting that this water channel is not regulated acutely through vesicular trafficking. Immunoblotting studies revealed that thirsting of rats for 48 h approximately doubled the amount of AQP-3 protein in the inner medulla. These studies are consistent with a role for AQP-3 in osmotically driven water absorption across the collecting duct epithelium and suggest that the expression of AQP-3 is regulated on a long-term basis.
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Affiliation(s)
- C A Ecelbarger
- Laboratory of Kidney and Electrolyte Metabolism, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
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Echevarria M, Windhager EE, Tate SS, Frindt G. Cloning and expression of AQP3, a water channel from the medullary collecting duct of rat kidney. Proc Natl Acad Sci U S A 1994; 91:10997-1001. [PMID: 7526388 PMCID: PMC45153 DOI: 10.1073/pnas.91.23.10997] [Citation(s) in RCA: 211] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The terminal part of the inner medullary collecting duct exhibits a high degree of water permeability that is independent of increased intracellular cAMP and not accounted for by the activity of the known renal epithelial water channels CHIP28 (28-kDa channel-forming integral protein) and WCH-CD (collecting duct water channel protein). Starting with rat kidney papilla mRNA, reverse transcription PCR was performed with degenerate primers assuming that the putative channel would be a member of the major intrinsic protein (MIP) family of proteins. A cDNA fragment was identified and used to screen a rat kidney cDNA library. A 1.9-kb cDNA clone was isolated. The open reading frame of 876 bp coded for a protein of 292 amino acids (M(r), 31,431). Aquaporin 3 (AQP3; 31.4-kDa water channel protein) is a newly discovered member of the MIP family. Northern blot analysis showed a single transcript for AQP3 of approximately 1.9 kb present in the renal medulla, predominantly in the inner medulla. With in situ hybridization, abundant message was found in the cells of the medullary collecting ducts. Injection of the complementary RNA of AQP3 into Xenopus oocytes markedly increased the osmotic water permeability. This permeability had an energy of activation of 3.0 kcal/mol (1 cal = 4.184 J), it was fully blocked by 1 mM p-chloromercuriphenylsulfonate, and this inhibition was reversed by 5 mM dithiothreitol. cAMP did not increase this water permeability. AQP3 did not permit passage of monovalent ions (Na, K, Cl); however, it is slightly permeable to urea. The present study demonstrates the existence of an additional water channel, AQP3, in epithelial cells of the medullary collecting duct.
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Affiliation(s)
- M Echevarria
- Department of Physiology, Cornell University Medical College, New York, NY 10021
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38
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Abstract
We measured the water (3H2O) and urea ([14C]urea) diffusive permeabilities (Pd) in intact proximal tubule cells (PTC). Isolated rabbit PTC were packed in polyethylene tubes to measure the diffusion coefficients for 3H2O and [14C]urea at 14 degrees C. Pd values for water and urea were estimated from the diffusion coefficients in intact cells, in extracellular and in intracellular media using a model of parallel and series diffusion in the packed PTC. Pd was 65 +/- 8 and 18 +/- 3 microns/s for water and urea, respectively. We examined the effect of different pharmacological agents on the Pd values for water and for urea. p-Chloromercuribenzenesulfonate at 2 mM markedly inhibited the Pd of water and urea. Phloretin (1 mM) inhibited the Pd for urea, whereas it increased Pd for water. KMnO4 (30 microM) markedly inhibited urea Pd but did not alter water Pd. The values for energy of activation of Pd for water and for urea were 2.9 +/- 2 and 7.3 +/- 4 kcal/mol, respectively. These results show that water and urea do not share the same pathway across the PTC membrane.
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Affiliation(s)
- M Echevarria
- Instituto Venezolano de Investigaciones Cientificas, Caracas
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Echevarria M, Frindt G, Preston GM, Milovanovic S, Agre P, Fischbarg J, Windhager EE. Expression of multiple water channel activities in Xenopus oocytes injected with mRNA from rat kidney. J Gen Physiol 1993; 101:827-41. [PMID: 7687270 PMCID: PMC2216749 DOI: 10.1085/jgp.101.6.827] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
To test the hypothesis that renal tissue contains multiple distinct water channels, mRNA prepared from either cortex, medulla, or papilla of rat kidney was injected into Xenopus oocytes. The osmotic water permeability (Pf) of oocytes injected with either 50 nl of water or 50 nl of renal mRNA (1 microgram/microliter) was measured 4 d after the injection. Pf was calculated from the rate of volume increase on exposure to hyposmotic medium. Injection of each renal mRNA preparation increased the oocyte Pf. This expressed water permeability was inhibited by p-chloromercuriphenylsulfonate and had a low energy of activation, consistent with the expression of water channels. The coinjection of an antisense oligonucleotide for CHIP28 protein, at an assumed > 100-fold molar excess, with either cortex, medulla, or papilla mRNA reduced the expression of the water permeability by approximately 70, 100, and 30%, respectively. Exposure of the oocyte to cAMP for 1 h resulted in a further increase in Pf only in oocytes injected with medulla mRNA. This cAMP activation was not altered by the CHIP28 antisense oligonucleotide. These results suggest that multiple distinct water channels were expressed in oocytes injected with mRNA obtained from sections of rat kidney: (a) CHIP28 water channels in cortex and medulla, (b) cAMP-activated water channels in medulla, and (c) cAMP-insensitive water channels in papilla.
