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Abu-Rustum NR, Yashar CM, Arend R, Barber E, Bradley K, Brooks R, Campos SM, Chino J, Chon HS, Crispens MA, Damast S, Fisher CM, Frederick P, Gaffney DK, Gaillard S, Giuntoli R, Glaser S, Holmes J, Howitt BE, Kendra K, Lea J, Lee N, Mantia-Smaldone G, Mariani A, Mutch D, Nagel C, Nekhlyudov L, Podoll M, Rodabaugh K, Salani R, Schorge J, Siedel J, Sisodia R, Soliman P, Ueda S, Urban R, Wethington SL, Wyse E, Zanotti K, McMillian N, Espinosa S. Vulvar Cancer, Version 3.2024, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2024; 22:117-135. [PMID: 38503056 DOI: 10.6004/jnccn.2024.0013] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Vulvar cancer is annually diagnosed in an estimated 6,470 individuals and the vast majority are histologically squamous cell carcinomas. Vulvar cancer accounts for 5% to 8% of gynecologic malignancies. Known risk factors for vulvar cancer include increasing age, infection with human papillomavirus, cigarette smoking, inflammatory conditions affecting the vulva, and immunodeficiency. Most vulvar neoplasias are diagnosed at early stages. Rarer histologies exist and include melanoma, extramammary Paget's disease, Bartholin gland adenocarcinoma, verrucous carcinoma, basal cell carcinoma, and sarcoma. This manuscript discusses recommendations outlined in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for treatments, surveillance, systemic therapy options, and gynecologic survivorship.
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Affiliation(s)
| | | | | | - Emma Barber
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jordan Holmes
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center
| | | | - Kari Kendra
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Jayanthi Lea
- UT Southwestern Simmons Comprehensive Cancer Center
| | - Nita Lee
- The UChicago Medicine Comprehensive Cancer Center
| | | | | | - David Mutch
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Christa Nagel
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | - John Schorge
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | | | - Stefanie Ueda
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | - Kristine Zanotti
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
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Peerenboom R, Ackroyd S, Lee N. The burden of cervical cancer survivorship: Understanding morbidity and survivorship needs through hospital admissions. Gynecol Oncol Rep 2024; 51:101328. [PMID: 38318201 PMCID: PMC10839575 DOI: 10.1016/j.gore.2024.101328] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 02/07/2024] Open
Abstract
Objective To describe disease- and treatment-related survivorship burden amongst survivors of cervical cancer and identify risk factors for hospital admissions after initial treatment. Methods Retrospective chart review including patients treated for cervical cancer from 2014 to 2020 at a single urban academic institution. Clinical, demographic, and hospital admission characteristics were summarized. Associations between patient characteristics and likelihood of admission were examined using univariate and multivariate regression. Results Of 366 patients undergoing surveillance following completion of primary treatment, 156 (43 %) were hospitalized for cancer or treatment-related sequela in the median follow-up of 3.6 years (IQR 1.4-6.4), with a median of 2 admissions (IQR 1-4.5) per patient and 570 unique admissions. While 65 (35 %) of admitted patients had multiple reasons for admission, the most common reasons for admission were: gastrointestinal complications (43 %), infection (38 %), genitourinary complications (33 %), and pain control (23 %). A substantial proportion of admitted patients underwent interventions including surgical procedures (57 %), transfusion of blood products (40 %), and interventional radiology procedures (28 %) and utilized supportive care services including case management (53 %), physical therapy (40 %), and occupational therapy (36 %). On multivariate analysis, odds of admission were higher among Black patients (aOR 2.4, p <.01), uninsured patients (aOR 2.7, p <.05), those with lower performance status (aOR 1.4, p <.05), and those with recurrence (aOR 5.5, p <.001). Conclusion Survivors of cervical cancer represent a high-risk population frequently hospitalized after initial treatment. Black patients, uninsured patients, those with recurrence, and those with lower performance status faced higher odds of admission. Comprehensive, team-based care is necessary to address complex survivorship needs.
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Affiliation(s)
- Rayne Peerenboom
- University of Chicago, Pritzker School of Medicine, United States
| | - Sarah Ackroyd
- University of Chicago, Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, United States
| | - Nita Lee
- University of Chicago, Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, United States
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Chor J, Snow SG, Lee N. Abortion Is Essential to Fully Supporting Healthy Surgical Family Building. JAMA Surg 2023; 158:1228. [PMID: 37405799 DOI: 10.1001/jamasurg.2023.2515] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Affiliation(s)
- Julie Chor
- Department of Obstetrics and Gynecology, Section of Complex Family Planning, University of Chicago, Chicago, Illinois
- MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois
| | - Shari G Snow
- Department of Obstetrics and Gynecology, Section of Gynecology and Minimally Invasive Surgery, University of Chicago, Chicago, Illinois
| | - Nita Lee
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago, Chicago, Illinois
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Lourenço A, Lee N, Charlwood F, Lambert J, Vera-Sánchez JA, Hussein M, Shipley D, Romano F, Lowe M, Clarke M, Lorentini S, Mazal A, Pettingell J, Palmans H, Thomas R. A portable primary-standard level graphite calorimeter for absolute dosimetry in clinical pencil beam scanning proton beams. Phys Med Biol 2023; 68:175005. [PMID: 37414003 DOI: 10.1088/1361-6560/ace50f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 07/06/2023] [Indexed: 07/08/2023]
Abstract
Objective. To report the use of a portable primary standard level graphite calorimeter for direct dose determination in clinical pencil beam scanning proton beams, which forms part of the recommendations of the proposed Institute of Physics and Engineering in Medicine (IPEM) Code of Practice (CoP) for proton therapy dosimetry.Approach. The primary standard proton calorimeter (PSPC) was developed at the National Physical Laboratory (NPL) and measurements were performed at four clinical proton therapy facilities that use pencil beam scanning for beam delivery. Correction factors for the presence of impurities and vacuum gaps were calculated and applied, as well as dose conversion factors to obtain dose to water. Measurements were performed in the middle of 10 × 10 × 10 cm3homogeneous dose volumes, centred at 10.0, 15.0 and 25.0 g·cm-2depth in water. The absorbed dose to water determined with the calorimeter was compared to the dose obtained using PTW Roos-type ionisation chambers calibrated in terms of absorbed dose to water in60Co applying the recommendations in the IAEA TRS-398 CoP.Main results.The relative dose difference between the two protocols varied between 0.4% and 2.1% depending on the facility. The reported overall uncertainty in the determination of absorbed dose to water using the calorimeter is 0.9% (k= 1), which corresponds to a significant reduction of uncertainty in comparison with the TRS-398 CoP (currently with an uncertainty equal or larger than 2.0% (k= 1) for proton beams).Significance. The establishment of a purpose-built primary standard and associated CoP will considerably reduce the uncertainty of the absorbed dose to water determination and ensure improved accuracy and consistency in the dose delivered to patients treated with proton therapy and bring proton reference dosimetry uncertainty in line with megavoltage photon radiotherapy.
