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Montemorano L, Shultz ZB, Farooque A, Hyun M, Chappell RJ, Hartenbach EM, Lang JD. TP53 mutations and the association with platinum resistance in high grade serous ovarian carcinoma. Gynecol Oncol 2024; 186:26-34. [PMID: 38555766 DOI: 10.1016/j.ygyno.2024.03.023] [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: 01/07/2024] [Revised: 03/21/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVES Alterations in the tumor suppressor TP53 gene are the most common mutations in high grade serous ovarian carcinoma. The impact of TP53 mutations on clinical outcomes and platinum resistance is controversial. We sought to evaluate the genomic profile of high grade serous ovarian carcinoma and explore the association of TP53 mutations with platinum resistance. METHODS Next generation sequencing data was obtained from our institutional database for patients with high grade serous ovarian carcinoma undergoing primary treatment. Sequencing data, demographic, and clinical information was reviewed. The primary outcome analyzed was time to recurrence or refractory diagnosis. Associations between the primary outcome and different classification schemes for TP53 mutations (structural, functional, hot spot, pathogenicity scores, immunohistochemical staining patterns) were performed. RESULTS 209 patients met inclusion criteria. TP53 mutations were the most common mutation. There were no differences in platinum response with TP53 hotspot mutations or high pathogenicity scores. Presence of TP53 gain-of-function mutations or measure of TP53 gain-of function activity were not associated with platinum resistance. Immunohistochemical staining patterns correlated with expected TP53 protein function and were not associated with platinum resistance. CONCLUSIONS TP53 hotspot mutations or high pathogenicity scores were not associated with platinum resistance or refractory disease. Contrary to prior studies, TP53 gain-of-function mutations were not associated with platinum resistance. Estimation of TP53 gain-of-function effect using missense mutation phenotype scores was not associated with platinum resistance. The polymorphic nature of TP53 mutations may be too complex to demonstrate effect using simple models, or response to platinum therapy may be independent of initiating TP53 mutation.
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Affiliation(s)
- Lauren Montemorano
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI, USA.
| | - Zoey B Shultz
- Department of Obstetrics and Gynecology, University of Minnesota, Minneapolis, MN, USA
| | - Alma Farooque
- Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI, USA
| | - Meredith Hyun
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Richard J Chappell
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Ellen M Hartenbach
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI, USA
| | - Jessica D Lang
- Center for Human Genomics & Precision Medicine, Department of Pathology & Laboratory Medicine, University of Wisconsin, Madison, WI, USA
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Jonaitis EM, Hermann BP, Mueller KD, Clark LR, Du L, Betthauser TJ, Cody K, Gleason CE, Christian BT, Asthana S, Chappell RJ, Chin NA, Johnson SC, Langhough RE. Longitudinal normative standards for cognitive tests and composites using harmonized data from two Wisconsin AD-risk-enriched cohorts. Alzheimers Dement 2024. [PMID: 38539269 DOI: 10.1002/alz.13774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Published norms are typically cross-sectional and often are not sensitive to preclinical cognitive changes due to dementia. We developed and validated demographically adjusted cross-sectional and longitudinal normative standards using harmonized outcomes from two Alzheimer's disease (AD) risk-enriched cohorts. METHODS Data from the Wisconsin Registry for Alzheimer's Prevention and the Wisconsin Alzheimer's Disease Research Center were combined. Quantile regression was used to develop unconditional (cross-sectional) and conditional (longitudinal) normative standards for 18 outcomes using data from cognitively unimpaired participants (N = 1390; mean follow-up = 9.25 years). Validity analyses (N = 2456) examined relationships between percentile scores (centiles), consensus-based cognitive statuses, and AD biomarker levels. RESULTS Unconditional and conditional centiles were lower in those with consensus-based impairment or biomarker positivity. Similarly, quantitative biomarker levels were higher in those whose centiles suggested decline. DISCUSSION This study presents normative standards for cognitive measures sensitive to pre-clinical changes. Future directions will investigate potential clinical applications of longitudinal normative standards. HIGHLIGHTS Quantile regression was used to construct longitudinal norms for cognitive tests. Poorer percentile scores were related to concurrent diagnosis and Alzheimer's disease biomarkers. A ShinyApp was built to display test scores and norms and flag low performance.
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Affiliation(s)
- Erin M Jonaitis
- Wisconsin Alzheimer's Institute, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, Wisconsin, USA
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Bruce P Hermann
- Department of Neurology, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Kimberly D Mueller
- Department of Communication Sciences and Disorders, University of Wisconsin - Madison, Madison, Wisconsin, USA
- Division of Geriatrics, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Lindsay R Clark
- Division of Geriatrics, University of Wisconsin - Madison, Madison, Wisconsin, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Madison, Wisconsin, USA
| | - Lianlian Du
- Wisconsin Alzheimer's Institute, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Tobey J Betthauser
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, Wisconsin, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Karly Cody
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Carey E Gleason
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, Wisconsin, USA
- Division of Geriatrics, University of Wisconsin - Madison, Madison, Wisconsin, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Madison, Wisconsin, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Bradley T Christian
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, Wisconsin, USA
- Waisman Center, University of Wisconsin - Madison, Madison, Wisconsin, USA
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Sanjay Asthana
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, Wisconsin, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Richard J Chappell
- Department of Statistics, School of Computer, Data and Information Sciences, University of Wisconsin - Madison, Madison, Wisconsin, USA
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Nathaniel A Chin
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, Wisconsin, USA
- Division of Geriatrics, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Sterling C Johnson
- Wisconsin Alzheimer's Institute, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, Wisconsin, USA
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, Wisconsin, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Madison, Wisconsin, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Rebecca E Langhough
- Wisconsin Alzheimer's Institute, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, Wisconsin, USA
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, Wisconsin, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, Wisconsin, USA
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Blitzer GC, Paz C, Glassey A, Ganz OR, Giri J, Pennati A, Meyers RO, Bates AM, Nickel KP, Weiss M, Morris ZS, Mattison RJ, McDowell KA, Croxford E, Chappell RJ, Glazer TA, Rogus-Pulia NM, Galipeau J, Kimple RJ. Functionality of bone marrow mesenchymal stromal cells derived from head and neck cancer patients - A FDA-IND enabling study regarding MSC-based treatments for radiation-induced xerostomia. Radiother Oncol 2024; 192:110093. [PMID: 38224919 PMCID: PMC10922976 DOI: 10.1016/j.radonc.2024.110093] [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: 07/05/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 01/17/2024]
Abstract
PURPOSE Salivary dysfunction is a significant side effect of radiation therapy for head and neck cancer (HNC). Preliminary data suggests that mesenchymal stromal cells (MSCs) can improve salivary function. Whether MSCs from HNC patients who have completed chemoradiation are functionally similar to those from healthy patients is unknown. We performed a pilot clinical study to determine whether bone marrow-derived MSCs [MSC(M)] from HNC patients could be used for the treatment of RT-induced salivary dysfunction. METHODS An IRB-approved pilot clinical study was undertaken on HNC patients with xerostomia who had completed treatment two or more years prior. Patients underwent iliac crest bone marrow aspirate and MSC(M) were isolated and cultured. Culture-expanded MSC(M) were stimulated with IFNγ and cryopreserved prior to reanimation and profiling for functional markers by flow cytometry and ELISA. MSC(M) were additionally injected into mice with radiation-induced xerostomia and the changes in salivary gland histology and salivary production were examined. RESULTS A total of six subjects were enrolled. MSC(M) from all subjects were culture expanded to > 20 million cells in a median of 15.5 days (range 8-20 days). Flow cytometry confirmed that cultured cells from HNC patients were MSC(M). Functional flow cytometry demonstrated that these IFNγ-stimulated MSC(M) acquired an immunosuppressive phenotype. IFNγ-stimulated MSC(M) from HNC patients were found to express GDNF, WNT1, and R-spondin 1 as well as pro-angiogenesis and immunomodulatory cytokines. In mice, IFNγ-stimulated MSC(M) injection after radiation decreased the loss of acinar cells, decreased the formation of fibrosis, and increased salivary production. CONCLUSIONS MSC (M) from previously treated HNC patients can be expanded for auto-transplantation and are functionally active. Furthermore IFNγ-stimulated MSC(M) express proteins implicated in salivary gland regeneration. This study provides preliminary data supporting the feasibility of using autologous MSC(M) from HNC patients to treat RT-induced salivary dysfunction.
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Affiliation(s)
- Grace C Blitzer
- Department of Human Oncology, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Cristina Paz
- Department of Human Oncology, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Annemarie Glassey
- Department of Human Oncology, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Olga R Ganz
- Department of Medicine, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Jayeeta Giri
- Department of Medicine, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Andrea Pennati
- Department of Medicine, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA; UW Carbone Cancer Center, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Ross O Meyers
- Department of Human Oncology, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA; Department of Medicine, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Amber M Bates
- Department of Human Oncology, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Kwangok P Nickel
- Department of Human Oncology, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Marissa Weiss
- Department of Human Oncology, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Zachary S Morris
- Department of Human Oncology, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Ryan J Mattison
- Department of Medicine, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA; UW Carbone Cancer Center, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Kimberly A McDowell
- Department of Medicine, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Emma Croxford
- Department of Biostatistics and Medical Informatics, 610 Walnut Street, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53726 USA
| | - Richard J Chappell
- Department of Biostatistics and Medical Informatics, 610 Walnut Street, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53726 USA; UW Carbone Cancer Center, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Tiffany A Glazer
- Department of Surgery, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Nicole M Rogus-Pulia
- Department of Medicine, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA; UW Carbone Cancer Center, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA; Geriatric Research Education and Clinical Center, 2500 Overlook Terrace, William S. Middleton Memorial Veterans Hospital, Madison, WI 53705 USA
| | - Jacques Galipeau
- Department of Medicine, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA; UW Carbone Cancer Center, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA
| | - Randall J Kimple
- Department of Human Oncology, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA; UW Carbone Cancer Center, 600 Highland Ave, University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705 USA.
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Baschnagel AM, Flakus MJ, Wallat EM, Wuschner AE, Chappell RJ, Bayliss RA, Kimple RJ, Christensen GE, Reinhardt JM, Bassetti MF, Bayouth JE. A Phase 2 Randomized Clinical Trial Evaluating 4DCT Ventilation-based Functional Lung Avoidance Radiotherapy for Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00327-4. [PMID: 38387810 DOI: 10.1016/j.ijrobp.2024.02.019] [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] [Received: 11/16/2023] [Revised: 01/10/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE To determine whether 4-dimensional computed tomography (4DCT) ventilation-based functional lung avoidance radiotherapy preserves pulmonary function compared with standard radiotherapy for non-small cell lung cancer (NSCLC). MATERIAL AND METHODS This single center, randomized, phase 2 trial enrolled patients with NSCLC receiving curative intent radiotherapy with either stereotactic body radiotherapy or conventionally fractionated radiotherapy between 2016 and 2022. Patients were randomized 1:1 to standard of care radiotherapy or functional lung avoidance radiotherapy. The primary endpoint was the change in Jacobian-based ventilation as measured on 4DCT from baseline to three months post-radiation. Secondary endpoints included changes in volume of high- and low-ventilating lung, pulmonary toxicity, and changes in pulmonary function tests (PFTs). RESULTS A total of 122 patients were randomized and 116 were available for analysis. Median follow up was 29.9 months. Functional avoidance plans significantly (P<.05) reduced dose to high-functioning lung without compromising target coverage or organs at risk constraints. When analyzing all patients, there was no difference in the amount of lung showing a reduction in ventilation from baseline to 3 months between the two arms (1.91% vs 1.87%; P=.90). Overall grade ≥2 and grade ≥3 pulmonary toxicities for all patients were 24.1% and 8.6%, respectively. There was no significant difference in pulmonary toxicity or changes in PFTs between the two study arms. In the conventionally fractionated cohort, there was a lower rate of grade ≥2 pneumonitis (8.2% vs 32.3%; P=.049) and less of a decline in change in FEV1 (-3 vs -5; P=.042) and FVC (1.5 vs -6; P=.005) at 3 months, favoring the functional avoidance arm. CONCLUSIONS There was no difference in post-treatment ventilation as measured by 4DCT between the arms. In the cohort of patients treated with conventionally fractionated radiotherapy with functional lung avoidance, there was reduced pulmonary toxicity, and less decline in PFTs suggesting a clinical benefit in patients with locally advanced NSCLC. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCTXXXX Anonymized for Review XXXX.
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Affiliation(s)
- Andrew M Baschnagel
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.
| | - Mattison J Flakus
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Eric M Wallat
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Antonia E Wuschner
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Richard J Chappell
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin
| | - R Adam Bayliss
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Randall J Kimple
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Gary E Christensen
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa; Department of Radiation Oncology, University of Iowa, Iowa City, Iowa
| | - Joseph M Reinhardt
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa
| | - Michael F Bassetti
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - John E Bayouth
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon.
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Merten N, Fischer ME, Pinto AA, Chappell RJ, Schubert CR. Lifestyle and factors of vascular and metabolic health and inflammation are associated with sensorineural-neurocognitive aging in older adults. Front Epidemiol 2024; 3:1299587. [PMID: 38455939 PMCID: PMC10910988 DOI: 10.3389/fepid.2023.1299587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/14/2023] [Indexed: 03/09/2024]
Abstract
This study's aim was to identify risk factors associated with sensorineural and neurocognitive function (brain aging) in older adults. In N = 1,478 Epidemiology of Hearing Loss Study participants (aged 64-100 years, 59% women), we conducted sensorineural and cognitive tests, which were combined into a summary measure using Principal Component Analysis (PCA). Participants with a PCA score <-1 standard deviation (SD) were considered to have brain aging. Incident brain aging was defined as PCA score <-1 SD at 5-year follow-up among participants who had a PCA score ≥-1 SD at baseline. Logistic regression and Poisson models were used to estimate associations between baseline risk factors of lifestyle, vascular and metabolic health, and inflammation and prevalent or incident brain aging, respectively. In an age-sex adjusted multivariable model, not consuming alcohol (odds ratio(OR) = 1.77, 95% confidence Interval (CI) = 1.18,2.66), higher interleukin-6 levels (OR = 1.30, 95% CI = 1.03,1.64), and depressive symptoms (OR = 2.44, 95% CI = 1.63,3.67) were associated with a higher odds of having brain aging, while higher education had protective effects (OR = 0.55, 95% CI = 0.33,0.94). A history of stroke, arterial stiffness, and obesity were associated with an increased risk of developing brain aging during the five years of follow-up. Lifestyle, vascular, metabolic and inflammatory factors were associated with brain aging in older adults, which adds to the evidence of shared pathways for sensorineural and neurocognitive declines in aging. Targeting these shared central processing etiological factors with interventions may lead to retention of better neurological function, benefiting multiple systems, i.e., hearing, smell, and cognition, ultimately helping older adults retain independence and higher quality of life longer.