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Affiliation(s)
- M Echevarria
- Department of Physiology and Biophysics, Cornell University Medical College, New York 10021
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Abstract
Methodology was developed to measure osmotic water permeability in monolayer cultured cells and applied to examine the proposed role of glucose transporters in the water pathway (1989. Proc. Natl. Acad. Sci. USA. 86:8397-8401). J774 macrophages were grown on glass coverslips and mounted in a channel-type perfusion chamber for rapid fluid exchange without cell detachment. Relative cell volume was measured by 45 degrees light scattering using an inverted microscope; measurement accuracy was validated by confocal imaging microscopy. The time required for greater than 90% fluid exchange was less than 1 s. In response to a decrease in perfusate osmolality from 300 to 210 mosM, cells swelled without lag at an initial rate of 4.5%/s, corresponding to a water permeability coefficient of (6.3 +/- 0.4) x 10(-3) cm/s (SE, n = 20, 23 degrees C), assuming a cell surface-to-volume ratio of 4,400 cm-1. The initial rate of cell swelling was proportional to osmotic gradient size, independent of perfusate viscosity, and increased by amphotericin B (25 micrograms/ml), and had an activation energy of 10.0 +/- 1 kcal/mol (12-39 degrees C). The compounds phloretin (20 microM) and cytochalasin B (2.5 micrograms/ml) inhibited glucose transport by greater than 85% but did not influence Pf in paired experiments in which Pf was measured before and after inhibitor addition. The mercurials HgCl2 (0.1 mM) and p-chloromercuribenzoate (1 mM) did not inhibit Pf. A stopped-flow light scattering technique was used to measure Pf independently in J774 macrophages grown in suspension culture. Pf in suspended cells was (4.4 +/- 0.3) x 10(-3) cm/s (assuming a surface-to-volume ratio of 8,800 cm-1), increased more than threefold by amphotericin B, and not inhibited by phloretin and cytochalasin B under conditions of strong inhibition of glucose transport. The glucose reflection coefficient was 0.98 +/- 0.03 as measured by induced osmosis, assuming a unity reflection coefficient for sucrose. These results establish a quantitative method for measurement of osmotic water transport in adherent cultured cells and provide evidence that glucose transporters are not involved in the water transporting pathway.
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Affiliation(s)
- M Echevarria
- Department of Medicine, Cardiovascular Research Institute, University of California, San Francisco 94143-0532
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Kitamura S, Echevarria M, Kay JH, Krohn BG, Redington JV, Mendez A, Zubiate P, Dunne EF. Left ventricular performance before and after removal of the noncontractile area of the left ventricle and revascularization of the myocardium. Circulation 1972; 45:1005-17. [PMID: 5020794 DOI: 10.1161/01.cir.45.5.1005] [Citation(s) in RCA: 63] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The left ventricular volume and the internal surface areas of noncontractile regions were measured by cineangiocardiography at 60 frames/sec in nine patients with a chronic localized noncontractile area of the left ventricle. Arteriosclerotic heart disease was proven in eight patients by means of coronary arteriography. Left ventricular end-diastolic pressure, stroke volume, ejection fraction, mean circumferential shortening, and cardiac output were also measured before and after removal of the noncontractile area and revascularization of the myocardium.
The noncontractile areas, measured at end-diastole, ranged from 12 to 40% of the internal surface area of the left ventricle. Generally, impairment of the left ventricular function depended on the size of the noncontractile areas. The end-diastolic volume was approximately 150 ml/m
2
when the size of noncontractile areas exceeded 20-25% of the left ventricular surface area (r = +0.72;
P
< 0.05). The ejection fraction decreased as the size of the noncontractile areas increased (r = –0.81;
P
< 0.01). Following surgery, the left ventricular function, as well as the clinical condition, improved significantly, although the cardiac performance remained in the abnormal range in most patients. The ejection fraction increased (
P
< 0.05), and the percent circumferential shortening also improved (
P
< 0.05).
Removal of the noncontractile area of the left ventricle and revascularization of the myocardium improved the cardiac performance and increased the sense of well being in these patients.
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