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Affiliation(s)
- A Lourenço
- Medical Radiation Science Group, National Physical Laboratory, Teddington TW11 0LW, United Kingdom
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, United Kingdom
| | - N Lee
- Medical Radiation Science Group, National Physical Laboratory, Teddington TW11 0LW, United Kingdom
| | - F Charlwood
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
| | - J Lambert
- Rutherford Cancer Centre South Wales, Newport NP10 8FZ, United Kingdom
| | - J A Vera-Sánchez
- Centro de Protonterapia Quirónsalud, E-28223 Pozuelo de Alarcón, Madrid, Spain
| | - M Hussein
- Medical Radiation Science Group, National Physical Laboratory, Teddington TW11 0LW, United Kingdom
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, United Kingdom
| | - D Shipley
- Medical Radiation Science Group, National Physical Laboratory, Teddington TW11 0LW, United Kingdom
| | - F Romano
- Istituto Nazionale di Fisica Nucleare, Sezione di Catania, Via S Sofia 64, I-95123, Catania, Italy
| | - M Lowe
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
| | - M Clarke
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
| | - S Lorentini
- Protontherapy Department, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - A Mazal
- Centro de Protonterapia Quirónsalud, E-28223 Pozuelo de Alarcón, Madrid, Spain
| | - J Pettingell
- Rutherford Cancer Centre North East, Bedlington NE22 7FD, United Kingdom
| | - H Palmans
- Medical Radiation Science Group, National Physical Laboratory, Teddington TW11 0LW, United Kingdom
- Medical Physics Group, MedAustron Ion Therapy Center, A-2700 Wiener Neustadt, Austria
| | - R Thomas
- Medical Radiation Science Group, National Physical Laboratory, Teddington TW11 0LW, United Kingdom
- University of Surrey, Faculty of Engineering and Physical Science, Guildford GU2 7XH, United Kingdom
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Avila S, Ruiz MJ, Petereit D, Arya R, Callender B, Hasan Y, Kim J, Lee N, McCall A, Son C, Stack K, Asif S, Besecker T, Juneja A, Li Z, Naik P, Ranka T, Saxena P, Siegfried B, Ichikawa T, Golden DW. Communicating the Gynecologic Brachytherapy Experience (CoGBE): Clinician perceived benefits of a graphic narrative discussion guide. Brachytherapy 2023; 22:352-360. [PMID: 36681540 PMCID: PMC10175118 DOI: 10.1016/j.brachy.2022.12.006] [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: 09/03/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Many current radiotherapy patient education materials are not patient-centered. An interprofessional team developed Communicating the Gynecologic Brachytherapy Experience (CoGBE), a graphic narrative discussion guide for cylinder, intracavitary, and interstitial high-dose-rate (HDR) gynecologic brachytherapy. This study assesses perceived clinical benefits, usability, and anxiety-reduction of CoGBE. METHODS AND MATERIALS An electronic survey was sent to members of the American Brachytherapy Society. Participants were assigned to assess one of the three modality-specific CoGBE versions using a modified Systems Usability Scale (SUS), modified state-trait anxiety index (mSTAI), and Likert-type questions. Free response data was analyzed using modified grounded theory. RESULTS Median modified SUS score was 76.3 (interquartile range [IQR], 71.3-82.5) and there were no significant differences between guide types. Median mSTAI was 40 (IQR, 40-43.3) for all guides collectively. The cylinder guide had a significantly higher median mSTAI than the intracavitary and interstitial guides (41.6 vs. 40.0 and 40.0; p = 0.04) suggesting the cylinder guide may have less impact on reducing anxiety. Most respondents reported that CoGBE was helpful (72%), would improve patient understanding (77%) and consultation memorability (82%), and was at least moderately likely to be incorporated into their practice (80%). Qualitative analysis themes included personalization and relatability (positive); generalizability (negative); illustrations (both). CONCLUSIONS Clinicians rate CoGBE as usable with potential to reduce patient anxiety, especially with more invasive treatment modalities including intracavitary or interstitial high-dose-rate. CoGBE has the potential to improve patient-clinician communication for a wider range of patients due to its accessible, adaptable, and patient-centered design.
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Affiliation(s)
- Santiago Avila
- Pritzker School of Medicine, The University of Chicago, Chicago, IL
| | - María J Ruiz
- Pritzker School of Medicine, The University of Chicago, Chicago, IL
| | | | - Ritu Arya
- Texas Oncology Arlington Cancer Center North, Arlington, TX
| | - Brian Callender
- Department of Medicine, The University of Chicago, Chicago, IL
| | - Yasmin Hasan
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| | - Josephine Kim
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, IL
| | - Nita Lee
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, IL
| | - Anne McCall
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| | - Christina Son
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| | - Kate Stack
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| | - Sabah Asif
- Institute of Design, Illinois Institute of Technology, Chicago, IL
| | - Tyler Besecker
- Institute of Design, Illinois Institute of Technology, Chicago, IL
| | - Arushi Juneja
- Institute of Design, Illinois Institute of Technology, Chicago, IL
| | - Zhongyang Li
- Institute of Design, Illinois Institute of Technology, Chicago, IL
| | - Pinakee Naik
- Institute of Design, Illinois Institute of Technology, Chicago, IL
| | - Tanvi Ranka
- Institute of Design, Illinois Institute of Technology, Chicago, IL
| | - Prachi Saxena
- Institute of Design, Illinois Institute of Technology, Chicago, IL
| | - Brian Siegfried
- Institute of Design, Illinois Institute of Technology, Chicago, IL
| | - Tomoko Ichikawa
- Institute of Design, Illinois Institute of Technology, Chicago, IL
| | - Daniel W Golden
- Pritzker School of Medicine, The University of Chicago, Chicago, IL; Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL.
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Metwaly AF, Koster AT, Abbasi M, Hassouneh A, Tiro J, Lee N, Odunsi A. Abstract 1973: A geo inelegant approach to cancer disparity. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-1973] [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: 04/07/2023]
Abstract
Abstract
UCRShiny is an intelligent user interface application that utilizes R and R-Shiny tools and statistical intelligence to allow users to visualize geospatial cancer data and perform advanced analyses and predictive modeling. UCRShiny's focus is the catchment area (in Illinois and Indiana) near UCCC and utilizes various metadata. This includes fitting univariate and multivariate models to make statistically sound inferences from the data. It also allows the user to plot specific data on a map of the catchment area as layers for descriptive analysis and visual geospatial assessment. As well as assessing the significance of the relation between these factors. These statistical tools should have a level of intelligence that can determine the correctness of the model's assumptions. An advantage of our tool is that it provides an overall diagnosis of the model to the user without the need for the intervention of an expert statistician. The data selected for analysis are assessed to ensure they meet the assumptions of the statistical model being used, and proper data transformations are applied. The presence of confounding factors is assessed using linear models in sequence. Initially, a single variable linear model is fit using the primary variable of interest (i.e., Cancer mortality) as the response variable and the second variable in the univariate analysis as the covariate. The second model adds the internal metadata columns as potential confounders to the model. In the third step, the percent change in the coefficient of the second variable in the first and second linear models is calculated. Multivariate analysis using ML is used to simultaneously assess the effect of multiple variables on the outcome variable. Here, we use various ML algorithms based on the problem and data at hand, report the significant features, and quantify their impact on the response of interest. The tool allows users to utilize the in-app data, load their dataset, or combine both datasets. It helps to visualize geospatial health data on a map, perform statistical analysis and build ML/AI models without being concerned about the validity of the statistical models. After uploading data and selecting the appropriate statistical test/analysis, results will be visualized as a plot on a map with the specified layers collared by the layer variable values. The layers can be turned on or off using specific buttons on the map. GIS maps may be easily shared and included in apps and are available to almost everyone, anywhere. The user can study the effect of multiple variables and rank their importance in predicting the response variable using multivariate ML/AI models. The UI allows the user to select an appropriate ML algorithm for the model or the application's intelligent backend algorithms to choose the proper ML model (This will be implemented in phase II). The outcome feature and the covariates to use in the model can be selected using searchable textboxes in the UI, and the model is run using the Run model button.
Citation Format: Ahmed Fadiel Metwaly, Adam Thomas Koster, Mohammad Abbasi, Aya Hassouneh, Jasmin Tiro, Nita Lee, Adekunle Odunsi. A geo inelegant approach to cancer disparity [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1973.
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Affiliation(s)
| | | | | | | | | | - Nita Lee
- 1University of Chicago, Chicago, IL
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van den Elzen P, Sander T, Palmans H, McManus M, Woodall N, Lee N, Fox OJL, Jones RM, Angal-Kalinin D, Subiel A. Alanine response to low energy synchrotron x-ray radiation. Phys Med Biol 2023; 68:065011. [PMID: 36731142 DOI: 10.1088/1361-6560/acb886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 02/01/2023] [Indexed: 02/04/2023]
Abstract
Objective. The radiation response of alanine is very well characterized in the MV photon energy range where it can be used to determine the dose delivered with an accuracy better than 1%, making it suitable as a secondary standard detector in cancer radiation therapy. This is not the case in the very low energy keV x-ray range where the alanine response is affected by large uncertainties and is strongly dependent on the x-ray beam energy. This motivated the study undertaken here.Approach. Alanine pellets with a nominal thickness of 0.5 mm and diameter of 5 mm were irradiated with monoenergetic x-rays at the Diamond Light Source synchrotron, to quantify their response in the 8-20 keV range relative to60Co radiation. The absorbed dose to graphite was measured with a small portable graphite calorimeter, and the DOSRZnrc code in the EGSnrc Monte Carlo package was used to calculate conversion factors between the measured dose to graphite and the absorbed dose to water delivered to the alanine pellets. GafChromic EBT3 films were used to measure the beam profile for modelling in the MC simulations.Main results. The relative responses measured in this energy range were found to range from 0.616 to 0.643, with a combined relative expanded uncertainty of 3.4%-3.5% (k= 2), where the majority of the uncertainty originated from the uncertainty in the alanine readout, due to the small size of the pellets used.Significance. The measured values were in good agreement with previously published data in the overlapping region of x-ray energies, while this work extended the dataset to lower energies. By measuring the response to monoenergetic x-rays, the response to a more complex broad-spectrum x-ray source can be inferred if the spectrum is known, meaning that this work supports the establishment of alanine as a secondary standard dosimeter for low-energy x-ray sources.