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Affiliation(s)
- Natascha Merten
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Mary E. Fischer
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Aaron Alex Pinto
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Richard J. Chappell
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Carla R. Schubert
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
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Schubert CR, Pinto AA, Paulsen AJ, Chappell RJ, Chen Y, Engelman CD, Ferrucci L, Hancock LM, Johnson SC, Merten N. Midlife sensory and motor functions improve long-term predictions of cognitive decline and incidence of cognitive impairment. Alzheimers Dement (Amst) 2024; 16:e12543. [PMID: 38288267 PMCID: PMC10823154 DOI: 10.1002/dad2.12543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/31/2024]
Abstract
INTRODUCTION We aimed to assess whether midlife sensory and motor functions improve risk prediction of 10-year cognitive decline and impairment when added to risk prediction models using the Cardiovascular Risk Factors, Aging, and Incidence of Dementia Score (CAIDE) and Framingham Risk Score (FRS). METHODS Longitudinal data of N = 1529 (mean age 49 years; 54% women) Beaver Dam Offspring Study (BOSS) participants from baseline, 5 and 10-year follow-up were included. We tested whether including baseline sensory (hearing, vision, olfactory) impairment and motor function improves CAIDE or FRS risk predictions of 10-year cognitive decline or cognitive impairment incidence using logistic regressions. RESULTS Adding sensory and motor measures to CAIDE-only and FRS-only models significantly improved areas under the curve for cognitive decline and impairment models. DISCUSSION Including midlife sensory and motor function improved risk predictions of long-term cognitive decline and impairment in middle-aged to older adults. Sensory and motor assessments could contribute to cost-effective and non-invasive screening tools that identify high-risk individuals earlier to target intervention and prevention strategies. Highlights Sensory and motor measures improve risk prediction models of cognitive decline.Sensory and motor measures improve risk prediction models of cognitive impairment.Prediction improvements were strongest in midlife (adults < 55 years of age).Sensory and motor changes may help identify high-risk individuals early.
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Affiliation(s)
- Carla R. Schubert
- Department of Population Health SciencesSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - A. Alex Pinto
- Department of Biostatistics and Medical InformaticsSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Adam J. Paulsen
- Department of Population Health SciencesSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Richard J. Chappell
- Department of Biostatistics and Medical InformaticsSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Department of StatisticsSchool of Computer, Data & Information SciencesUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Yanjun Chen
- Department of Ophthalmology and Visual SciencesSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Corinne D. Engelman
- Department of Population Health SciencesSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Luigi Ferrucci
- Longitudinal Study Section, Intramural Research ProgramNational Institute on Aging, NIHGaithersburgMarylandUSA
| | - Laura M. Hancock
- Neurological InstituteSection of NeuropsychologyCleveland ClinicClevelandOhioUSA
| | - Sterling C. Johnson
- Division of Geriatrics and GerontologyDepartment of MedicineSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Natascha Merten
- Department of Population Health SciencesSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Division of Geriatrics and GerontologyDepartment of MedicineSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
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Paulsen AJ, Pinto AA, Schubert CR, Chappell RJ, Chen Y, Engelman CD, Ferrucci L, Hancock LM, Johnson SC, Merten N. Midlife sensory and motor functions improve prediction of blood-based measures of neurodegeneration and Alzheimer's disease in late middle-age. Alzheimers Dement (Amst) 2024; 16:e12564. [PMID: 38476637 PMCID: PMC10927920 DOI: 10.1002/dad2.12564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/29/2024] [Accepted: 02/03/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION We assessed whether midlife sensory and motor functions added to prediction models using the Cardiovascular Risk Factors, Aging, and Incidence of Dementia Score (CAIDE) and Framingham Risk Score (FRS) improve risk predictions of 10-year changes in biomarkers of neurodegeneration and Alzheimer's disease. METHODS Longitudinal data of N = 1529 (mean age 49years) Beaver Dam Offspring Study participants from baseline, 5-year, and 10-year follow-up were included. We tested whether including baseline sensory (hearing, vision, olfactory) impairment and motor function measures improves CAIDE or FRS risk predictions of 10-year incidence of biomarker positivity of serum-based neurofilament light chain (NfL) and amyloid beta (Aβ)42/Aβ40 using logistic regression. RESULTS Adding sensory and motor measures to CAIDE-only and FRS-only models significantly improved NfL and Aβ42/Aβ40 positivity predictions in adults above the age of 55. DISCUSSION Including midlife sensory and motor function improved long-term biomarker positivity predictions. Non-invasive sensory and motor assessments could contribute to cost-effective screening tools that identify individuals at risk for neurodegeneration early to target interventions and preventions. Highlights Sensory and motor measures improve risk prediction models of neurodegenerative biomarkersSensory and motor measures improve risk prediction models of AD biomarkersPrediction improvements were strongest in late midlife (adults >55 years of age)Sensory and motor assessments may help identify high-risk individuals early.
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Affiliation(s)
- Adam J. Paulsen
- Department of Population Health SciencesSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - A. Alex Pinto
- Department of Biostatistics and Medical InformaticsSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Carla R. Schubert
- Department of Population Health SciencesSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Richard J. Chappell
- Department of Biostatistics and Medical InformaticsSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Department of StatisticsSchool of ComputerData & Information SciencesUniversity of Wisconsin ‐ MadisonMadisonWisconsinUSA
| | - Yanjun Chen
- Department of Ophthalmology and Visual SciencesSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Corinne D. Engelman
- Department of Population Health SciencesSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Luigi Ferrucci
- Longitudinal Study Section, Intramural Research ProgramNational Institute on Aging, NIHGaithersburgMarylandUSA
| | - Laura M. Hancock
- Neurological InstituteSection of NeuropsychologyCleveland ClinicClevelandOhioUSA
| | - Sterling C. Johnson
- Division of Geriatrics and GerontologyDepartment of MedicineSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Natascha Merten
- Department of Population Health SciencesSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Division of Geriatrics and GerontologyDepartment of MedicineSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
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Morris BA, Holmes EE, Anger NJ, Cooley G, Schuster JM, Hurst N, Baschnagel AM, Bassetti MF, Blitzer GC, Chappell RJ, Bayliss RA, Morris ZS, Ritter MA, Floberg JM. Toxicity and Patient-Reported Quality-of-Life Outcomes After Prostate Stereotactic Body Radiation Therapy With Focal Boost to Magnetic Resonance Imaging-Identified Prostate Cancer Lesions: Results of a Phase 2 Trial. Int J Radiat Oncol Biol Phys 2023; 117:613-623. [PMID: 37179035 DOI: 10.1016/j.ijrobp.2023.05.004] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/29/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE In this prospective phase 2 trial, we investigated the toxicity and patient-reported quality-of-life outcomes in patients treated with stereotactic body radiation therapy (SBRT) to the prostate gland and a simultaneous focal boost to magnetic resonance imaging (MRI)-identified intraprostatic lesions while also de-escalating dose to the adjacent organs at risk. METHODS AND MATERIALS Eligible patients included low- or intermediate-risk prostate cancer (Gleason score ≤7, prostate specific antigen ≤20, T stage ≤2b). SBRT was prescribed to 40 Gy in 5 fractions delivered every other day to the prostate, with any areas of high disease burden (MRI-identified prostate imaging reporting and data system 4 or 5 lesions) simultaneously escalated to 42.5 to 45 Gy and areas overlapping organs at risk (within 2 mm of urethra, rectum, and bladder) constrained to 36.25 Gy (n = 100). Patients without a pretreatment MRI or without MRI-identified lesions were treated to dose of 37.5 Gy with no focal boost (n = 14). RESULTS From 2015 to 2022, a total of 114 patients were enrolled with a median follow-up of 42 months. No acute or late grade 3+ gastrointestinal (GI) toxicity was observed. One patient developed late grade 3 genitourinary (GU) toxicity at 16 months. In patients treated with focal boost (n = 100), acute grade 2 GU and GI toxicity was seen in 38% and 4% of patients, respectively. Cumulative late grade 2+ GU and GI toxicities at 24 months were 13% and 5% respectively. Patient-reported outcomes showed no significant long-term change from baseline in urinary, bowel, hormonal, or sexual quality-of-life scores after treatment. CONCLUSIONS SBRT to a dose of 40 Gy to the prostate gland with a simultaneous focal boost up to 45 Gy is well tolerated with similar rates of acute and late grade 2+ GI and GU toxicity as seen in other SBRT regimens without intraprostatic boost. Moreover, no significant long-term changes were seen in patient-reported urinary, bowel, or sexual outcomes from pretreatment baseline.
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Affiliation(s)
| | - Emma E Holmes
- Biostatistics & Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | | | | | | | | | | | | | - Richard J Chappell
- Biostatistics & Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Schubert CR, Paulsen AJ, Alex Pinto A, Chappell RJ, Chen Y, Ferrucci L, Hancock LM, Cruickshanks KJ, Merten N. Effect of Neurotoxin Exposure on Blood Biomarkers of Neurodegeneration and Alzheimer Disease. Alzheimer Dis Assoc Disord 2023; 37:310-314. [PMID: 37698523 PMCID: PMC10841324 DOI: 10.1097/wad.0000000000000579] [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: 12/19/2022] [Accepted: 07/25/2023] [Indexed: 09/13/2023]
Abstract
AIM To determine whether exposure to neurotoxins in midlife is associated with changes in blood-based biomarkers of neurodegeneration and Alzheimer disease pathology. METHODS Blood cadmium, lead, neurofilament light (NfL) chain, total tau (TTau), and amyloid beta (Aβ) 40 and Aβ42 concentrations were measured in 1516 participants in the Beaver Dam Offspring Study. Linear mixed-effect models were used to determine associations between baseline cadmium and lead levels and baseline NfL, TTau, and Aβ42/Aβ40, and 10-year change in concentrations using repeated measures of these biomarkers as the outcome. RESULTS In women, higher cadmium and lead levels were associated with higher baseline TTau concentrations. A higher baseline cadmium level was associated with lower baseline Aβ42/Aβ40 in both men and women. In age-sex-adjusted models, a doubling in baseline cadmium level was associated with a 0.2% (95% CI: 0.0, 0.3) higher increase per year in NfL concentrations. In men, a doubling of baseline lead level was associated with a 0.9% (95% CI: 0.1, 1.7) higher increase per year in TTau concentration. CONCLUSIONS Participants with relatively higher levels of cadmium and lead had blood biomarker concentrations consistent with more neuronal damage and Alzheimer disease pathology. Environmental exposure to neurotoxins may contribute to neurodegeneration.
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Affiliation(s)
- Carla R. Schubert
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
| | - Adam J. Paulsen
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
| | - A. Alex Pinto
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
| | - Richard J. Chappell
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
- Department of Statistics, School of Computer, Data & Information Sciences, University of Wisconsin - Madison, Madison, WI, USA
| | - Yanjun Chen
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
| | - Luigi Ferrucci
- Longitudinal Study Section, Intramural Research Program, National Institute on Aging, NIH, Baltimore, MD, USA
| | - Laura M. Hancock
- Department of Neurology, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
- William S. Middleton Memorial VA Medical Center, Madison, WI, USA
| | - Karen J. Cruickshanks
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
| | - Natascha Merten
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
- Department of Medicine - Division of Geriatrics and Adult Development, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
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Blitzer GC, Glazer T, Gustafson S, Burr A, Mattison R, Ganz O, Meyers R, McDowell K, Weiss M, Nickel KP, Chappell RJ, Pulia N, Gallipeau J, Kimple RJ. A Pilot, First in Human Study of Autologous IFN-Gamma Stimulated Mesenchymal Stromal Cells for Treatment of Radiation-Induced Xerostomia. Int J Radiat Oncol Biol Phys 2023; 117:S152. [PMID: 37784385 DOI: 10.1016/j.ijrobp.2023.06.573] [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) There are no existing effective treatments for radiation-induced xerostomia (RIX), a common side effect of head and neck radiation. Mesenchymal stromal cells (MSCs) exhibit regenerative effects in multiple tissues and may represent an effective cell therapy for the treatment of RIX. Here we present the primary safety and secondary efficacy endpoints of a first-in-human pilot study of IFNγ-stimulated autologous bone marrow- derived MSCs [MSC(M)] for the treatment of RIX. MATERIALS/METHODS We conducted a single-center clinical trial investigating the safety and tolerability of autologous IFNγ-stimulated MSC(M). The study was conducted under an FDA-IND and approved by the local IRB. Patients underwent bone marrow aspiration, MSC(M) were then culture-expanded, stimulated with IFNγ, and cryopreserved. Banked IFNγ-stimulated MSC(M) were thawed, allowed to recover, and then 10 × 106 MSC(M) were injected transcutaneously via ultrasound guidance into one submandibular gland. The primary objective was safety and tolerability determined by dose-limiting toxicity (DLT) defined as submandibular pain > 5 on a standard 10-point pain scale or any serious adverse event (SAE) within one month after injection. Secondary objectives included analysis of efficacy as measured by salivary quantification and using 3 validated quality of life instruments. Quantitative results are reported as mean and standard deviation (SD). RESULTS Six radiation-induced xerostomia patients with head and neck cancer who had completed radiation at least 2 years earlier were enrolled. The median age was 71 (61-74) and 5 (83%) patients were male. Five patients (83%) were treated with chemoradiation and one patient (17%) with radiation alone. The average dose of radiation to the injected submandibular gland was 59.9 Gy. Three patients (50%) reported a pain score of 1 after submandibular gland injection, all pain resolved within 4 days. No patients reported pain 1 month after injection, with no SAEs or other DLTs reported 1 month after injection. The analysis of secondary endpoints demonstrated a trend of increased salivary production. The mean unstimulated saliva was 0.13 mL/min (SD 0.17) at baseline and increased to 0.14 mL/min (SD 0.12) at 1 month after injection and 0.19 mL/min (SD 0.21) at 3-months. Quality of life surveys also showed a trend towards improvement. CONCLUSION Injection of autologous IFNγ-stimulated MSC(M) into the submandibular gland of patients with RIX is safe and well tolerated. A trend towards an improvement in secondary endpoints of salivary quantity and quality of life was observed. This first-in-human pilot study provides support for further investigation into IFNγ-stimulated MSC(M) as an innovative, potentially curative, remedy to treat RIX. A phase I dose-escalation study injecting into bilateral submandibular glands is scheduled to begin accrual in the spring of 2023.
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Affiliation(s)
- G C Blitzer
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI
| | - T Glazer
- University of Wisconsin, Madison, WI
| | | | - A Burr
- Department of Human Oncology, University of Wisconsin Hospitals and Clinics, Madison, WI
| | | | - O Ganz
- University of Wisconsin, Madison, WI
| | - R Meyers
- University of Wisconsin, Madison, WI
| | | | - M Weiss
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI
| | | | - R J Chappell
- University of Wisconsin, Department of Statistics, Biostatistics, and Medical Informatics, Madison, WI
| | - N Pulia
- University of Wisconsin, Madison, WI
| | | | - R J Kimple
- Department of Human Oncology, University of Wisconsin, Madison, WI
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11
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Du L, Koscik RL, Betthauser TJ, Jonaitis EM, Hermann BP, Johnson SC, Larget B, Chappell RJ. Trajectories of cognitive performance in late middle‐aged adults: Bayesian random change point mixed model analysis in WRAP. Alzheimers Dement 2022. [DOI: 10.1002/alz.064025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Lianlian Du
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin‐Madison Madison WI USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Rebecca Langhough Koscik
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health Madison WI USA
- Department of Medicine, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Tobey J Betthauser
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Department of Medicine, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Erin M. Jonaitis
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Department of Medicine, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Bruce P Hermann
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Department of Neurology, School of Medicine and Public Health, Univeristy of Wisconsin‐Madison Madison WI USA
| | - Sterling C. Johnson
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Department of Medicine, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- William S. Middleton Memorial Veterans Hospital Madison WI USA
| | - Bret Larget
- Department of Statistics, University of Wisconsin‐Madison Madison WI USA
| | - Richard J. Chappell
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin‐Madison Madison WI USA
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
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12
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Du L, Hermann BP, Jonaitis EM, Burghy C, Cody KA, Betthauser TJ, Larget B, Chappell RJ, Janelidze S, Hansson O, Johnson SC, Koscik RL. Examining differences across cognitive trajectory profiles in late middle‐aged adults: Results from the Wisconsin Registry for Alzheimer’s Prevention. Alzheimers Dement 2022. [DOI: 10.1002/alz.069423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Lianlian Du
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin‐Madison Madison WI USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Bruce P Hermann
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Department of Neurology, School of Medicine and Public Health, Univeristy of Wisconsin‐Madison Madison WI USA
| | - Erin M. Jonaitis
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Department of Medicine, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Cory Burghy
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Karly Alex Cody
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Department of Medicine, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Tobey J Betthauser
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Department of Medicine, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Bret Larget
- Department of Statistics, University of Wisconsin‐Madison Madison WI USA
| | - Richard J. Chappell
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin‐Madison Madison WI USA
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | | | - Oskar Hansson
- Clinical Memory Research Unit, Lund University Malmö Sweden
| | - Sterling C. Johnson
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Department of Medicine, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Geriatric Research Education and Clinical Center, William S. Middleton Veterans Hospital Madison WI USA
| | - Rebecca Langhough Koscik
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Department of Medicine, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
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13
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Paulsen AJ, Schubert CR, Pinto AA, Chappell RJ, Chen Y, Cruickshanks KJ, Engelman CD, Ferrucci L, Hancock LM, Johnson SC, Merten N. Associations of sensory and motor function with blood-based biomarkers of neurodegeneration and Alzheimer's disease in midlife. Neurobiol Aging 2022; 120:177-188. [PMID: 36209638 PMCID: PMC9613601 DOI: 10.1016/j.neurobiolaging.2022.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 04/28/2022] [Revised: 08/12/2022] [Accepted: 08/17/2022] [Indexed: 10/15/2022]
Abstract
Pathological biomarkers of dementia and Alzheimer's disease (AD) change decades before clinical symptoms. Common sensory and motor changes in aging adults may be early markers of neurodegeneration. We investigated if midlife sensory and motor functions in Beaver Dam Offspring Study (BOSS) participants (N = 1529) were associated with longitudinal changes in blood-based biomarkers of neurodegeneration (neurofilament light chain (NfL); total tau (TTau)) and AD (amyloid beta (Aβ)). Mixed-effects models with baseline sensory and motor function as determinants and 10-year biomarker change as outcome were used. Participants with hearing impairment and worse motor function (among women) showed faster increases in NfL level over time (0.8% per year; 0.3% per year, respectively). There were no significant associations with TTau or Aβ. We found consistent relationships between worse baseline hearing and motor function with a faster increase in neurodegeneration, specifically serum NfL level. Future studies with longer follow-up should determine if sensory and motor changes are more reflective of general neurodegeneration than AD-specific pathology and whether sensory and motor tests may be useful screening tools for neurodegeneration risk.
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Affiliation(s)
- Adam J Paulsen
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
| | - Carla R Schubert
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Alex A Pinto
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Richard J Chappell
- Department of Biostatistics and Medical Informatics and Department of Statistics, University of Wisconsin, Madison, WI, USA
| | - Yanjun Chen
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Karen J Cruickshanks
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA; Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Corinne D Engelman
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Luigi Ferrucci
- Longitudinal Study Section, Intramural Research Program, National Institute on Aging, NIH, Baltimore, MD, USA
| | - Laura M Hancock
- Department of Neurology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Sterling C Johnson
- Alzheimer's Disease Research Center and Wisconsin Alzheimer's Institute, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA; Geriatric Research Education and Clinical Center of the William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Natascha Merten
- Department of Geriatrics and Adult Development, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
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Mukhopadhyay P, Ye J, Anderson KM, Roychoudhury S, Rubin EH, Halabi S, Chappell RJ. Log-Rank Test vs MaxCombo and Difference in Restricted Mean Survival Time Tests for Comparing Survival Under Nonproportional Hazards in Immuno-oncology Trials: A Systematic Review and Meta-analysis. JAMA Oncol 2022; 8:1294-1300. [PMID: 35862037 PMCID: PMC9305601 DOI: 10.1001/jamaoncol.2022.2666] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The log-rank test is considered the criterion standard for comparing 2 survival curves in pivotal registrational trials. However, with novel immunotherapies that often violate the proportional hazards assumptions over time, log-rank can lose power and may fail to detect treatment benefit. The MaxCombo test, a combination of weighted log-rank tests, retains power under different types of nonproportional hazards. The difference in restricted mean survival time (dRMST) test is frequently proposed as an alternative to the log-rank under nonproportional hazard scenarios. Objective To compare the log-rank with the MaxCombo and dRMST in immuno-oncology trials to evaluate their performance in practice. Data Sources Comprehensive literature review using Google Scholar, PubMed, and other sources for randomized clinical trials published in peer-reviewed journals or presented at major clinical conferences before December 2019 assessing efficacy of anti-programmed cell death protein-1 or anti-programmed death/ligand 1 monoclonal antibodies. Study Selection Pivotal studies with overall survival or progression-free survival as the primary or key secondary end point with a planned statistical comparison in the protocol. Sixty-three studies on anti-programmed cell death protein-1 or anti-programmed death/ligand 1 monoclonal antibodies used as monotherapy or in combination with other agents in 35 902 patients across multiple solid tumor types were identified. Data Extraction and Synthesis Statistical comparisons (n = 150) were made between the 3 tests using the analysis populations as defined in the original protocol of each trial. Main Outcomes and Measures Nominal significance based on a 2-sided .05-level test was used to evaluate concordance. Case studies featuring different types of nonproportional hazards were used to discuss more robust ways of characterizing treatment benefit instead of sole reliance on hazard ratios. Results In this systematic review and meta-analysis of 63 studies including 35 902 patients, between the log-rank and MaxCombo, 135 of 150 comparisons (90%) were concordant; MaxCombo achieved nominal significance in 15 of 15 discordant cases, while log-rank did not. Several cases appeared to have clinically meaningful benefits that would not have been detected using log-rank. Between the log-rank and dRMST tests, 137 of 150 comparisons (91%) were concordant; log-rank was nominally significant in 5 of 13 cases, while dRMST was significant in 8 of 13. Among all 3 tests, 127 comparisons (85%) were concordant. Conclusions and Relevance The findings of this review show that MaxCombo may provide a pragmatic alternative to log-rank when departure from proportional hazards is anticipated. Both tests resulted in the same statistical decision in most comparisons. Discordant studies had modest to meaningful improvements in treatment effect. The dRMST test provided no added sensitivity for detecting treatment differences over log-rank.
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Affiliation(s)
| | - Jiabu Ye
- Merck & Co, Inc, Kenilworth, New Jersey
| | | | | | | | - Susan Halabi
- Duke Cancer Institute, Duke University, Durham, North Carolina.,Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Richard J Chappell
- Department of Statistics, University of Wisconsin Madison.,Department of Biostatistics and Medical Informatics, University of Wisconsin Madison
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15
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Blitzer GC, Rogus‐Pulia NM, Paz C, Nickel KP, Cannaday VL, Kelm‐Nelson CA, Sudakaran S, Chappell RJ, Glazer T, Kimple RJ. Quantification of very late xerostomia in head and neck cancer patients after irradiation. Laryngoscope Investig Otolaryngol 2022; 7:1018-1024. [PMID: 36000048 PMCID: PMC9392383 DOI: 10.1002/lio2.864] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 06/23/2022] [Accepted: 06/29/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Radiation therapy (RT) for head and neck cancer (HNC) can result in severe xerostomia, or the subjective feeling of dry mouth. Characterizing xerostomia is critical to designing future clinical trials investigating how to improve HNC patients' quality of life (QoL). Few studies have investigated the very late (>5 years post‐RT) effects of RT for HNC. We undertook preliminary studies quantifying very late xerostomia. Methods Six adults who underwent RT for HNC at least 5 years prior and reported xerostomia were enrolled. Five healthy adults without a self‐reported history of HNC or xerostomia were enrolled as controls. All participants completed three validated surveys to measure xerostomia‐related QoL. Salivary production rates were measured and compositional analysis of the saliva and oral microbiome was completed. Results The QoL survey scores for the HNC participants were significantly worse as compared to the control participants. The HNC participants produced less unstimulated saliva (p = .02) but not less stimulated saliva. The median salivary mucin significantly higher in HNC participants than in control participants (p = .02). There was no significant difference between the pH, amylase, or total protein. Microbiome analysis revealed alpha diversity to be significantly lower in the HNC participants. Conclusion In the survivors of HNC who suffer from late toxicities, multiple means of measuring toxicity may be useful. We found that in patients with radiation‐induced xerostomia over 5 years after therapy, not only were the QoL surveys significantly worse, as expected, but other measurements such as mucin and oral microbiome diversity were also significantly different. Level of evidence 3.
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Affiliation(s)
- Grace C. Blitzer
- Department of Human Oncology University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Nicole M. Rogus‐Pulia
- Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Department of Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Cristina Paz
- Department of Human Oncology University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Kwangok P. Nickel
- Department of Human Oncology University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Vanessa L. Cannaday
- Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Department of Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Cynthia A. Kelm‐Nelson
- Department of Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | | | - Richard J. Chappell
- Department of Biostatistics & Medical Informatics University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Department of Statistics University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Tiffany Glazer
- Department of Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Randall J. Kimple
- Department of Human Oncology University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
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16
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Lee AW, Ng WT, Choi CW, But B, Ngan RKC, Tung S, Cheng AC, Kwong DL, Lu TX, Chan AT, Yiu H, Lee S, Wong F, Yuen KT, Chappell RJ. Exploratory Study of NPC-0501 Trial - Optimal Cisplatin Dose of Concurrent and Induction/Adjuvant Chemotherapy for Locoregionally Advanced Nasopharyngeal Carcinoma. Clin Cancer Res 2022; 28:2679-2689. [PMID: 35381064 DOI: 10.1158/1078-0432.ccr-21-3375] [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] [Received: 09/17/2021] [Revised: 11/10/2021] [Accepted: 04/04/2022] [Indexed: 11/16/2022]
Abstract
Background The current recommendation for locoregionally advanced nasopharyngeal carcinoma (NPC) patients is cisplatin-based induction (IC) or adjuvant (AC) chemotherapy plus concurrent chemoradiotherapy (CRT). However, data on the optimal platinum doses for each phase of combined regimens are lacking. Patients and Methods 742 NPC patients in the NPC-0501 Trial treated with CRT plus IC/AC and irradiated with intensity-modulated radiotherapy (IMRT) were analyzed. The optimal platinum dose to achieve the best overall survival (OS) in the concurrent and induction/adjuvant phases were studied. Results Evaluation of the whole series shows the optimal platinum dose was 160 mg/m2 in the concurrent and 260 mg/m2 in the induction/adjuvant phase. Repeating the analyses on 591 patients treated with cisplatin throughout (no replacement by carboplatin) confirmed the same results. The cohort with optimal platinum doses in both phases had better OS than the cohort suboptimal in both phases (Stage III: 90% vs 75%, Stage IVA-B: 80% vs 56%, at 5-year). Multivariable analyses confirmed optimal platinum doses in both phases vs. suboptimal dose in each phase are significant independent factors for OS, with hazard ratio of 0.61 (95% confidence interval [CI]=0.41-0.91) and 0.67 (95% CI=0.48-0.94), respectively. Treatment sequence was statistically insignificant after adjusting for platinum doses. Conclusion Both concurrent and IC/AC are needed for locoregionally advanced NPC, even for patients irradiated by IMRT; the concurrent platinum dosage could be set at {greater than or equal to}160 mg/m2 when coupled with adequate induction/adjuvant dosage at {greater than or equal to}260 mg/m2 (or at least {greater than or equal to}240 mg/m2). To achieve these optimal dosages, IC-CRT at conventional fractionation is favored.