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Affiliation(s)
- P van den Elzen
- National Physical Laboratory, Medical Radiation Science Group, Teddington, United Kingdom
- University of Manchester, Department of Physics and Astronomy, Manchester, United Kingdom
- The Cockcroft Institute of Accelerator Science and Technology, Daresbury, United Kingdom
| | - T Sander
- National Physical Laboratory, Medical Radiation Science Group, Teddington, United Kingdom
| | - H Palmans
- National Physical Laboratory, Medical Radiation Science Group, Teddington, United Kingdom
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - M McManus
- National Physical Laboratory, Medical Radiation Science Group, Teddington, United Kingdom
| | - N Woodall
- National Physical Laboratory, Medical Radiation Science Group, Teddington, United Kingdom
| | - N Lee
- National Physical Laboratory, Medical Radiation Science Group, Teddington, United Kingdom
| | - O J L Fox
- Diamond Light Source Ltd, Harwell Science Innovation Campus, Didcot, United Kingdom
| | - R M Jones
- University of Manchester, Department of Physics and Astronomy, Manchester, United Kingdom
- The Cockcroft Institute of Accelerator Science and Technology, Daresbury, United Kingdom
| | - D Angal-Kalinin
- University of Manchester, Department of Physics and Astronomy, Manchester, United Kingdom
- The Cockcroft Institute of Accelerator Science and Technology, Daresbury, United Kingdom
- Science and Technology Facilities Council, Accelerator Science and Technology Centre, Daresbury, United Kingdom
| | - A Subiel
- National Physical Laboratory, Medical Radiation Science Group, Teddington, United Kingdom
- University College London, UCL Cancer Institute, London, United Kingdom
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Guttman-Yassky E, Pavel A, Facheris P, Correa Da Rosa J, Pagan A, Del Duca E, Estrada Y, Bissonnette R, Kumar M, Trujillo D, Rulloda J, Lee N, Ikeda S, Jankicevic J, Wustrow D, Brockstedt D, Ho W, Cheng L, Kassner P. 822 RPT193, a CCR4 inhibitor, improves the inflammatory skin transcriptomic profile in patients with atopic dermatitis. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.836] [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: 10/17/2022]
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Betancourt G, Ackroyd S, Liao C, Lee N, Yamada D, Lengyel E, Kurnit K. Sarcoma regimens for gynecologic carcinosarcoma: Is there a benefit? (186). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01413-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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10
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Ackroyd S, Kurnit K, Hlubocky F, Lee N. Decision-making preferences in patients with advanced and recurrent endometrial cancer (502). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01724-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Alexander M, Harris S, Underhill C, Torres J, Sharma S, Lee N, Wong H, Eek R, Michael M, Tie J, Rogers J, Heriot A, Ball D, MacManus M, Wolfe R, Solomon B, Burbury K. PO-44: Risk assessment model potency to detect patients most likely to benefit from thromboprophylaxis: an application of the TARGET- TP score. Thromb Res 2022. [DOI: 10.1016/s0049-3848(22)00234-1] [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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Alexander M, Harris S, Underhill C, Torres J, Sharma S, Lee N, Wong H, Eek R, Michael M, Tie J, Rogers J, Heriot A, Ball D, MacManus M, Wolfe R, Solomon B, Burbury K. OC-15: Targeted thromboprophylaxis in ambulatory patients receiving anticancer therapies for lung or gastrointestinal cancers (TARGET-TP); a randomized trial. Thromb Res 2022. [DOI: 10.1016/s0049-3848(22)00187-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Shalaby B, Nickerson JH, Dam RF, Lee N. The role of PLiM technologies in CANDU TM ongoing aging management, life extension, and new designs. KERNTECHNIK 2022. [DOI: 10.1515/kern-2002-0078] [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: 11/15/2022]
Abstract
Abstract
This paper will discuss AECL’s approach in providing a comprehensive “full knowledge” support to plant ageing and ageing management. This requires the integration of research and development into safety, design, and service areas of the company. The paper will also explore how this integration is being accomplished through the initiatives of the PLiM program. The paper will examine several examples of how AECL is developing its understanding of ageing degradation, the engineered solutions, applying those solutions, improving those solutions, and finally incorporating these solutions into both the PLiM program and into new designs.
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Affiliation(s)
- B. Shalaby
- Atomic Energy of Canada Limited , 2251 Speakman Drive , Mississauga , Ontario, L5K 1B2 , Canada
| | - J. H. Nickerson
- Atomic Energy of Canada Limited , 2251 Speakman Drive , Mississauga , Ontario, L5K 1B2 , Canada
| | - R. F. Dam
- Atomic Energy of Canada Limited , 2251 Speakman Drive , Mississauga , Ontario, L5K 1B2 , Canada
| | - N. Lee
- Atomic Energy of Canada Limited , 2251 Speakman Drive , Mississauga , Ontario, L5K 1B2 , Canada
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Mccallum S, Romano F, Lee N. FLASH Modalities Track (Oral Presentations) CALORIMETRY TECHNIQUES FOR ABSOLUTE DOSIMETRY OF LASER-DRIVEN IONS BEAMS. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01539-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Douralis A, Bass G, Dumbill A, Flynn S, Lee N, Manning J, Subiel A. ESTABLISHMENT OF A FLASH RADIOTHERAPY FACILITY AT NPL AND DOSIMETRY STUDY. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01627-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Lee N, Lourenco A, Thomas R, Romano F, Palmans H, Lee E, Mascia A, Amos R, Subiel A. FLASH Modalities Track (Oral Presentations) DEVELOPMENT AND TEST OF A SMALL PORTABLE GRAPHITE CALORIMETER FOR USE IN ULTRA-HIGH DOSE RATE PARTICLE BEAMS. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01482-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Van Den Elzen P, Sander T, Palmans H, Mcmanus M, Woodall N, Lee N, Jones R, Angal-Kalinin D, Subiel A. ALANINE RESPONSE IN ULTRA-HIGH DOSE-RATE (UHDR) LOW-ENERGY SYNCHROTRON RADIATION. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01618-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Jayyosi C, Lee N, Madhukaran SP, Nallasamy S, Mahendroo M, Myers K. The swelling behavior of the mouse cervix: Changing kinetics with osmolarity and the role of hyaluronan in pregnancy. Acta Biomater 2021; 135:414-424. [PMID: 34411755 DOI: 10.1016/j.actbio.2021.08.018] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 11/29/2022]
Abstract
The cervical remodeling process during pregnancy is characterized by progressive compositional and structural changes in the tissues extra-cellular matrix (ECM). Appropriately timed remodeling is critical for healthy gestation and prevention of premature cervical softening leading to preterm birth (PTB). Modification of the ECM glycosaminoglycans (GAGs) content with advancing pregnancy, especially the non-sulfated GAG hyaluronan (HA), is a fundamental change associated with cervical remodeling. While GAGs have numerous physiological roles, the mechanical consequence of evolving GAG content on cervical structure-function behavior remains an open question. Additionally, an understanding of cervical swelling properties, postulated to be regulated in part by GAGs, is required for the appropriate definition of a reference configuration for mechanical tests and to enhance biological understanding. To investigate cervical swelling, osmotic loading tests are conducted on isolated wild type mouse cervices throughout pregnancy. These tests are performed in various osmolarity solutions to assess the influence of the media on swelling kinetics. A genetically altered strain of mice with depletion of cervical HA is also tested to elucidate the contribution of HA to tissue swelling. Results show ex vivo cervical swelling is significant with volume changes ranging from 20 to 100% after 3h of free swelling. The swelling kinetics depend highly on osmolarity of the media and is altered with advancing pregnancy. The contribution of HA to swelling is only significant in hypo-osmotic solution when HA cervical content is high at the end of pregnancy. In summary, it is critical to account for swelling deformation mechanisms after excision in mechanical experiments. STATEMENT OF SIGNIFICANCE: The cervical extracellular matrix (ECM) undergoes drastic changes to fulfill the functional change of the cervix during pregnancy. Inappropriate timing for this transformation can result in preterm birth, a severe clinical challenge. One of the fundamental changes of the cervical ECM is the significant modification of the glycosaminoglycan content, especially hyaluronan (HA), which is thought to contribute significantly to the swelling and mechanical properties of the cervix. This study aims to measure the swelling kinetics of cervical tissue during pregnancy and to investigate the role of HA in these swelling tendencies. Results show the significant swelling of cervical tissue, which evolves as pregnancy progresses, highlighting a key material property feature of the remodeled cervix. Using a mouse strain with a cervical HA depletion, this work shows HA contributes to the swelling trends of late-term cervical tissue, in a hypo-osmotic solution.