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Affiliation(s)
| | - Wai-Tong Ng
- University of Hong Kong, Hong Kong, Hong Kong
| | | | - Barton But
- University of Hong Kong, Hong Kong, Hong Kong
| | | | | | | | | | - Tai-Xiang Lu
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | | | - Harry Yiu
- Queen Elizabeth Hospital, Hong Kong, China
| | - Sarah Lee
- Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | | | | | - Richard J Chappell
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
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17
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Du L, Koscik RL, Chin NA, Bratzke LC, Cody KA, Erickson CM, Betthauser TJ, Jonaitis EM, Hermann BP, Vasiljevic E, Deming Y, Mueller KD, Engelman CD, Chappell RJ, Johnson SC. Association of anticholinergic medication and AD biomarkers among cognitively normal late middle‐age adults: Results from the Wisconsin Registry for Alzheimer's Prevention (WRAP). Alzheimers Dement 2021. [DOI: 10.1002/alz.056314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Lianlian Du
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin‐Madison Madison WI USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Rebecca L Koscik
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Department of Medicine, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Nathaniel A Chin
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Department of Medicine, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- VA Geriatric Research, Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital Madison WI USA
| | - Lisa C Bratzke
- School of Nursing, University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Karly Alex Cody
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Department of Medicine, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Claire M Erickson
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Department of Medicine, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Tobey J Betthauser
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Department of Medicine, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Erin M Jonaitis
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Department of Medicine, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Bruce P Hermann
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- VA Geriatric Research, Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital Madison WI USA
- Department of Neurology, School of Medicine and Public Health, University of Wisconsin‐Madison Madison WI USA
| | - Eva Vasiljevic
- School of Medicine & Public Health, University of Wisconsin‐Madison Madison WI USA
| | - Yuetiva Deming
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- School of Medicine & Public Health, University of Wisconsin‐Madison Madison WI USA
| | - Kimberly D Mueller
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Department of Communication Sciences and Disorders, University of Wisconsin ‐ Madison Madison WI USA
| | - Corinne D Engelman
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- School of Medicine & Public Health, University of Wisconsin‐Madison Madison WI USA
| | - Richard J Chappell
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin‐Madison Madison WI USA
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Sterling C Johnson
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Department of Medicine, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- VA Geriatric Research, Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital Madison WI USA
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18
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Wyman MF, Burke SL, Paukner MJ, Umucu E, Naseh M, Grudzien A, Zuelsdorff M, Walaszek A, Chappell RJ, Gleason CE. Differential discordance of informant‐ and self‐rated depression and apathy in Black, Hispanic, and White participants in the NACC dataset. Alzheimers Dement 2021. [DOI: 10.1002/alz.053016] [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] [Indexed: 11/08/2022]
Affiliation(s)
- Mary F. Wyman
- University of Wisconsin School of Medicine and Public Health Madison WI USA
- Geriatric Research, Education, and Clinical Center (GRECC), Middleton Memorial Veterans Hospital Madison WI USA
| | | | | | - Emre Umucu
- University of Texas, El Paso El Paso TX USA
| | | | | | - Megan Zuelsdorff
- University of Wisconsin‐Madison School of Nursing Madison WI USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Art Walaszek
- University of Wisconsin School of Medicine and Public Health Madison WI USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Richard J. Chappell
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Carey E. Gleason
- Geriatric Research, Education, and Clinical Center (GRECC), Middleton Memorial Veterans Hospital Madison WI USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health Madison WI USA
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19
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Ma Y, Spalitta A, Wahoske ML, Blazel H, Chappell RJ, Chin NA, Johnson SC, Asthana S, Gleason CE, Carlsson CM. Greater COVID‐19 impact for underrepresented racial and ethnic minority groups: A survey study on the Wisconsin Alzheimer’s Disease Research Center participants. Alzheimers Dement 2021. [PMCID: PMC9011737 DOI: 10.1002/alz.050539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Yue Ma
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Alice Spalitta
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Michelle L Wahoske
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Hanna Blazel
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Richard J Chappell
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Nathaniel A Chin
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Sterling C Johnson
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital Madison WI USA
- Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Sanjay Asthana
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health Madison WI USA
- Geriatric Research, Education, and Clinical Center (GRECC), Middleton Memorial Veterans Hospital Madison WI USA
| | - Carey E Gleason
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health Madison WI USA
- University of Wisconsin‐Madison Madison WI USA
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Cynthia M Carlsson
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Geriatric Research, Education and Clinical Center, Madison VA Hospital Madison WI USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
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20
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Du L, Koscik RL, Jonaitis EM, Betthauser TJ, Cody KA, Hermann BP, Mueller KD, Zuelsdorff M, Chin NA, Ennis GE, Bendlin BB, Gleason CE, Christian BT, Plante DT, Chappell RJ, Johnson SC. Examining differences across sleep profiles in late middle‐aged adults: Results from the Wisconsin Registry for Alzheimer's Prevention (WRAP). Alzheimers Dement 2021. [DOI: 10.1002/alz.056304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Lianlian Du
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- School of Medicine and Public Health, University of Wisconsin‐Madison Madison WI USA
| | - Rebecca L Koscik
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- School of Medicine and Public Health, University of Wisconsin‐Madison Madison WI USA
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Erin M Jonaitis
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- School of Medicine and Public Health, University of Wisconsin‐Madison Madison WI USA
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Tobey J Betthauser
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- School of Medicine and Public Health, University of Wisconsin‐Madison Madison WI USA
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Karly Alex Cody
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- School of Medicine and Public Health, University of Wisconsin‐Madison Madison WI USA
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Bruce P Hermann
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- School of Medicine and Public Health, University of Wisconsin‐Madison Madison WI USA
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- VA Geriatric Research, Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital Madison WI USA
| | - Kimberly D Mueller
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Department of Communication Sciences and Disorders, University of Wisconsin ‐ Madison Madison WI USA
| | - Megan Zuelsdorff
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- University of Wisconsin‐Madison School of Nursing Madison WI USA
| | - Nathaniel A Chin
- School of Medicine and Public Health, University of Wisconsin‐Madison Madison WI USA
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- VA Geriatric Research, Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital Madison WI USA
- Department of Medicine, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Gilda E. Ennis
- School of Medicine and Public Health, University of Wisconsin‐Madison Madison WI USA
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Barbara B Bendlin
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- School of Medicine and Public Health, University of Wisconsin‐Madison Madison WI USA
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- VA Geriatric Research, Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital Madison WI USA
| | - Carey E. Gleason
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- School of Medicine and Public Health, University of Wisconsin‐Madison Madison WI USA
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - Bradley T Christian
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Department of Medical Physics, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
| | - David T Plante
- University of Wisconsin School of Medicine and Public Health, Department of Psychiatry Madison WI USA
| | - Richard J. Chappell
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin‐Madison Madison, WI, USA Madison WI USA
| | - Sterling C. Johnson
- Wisconsin Alzheimer’s Institute, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- School of Medicine and Public Health, University of Wisconsin‐Madison Madison WI USA
- Alzheimer’s Disease Research Center, University of Wisconsin‐Madison School of Medicine and Public Health Madison WI USA
- VA Geriatric Research, Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital Madison WI USA
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21
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Scribano CM, Wan J, Esbona K, Tucker JB, Lasek A, Zhou AS, Zasadil LM, Molini R, Fitzgerald J, Lager AM, Laffin JJ, Correia-Staudt K, Wisinski KB, Tevaarwerk AJ, O’Regan R, McGregor SM, Fowler AM, Chappell RJ, Bugni TS, Burkard ME, Weaver BA. Chromosomal instability sensitizes patient breast tumors to multipolar divisions induced by paclitaxel. Sci Transl Med 2021; 13:eabd4811. [PMID: 34516829 PMCID: PMC8612166 DOI: 10.1126/scitranslmed.abd4811] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [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] [Indexed: 12/20/2022]
Abstract
Paclitaxel (Taxol) is a cornerstone of cancer treatment. However, its mechanism of cytotoxicity is incompletely understood and not all patients benefit from treatment. We show that patients with breast cancer did not accumulate sufficient intratumoral paclitaxel to induce mitotic arrest in tumor cells. Instead, clinically relevant concentrations induced multipolar mitotic spindle formation. However, the extent of early multipolarity did not predict patient response. Whereas multipolar divisions frequently led to cell death, multipolar spindles focused into bipolar spindles before division at variable frequency, and maintaining multipolarity throughout mitosis was critical to induce the high rates of chromosomal instability necessary for paclitaxel to elicit cell death. Increasing multipolar divisions in paclitaxel resulted in improved cytotoxicity. Conversely, decreasing paclitaxel-induced multipolar divisions reduced paclitaxel efficacy. Moreover, we found that preexisting chromosomal instability sensitized breast cancer cells to paclitaxel. Both genetic and pharmacological methods of inducing chromosomal instability were sufficient to increase paclitaxel efficacy. In patients, the amount of pretreatment chromosomal instability directly correlated with taxane response in metastatic breast cancer such that patients with a higher rate of preexisting chromosomal instability showed improved response to taxanes. Together, these results support the use of baseline rates of chromosomal instability as a predictive biomarker for paclitaxel response. Furthermore, they suggest that agents that increase chromosomal instability or maintain multipolar spindles throughout mitosis will improve the clinical utility of paclitaxel.
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Affiliation(s)
- Christina M. Scribano
- Molecular and Cellular Pharmacology Graduate Training Program, University of Wisconsin, Madison, WI 53705, USA
| | - Jun Wan
- Physiology Graduate Training Program, University of Wisconsin, Madison, WI 53705, USA
| | - Karla Esbona
- Department of Medicine, University of Wisconsin, Madison, WI 53705, USA
| | - John B. Tucker
- Cancer Biology Graduate Training Program, University of Wisconsin, Madison, WI 53705, USA
| | - Amber Lasek
- Department of Cell and Regenerative Biology, University of Wisconsin, Madison, WI 53705, USA
| | - Amber S. Zhou
- Molecular and Cellular Pharmacology Graduate Training Program, University of Wisconsin, Madison, WI 53705, USA
| | - Lauren M. Zasadil
- Molecular and Cellular Pharmacology Graduate Training Program, University of Wisconsin, Madison, WI 53705, USA
| | - Ryan Molini
- Department of Cell and Regenerative Biology, University of Wisconsin, Madison, WI 53705, USA
| | - Jonathan Fitzgerald
- Molecular and Cellular Pharmacology Graduate Training Program, University of Wisconsin, Madison, WI 53705, USA
| | - Angela M. Lager
- Wisconsin State Laboratory of Hygiene, Madison, WI 53705, USA
| | | | | | - Kari B. Wisinski
- Department of Medicine, University of Wisconsin, Madison, WI 53705, USA
| | | | - Ruth O’Regan
- Department of Medicine, University of Wisconsin, Madison, WI 53705, USA
| | - Stephanie M. McGregor
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, WI 53705, USA
| | - Amy M. Fowler
- Department of Radiology, University of Wisconsin, Madison, WI 53792, USA
- Department of Medical Physics, University of Wisconsin, Madison, WI 53705, USA
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI 53705, USA
| | | | - Tim S. Bugni
- School of Pharmacy, University of Wisconsin, Madison, WI 53705, USA
| | - Mark E. Burkard
- Department of Medicine, University of Wisconsin, Madison, WI 53705, USA
- Department of Oncology/McArdle Laboratory for Cancer Research, University of Wisconsin, Madison, WI 53705, USA
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Beth A. Weaver
- Department of Cell and Regenerative Biology, University of Wisconsin, Madison, WI 53705, USA
- Department of Oncology/McArdle Laboratory for Cancer Research, University of Wisconsin, Madison, WI 53705, USA
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI 53705, USA
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22
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Vogt NM, Hunt JFV, Ma Y, Van Hulle CA, Adluru N, Chappell RJ, Lazar KK, Jacobson LE, Austin BP, Asthana S, Johnson SC, Bendlin BB, Carlsson CM. Effects of simvastatin on white matter integrity in healthy middle-aged adults. Ann Clin Transl Neurol 2021; 8:1656-1667. [PMID: 34275209 PMCID: PMC8351379 DOI: 10.1002/acn3.51421] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 04/27/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 11/29/2022] Open
Abstract
Background The brain is the most cholesterol‐rich organ and myelin contains 70% of total brain cholesterol. Statins are potent cholesterol‐lowing medications used by millions of adults for prevention of vascular disease, yet the effect of statins on cholesterol‐rich brain white matter (WM) is largely unknown. Methods We used longitudinal neuroimaging data acquired from 73 healthy, cognitively unimpaired, statin‐naïve, middle‐aged adults during an 18‐month randomized controlled trial of simvastatin 40 mg daily (n = 35) or matching placebo (n = 38). ANCOVA models (covariates: age, sex, APOE‐ɛ4) tested the effect of treatment group on percent change in WM, gray matter (GM), and WM hyperintensity (WMH) neuroimaging measures at each study visit. Mediation analysis tested the indirect effects of simvastatin on WM microstructure through change in serum total cholesterol levels. Results At 18 months, the simvastatin group showed a significant preservation in global WM fractional anisotropy (β = 0.88%, 95% CI 0.27 to 1.50, P = 0.005), radial diffusivity (β = −1.10%, 95% CI −2.13 to −0.06, P = 0.039), and WM volume (β = 0.72%, 95% CI 0.13 to 1.32, P = 0.018) relative to the placebo group. There was no significant effect of simvastatin on GM or WMH volume. Change in serum total cholesterol mediated approximately 30% of the effect of simvastatin on WM microstructure. Conclusions Simvastatin treatment in healthy, middle‐aged adults resulted in preserved WM microstructure and volume at 18 months. The partial mediation by serum cholesterol reduction suggests both peripheral and central mechanisms. Future studies are needed to determine whether these effects persist and translate to cognitive outcomes. Trial Registration NCT00939822 (ClinicalTrials.gov).
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Affiliation(s)
- Nicholas M Vogt
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jack F V Hunt
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Yue Ma
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Carol A Van Hulle
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Nagesh Adluru
- Waisman Laboratory for Brain Imaging and Behavior, Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Richard J Chappell
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.,Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Karen K Lazar
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Laura E Jacobson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Benjamin P Austin
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Sanjay Asthana
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.,Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Geriatrics Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Sterling C Johnson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.,Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Geriatrics Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.,Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Barbara B Bendlin
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.,Geriatrics Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.,Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Cynthia M Carlsson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.,Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Geriatrics Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.,Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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23
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Ma Y, Norton DL, Van Hulle CA, Chappell RJ, Lazar KK, Jonaitis EM, Koscik RL, Clark LR, Krause R, Andreasson U, Chin NA, Bendlin BB, Asthana S, Okonkwo OC, Gleason CE, Johnson SC, Zetterberg H, Blennow K, Carlsson CM. Measurement batch differences and between-batch conversion of Alzheimer's disease cerebrospinal fluid biomarker values. Alzheimers Dement (Amst) 2021; 13:e12194. [PMID: 34084888 PMCID: PMC8144935 DOI: 10.1002/dad2.12194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 04/06/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Batch differences in cerebrospinal fluid (CSF) biomarker measurement can introduce bias into analyses for Alzheimer's disease studies. We evaluated and adjusted for batch differences using statistical methods. METHODS A total of 792 CSF samples from 528 participants were assayed in three batches for 12 biomarkers and 3 biomarker ratios. Batch differences were assessed using Bland-Altman plot, paired t test, Pitman-Morgan test, and linear regression. Generalized linear models were applied to convert CSF values between batches. RESULTS We found statistically significant batch differences for all biomarkers and ratios, except that neurofilament light was comparable between batches 1 and 2. The conversion models generally had high R 2 except for converting P-tau between batches 1 and 3. DISCUSSION Between-batch conversion allows harmonized CSF values to be used in the same analysis. Such method may be applied to adjust for other sources of variability in measuring CSF or other types of biomarkers.