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Affiliation(s)
- C Jayyosi
- Department of Mechanical Engineering, Columbia University, New York, NY, 10027, USA
| | - N Lee
- Department of Mechanical Engineering, Columbia University, New York, NY, 10027, USA
| | - S P Madhukaran
- Department of Obstetrics and Gynecology and Cecil H. and Ida Green Center for Reproductive Biological Science, The University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
| | - S Nallasamy
- Department of Obstetrics and Gynecology and Cecil H. and Ida Green Center for Reproductive Biological Science, The University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
| | - M Mahendroo
- Department of Obstetrics and Gynecology and Cecil H. and Ida Green Center for Reproductive Biological Science, The University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
| | - K Myers
- Department of Mechanical Engineering, Columbia University, New York, NY, 10027, USA.
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Lui G, Wong CK, Chan M, Chong KC, Wong R, Chu I, Zhang M, Li T, Hui D, Lee N, Chan P. Host inflammatory response is the major marker of severe respiratory syncytial virus infection in older adults. J Infect 2021; 83:686-692. [PMID: 34614399 DOI: 10.1016/j.jinf.2021.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/23/2020] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES We aim to study the viral kinetics and host inflammatory response of RSV infection in older adults, and their correlation with disease severity. METHODS We performed a prospective observational study in adults with RSV infection. We serially collected nasal-throat swabs for quantification of RSV-A and RSV-B viral load, and peripheral blood samples for measurement of cytokine/chemokine concentrations. The study endpoints were (i) requiring supplemental oxygen therapy, and (ii) non-invasive ventilation, intensive care, or died within 30 days of admission. We performed multivariable logistic regression models to identify independent variables for severe disease. RESULTS We enrolled 71 hospitalized patients and 10 outpatients treated for RSV infection (median age 75 years, 51% male, and 74% with comorbidities). Among hospitalized patients, 61% required supplemental oxygen therapy, and 18% had severe disease requiring non-invasive ventilation or intensive care, or died within 30 days. Inflammatory cytokine/chemokines IL-6, CXCL8/IL-8, CXCL9/MIG and CXCL10/IP-10 increased significantly during the acute phase of illness. IL-6 concentration was independently associated with severe disease after adjusting for confounding factors. RSV viral load was not associated with disease severity throughout the course of illness. CONCLUSION Host inflammatory response is a major marker of severe disease in older adults with RSV infection.
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Affiliation(s)
- G Lui
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, China Hong Kong Special Administrative Region; Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, China Hong Kong Special Administrative Region
| | - C K Wong
- Department of Chemical Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, China Hong Kong Special Administrative Region
| | - M Chan
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, China Hong Kong Special Administrative Region; Department of Microbiology, Prince of Wales Hospital, The Chinese University of Hong Kong, China Hong Kong Special Administrative Region
| | - K C Chong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, China Hong Kong Special Administrative Region; Centre for Health System and Policy Research, The Chinese University of Hong Kong, China Hong Kong Special Administrative Region
| | - R Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, China Hong Kong Special Administrative Region
| | - I Chu
- Department of Chemical Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, China Hong Kong Special Administrative Region
| | - M Zhang
- Department of Microbiology, Prince of Wales Hospital, The Chinese University of Hong Kong, China Hong Kong Special Administrative Region
| | - T Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, China Hong Kong Special Administrative Region
| | - Dsc Hui
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, China Hong Kong Special Administrative Region; Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, China Hong Kong Special Administrative Region
| | - N Lee
- Institute for Pandemics, Dalla Lana School of Public Health, University of Toronto, Canada
| | - Pks Chan
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, China Hong Kong Special Administrative Region; Department of Microbiology, Prince of Wales Hospital, The Chinese University of Hong Kong, China Hong Kong Special Administrative Region.
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Vinod S, Lee N, Shafiq J, Field M, Fiddler C, Varadarajan S, Gandhidasan S, Hau E. PO-1200 Development and validation of two Australian models to predict 2-year survival in stage I-III NSCLC. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07651-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Ackroyd S, Kim J, Lee N. Telemedicine utilization in gynecologic cancers: understanding the digital divide. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)01195-1] [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: 10/20/2022]
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22
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Avila S, Ruiz MJ, Arya R, Callender B, Hasan Y, Kim JS, Lee N, McCall A, Son CH, Stack K, Asif S, Besecker T, Juneja A, Li Z, Naik P, Ranka T, Saxena P, Siegfried B, Ichikawa T, Golden DW. Abstract 105: Communicating the Gynecologic Brachytherapy Experience (CoGBE): Clinician Perceived Benefits of a Graphic Narrative Patient Education Tool. Cancer Epidemiol Biomarkers Prev 2021. [DOI: 10.1158/1538-7755.asgcr21-105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose: Radiotherapy patient education materials fail to meet readability standards, impairing access for patients with low educational attainment, disabilities, or limited-English proficiency. Design professionals and physicians developed graphic narrative discussion guides, Communication of the Gynecologic Brachytherapy Experience (CoGBE), for cylinder, intracavitary, and interstitial high-dose rate (HDR) gynecologic brachytherapy. This study assesses perceived clinical benefits, usability, and anxiety-reduction of CoGBE.
Methods: An electronic survey was sent to members of the American Brachytherapy Society. Participants were assigned to assess one of the three modality-specific CoGBE guides using a modified Systems Usability Scale (mSUS), modified state-trait anxiety index (mSTAI), and Likert-type questions. Free response data was analyzed using modified grounded theory.
Results: Median mSUS score was 76.3 (interquartile range [IQR], 71.3-82.5) and there were no significant differences between guide types. Median mSTAI was 40 (IQR, 40-43.3) for all guides collectively. The cylinder guide had a significantly higher median mSTAI than the intracavitary and interstitial guides (41.6 vs 40.0 and 40.0; p=0.04) suggesting the cylinder guide may have less impact on reducing anxiety. 72.7% rated CoGBE as “quite” or “extremely” helpful compared to a text-only pamphlet. When compared to their current education practices, 77.3% reported patients would understand “more” or “a lot more” after initial consultation and 81.8% reported CoGBE would be at least moderately helpful in making initial consultations more memorable for patients. Lastly, 79.5% reported at least a moderate likelihood of using CoGBE. Qualitative analysis themes included personalization, relatability, and graphic narrative (positive domains); generalizability and character affect (negative domains).
Conclusion: Clinicians rate CoGBE as usable with potential to reduce patient anxiety, especially with more invasive treatment modalities including intracavitary or interstitial HDR. The CoGBE guides (including multilingual versions) have global applicability, in low resource settings with high cervical cancer burdens and patient populations that may benefit from the graphic narrative format.
Citation Format: Santiago Avila, María J. Ruiz, Ritu Arya, Brian Callender, Yasmin Hasan, Josephine S. Kim, Nita Lee, Anne McCall, Christina H. Son, Kate Stack, Sabah Asif, Tyler Besecker, Arushi Juneja, Zhongyang Li, Pinakee Naik, Tanvi Ranka, Prachi Saxena, Brian Siegfried, Tomoko Ichikawa, Daniel W. Golden. Communicating the Gynecologic Brachytherapy Experience (CoGBE): Clinician Perceived Benefits of a Graphic Narrative Patient Education Tool [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 105.
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Affiliation(s)
| | - María J. Ruiz
- 1The University of Chicago Pritzker School of Medicine,
| | - Ritu Arya
- 2Hendricks Regional Health Cancer Center,
| | | | - Yasmin Hasan
- 4Department of Radiation and Cellular Oncology, The University of Chicago,
| | - Josephine S. Kim
- 5Department of Obstetrics and Gynecology, The University of Chicago,
| | - Nita Lee
- 5Department of Obstetrics and Gynecology, The University of Chicago,
| | - Anne McCall
- 4Department of Radiation and Cellular Oncology, The University of Chicago,
| | - Christina H. Son
- 4Department of Radiation and Cellular Oncology, The University of Chicago,
| | - Kate Stack
- 4Department of Radiation and Cellular Oncology, The University of Chicago,
| | - Sabah Asif
- 6Institute of Design, Illinois Institute of Technology
| | | | - Arushi Juneja
- 6Institute of Design, Illinois Institute of Technology
| | - Zhongyang Li
- 6Institute of Design, Illinois Institute of Technology
| | | | | | - Prachi Saxena
- 6Institute of Design, Illinois Institute of Technology
| | | | | | - Daniel W. Golden
- 4Department of Radiation and Cellular Oncology, The University of Chicago,
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Ghumra W, Lee N, Whitehouse H, Bhutani R, Lagos D, Layton AM. MicroRNAs as biomarkers of atrophic scarring in acne: a cross-sectional analysis of 41 patients. Clin Exp Dermatol 2021; 46:1495-1503. [PMID: 34101224 DOI: 10.1111/ced.14792] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Acne is the commonest inflammatory dermatosis seen worldwide. Atrophic acne scarring is a frequent complication, which can arise from acne of any severity. Micro (mi)RNAs are noncoding RNA molecules of 19-25 nucleotides that function as post-transcriptomic mediators of gene expression. They have demonstrated differential expression in various pathologies, such as eczema and psoriasis, allowing for a unique miRNA 'signature' profile to be established for different disease states. AIM To establish a miRNA signature for acne, and acne-associated atrophic scarring and to identify if a pattern of circulating miRNA is evident in patients who are prone to scarring. METHODS In total, 41 participants were consecutively recruited to this study. Circulating miRNA was quantified from plasma samples in all 41 patients, while in 8 patients, and in a further validation cohort of 9 patients, whole miRNAome was undertaken from tissue specimens, which included lesional, normal and where present, scarred skin. RESULTS Three miRNAs, miR-223, miR-21 and miR-150, were statistically significantly overexpressed in acne lesions, and notably, in clinically uninvolved skin in participants prone to scarring. In this subgroup, we also found statistically significantly elevated levels of circulating miRNA-21 and miRNA-150. CONCLUSION The presence of elevated levels of these specific miRNAs in the serum of patients with acne raises the potential of a blood test to identify those at risk of scarring, allowing for earlier intervention with effective therapy.
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Affiliation(s)
- W Ghumra
- Department of Dermatology, Harrogate District Hospital, Harrogate District and NHS Foundation Trust, Harrogate, Yorkshire, UK
| | - N Lee
- Department of Dermatology, Harrogate District Hospital, Harrogate District and NHS Foundation Trust, Harrogate, Yorkshire, UK
| | - H Whitehouse
- Department of Dermatology, Harrogate District Hospital, Harrogate District and NHS Foundation Trust, Harrogate, Yorkshire, UK
| | - R Bhutani
- Department of Dermatology, Harrogate District Hospital, Harrogate District and NHS Foundation Trust, Harrogate, Yorkshire, UK
| | - D Lagos
- Hull York Medical School and York Biomedical Research Institute, University of York, York, UK
| | - A M Layton
- Department of Dermatology, Harrogate District Hospital, Harrogate District and NHS Foundation Trust, Harrogate, Yorkshire, UK
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Han D, Shin D, Kang M, Choi S, Lee N, Cho J. The change of serum serotonin levels between acute coronary syndrome and chronic stable angina undergoing percutaneous coronary intervention. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1542] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Activated platelets release serotonin (5-hydroxytryptamine, 5HT) causing vasoconstriction and aggregation of platelets in patients with acute coronary syndrome (ACS). It can lead to undergo percutaneous coronary intervention (PCI). We investigated the serial changes of serotonin level in patients with ACS and chronic stable angina (CSA) treated with PCI.
Methods
From July 2009 to April 2010, 123 consecutive patients who have undergone PCI for either ACS (n=63) or CSA (n=60) were enrolled. After the loading dose of aspirin 300mg and clopidogrel 600mg before PCI, maintenance once daily dose of 100mg and 75mg have been given from the day after PCI in all patients. Serum serotonin level (SERO) were serially measured at baseline, pre-, post-PCI, 90 min, 6 hours, 12 hours, 24 hours and 48 hours to compare between ACS and CSA groups. All demographic, biochemical variables, and clinical events were also collected for comparison in each group.
Results
SERO at post-PCI (55.2±120.0 vs 20.1±24.0, p=0.03) and peak level (94.0±170.9 vs 38.8±72.3, p=0.02) were significantly higher in ACS group. SERO after 90 min (34.4±66.1 vs 28.7±38.2, p=0.8), 6 hours (23.9±38.3 vs 10.1±10.0, p=0.34), 24 hours (55.8±108.5 vs 37.2±88.2, p=0.39) and 48 hours (43.5±122.9 vs 25.2±65.5, p=0.53) tended to be higher in ACS group than CSA group without statistical significance. SERO rebounded at 24 hours post-PCI and dropped at 48 hours.
Conclusions
SERO was more elevated in patients with ACS than those with CSA undergoing PCI, suggesting the need for more potent and sustained platelet inhibition particularly in ACS patients. SERO might be considered as a substitute marker of platelet activation. Triple antiplatelet therapy including selective serotonin receptor antagonist on top of aspirin and clopidogrel could be as an option for ACS patients undergoing PCI
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Hallym University Research Fund 2017 (HURF-2017-84)
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Affiliation(s)
- D Han
- Kangnam Sacred Heart Hospital, Seoul, Korea (Republic of)
| | - D.G Shin
- Kangnam Sacred Heart Hospital, Seoul, Korea (Republic of)
| | - M.K Kang
- Kangnam Sacred Heart Hospital, Seoul, Korea (Republic of)
| | - S Choi
- Kangnam Sacred Heart Hospital, Seoul, Korea (Republic of)
| | - N Lee
- Kangnam Sacred Heart Hospital, Seoul, Korea (Republic of)
| | - J.R Cho
- Kangnam Sacred Heart Hospital, Seoul, Korea (Republic of)
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Fong L, Lee N, Yan A, Ng M. Comparison of prasugrel and ticagrelor for patient with acute coronary syndrome: a systematic review and meta-analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1434] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Prasugrel and ticagrelor are both effective anti-platelet drugs for patients with acute coronary syndrome. However, there has been limited data on the direct comparison of prasugrel and ticagrelor until the recent ISAR-REACT 5 trial.
Purpose
To compare the efficacy of prasugrel and ticagrelor in patients with acute coronary syndrome with respect to the primary composite endpoint of myocardial infarction (MI), stroke or cardiac cardiovascular death, and secondary endpoints including MI, stroke, cardiovascular death, major bleeding (Bleeding Academic Research Consortium (BARC) type 2 or above), and stent thrombosis within 1 year.
Methods
Meta-analysis was performed on randomised controlled trials (RCT) up to December 2019 that randomised patients with acute coronary syndrome to either prasugrel or ticagrelor. RCTs were identified from Medline, Embase and ClinicalTrials.gov using Cochrane library CENTRAL by 2 independent reviewers with “prasugrel” and “ticagrelor” as search terms. Effect estimates with confidence intervals were generated using the random effects model by extracting outcome data from the RCTs to compare the primary and secondary clinical outcomes. Cochrane risk-of-bias tool for randomised trials (Ver 2.0) was used for assessment of all eligible RCTs.