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24
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Lara-Velazquez M, Shireman JM, Lehrer EJ, Bowman KM, Ruiz-Garcia H, Paukner MJ, Chappell RJ, Dey M. A Comparison Between Chemo-Radiotherapy Combined With Immunotherapy and Chemo-Radiotherapy Alone for the Treatment of Newly Diagnosed Glioblastoma: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:662302. [PMID: 34046356 PMCID: PMC8144702 DOI: 10.3389/fonc.2021.662302] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/19/2021] [Indexed: 12/15/2022] Open
Abstract
Background Immunotherapy for GBM is an emerging field which is increasingly being investigated in combination with standard of care treatment options with variable reported success rates. Objective To perform a systematic review of the available data to evaluate the safety and efficacy of combining immunotherapy with standard of care chemo-radiotherapy following surgical resection for the treatment of newly diagnosed GBM. Methods A literature search was performed for published clinical trials evaluating immunotherapy for GBM from January 1, 2000, to October 1, 2020, in PubMed and Cochrane using PICOS/PRISMA/MOOSE guidelines. Only clinical trials with two arms (combined therapy vs. control therapy) were included. Outcomes were then pooled using weighted random effects model for meta-analysis and compared using the Wald-type test. Primary outcomes included 1-year overall survival (OS) and progression-free survival (PFS), secondary outcomes included severe adverse events (SAE) grade 3 or higher. Results Nine randomized phase II and/or III clinical trials were included in the analysis, totaling 1,239 patients. The meta-analysis revealed no statistically significant differences in group’s 1-year OS [80.6% (95% CI: 68.6%–90.2%) vs. 72.6% (95% CI: 65.7%–78.9%), p = 0.15] or in 1-year PFS [37% (95% CI: 26.4%–48.2%) vs. 30.4% (95% CI: 25.4%–35.6%) p = 0.17] when the immunotherapy in combination with the standard of care group (combined therapy) was compared to the standard of care group alone (control). Severe adverse events grade 3 to 5 were more common in the immunotherapy and standard of care group than in the standard of care group (47.3%, 95% CI: 20.8–74.6%, vs 43.8%, 95% CI: 8.7–83.1, p = 0.81), but this effect also failed to reach statistical significance. Conclusion Our results suggests that immunotherapy can be safely combined with standard of care chemo-radiotherapy without significant increase in grade 3 to 5 SAE; however, there is no statistically significant increase in overall survival or progression free survival with the combination therapy.
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Affiliation(s)
- Montserrat Lara-Velazquez
- Department of Neurosurgery, University of Wisconsin School of Medicine & Public Health, UW Carbone Cancer Center, Madison, WI, United States
| | - Jack M Shireman
- Department of Neurosurgery, University of Wisconsin School of Medicine & Public Health, UW Carbone Cancer Center, Madison, WI, United States
| | - Eric J Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Kelsey M Bowman
- Department of Neurosurgery, University of Wisconsin School of Medicine & Public Health, UW Carbone Cancer Center, Madison, WI, United States
| | - Henry Ruiz-Garcia
- Department of Neurosurgery and Radiation Oncology, Mayo Clinic, Jacksonville, FL, United States
| | - Mitchell J Paukner
- Department of Statistics, Biostatistics and Medical Informatics, University of Wisconsin School of Medicine & Public Health, UW Carbone Cancer Center, Madison, WI, United States
| | - Richard J Chappell
- Department of Statistics, Biostatistics and Medical Informatics, University of Wisconsin School of Medicine & Public Health, UW Carbone Cancer Center, Madison, WI, United States
| | - Mahua Dey
- Department of Neurosurgery, University of Wisconsin School of Medicine & Public Health, UW Carbone Cancer Center, Madison, WI, United States
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Ma Y, Carlsson CM, Wahoske ML, Blazel HM, Chappell RJ, Johnson SC, Asthana S, Gleason CE. Latent Factor Structure and Measurement Invariance of the NIH Toolbox Cognition Battery in an Alzheimer's Disease Research Sample. J Int Neuropsychol Soc 2021; 27:412-425. [PMID: 33012297 PMCID: PMC8108547 DOI: 10.1017/s1355617720000922] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study investigated the latent factor structure of the NIH Toolbox Cognition Battery (NIHTB-CB) and its measurement invariance across clinical diagnosis and key demographic variables including sex, race/ethnicity, age, and education for a typical Alzheimer's disease (AD) research sample. METHOD The NIHTB-CB iPad English version, consisting of 7 tests, was administered to 411 participants aged 45-94 with clinical diagnosis of cognitively unimpaired, dementia, mild cognitive impairment (MCI), or impaired not MCI. The factor structure of the whole sample was first examined with exploratory factor analysis (EFA) and further refined using confirmatory factor analysis (CFA). Two groups were classified for each variable (diagnosis or demographic factors). The confirmed factor model was next tested for each group with CFA. If the factor structure was the same between the groups, measurement invariance was then tested using a hierarchical series of nested two-group CFA models. RESULTS A two-factor model capturing fluid cognition (executive function, processing speed, and memory) versus crystalized cognition (language) fit well for the whole sample and each group except for those with age < 65. This model generally had measurement invariance across sex, race/ethnicity, and education, and partial invariance across diagnosis. For individuals with age < 65, the language factor remained intact while the fluid cognition was separated into two factors: (1) executive function/processing speed and (2) memory. CONCLUSIONS The findings mostly supported the utility of the battery in AD research, yet revealed challenges in measuring memory for AD participants and longitudinal change in fluid cognition.
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Affiliation(s)
- Yue Ma
- Wisconsin Alzheimer’s Disease Research Center,
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Cynthia M. Carlsson
- Wisconsin Alzheimer’s Disease Research Center,
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Wisconsin Alzheimer’s Institute, University of
Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William
S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Michelle L. Wahoske
- Wisconsin Alzheimer’s Disease Research Center,
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Hanna M. Blazel
- Wisconsin Alzheimer’s Disease Research Center,
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Richard J. Chappell
- Wisconsin Alzheimer’s Disease Research Center,
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Biostatistics and Medical Informatics,
University of Wisconsin, Madison, WI, USA
- Department of Statistics, University of Wisconsin, Madison,
WI, USA
| | - Sterling C. Johnson
- Wisconsin Alzheimer’s Disease Research Center,
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Wisconsin Alzheimer’s Institute, University of
Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William
S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Sanjay Asthana
- Wisconsin Alzheimer’s Disease Research Center,
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William
S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Carey E. Gleason
- Wisconsin Alzheimer’s Disease Research Center,
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Wisconsin Alzheimer’s Institute, University of
Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William
S. Middleton Memorial Veterans Hospital, Madison, WI, USA
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Abstract
Environmental routes of transmission contribute to the spread of the prion diseases chronic wasting disease of deer and elk and scrapie of sheep and goats. Prions can persist in soils and other environmental matrices and remain infectious for years. Prions bind avidly to the common soil mineral montmorillonite, and such binding can dramatically increase oral disease transmission. Decontamination of soil in captive facilities and natural habitats requires inactivation agents that are effective when prions are bound to soil microparticles. Here, we investigate the inactivation of free and montmorillonite-bound prions with sodium hydroxide, acidic pH, Environ LpH, and sodium hypochlorite. Immunoblotting and bioassays confirm that sodium hydroxide and sodium hypochlorite are effective for prion deactivation, although montmorillonite appears to reduce the efficacy of hypochlorite. Acidic conditions slightly reduce prion infectivity, and the acidic phenolic disinfectant Environ LpH produces slight reductions in infectivity and immunoreactivity. The extent to which the association with montmorillonite protects prions from chemical inactivation appears influenced by the effect of chemical agents on the clay structure and surface pH. When clay morphology remains relatively unaltered, as when exposed to hypochlorite, montmorillonite-bound prions appear to be protected from inactivation. In contrast, when the clay structure is substantially transformed, as when exposed to high concentrations of sodium hydroxide, the attachment to montmorillonite does not slow degradation. A reduction in surface pH appears to cause slight disruptions in clay structure, which enhances degradation under these conditions. We expect our findings will aid the development of remediation approaches for successful decontamination of prion-contaminated sites.
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Affiliation(s)
- Clarissa J. Booth
- Molecular and Environmental Toxicology Center, University of Wisconsin, Madison, Wisconsin 53706, United States
| | | | - Richard J. Chappell
- Department of Biostatistics & Medical Informatics and Department of Statistics, University of Wisconsin, Madison, Wisconsin 53706, United States
| | - Joel A. Pedersen
- Molecular and Environmental Toxicology Center, University of Wisconsin, Madison, Wisconsin 53706, United States
- Department of Soil Science, University of Wisconsin, Madison, Wisconsin 53706, United States
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Antony KM, Adams JH, Jacques L, Hetzel S, Chappell RJ, Gnadt SE, Tevaarwerk AJ. Lidocaine patches for postcesarean pain control in obese women: a pilot randomized controlled trial. Am J Obstet Gynecol MFM 2021; 3:100281. [DOI: 10.1016/j.ajogmf.2020.100281] [Citation(s) in RCA: 3] [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] [Received: 10/23/2020] [Accepted: 11/18/2020] [Indexed: 02/07/2023]
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Abstract
BACKGROUND In randomized clinical trials with censored time-to-event outcomes, the logrank test is known to have substantial statistical power under the proportional hazards assumption and is widely adopted as a tool to compare two survival distributions. However, the proportional hazards assumption is impossible to validate in practice until the data are unblinded. However, the statistical analysis plan of a randomized clinical trial and in particular its primary analysis method must be pre-specified before any unblinded information may be reviewed. PURPOSE The purpose of this article is to guide applied biostatisticians in the prespecification of a desired primary analysis method when a treatment effect with nonproportional hazards is anticipated. While articles proposing alternate statistical tests are aplenty, to the best of our knowledge, there is no article available that attempts to simplify the choice and prespecification of a primary statistical test under specific expected patterns on nonproportional hazards. We provide such guidance by reviewing various tests proposed as more powerful alternatives to the standard logrank test under nonproportional hazards and simultaneously comparing their performance under a wide variety of nonproportional hazards scenarios to elucidate their advantages and disadvantages. METHOD In order to select the most preferable test for detecting specific differences between survival distributions of interest while controlling false positive rates, we review and assess the performance of weighted and adaptively weighted logrank tests, weighted and adaptively weighted Kaplan-Meier tests and versatile tests under various patterns of nonproportional hazards treatment effects through simulation. CONCLUSION We validate some of the claimed properties of the proposed extensions and identify tests that may be more preferable under specific expected pattern of nonproportional hazards when such knowledge is available. We show that versatile tests, while achieving robustness to departures from proportional hazards, may lose interpretation of directionality (superiority or inferiority) and can only be seen to test departures from equality. Detailed summary and discussion of the performance of each test in terms of type I error rate and power are provided to formulate specific guidance about their applicability and use.
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Affiliation(s)
| | - Xin Wang
- Vertex Pharmaceuticals, Boston, MA, USA
| | - Kun Chen
- Gilead Sciences, Inc., Foster City, CA, USA
| | | | - Richard J Chappell
- Department of Statistics and Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
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29
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Singh A, Denu RA, Wolfe SK, Sperger JM, Schehr J, Witkowsky T, Esbona K, Chappell RJ, Weaver BA, Burkard ME, Lang JM. Centrosome amplification is a frequent event in circulating tumor cells from subjects with metastatic breast cancer. Mol Oncol 2020; 14:1898-1909. [PMID: 32255253 PMCID: PMC7400789 DOI: 10.1002/1878-0261.12687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 03/03/2020] [Accepted: 03/07/2020] [Indexed: 01/05/2023] Open
Abstract
Centrosome amplification (CA) is a common phenomenon in cancer, promotes genomic stability and cancer evolution, and has been reported to promote metastasis. CA promotes a stochastic gain/loss of chromosomes during cell division, known as chromosomal instability (CIN). However, it is unclear whether CA is present in circulating tumor cells (CTCs), the seeds for metastasis. Here, we surveyed CA in CTCs from human subjects with metastatic breast cancer. CTCs were captured by CD45 exclusion and selection of EpCAM‐positive cells using an exclusion‐based sample preparation technology platform known as VERSA (versatile exclusion‐based rare sample analysis). Centriole amplification (centrin foci> 4) is the definitive assay for CA. However, determination of centrin foci is technically challenging and incompatible with automated analysis. To test if the more technically accessible centrosome marker pericentrin could serve as a surrogate for centriole amplification in CTCs, cells were stained with pericentrin and centrin antibodies to evaluate CA. This assay was first validated using breast cancer cell lines and a nontransformed epithelial cell line model of inducible CA, then translated to CTCs. Pericentrin area and pericentrin area x intensity correlate well with centrin foci, validating pericentrin as a surrogate marker of CA. CA is found in CTCs from 75% of subjects, with variability in the percentage and extent of CA in individual circulating cells in a given subject, similar to the variability previously seen in primary tumors and cell lines. In summary, we created, validated, and implemented a novel method to assess CA in CTCs from subjects with metastatic breast cancer. Such an assay will be useful for longitudinal monitoring of CA in cancer patients and in prospective clinical trials for assessing the impact of CA on response to therapy.