Results
411 reports were screened, and we identified 11 eligible RCTs with 6098 patients randomised to prasugrel (n=3050) or ticagrelor (n=3048). The included trials had a follow up period ranging from 1 day to 1 year. 330 events on the prasugrel arm and 408 events on the ticagrelor arm were recorded. There were some concerns over the integrity of allocation concealment over 7 trials otherwise risk of other bias was minimal. Patients had a mean age of 61±4 (76% male; 50% with ST elevation MI; 35% with non-ST elevation MI; 15% with unstable angina; 25% with diabetes mellitus; 64% with hypertension; 51% with hyperlipidaemia; 42% smokers). There was no significant difference in risk between the prasugrel group and the ticagrelor group on the primary composite endpoint (Figure 1) (Risk Ratio (RR)=1.17; 95% CI=0.97–1.41; p=0.10, I2=0%). There was no significant difference between the use of prasugrel and ticagrelor with respect to MI (RR=1.24; 95% CI=0.81–1.90; p=0.31); stroke (RR=1.05; 95% CI=0.66–1.67; p=0.84); cardiovascular death (RR=1.01; 95% CI=0.75–1.36; p=0.95); BARC type 2 or above bleeding (RR=1.17; 95% CI =0.90–1.54; p=0.24); stent thrombosis (RR=1.58; 95% CI =0.90–2.76; p=0.11).
Conclusion
Compared with ticagrelor, prasugrel did not reduce the primary composite endpoint of MI, stroke and cardiovascular death within 1 year. There was also no significant difference in the risk of MI, stroke, cardiovascular death, major bleeding and stent thrombosis respectively.
Figure 1. Primary Objective
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- L.C.W Fong
- The University of Hong Kong, Hong Kong, Hong Kong
| | - N Lee
- The University of Hong Kong, Hong Kong, Hong Kong
| | - A.T Yan
- St. Michael's Hospital, Department of Medicine, University of Toronto Division of Cardiology, Toronto, Canada
| | - M.Y Ng
- The University of Hong Kong, Department of Diagnostic Radiology, Hong Kong, Hong Kong
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Sanduleanu S, Tamanupadhaya@gmail.com T, Klaassen R, Woodruff H, Hatt M, Kaanders J, Vrieze O, Laarhoven H, Subramiam R, Huang S, Bratman S, Dubois L, Miclea R, Di Perri D, Geets X, Crispin-Ortuzar M, Aptea A, Hun Oh J, Lee N, Humm J, Schoder H, Ruysscher D, Hoebers F, Lambin P. PO-1583: Non-invasive radiomic imaging prediction of tumour hypoxia: biomarker for FLASH irradiation? Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01601-7] [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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Oh J, Katsoulakis E, Riaz N, Yu Y, Apte A, Leeman J, Katabi N, Morris L, Chan T, Hatzoglou V, Lee N, Deasy J. PO-1550: Radiomics characteristics correlate with immune activation and HPV status in head and neck cancer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01568-1] [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: 10/22/2022]
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Kang J, Tchekmedyian V, Fan M, Wang H, Kitpanit S, Mohamed N, Rybkin A, Lee A, Chen L, Yu Y, Riaz N, McBride S, Tsai C, Ho A, Dunn L, Fetten J, Pfister D, Zhang Z, Lee N, Sherman E. Split High-Dose Cisplatin: An Alternate High-Dose Cisplatin Administration Schedule for Definitive Chemoradiation in Oropharyngeal Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.279] [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: 10/23/2022]
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Lee N, Lee K, Kim K, Hong J, Yim G, Seong S, Lee B, Lee J, Lim S, Ouh Y, Kim Y. Risk of occult atypical hyperplasia or cancer in women with non-atypical endometrial hyperplasia. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chung C, WANG Y, Lee N. PSU2 Clinical Outcomes and Economics Associated with Surgical Mitral Valve Replacement in Taiwan. Value Health Reg Issues 2020. [DOI: 10.1016/j.vhri.2020.07.544] [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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31
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Chung C, WANG Y, Lee N. PSU3 Clinical Outcomes and Economics Associated with Surgical Aortic Valve Replacement in Taiwan. Value Health Reg Issues 2020. [DOI: 10.1016/j.vhri.2020.07.545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sherman E, Harris J, Bible K, Xia P, Ghossein R, Chung C, Riaz N, Gunn B, Foote R, Yom S, Wong S, Koyfman S, Dzeda M, Clump D, Khan S, Chakravarti A, Redmond K, Torres-Saavedra P, Le QT, Lee N. 1914MO Randomized phase II study of radiation therapy and paclitaxel with pazopanib or placebo: NRG-RTOG 0912. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Kim B, Lee N, Lee C, Lee Y, Lee S, Hwang H, Kim E, Choi E. 213 Increased 11β-hydroxysteroid dehydrogenase type 1 contributes to the impaired barrier in aged skin. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Cheng L, Jorapur A, Jacobson S, Talay O, Miakicheva S, Trujillo D, Lee N, Jankicevic J, Wustrow D, Kassner P, Ho W, Brockstedt D. 561 Development and first-in-human characterization of a potent oral CCR4 antagonist for the treatment of atopic dermatitis. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- S Ryan
- Companion Animal Surgery, Singapore, 329586, Republic of Singapore
| | - H Bacon
- The Royal (Dick) School of Veterinary Studies, The University of Edinburgh Easter Bush Veterinary Centre, Roslin, Midlothian, EH25 9RG, UK
| | - N Endenburg
- Department of Animals in Science and Society Faculty of Veterinary Sciences, Utrecht University, Utrecht, The Netherlands
| | - S Hazel
- School of Animal & Veterinary Sciences, The University of Adelaide, Roseworthy, South Australia, 5005, Australia
| | - R Jouppi
- Wild at Heart Wildlife Center, Lively, Ontario, P3Y 1C3, Canada
| | - N Lee
- Asia Animal Happiness, Selangor, 68000, Malaysia
| | - K Seksel
- Sydney Animal Behaviour Service, Seaforth, New South Wales, 2092, Australia
| | - G Takashima
- Animal Care Group of Lake Oswego, Lake Oswego, Oregon, 97035, USA
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Edwards T, White LV, Lee N, Castro MC, Saludar NR, Faguer BN, Fuente ND, Mayoga F, Ariyoshi K, Garfin AMCG, Solon JA, Cox SE. Effects of comorbidities on quality of life in Filipino people with tuberculosis. Int J Tuberc Lung Dis 2020; 24:712-719. [PMID: 32718405 DOI: 10.5588/ijtld.19.0734] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: We investigated health-related quality of life (HrQoL) in Filipino people undergoing TB treatment, and whether HrQoL was negatively impacted by comorbidity with undernutrition, diabetes (DM) and anaemia.METHODS: Adult participants were enrolled in public facilities in Metro Manila (three sites) and Negros Occidental (two sites). Multivariate linear regression was used to model the four correlated domain scores from a WHOQOL-BREF questionnaire (physical, psychological, social, environmental). A forward-stepwise approach was used to select a final multivariable model with inclusion based on global tests of significance at P < 0.1.RESULTS: In 446 people on drug-susceptible TB treatment, DM and moderate/severe anaemia were not associated with HrQoL. After adjustment for age, sex, education, food insecurity, treatment adherence, inflammation, Category I or II TB treatment, treatment phase, current side effects and inhibited ability to work, moderate/severe undernutrition (body mass index < 17 kg/m²) was associated with lower HrQoL (P = 0.003) with reduced psychological (coefficient: -1.02, 95% CI -1.54 to -0.51), physical (-0.62, 95% CI -1.14 to -0.09) and environmental domain scores (-0.45, 95% CI -0.88 to -0.01). In 225 patients with known HIV status in Metro Manila, HIV was associated with modestly reduced HrQoL (P = 0.014).CONCLUSION: Nutritional status and food insecurity represent modifiable risk factors for poor HrQoL that may be alleviated through interventions.
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Affiliation(s)
- T Edwards
- Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine (LSHTM), London, UK, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - L V White
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - N Lee
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan, Royal Free Hospital, London, UK
| | | | | | - B N Faguer
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - N D Fuente
- Valladolid Health Center, Valladolid, Negros Occidental
| | - F Mayoga
- Bago City Health Center, Bago City, Negros Occidental, the Philippines
| | - K Ariyoshi
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - A M C G Garfin
- National TB Control Programme, Department of Health, Manila, the Philippines
| | - J A Solon
- Nutrition Center Philippines, Manila
| | - S E Cox
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan, Faculty of Population Health, LSHTM, London, UK
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Lee K, Lee N, Shin E, Lee N, Chang J, Na D, Lee J. Enhancing the therapeutic potential of mesenchymal stem cell-based therapy via CRISPR/Cas9-based genome editing. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lee N, Harris J, Pfister D, Kim J, Garden A, Mechalakos J, Chan A, Hu K, Yom S, Glisson B, Shenouda G, Ad VB, Waldron J, Harari P, Le Q. Long-Term Update of a Phase II Study of Concurrent Chemoradiotherapy Using Radiation + Bevacizumab (BV) For Locally or Regionally Advanced Nasopharyngeal Cancer (NPC): RTOG 0615. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Tsai C, McBride S, Riaz N, Kang J, Yu Y, Chen L, Gelblum D, Wong R, Boyle J, Dunn L, Sherman E, Pfister D, Lee N. Radical Reduction of Radiation Therapy Dose Prescription for Elective Treatment Areas in Human Papillomavirus (HPV) - Associated Oropharyngeal Carcinoma (OPC). Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.209] [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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Verma N, Patel S, Osborn V, McBride S, Riaz N, Lee A, Katabi N, Sherman E, Lee N, Tsai C. Prognostic significance of Human Papillomavirus and Epstein-Bar Virus in Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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41
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Riaz N, Sherman E, Pei X, Schoder H, Paudyal R, Katabi N, Ma D, Tsai C, McBride S, Morris L, Boyle J, Singh B, Foote R, Ho A, Wong R, Humm J, Dave A, Pfister D, Reis-Filho J, Lee N. Genetic and micro-environmental factors influencing response to definitive 30Gy chemo-radiotherapy (chemoRT) in HPV Positive Oropharyngeal Cancer (OPC). Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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42
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Zakeri K, Wang H, Kang J, Lee A, Gelblum D, Sherman E, Dunn L, Boyle J, Wong R, Chen L, Yu Y, Tsai C, McBride S, Riaz N, Lee N. Outcomes of Major Salivary Gland Tumors Treated with Proton Beam Radiation Therapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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43
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Fan D, Fan M, Wang H, Lee A, Yu Y, Chen L, Tsai C, McBride S, Riaz N, Bernstein M, Mueller B, Gelblum D, Fetten J, Dunn L, Michel L, Pfister D, Ho A, Boyle J, Cohen M, Roman B, Cracchiolo J, Morris L, Ganly I, Singh B, Shaha A, Patel S, Shah J, Wong R, Sherman E, Lee N, Kang J. Last-line Local Treatment with the Quad Shot Regimen for Previously Irradiated Head and Neck Cancers. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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44
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Kitpanit S, Lee A, Fan D, Fan M, Wang H, Mohamed N, Spielsinger D, Gelblum D, Sherman E, Dunn L, Boyle J, Wong R, Cohen M, Kang J, Tsai C, McBride S, Zakeri K, Chen L, Yu Y, Riaz N, Lee N. Clinical Outcomes and Toxicities in Oropharyngeal Cancer (OPC) Patients Treated with Proton Therapy: A Single Institutional Experience. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.231] [Citation(s) in RCA: 2] [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: 10/24/2022]
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45
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Kang J, Cartano O, Fan D, Fan M, Wang H, Kitpanit S, Lee A, Gelblum D, Sherman E, Dunn L, Cohen M, Boyle J, Wong R, Tsai C, McBride S, Zakeri K, Chen L, Yu Y, Riaz N, Lee N. Changing the Paradigm in HPV-Negative Oropharyngeal Cancer: Deintensification Based on Low Risk of Locoregional Relapse. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.229] [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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46
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Fan M, Lee N, Lee A, Kang J, Fan D, Tsai C, Chen L. Improved Outcomes by proton beam radiation for nasal cavity and paranasal sinus malignances. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.199] [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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47
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Lee N, Seo J, Park H, Yoon J. Diagnosis and successful percutaneous ultrasound-guided aspiration treatment of multiple bilomas in a dog. J Small Anim Pract 2020; 61:321-322. [PMID: 32166748 DOI: 10.1111/jsap.13133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/13/2020] [Accepted: 01/15/2020] [Indexed: 11/30/2022]
Affiliation(s)
- N Lee
- College of Veterinary Medicine and the Research Institute for Veterinary Science, Seoul National University, Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea.,Time Animal Medical Center, 57, Dunsan-ro, Seo-gu, Daejeon, 35233, Republic of Korea
| | - J Seo
- Time Animal Medical Center, 57, Dunsan-ro, Seo-gu, Daejeon, 35233, Republic of Korea
| | - H Park
- Time Animal Medical Center, 57, Dunsan-ro, Seo-gu, Daejeon, 35233, Republic of Korea
| | - J Yoon
- College of Veterinary Medicine and the Research Institute for Veterinary Science, Seoul National University, Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
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Hasan Y, Furtado L, Tergas A, Lee N, Brooks R, McCall A, Golden D, Jolly S, Fleming G, Morrow M, Kraynyak K, Sylvester A, Arif F, Levin M, Schwartz D, Boyer J, Skolnik J, Esser M, Kumar R, Bagarazzi M, Weichselbaum R, Spiotto M. A Phase 1 Trial Assessing the Safety and Tolerability of a Therapeutic DNA Vaccination Against HPV16 and HPV18 E6/E7 Oncogenes After Chemoradiation for Cervical Cancer. Int J Radiat Oncol Biol Phys 2020; 107:487-498. [PMID: 32151670 DOI: 10.1016/j.ijrobp.2020.02.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/12/2020] [Accepted: 02/18/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE This study assessed the safety and tolerability of therapeutic immunization against the human papillomavirus (HPV) viral oncoproteins E6 and E7 in patients with cervical cancer after chemoradiation. METHODS AND MATERIALS MEDI0457 (INO-3112) is a DNA-based vaccine targeting E6 and E7 of HPV-16/18 that is coinjected with an IL-12 plasmid followed by electroporation with the CELLECTRA 5P device. At 2 to 4 weeks after chemoradiation, patients with newly diagnosed stage IB1-IVA (cohort 1) or persistent/recurrent (cohort 2) cervical cancers were treated with 4 immunizations of MEDI0457 every 4 weeks. The primary endpoints were incidence of adverse events and injection site reactions. Immune responses against HPV antigens were measured by ELISpot for interferon-γ (IFNγ), enzyme-linked immunosorbent assay for antibody responses and multiplexed immunofluorescence for immune cells in cervical biopsy specimens. RESULTS Ten patients (cohort 1, n = 7; cohort 2, n = 3) with HPV16 (n = 7) or HPV18 (n = 3) cervical cancers received MEDI0457 after chemoradiation. Treatment-related adverse events were all grade 1, primarily related to the injection site. Eight of 10 patients had detectable cellular or humoral immune responses against HPV antigens after chemoradiation and vaccination: 6 of 10 patients generated anti-HPV antibody responses and 6 of 10 patients generated IFNγ-producing T cell responses. At the completion of chemoradiation and vaccination, cervical biopsy specimens had detectable CD8+ T cells and decreased PD-1+CD8+, PD-L1+CD8+, and PD-L1+CD68+ subpopulations. All patients cleared detectable HPV DNA in cervical biopsies by completion of chemoradiation and vaccination. CONCLUSIONS Adjuvant MEDI0457 is safe and well tolerated after chemoradiation for locally advanced or recurrent cervical cancers, supporting further investigation into combining tumor-specific vaccines with radiation therapy.