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Affiliation(s)
- Ashok Singh
- Carbone Cancer Center, University of Wisconsin-Madison, WI, USA
| | - Ryan A Denu
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin-Madison, WI, USA
| | - Serena K Wolfe
- Carbone Cancer Center, University of Wisconsin-Madison, WI, USA
| | - Jamie M Sperger
- Carbone Cancer Center, University of Wisconsin-Madison, WI, USA
| | - Jennifer Schehr
- Carbone Cancer Center, University of Wisconsin-Madison, WI, USA
| | - Tessa Witkowsky
- Carbone Cancer Center, University of Wisconsin-Madison, WI, USA
| | - Karla Esbona
- Carbone Cancer Center, University of Wisconsin-Madison, WI, USA
| | - Richard J Chappell
- Departments of Statistics and of Biostatistics & Medical Informatics, University of Wisconsin-Madison, WI, USA
| | - Beth A Weaver
- Carbone Cancer Center, University of Wisconsin-Madison, WI, USA.,Department of Cell and Regenerative Biology and Department of Oncology, McArdle Laboratory for Cancer Research, University of Wisconsin-Madison, WI, USA
| | - Mark E Burkard
- Carbone Cancer Center, University of Wisconsin-Madison, WI, USA.,Department of Medicine, Division of Hematology/Oncology, University of Wisconsin-Madison, WI, USA
| | - Joshua M Lang
- Carbone Cancer Center, University of Wisconsin-Madison, WI, USA.,Department of Medicine, Division of Hematology/Oncology, University of Wisconsin-Madison, WI, USA
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Ritter MA, Kupelian PA, Petereit DG, Lawton CA, Anger N, Geye H, Chappell RJ, Forman JD. A Prospective Multi-Institutional Phase I/II Trial of Step-Wise Dose-per-Fraction Escalation in Low and Intermediate Risk Prostate Cancer. Pract Radiat Oncol 2020; 10:345-353. [PMID: 32169590 DOI: 10.1016/j.prro.2020.02.013] [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] [Received: 01/24/2020] [Revised: 02/06/2020] [Accepted: 02/09/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE This phase I/II, multi-institutional trial explored the tolerance and efficacy of stepwise increasing hypofractionation (HPFX) radiation therapy regimens for fraction sizes up to 4.3 Gy in localized prostate cancer. METHODS AND MATERIALS Three escalating dose-per-fraction schedules were designed to yield similar predicted tumor control while maintaining equivalent predicted late toxicity. HPFX levels I, II, and III were carried out sequentially and delivered schedules of 64.7 Gy/22 fx/2.94 Gy, 58.08 Gy/16 fx/3.63 Gy, and 51.6 Gy/12 fx/4.3 Gy, respectively with next level escalations contingent upon acceptable gastrointestinal (GI) toxicity. The primary endpoints were biochemical control and toxicity. RESULTS A total of 347 patients were recruited by 5 institutions with 101, 111, and 135 patients treated on HPFX levels I, II, and III with median follow-ups of 100, 85.5, and 61.7 months, respectively (83.2 months combined). The National Comprehensive Cancer Network low- or intermediate-risk group distribution was 46% and 54%, respectively. Sixteen percent of patients, primarily intermediate risk, received 6 months of androgen deprivation therapy. The 8-year nadir + 2 actuarial biochemical control rates for HPFX levels I, II, and III were 91.1% ± 3.0%, 92.7% ± 2.7%, and 88.5% ± 4.6%, respectively (Kaplan-Meier log rank, 0.903). Among clinical covariates, only Gleason score reached near significance in multivariate analysis (P = .054). Twenty-six patients failed biochemically (crude incidence of 7.5%), and there were 5 cause-specific deaths. GI and genitourinary toxicities were acceptable and similar across the 3 HPFX levels. The combined actuarial cumulative incidence of grade 2+ GI and genitourinary toxicities at 7 years were 16.3% ± 2.1% and 22.1% ± 2.4%, respectively. CONCLUSIONS HPFX employing fraction sizes extending into the 3.6 to 4.3 Gy/fraction range can be delivered with excellent oncologic outcomes. Such schedules, positioned between moderate and ultra-HPFX, may provide additional options for patients wishing to avoid prolonged treatment schedules associated with conventionally fractionated radiation therapy for prostate cancer.
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Affiliation(s)
- Mark A Ritter
- Department of Human Oncology, University of Wisconsin Carbone Cancer Center, Madison, Wisconsin.
| | | | - Daniel G Petereit
- John T. Vucurevich Cancer Center Institute, Rapid City, South Dakota
| | | | - Nick Anger
- Department of Human Oncology, University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Heather Geye
- Department of Human Oncology, University of Wisconsin Carbone Cancer Center, Madison, Wisconsin
| | - Richard J Chappell
- Department of Biostatistics and Medical Informatics and Department of Statistics, University of Wisconsin, Madison, Wisconsin
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Ma Y, Bendlin BB, Johnson SC, Berman SE, Gleason CE, Clark LR, Okonkwo OC, Zetterberg H, Blennow K, Van Hulle CA, Lazar KK, Illingworth C, Chappell RJ, Rowley HA, Asthana S, Carlsson C. O3-08-04: A MEDIATION ANALYSIS OF THE RELATIONSHIP BETWEEN WHITE MATTER HYPERINTENSITIES, CSF BIOMARKERS, AND COGNITION IN COGNITIVELY UNIMPAIRED AND IMPAIRED ADULTS. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.4669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Yue Ma
- Wisconsin Alzheimer's Disease Research Center; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - Barbara B. Bendlin
- Wisconsin Alzheimer's Disease Research Center; University of Wisconsin School of Medicine and Public Health; Madison WI USA
- Wisconsin Alzheimer's Institute; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - Sterling C. Johnson
- Wisconsin Alzheimer's Disease Research Center; University of Wisconsin School of Medicine and Public Health; Madison WI USA
- Wisconsin Alzheimer's Institute; University of Wisconsin School of Medicine and Public Health; Madison WI USA
- VA Geriatric Research, Education and Clinical Center (GRECC); William S. Middleton Memorial Veterans Hospital; Madison WI USA
| | - Sara E. Berman
- Wisconsin Alzheimer's Disease Research Center; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - Carey E. Gleason
- Wisconsin Alzheimer's Disease Research Center; University of Wisconsin School of Medicine and Public Health; Madison WI USA
- VA Geriatric Research, Education and Clinical Center (GRECC); William S. Middleton Memorial Veterans Hospital; Madison WI USA
| | - Lindsay R. Clark
- Wisconsin Alzheimer's Disease Research Center; University of Wisconsin School of Medicine and Public Health; Madison WI USA
- Wisconsin Alzheimer's Institute; University of Wisconsin School of Medicine and Public Health; Madison WI USA
- VA Geriatric Research, Education and Clinical Center (GRECC); William S. Middleton Memorial Veterans Hospital; Madison WI USA
| | - Ozioma C. Okonkwo
- Wisconsin Alzheimer's Disease Research Center; University of Wisconsin School of Medicine and Public Health; Madison WI USA
- Wisconsin Alzheimer's Institute; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory; Sahlgrenska University Hospital; Mölndal Sweden
| | - Kaj Blennow
- The Sahlgrenska Academy at the University of Gothenburg; Mölndal Sweden
| | - Carol A. Van Hulle
- Wisconsin Alzheimer's Disease Research Center; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - Karen K. Lazar
- Wisconsin Alzheimer's Disease Research Center; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - Chuck Illingworth
- Wisconsin Alzheimer's Disease Research Center; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - Richard J. Chappell
- Wisconsin Alzheimer's Disease Research Center; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - Howard A. Rowley
- Wisconsin Alzheimer's Disease Research Center; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - Sanjay Asthana
- Wisconsin Alzheimer's Disease Research Center; University of Wisconsin School of Medicine and Public Health; Madison WI USA
- Wisconsin Alzheimer's Institute; University of Wisconsin School of Medicine and Public Health; Madison WI USA
- VA Geriatric Research, Education and Clinical Center (GRECC); William S. Middleton Memorial Veterans Hospital; Madison WI USA
| | - Cynthia Carlsson
- Wisconsin Alzheimer's Disease Research Center; University of Wisconsin School of Medicine and Public Health; Madison WI USA
- Wisconsin Alzheimer's Institute; University of Wisconsin School of Medicine and Public Health; Madison WI USA
- VA Geriatric Research, Education and Clinical Center (GRECC); William S. Middleton Memorial Veterans Hospital; Madison WI USA
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Jonaitis E, Clark LR, Betthauser TJ, Allison SL, Mueller KD, Hermann BP, Chappell RJ, Johnson SC, Koscik RL. P2-472: CONDITIONAL STANDARDS: IDENTIFYING CUTOFFS FOR PREDICTING AD SURROGATES USING TRADITIONAL AND MACHINE LEARNING METHODS. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.2879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Erin Jonaitis
- Wisconsin Alzheimer's Institute; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - Lindsay R. Clark
- VA Geriatric Research, Education and Clinical Center (GRECC); William S. Middleton Memorial Veterans Hospital; Madison WI USA
- Wisconsin Alzheimer's Disease Research Center; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - Tobey J. Betthauser
- Wisconsin Alzheimer's Disease Research Center; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - Samantha L. Allison
- Wisconsin Alzheimer's Disease Research Center; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - Kimberly D. Mueller
- Wisconsin Alzheimer's Disease Research Center; University of Wisconsin School of Medicine and Public Health; Madison WI USA
- Department of Communication Sciences and Disorders; University of Wisconsin-Madison; Madison WI USA
| | - Bruce P. Hermann
- Department of Neurology, School of Medicine and Public Health; University of Wisconsin-Madison; Madison WI USA
| | - Richard J. Chappell
- Wisconsin Alzheimer's Disease Research Center; University of Wisconsin School of Medicine and Public Health; Madison WI USA
- Institute for Clinical and Translational Research and Department of Biostatistics and Medical Informatics; University of Wisconsin; Madison WI USA
| | - Sterling C. Johnson
- Wisconsin Alzheimer's Institute; University of Wisconsin School of Medicine and Public Health; Madison WI USA
- VA Geriatric Research, Education and Clinical Center (GRECC); William S. Middleton Memorial Veterans Hospital; Madison WI USA
- Wisconsin Alzheimer's Disease Research Center; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - Rebecca L. Koscik
- Wisconsin Alzheimer's Institute; University of Wisconsin School of Medicine and Public Health; Madison WI USA
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Harrison RF, Mcnamara JE, Beaumont CB, Sadowski EA, Chappell RJ, Shahzad MM, Spencer RJ, Al-Niaimi AN, Barroilhet LM, Rose SL, Kushner DM. Using simple radiologic measurements to anticipate surgical challenge in endometrial cancer: a prospective study. Int J Gynecol Cancer 2019; 29:102-107. [DOI: 10.1136/ijgc-2018-000037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/27/2018] [Accepted: 09/13/2018] [Indexed: 11/04/2022] Open
Abstract
ObjectivesTo determine if linear measurements of adiposity from pre-operative imaging can improve anticipation of surgical difficulty among endometrial cancer patients.MethodsEighty patients with newly diagnosed endometrial cancer were enrolled. Routine pre-operative imaging (MRI or CT) was performed. Radiologic linear measurements of the following were obtained: anterior-to-posterior skin distance; anterior skin to anterior edge of L5 distance (total anterior); anterior peritoneum to anterior edge of L5 distance (visceral obesity); and posterior edge of L5 to posterior skin distance (total posterior). Surgeons completed questionnaires quantifying preoperative anticipated operative difficulty and postoperative reported operative difficulty. The primary objective was to assess for a correlation between linear measurements of visceral fat and reported operative difficulty.ResultsSeventy-nine patients had questionnaires completed, preoperative imaging obtained, and surgery performed. Univariate analysis showed all four linear measurements, body mass index, weight, and anticipated operative difficulty were associated with increased reported operative difficulty (P< 0.05). Multivariate analysis demonstrated that body mass index and linear measurements visceral obesity and total posterior were independently associated with increased reported operative difficulty (P< 0.05). Compared with body mass index, the visceral obesity measurement was more sensitive and specific for predicting increased reported operative difficulty (visceral obesity; sensitivity 54%, specificity 91 %; body mass index; sensitivity 38%, specificity 89%). A difficulty risk model combining body mass index, visceral obesity, and total posterior demonstrated better predictive performance than any individual preoperative variable.ConclusionsSimple linear measurements of visceral fat obtained from preoperative imaging are more predictive than body mass index alone in anticipating surgeon-reported operative difficulty. These easily obtained measurements may assist in preoperative decision making in this challenging patient population.
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Russek NS, Berman SE, Lazar KK, Ma Y, Hoffman CA, Rivera LA, Austin B, Chappell RJ, Clark LR, Oh JM, Illingworth C, Zettenberg H, Blennow K, Dowling M, Jacobson L, Blazel H, Gleason CE, Bendlin BB, Asthana S, Rowley HA, Turski P, Johnson SC, Wieben O, Carlsson CM. P4‐305: IMPACT OF SIMVASTATIN ON CEREBRAL BLOOD FLOW, PULSATILITY INDEX, AND ALZHEIMER'S DISEASE BIOMARKERS: A CLINICAL TRIAL. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.07.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Van Hulle CA, Lazar KK, Ma Y, Johnson SC, Clark LR, Zetterberg H, Blennow K, Bendlin BB, Okonkwo OC, Gleason CE, Chappell RJ, Jacobson LH, Blazel H, Cole A, Asthana S, Carlsson CM. P1‐248: LATENT PROFILES DERIVED FROM ATN RELATED CSF BIOMARKERS. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Carol A. Van Hulle
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWIUSA
| | - Karen K. Lazar
- Wisconsin Alzheimer's Disease Research CenterMadisonWIUSA
| | - Yue Ma
- Wisconsin Alzheimer's Disease Research CenterMadisonWIUSA
| | - Sterling C. Johnson
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin School of Medicine and Public HealthMadisonWIUSA
| | - Lindsay R. Clark
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWIUSA
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and PhysiologyThe Sahlgrenska Academy at the University of GothenburgMölndalSweden
| | - Kaj Blennow
- The Sahlgrenska Academy at the University of GothenburgMölndalSweden
| | - Barbara B. Bendlin
- VA Geriatric Research, Education and Clinical Center (GRECC)William S. Middleton Memorial Veterans HospitalMadisonWIUSA
| | - Ozioma C. Okonkwo
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWIUSA
| | - Carey E. Gleason
- Geriatric Research Education and Clinical CenterWilliam S. Middleton Memorial Veterans HospitalMadisonWIUSA
| | - Richard J. Chappell
- Institute for Clinical and Translational Research and Department of Biostatistics & Medical InformaticsUniversity of WisconsinMadisonWIUSA
| | | | - Hanna Blazel
- Wisconsin Alzheimer's Disease Research CenterMadisonWIUSA
| | | | - Sanjay Asthana
- Wisconsin Alzheimer's Disease Research CenterMadisonWIUSA
| | - Cynthia M. Carlsson
- VA Geriatric Research, Education and Clinical Center (GRECC)William S. Middleton Memorial Veterans HospitalMadisonWIUSA
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Russek NS, Gepner AD, Korcarz CE, Berman SE, Lazar KK, Ma Y, Hoffman CA, Rivera LA, Austin B, Chappell RJ, Clark LR, Oh JM, Illingworth C, Jacobson L, Blazel H, Gleason CE, Bendlin BB, Asthana S, Turski P, Johnson SC, Stein JH, Wieben O, Carlsson CM. P4‐304: RELATIONSHIP BETWEEN AORTIC AUGMENTATION INDEX BY RADIAL ARTERY TONOMETRY AND CEREBRAL PULSATILITY INDEX IN INDIVIDUALS AT RISK FOR ALZHEIMER'S DISEASE. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.07.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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37
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Ma Y, Chappell RJ, Clark LR, Wahoske ML, Johnson SC, Carlsson CM, Chin NA, Asthana S, Gleason CE. P2‐480: LATENT FACTOR STRUCTURE AND MEASUREMENT INVARIANCE OF THE NIH TOOLBOX COGNITION BATTERY IN A SAMPLE FROM THE WISCONSIN ALZHEIMER'S DISEASE RESEARCH CENTER. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.1173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Yue Ma
- Wisconsin Alzheimer's Disease Research CenterMadisonWIUSA
| | | | - Lindsay R. Clark
- Wisconsin Alzheimer's Disease Research CenterMadisonWIUSA
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin School of Medicine and Public HealthMadisonWIUSA
- VA Geriatric Research, Education and Clinical Center (GRECC)William S. Middleton Memorial Veterans HospitalMadisonWIUSA
| | - Michelle L. Wahoske
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWIUSA
| | - Sterling C. Johnson
- Wisconsin Alzheimer's Disease Research CenterMadisonWIUSA
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin School of Medicine and Public HealthMadisonWIUSA
- VA Geriatric Research, Education and Clinical Center (GRECC)William S. Middleton Memorial Veterans HospitalMadisonWIUSA
| | - Cynthia M. Carlsson
- Wisconsin Alzheimer's Disease Research CenterMadisonWIUSA
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin School of Medicine and Public HealthMadisonWIUSA
- VA Geriatric Research, Education and Clinical Center (GRECC)William S. Middleton Memorial Veterans HospitalMadisonWIUSA
| | - Nathaniel A. Chin
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWIUSA
| | - Sanjay Asthana
- Wisconsin Alzheimer's Disease Research CenterMadisonWIUSA
- Geriatric Research Education and Clinical CenterWilliam S. Middleton Memorial Veterans HospitalMadisonWIUSA
| | - Carey E. Gleason
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin School of Medicine and Public HealthMadisonWIUSA
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWIUSA
- Geriatric Research Education and Clinical CenterWilliam S. Middleton Memorial Veterans HospitalMadisonWIUSA
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Ablove T, Bell LN, Liang H, Chappell RJ, Toklu HZ, Yale SH. The effect of solifenacin on postvoid dribbling in women: results of a randomized, double-blind placebo-controlled trial. Int Urogynecol J 2018; 29:1051-1060. [PMID: 29574484 DOI: 10.1007/s00192-018-3594-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 02/14/2018] [Indexed: 01/23/2023]
Abstract
INTRODUCTION AND HYPOTHESIS To determine the effectiveness of the muscarinic receptor antagonist solifenacin (VESIcare®) in the treatment of postvoid dribbling (PVD). METHODS We carried out a multicenter, 12-week, double-blind, randomized, placebo-controlled, parallel design study. Between 2012 and 2015, a total of 118 women (age 18-89 years) with PVD at least twice/weekly, were randomized to receive solifenacin (5 mg; n = 58) or placebo (n = 60) once daily. The primary outcome was the percentage reduction in PVD episodes. Secondary outcomes included the percentage of patients with ≥50% reduction in PVD episodes and changes in quality of life. RESULTS There were no differences in either the primary or secondary outcome variables. Subgroup analysis, based on those with more severe disease (>10 PVD episodes/week), showed a greater and significant percentage reduction in the frequency of PVD episodes per day (60.3% vs 32.1%; p = 0.035) and a higher percentage of patients showing ≥50% reduction in the frequency of PVD episodes with solifenacin (68.1% vs 45.8%; p = 0.0476). A significant solifenacin effect occurred at week 2 and continued through week 12 for the subgroup. For solifenacin, PVD reduction was the same for the entire cohort and subgroup, whereas for placebo, it was 10% lower in the subgroup, declining from 42% to 32%. CONCLUSION There were no differences in PVD outcomes between the solifenacin and placebo groups. Solifenacin may play a role in treating women with the most severe symptoms. Because of the powerful placebo response seen in this study, behavior-based interventions may be useful for treating PVD.
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Affiliation(s)
- Tova Ablove
- Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI, USA.
- Department of Obstetrics and Gynecology, University at Buffalo, Buffalo, NY, USA.
- Department of Obstetrics and Gynecology, Conventus, 1001 Main Street, 4th Floor, Buffalo, NY, 14203, USA.
| | - Lauren N Bell
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Hong Liang
- University of Central Florida College of Medicine, Orlando, FL, USA
- Departments of Medicine and Graduate Medical Education, North Florida Regional Medical Center, Gainesville, FL, USA
| | - Richard J Chappell
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, USA
| | - Hale Z Toklu
- University of Central Florida College of Medicine, Orlando, FL, USA
- Departments of Medicine and Graduate Medical Education, North Florida Regional Medical Center, Gainesville, FL, USA
| | - Steven H Yale
- University of Central Florida College of Medicine, Orlando, FL, USA
- Departments of Medicine and Graduate Medical Education, North Florida Regional Medical Center, Gainesville, FL, USA
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Koscik RL, Clark LR, Mueller KD, Hermann BP, Chappell RJ, Gleason CE, Johnson SC. [P2–471]: LONGITUDINAL NORMS FOR MID‐LIFE COGNITIVE PERFORMANCE: IDENTIFYING ABNORMAL WITHIN‐PERSON CHANGES IN WRAP. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.1128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Rebecca L. Koscik
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public HealthMadisonWIUSA
| | - Lindsay R. Clark
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public HealthMadisonWIUSA
- Geriatric Research, Education and Clinical CenterWilliam S. Middleton Memorial Veterans HospitalMadisonWIUSA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public HealthMadisonWIUSA
| | - Kimberly D. Mueller
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public HealthMadisonWIUSA
- Department of Communication Sciences and DisordersUniversity of Wisconsin ‐ MadisonMadisonWIUSA
| | - Bruce P. Hermann
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public HealthMadisonWIUSA
- Department of NeurologySchool of Medicine and Public Health, University of Wisconsin‐MadisonMadisonWIUSA
| | - Richard J. Chappell
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public HealthMadisonWIUSA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public HealthMadisonWIUSA
| | - Carey E. Gleason
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public HealthMadisonWIUSA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public HealthMadisonWIUSA
- Geriatric Research Education and Clinical CenterW.S. Middleton Memorial Veterans HospitalMadisonWIUSA
| | - Sterling C. Johnson
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public HealthMadisonWIUSA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public HealthMadisonWIUSA
- Geriatric Research Education and Clinical CenterWm. S. Middleton Veterans HospitalMadisonWIUSA
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Fischer BL, Bacher R, Bendlin BB, Birdsill AC, Ly M, Hoscheidt SM, Chappell RJ, Mahoney JE, Gleason CE. An Examination of Brain Abnormalities and Mobility in Individuals with Mild Cognitive Impairment and Alzheimer's Disease. Front Aging Neurosci 2017; 9:86. [PMID: 28424612 PMCID: PMC5380746 DOI: 10.3389/fnagi.2017.00086] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 03/20/2017] [Indexed: 11/13/2022] Open
Abstract
Background: Mobility changes are concerning for elderly patients with cognitive decline. Given frail older individuals' vulnerability to injury, it is critical to identify contributors to limited mobility. Objective: To examine whether structural brain abnormalities, including reduced gray matter volume and white matter hyperintensities, would be associated with limited mobility among individuals with cognitive impairment, and to determine whether cognitive impairment would mediate this relationship. Methods: Thirty-four elderly individuals with mild cognitive impairment (MCI) and Alzheimer's disease underwent neuropsychological evaluation, mobility assessment, and structural brain neuroimaging. Linear regression was conducted with predictors including gray matter volume in six regions of interest (ROI) and white matter hyperintensity (WMH) burden, with mobility measures as outcomes. Results: Lower gray matter volume in caudate nucleus was associated with slower speed on a functional mobility task. Higher cerebellar volume was also associated with slower functional mobility. White matter hyperintensity burden was not significantly associated with mobility. Conclusion: Our findings provide evidence for associations between subcortical gray matter volume and speed on a functional mobility task among cognitively impaired individuals.
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Affiliation(s)
- Barbara L Fischer
- Geriatric Research, Education, and Clinical Center, William S. Middleton Memorial Veterans HospitalMadison, WI, USA
| | - Rhonda Bacher
- Department of Statistics, University of Wisconsin-MadisonMadison, WI, USA
| | - Barbara B Bendlin
- School of Medicine and Public Health, University of Wisconsin-MadisonMadison, WI, USA.,Wisconsin Alzheimer's Disease Research CenterMadison, WI, USA
| | - Alex C Birdsill
- School of Medicine and Public Health, University of Wisconsin-MadisonMadison, WI, USA
| | - Martina Ly
- School of Medicine and Public Health, University of Wisconsin-MadisonMadison, WI, USA
| | - Siobhan M Hoscheidt
- School of Medicine and Public Health, University of Wisconsin-MadisonMadison, WI, USA.,Wisconsin Alzheimer's Disease Research CenterMadison, WI, USA
| | - Richard J Chappell
- Department of Statistics, University of Wisconsin-MadisonMadison, WI, USA.,Wisconsin Alzheimer's Disease Research CenterMadison, WI, USA.,Departments of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-MadisonMadison, WI, USA
| | - Jane E Mahoney
- Division of Geriatrics, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-MadisonMadison, WI, USA
| | - Carey E Gleason
- Geriatric Research, Education, and Clinical Center, William S. Middleton Memorial Veterans HospitalMadison, WI, USA.,School of Medicine and Public Health, University of Wisconsin-MadisonMadison, WI, USA.,Wisconsin Alzheimer's Disease Research CenterMadison, WI, USA
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41
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Martinez EE, Sinha D, Wang W, Lipsitz SR, Chappell RJ. Tests for equivalence of two survival functions: Alternative to the tests under proportional hazards. Stat Methods Med Res 2016; 26:75-87. [PMID: 24925887 DOI: 10.1177/0962280214539282] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
For either the equivalence trial or the non-inferiority trial with survivor outcomes from two treatment groups, the most popular testing procedure is the extension (e.g., Wellek, A log-rank test for equivalence of two survivor functions, Biometrics, 1993; 49: 877-881) of log-rank based test under proportional hazards model. We show that the actual type I error rate for the popular procedure of Wellek is higher than the intended nominal rate when survival responses from two treatment arms satisfy the proportional odds survival model. When the true model is proportional odds survival model, we show that the hypothesis of equivalence of two survival functions can be formulated as a statistical hypothesis involving only the survival odds ratio parameter. We further show that our new equivalence test, formulation, and related procedures are applicable even in the presence of additional covariates beyond treatment arms, and the associated equivalence test procedures have correct type I error rates under the proportional hazards model as well as the proportional odds survival model. These results show that use of our test will be a safer statistical practice for equivalence trials of survival responses than the commonly used log-rank based tests.
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Affiliation(s)
- Elvis E Martinez
- 1 Department of Statistics, Florida State University, Tallahassee, USA
| | - Debajyoti Sinha
- 1 Department of Statistics, Florida State University, Tallahassee, USA
| | - Wenting Wang
- 2 Department of Biostatistics, MD Anderson Cancer Center, University of Texas, Houston, USA
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Ithapu VK, Singh V, Okonkwo OC, Chappell RJ, Dowling NM, Johnson SC. Imaging-based enrichment criteria using deep learning algorithms for efficient clinical trials in mild cognitive impairment. Alzheimers Dement 2015; 11:1489-1499. [PMID: 26093156 PMCID: PMC4684492 DOI: 10.1016/j.jalz.2015.01.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [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: 07/27/2014] [Revised: 11/01/2014] [Accepted: 01/06/2015] [Indexed: 01/10/2023]
Abstract
The mild cognitive impairment (MCI) stage of Alzheimer's disease (AD) may be optimal for clinical trials to test potential treatments for preventing or delaying decline to dementia. However, MCI is heterogeneous in that not all cases progress to dementia within the time frame of a trial and some may not have underlying AD pathology. Identifying those MCIs who are most likely to decline during a trial and thus most likely to benefit from treatment will improve trial efficiency and power to detect treatment effects. To this end, using multimodal, imaging-derived, inclusion criteria may be especially beneficial. Here, we present a novel multimodal imaging marker that predicts future cognitive and neural decline from [F-18]fluorodeoxyglucose positron emission tomography (PET), amyloid florbetapir PET, and structural magnetic resonance imaging, based on a new deep learning algorithm (randomized denoising autoencoder marker, rDAm). Using ADNI2 MCI data, we show that using rDAm as a trial enrichment criterion reduces the required sample estimates by at least five times compared with the no-enrichment regime and leads to smaller trials with high statistical power, compared with existing methods.