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Affiliation(s)
- Yasmin Hasan
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago Illinois.
| | - Larissa Furtado
- Department of Pathology, University of Utah, Salt Lake City, Utah
| | - Ana Tergas
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York
| | - Nita Lee
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago Illinois
| | - Rebecca Brooks
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago Illinois
| | - Anne McCall
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago Illinois
| | - Daniel Golden
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago Illinois
| | - Shruti Jolly
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Gini Fleming
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago Illinois
| | - Matthew Morrow
- Inovio Pharmaceuticals Inc, Plymouth Meeting, Pennsylvania
| | | | | | - Fauzia Arif
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago Illinois
| | | | | | - Jean Boyer
- Inovio Pharmaceuticals Inc, Plymouth Meeting, Pennsylvania
| | | | | | | | - Mark Bagarazzi
- Inovio Pharmaceuticals Inc, Plymouth Meeting, Pennsylvania
| | - Ralph Weichselbaum
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago Illinois
| | - Michael Spiotto
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago Illinois
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49
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Chen YP, Wang YQ, Lv JW, Li YQ, Chua MLK, Le QT, Lee N, Colevas AD, Seiwert T, Hayes DN, Riaz N, Vermorken JB, O'Sullivan B, He QM, Yang XJ, Tang LL, Mao YP, Sun Y, Liu N, Ma J. Identification and validation of novel microenvironment-based immune molecular subgroups of head and neck squamous cell carcinoma: implications for immunotherapy. Ann Oncol 2020; 30:68-75. [PMID: 30407504 DOI: 10.1093/annonc/mdy470] [Citation(s) in RCA: 161] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background Targeting the immune checkpoint pathway has demonstrated antitumor cytotoxicity in treatment-refractory head and neck squamous cell carcinoma (HNSC). To understand the molecular mechanisms underpinning its antitumor response, we characterized the immune landscape of HNSC by their tumor and stromal compartments to identify novel immune molecular subgroups. Patients and methods A training cohort of 522 HNSC samples from the Cancer Genome Atlas profiled by RNA sequencing was analyzed. We separated gene expression patterns from tumor, stromal, and immune cell gene using a non-negative matrix factorization algorithm. We correlated the expression patterns with a set of immune-related gene signatures, potential immune biomarkers, and clinicopathological features. Six independent datasets containing 838 HNSC samples were used for validation. Results Approximately 40% of HNSCs in the cohort (211/522) were identified to show enriched inflammatory response, enhanced cytolytic activity, and active interferon-γ signaling (all, P < 0.001). We named this new molecular class of tumors the Immune Class. Then we found it contained two distinct microenvironment-based subtypes, characterized by markers of active or exhausted immune response. The Exhausted Immune Class was characterized by enrichment of activated stroma and anti-inflammatory M2 macrophage signatures, WNT/transforming growth factor-β signaling pathway activation and poor survival (all, P < 0.05). An enriched proinflammatory M1 macrophage signature, enhanced cytolytic activity, abundant tumor-infiltrating lymphocytes, high human papillomavirus (HPV) infection, and favorable prognosis were associated with Active Immune Class (all, P < 0.05). The robustness of these immune molecular subgroups was verified in the validation cohorts, and Active Immune Class showed potential response to programmed cell death-1 blockade (P = 0.01). Conclusions This study revealed a novel Immune Class in HNSC; two subclasses characterized by active or exhausted immune responses were also identified. These findings provide new insights into tailoring immunotherapeutic strategies for different HNSC subgroups.
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Affiliation(s)
- Y-P Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou; State Key Laboratory of Oncology in South China, Guangzhou; Collaborative Innovation Center for Cancer Medicine, Guangzhou; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China
| | - Y-Q Wang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou; State Key Laboratory of Oncology in South China, Guangzhou; Collaborative Innovation Center for Cancer Medicine, Guangzhou; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China
| | - J-W Lv
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou; State Key Laboratory of Oncology in South China, Guangzhou; Collaborative Innovation Center for Cancer Medicine, Guangzhou; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China
| | - Y-Q Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou; State Key Laboratory of Oncology in South China, Guangzhou; Collaborative Innovation Center for Cancer Medicine, Guangzhou; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China
| | - M L K Chua
- Division of Radiation Oncology, National Cancer Centre, Singapore; Oncology Academic Clinical Programme Duke-NUS Medical School, Singapore
| | - Q-T Le
- Department of Radiation Oncology, Stanford University, Stanford
| | - N Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York
| | | | - T Seiwert
- Department of Medicine, The University of Chicago, Chicago
| | - D N Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - N Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York
| | - J B Vermorken
- Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium
| | - B O'Sullivan
- Ontario Cancer Institute, University Health Network, Toronto, Canada
| | - Q-M He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou; State Key Laboratory of Oncology in South China, Guangzhou; Collaborative Innovation Center for Cancer Medicine, Guangzhou; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China
| | - X-J Yang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou; State Key Laboratory of Oncology in South China, Guangzhou; Collaborative Innovation Center for Cancer Medicine, Guangzhou; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China
| | - L-L Tang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou; State Key Laboratory of Oncology in South China, Guangzhou; Collaborative Innovation Center for Cancer Medicine, Guangzhou; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China
| | - Y-P Mao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou; State Key Laboratory of Oncology in South China, Guangzhou; Collaborative Innovation Center for Cancer Medicine, Guangzhou; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China; Department of Radiation Oncology, University of Michigan, Ann Arbor
| | - Y Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou; State Key Laboratory of Oncology in South China, Guangzhou; Collaborative Innovation Center for Cancer Medicine, Guangzhou; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China
| | - N Liu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou; State Key Laboratory of Oncology in South China, Guangzhou; Collaborative Innovation Center for Cancer Medicine, Guangzhou; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China; Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
| | - J Ma
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou; State Key Laboratory of Oncology in South China, Guangzhou; Collaborative Innovation Center for Cancer Medicine, Guangzhou; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, People's Republic of China.
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Lim SB, Tsai CJ, Yu Y, Greer P, Fuangrod T, Hwang K, Fontenla S, Coffman F, Lee N, Lovelock DM. Investigation of a Novel Decision Support Metric for Head and Neck Adaptive Radiation Therapy Using a Real-Time In Vivo Portal Dosimetry System. Technol Cancer Res Treat 2020; 18:1533033819873629. [PMID: 31551011 PMCID: PMC6763934 DOI: 10.1177/1533033819873629] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
In adaptive radiation therapy of head and neck cancer, any significant anatomical changes observed are used to adapt the treatment plan to maintain target coverage without elevating the risk of xerostomia. However, the additional resources required for adaptive radiation therapy pose a challenge for broad-based implementation. It is hypothesized that a change in transit fluence is associated with volumetric change in the vicinity of the target and therefore can be used as a decision support metric for adaptive radiation therapy. This was evaluated by comparing the fluence with volumetric changes in 12 patients. Transit fluence was measured by an in vivo portal dosimetry system. Weekly cone beam computed tomography was used to determine volume change in the rectangular region of interest from condyloid process to C6. The integrated transit fluence through the region of interest on the day of the cone beam computed tomography scan was calculated with the first treatment as the baseline. The correlation between fluence change and volume change was determined. A logistic regression model was also used to associate the 5% region of interest volume reduction replanning trigger point and the fluence change. The model was assessed by a chi-square test. The area under the receiver-operating characteristic curve was also determined. A total of 46 pairs of measurements were obtained. The correlation between fluence and volumetric changes was found to be -0.776 (P value <.001). The negative correlation is attributed to the increase in the photon fluence transport resulting from the volume reduction. The chi-square of the logistic regression was found to be 17.4 (P value <.001). The area under the receiver-operating characteristic curve was found to be 0.88. Results indicate the change in transit fluence, which can be measured without consuming clinical resources or requiring additional time in the treatment room, can be used as a decision support metric for adaptive therapy.
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Affiliation(s)
- S B Lim
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Health Informatics, Rutgers University, Newark, NJ, USA
| | - C J Tsai
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Y Yu
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - P Greer
- Calvary Mater Newcastle Hospital, Newcastle, Australia
| | - T Fuangrod
- HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, BKK, Thailand
| | - K Hwang
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - S Fontenla
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - F Coffman
- Department of Health Informatics, Rutgers University, Newark, NJ, USA
| | - N Lee
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - D M Lovelock
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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