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Affiliation(s)
- Vamsi K. Ithapu
- Department of Computer Sciences, University of Wisconsin Madison, Madison WI, USA 53706
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin Madison, Madison WI, USA 53705
| | - Vikas Singh
- Department of Computer Sciences, University of Wisconsin Madison, Madison WI, USA 53706
- Department of Biostatistics and Medical Informatics, University of Wisconsin Madison, Madison WI, USA 53792
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin Madison, Madison WI, USA 53705
| | - Ozioma C. Okonkwo
- Department of Medicine, University of Wisconsin Madison, Madison WI, USA 53705
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin Madison, Madison WI, USA 53705
| | - Richard J. Chappell
- Department of Biostatistics and Medical Informatics, University of Wisconsin Madison, Madison WI, USA 53792
| | - N. Maritza Dowling
- Department of Biostatistics and Medical Informatics, University of Wisconsin Madison, Madison WI, USA 53792
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin Madison, Madison WI, USA 53705
| | - Sterling C. Johnson
- Department of Medicine, University of Wisconsin Madison, Madison WI, USA 53705
- William S. Middleton Memorial Veterans Hospital, University of Wisconsin Madison, Madison WI, USA 53705
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin Madison, Madison WI, USA 53705
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Bradshaw TJ, Bowen SR, Deveau MA, Kubicek L, White P, Bentzen SM, Chappell RJ, Forrest LJ, Jeraj R. Molecular imaging biomarkers of resistance to radiation therapy for spontaneous nasal tumors in canines. Int J Radiat Oncol Biol Phys 2015; 91:787-95. [PMID: 25752393 DOI: 10.1016/j.ijrobp.2014.12.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 11/26/2014] [Accepted: 12/04/2014] [Indexed: 12/12/2022]
Abstract
PURPOSE Imaging biomarkers of resistance to radiation therapy can inform and guide treatment management. Most studies have so far focused on assessing a single imaging biomarker. The goal of this study was to explore a number of different molecular imaging biomarkers as surrogates of resistance to radiation therapy. METHODS AND MATERIALS Twenty-two canine patients with spontaneous sinonasal tumors were treated with accelerated hypofractionated radiation therapy, receiving either 10 fractions of 4.2 Gy each or 10 fractions of 5.0 Gy each to the gross tumor volume. Patients underwent fluorodeoxyglucose (FDG)-, fluorothymidine (FLT)-, and Cu(II)-diacetyl-bis(N4-methylthiosemicarbazone) (Cu-ATSM)-labeled positron emission tomography/computed tomography (PET/CT) imaging before therapy and FLT and Cu-ATSM PET/CT imaging during therapy. In addition to conventional maximum and mean standardized uptake values (SUV(max); SUV(mean)) measurements, imaging metrics providing response and spatiotemporal information were extracted for each patient. Progression-free survival was assessed according to response evaluation criteria in solid tumor. The prognostic value of each imaging biomarker was evaluated using univariable Cox proportional hazards regression. Multivariable analysis was also performed but was restricted to 2 predictor variables due to the limited number of patients. The best bivariable model was selected according to pseudo-R(2). RESULTS The following variables were significantly associated with poor clinical outcome following radiation therapy according to univariable analysis: tumor volume (P=.011), midtreatment FLT SUV(mean) (P=.018), and midtreatment FLT SUV(max) (P=.006). Large decreases in FLT SUV(mean) from pretreatment to midtreatment were associated with worse clinical outcome (P=.013). In the bivariable model, the best 2-variable combination for predicting poor outcome was high midtreatment FLT SUV(max) (P=.022) in combination with large FLT response from pretreatment to midtreatment (P=.041). CONCLUSIONS In addition to tumor volume, pronounced tumor proliferative response quantified using FLT PET, especially when associated with high residual FLT PET at midtreatment, is a negative prognostic biomarker of outcome in canine tumors following radiation therapy. Neither FDG PET nor Cu-ATSM PET were predictive of outcome.
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Affiliation(s)
- Tyler J Bradshaw
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Stephen R Bowen
- Departments of Radiation Oncology and Radiology, University of Washington, Seattle, Washington
| | - Michael A Deveau
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas
| | | | - Pamela White
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Søren M Bentzen
- Division of Biostatistics and Bioinformatics, University of Maryland Greenebaum Cancer Center, and Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Richard J Chappell
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Lisa J Forrest
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Robert Jeraj
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin; Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin.
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La Fontaine MD, McDaniel LS, Kubicek LN, Chappell RJ, Forrest LJ, Jeraj R. Patient characteristics influencing the variability of distributed parameter-based models in DCE-CT kinetic analysis. Vet Comp Oncol 2015; 15:105-117. [PMID: 25702795 DOI: 10.1111/vco.12143] [Citation(s) in RCA: 4] [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] [Received: 07/18/2014] [Revised: 01/07/2015] [Accepted: 01/13/2015] [Indexed: 12/17/2022]
Abstract
Kinetic parameter variability may be sensitive to kinetic model choice, kinetic model implementation or patient-specific effects. The purpose of this study was to assess their impact on the variability of dynamic contrast-enhanced computed tomography (DCE-CT) kinetic parameters. A total of 11 canine patients with sinonasal tumours received high signal-to-noise ratio, test-double retest DCE-CT scans. The variability for three distributed parameter (DP)-based models was assessed by analysis of variance. Mixed-effects modelling evaluated patient-specific effects. Inter-model variability (CVinter ) was comparable to or lower than intra-model variability (CVintra ) for blood flow (CVinter :[4-28%], CVintra :[28-31%]), fractional vascular volume (CVinter :[3-17%], CVintra :[16-19%]) and permeability-surface area product (CVinter :[5-12%], CVintra :[14-15%]). The kinetic models were significantly (P<0.05) impacted by patient characteristics for patient size, area underneath the curve of the artery and of the tumour. In conclusion, DP-based models demonstrated good agreement with similar differences between models and scans. However, high variability in the kinetic parameters and their sensitivity to patient size may limit certain quantitative applications.
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Affiliation(s)
- M D La Fontaine
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | - L S McDaniel
- Department of Statistics, University of Wisconsin, Madison, WI, USA
| | - L N Kubicek
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI, USA
| | - R J Chappell
- Department of Statistics, University of Wisconsin, Madison, WI, USA
| | - L J Forrest
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI, USA
| | - R Jeraj
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
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Cannon DM, Geye HM, Hartig GK, Traynor AM, Hoang T, McCulloch TM, Wiederholt PA, Chappell RJ, Harari PM. Increased local failure risk with prolonged radiation treatment time in head and neck cancer treated with concurrent chemotherapy. Head Neck 2013; 36:1120-5. [PMID: 23804248 DOI: 10.1002/hed.23419] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 03/01/2013] [Accepted: 06/10/2013] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Prolonged radiation treatment time (RTT) in head and neck squamous cell carcinoma (HNSCC) is associated with inferior tumor control in patients treated with radiation therapy (RT) alone. However, the significance of prolonged RTT with concurrent chemotherapy is less clear. METHODS We reviewed outcomes for 171 patients with primary HNSCC treated with curative intent RT and concurrent drug therapy from 2001 to 2009. The effects of RTT and other variables on local control and survival were analyzed. RESULTS Patients with RTT >7 weeks had a significantly increased risk of local failure (hazard ratio [HR], 2.6; p = .018) and death (HR, 1.9 p = .035). These results retained significance even after adjustment for tumor stage (age was not significant). CONCLUSION For patients treated with concurrent chemoradiotherapy (chemoRT), prolonged RTT may compromise tumor control as has been established in the setting of RT alone. Symptoms of patients with HNSCC undergoing definitive chemoRT should be managed aggressively to limit treatment interruptions.
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Affiliation(s)
- Donald M Cannon
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Cannon DM, Mehta MP, Adkison JB, Khuntia D, Traynor AM, Tomé WA, Chappell RJ, Tolakanahalli R, Mohindra P, Bentzen SM, Cannon GM. Dose-limiting toxicity after hypofractionated dose-escalated radiotherapy in non-small-cell lung cancer. J Clin Oncol 2013; 31:4343-8. [PMID: 24145340 DOI: 10.1200/jco.2013.51.5353] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Local failure rates after radiation therapy (RT) for locally advanced non-small-cell lung cancer (NSCLC) remain high. Consequently, RT dose intensification strategies continue to be explored, including hypofractionation, which allows for RT acceleration that could potentially improve outcomes. The maximum-tolerated dose (MTD) with dose-escalated hypofractionation has not been adequately defined. PATIENTS AND METHODS Seventy-nine patients with NSCLC were enrolled on a prospective single-institution phase I trial of dose-escalated hypofractionated RT without concurrent chemotherapy. Escalation of dose per fraction was performed according to patients' stratified risk for radiation pneumonitis with total RT doses ranging from 57 to 85.5 Gy in 25 daily fractions over 5 weeks using intensity-modulated radiotherapy. The MTD was defined as the maximum dose with ≤ 20% risk of severe toxicity. RESULTS No grade 3 pneumonitis was observed and an MTD for acute toxicity was not identified during patient accrual. However, with a longer follow-up period, grade 4 to 5 toxicity occurred in six patients and was correlated with total dose (P = .004). An MTD was identified at 63.25 Gy in 25 fractions. Late grade 4 to 5 toxicities were attributable to damage to central and perihilar structures and correlated with dose to the proximal bronchial tree. CONCLUSION Although this dose-escalation model limited the rates of clinically significant pneumonitis, dose-limiting toxicity occurred and was dominated by late radiation toxicity involving central and perihilar structures. The identified dose-response for damage to the proximal bronchial tree warrants caution in future dose-intensification protocols, especially when using hypofractionation.
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Affiliation(s)
- Donald M Cannon
- Donald M. Cannon, Pranshu Mohindra, Søren M. Bentzen, Anne M. Traynor, Richard J. Chappell, University of Wisconsin School of Medicine and Public Health, Madison, WI; Minesh P. Mehta, University of Maryland, Baltimore, MD; Jarrod B. Adkison, Southeast Alabama Medical Center, Dothan, AL; Deepak Khuntia, Varian Medical Systems, Palo Alto, CA; Wolfgang A. Tomé, Albert Einstein College of Medicine, Bronx, NY; George M. Cannon, Intermountain Medical Center, Salt Lake City, UT; Ranjini Tolakanahalli, Juravinski Cancer Center, Hamilton, Canada
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Abstract
The tumor-node-metastasis staging system has been the lynchpin of cancer diagnosis, treatment, and prognosis for many years. For meaningful clinical use, an orderly grouping of the T and N categories into a staging system needs to be defined, usually with respect to a time-to-event outcome. This can be reframed as a model selection problem with respect to features arranged on a partially ordered two-way grid, and a penalized regression method is proposed for selecting the optimal grouping. Instead of penalizing the L1-norm of the coefficients like lasso, in order to enforce the stage grouping, we place L1 constraints on the differences between neighboring coefficients. The underlying mechanism is the sparsity-enforcing property of the L1 penalty, which forces some estimated coefficients to be the same and hence leads to stage grouping. Partial ordering constraints is also required as both the T and N categories are ordinal. A series of optimal groupings with different numbers of stages can be obtained by varying the tuning parameter, which gives a tree-like structure offering a visual aid on how the groupings are progressively made. We hence call the proposed method the lasso tree. We illustrate the utility of our method by applying it to the staging of colorectal cancer using survival outcomes. Simulation studies are carried out to examine the finite sample performance of the selection procedure. We demonstrate that the lasso tree is able to give the right grouping with moderate sample size, is stable with regard to changes in the data, and is not affected by random censoring.
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Affiliation(s)
- Yunzhi Lin
- Department of Statistics, University of Wisconsin-Madison, Madison, WI 53706, USA.
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M. Carlsson C, Xu G, Wen Z, H. Barnet J, M. Blazel H, J. Chappell R, H. Stein J, Asthana S, A. Sager M, C. Alsop D, A. Rowley H, B. Fain S, C. Johnson S. Effects of Atorvastatin on Cerebral Blood Flow in Middle-Aged Adults at Risk for Alzheimer’s Disease: A Pilot Study. Curr Alzheimer Res 2012; 9:990-7. [DOI: 10.2174/156720512803251075] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 11/22/2011] [Accepted: 12/04/2011] [Indexed: 11/22/2022]
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Zhong W, Cruickshanks KJ, Schubert CR, Acher CW, Carlsson CM, Klein BEK, Klein R, Chappell RJ. Carotid atherosclerosis and 10-year changes in cognitive function. Atherosclerosis 2012; 224:506-10. [PMID: 22854188 DOI: 10.1016/j.atherosclerosis.2012.07.024] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 07/13/2012] [Accepted: 07/16/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Carotid atherosclerosis has been suggested to be involved in cognitive decline. METHODS The Epidemiology of Hearing Loss Study is a longitudinal study of aging among Beaver Dam residents, WI. In 1998-2000, carotid intima-media thickness (IMT) and plaque were measured by ultrasound; cognitive function was measured by the Mini-Mental State Examination (MMSE). Follow-up examinations were conducted in 2003-2005 and 2009-2010. Incidence of cognitive impairment was defined as an MMSE score <24 or reported physician-diagnosed dementia during the follow-up. In the last examination, five additional cognitive tests were added. The associations of carotid atherosclerosis with incident cognitive impairment and cognitive test performance ten years later were evaluated. RESULTS A total of 1651 participants (mean age 66.8 years, 41% men) without cognitive impairment at baseline were included in the incidence analysis. IMT was associated with incidence of cognitive impairment after multiple adjustments (hazard ratio: 1.09, p = 0.02 for each 0.1 mm increase in IMT). A total of 1311 participants with atherosclerosis data at baseline had the additional cognitive tests 10 years later. Larger IMT was associated with longer time to complete the Trail-Making Test-part B after multiple adjustments (0.1 mm IMT: 2.3 s longer, p = 0.02). Plaque was not associated with incident cognitive impairment or cognitive test performance 10 years later. CONCLUSIONS In this population-based longitudinal study, carotid IMT was associated with a higher risk of developing cognitive impairment during the 10-year follow-up, and was associated with poorer performance in a test of executive function 10 years later.
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Affiliation(s)
- Wenjun Zhong
- University of Wisconsin-Madison, 1036 WARF, 610 Walnut Street, WI 53726, USA.
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Kubicek LN, Seo S, Chappell RJ, Jeraj R, Forrest LJ. Helical tomotherapy setup variations in canine nasal tumor patients immobilized with a bite block. Vet Radiol Ultrasound 2012; 53:474-81. [PMID: 22731939 DOI: 10.1111/j.1740-8261.2012.01947.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Accepted: 04/07/2012] [Indexed: 12/25/2022] Open
Abstract
The purpose of our study was to compare setup variation in four degrees of freedom (vertical, longitudinal, lateral, and roll) between canine nasal tumor patients immobilized with a mattress and bite block, versus a mattress alone. Our secondary aim was to define a clinical target volume (CTV) to planning target volume (PTV) expansion margin based on our mean systematic error values associated with nasal tumor patients immobilized by a mattress and bite block. We evaluated six parameters for setup corrections: systematic error, random error, patient-patient variation in systematic errors, the magnitude of patient-specific random errors (root mean square [RMS]), distance error, and the variation of setup corrections from zero shift. The variations in all parameters were statistically smaller in the group immobilized by a mattress and bite block. The mean setup corrections in the mattress and bite block group ranged from 0.91 mm to 1.59 mm for the translational errors and 0.5°. Although most veterinary radiation facilities do not have access to Image-guided radiotherapy (IGRT), we identified a need for more rigid fixation, established the value of adding IGRT to veterinary radiation therapy, and define the CTV-PTV setup error margin for canine nasal tumor patients immobilized in a mattress and bite block.
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