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Zarinshenas R, Campbell P, Sun K, Molitoris JK, Patel AN, Witek ME, Cullen KJ, Mehra R, Hatten KM, Moyer KF, Taylor RJ, Vakharia KT, Wolf JS, Ferris MJ. Disease and toxicity outcomes for a modern cohort of patients with squamous cell carcinoma of cutaneous origin involving the parotid gland: Comparison of volumetric modulated arc therapy and pencil beam scanning proton therapy. Radiother Oncol 2024; 193:110112. [PMID: 38309587 DOI: 10.1016/j.radonc.2024.110112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVES We sought to describe outcomes for locally advanced cutaneous squamous cell carcinoma (SCC) involving the parotid treated with volumetric modulated arc therapy (VMAT) versus pencil beam scanning proton beam therapy (PBT). MATERIALS AND METHODS Patients were gathered from 2016 to 2022 from 5 sites of a large academic RT department; included patients were treated with RT and had parotid involvement by: direct extension of a cutaneous primary, parotid regional spread from a previously or contemporaneously resected but geographically separate cutaneous primary, or else primary parotid SCC (with a cutaneous primary ostensibly occult). Acute toxicities were provider-reported (CTCAE v5.0) and graded at each on treatment visit. Statistical analyses were conducted. RESULTS Median follow-up was 12.9 months (1.3 - 72.8); 67 patients were included. Positive margins/extranodal extension were present in 34 cases; gross disease in 17. RT types: 39 (58.2 %) VMAT and 28 (41.8 %) PBT. Concurrent systemic therapy was delivered in 10 (14.9 %) patients. There were 17 treatment failures (25.4 %), median time of 168 days. Pathologically positive neck nodes were associated with locoregional recurrence (p = 0.015). Oral cavity, pharyngeal constrictor, and contralateral parotid doses were all significantly lower for PBT. Median weight change was -3.8 kg (-14.1 - 5.1) for VMAT and -3 kg (-16.8 - 3) for PBT (p = 0.013). Lower rates of ≥ grade 1 xerostomia (p = 0.002) and ≥ grade 1 dysguesia (p < 0.001) were demonstrated with PBT. CONCLUSIONS Cutaneous SCC involving the parotid can be an aggressive clinical entity despite modern multimodal therapy. PBT offers significantly lower dose to organs at risk compared to VMAT, which seemingly yields diminished acute toxicities.
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Affiliation(s)
- Reza Zarinshenas
- Department of Radiation Oncology, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD 21201, USA
| | - Peter Campbell
- Department of Radiation Oncology, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD 21201, USA
| | - Kai Sun
- Department of Radiation Oncology, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD 21201, USA
| | - Jason K Molitoris
- Department of Radiation Oncology, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD 21201, USA
| | - Akshar N Patel
- Chesapeake Oncology Hematology Associates, 305 Hospital Drive, 2nd Floor, Glen Burnie, MD 21061, USA
| | - Matthew E Witek
- Department of Radiation Oncology, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD 21201, USA
| | - Kevin J Cullen
- Division of Hematology/Oncology, Department of Medicine, University of Maryland School of Medicine, 22 S. Greene S.t, Baltimore, MD 21201, USA
| | - Ranee Mehra
- Division of Hematology/Oncology, Department of Medicine, University of Maryland School of Medicine, 22 S. Greene S.t, Baltimore, MD 21201, USA
| | - Kyle M Hatten
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Maryland School of Medicine, 16 S. Eutaw St., Suite 500, Baltimore, MD 20201, USA
| | - Kelly F Moyer
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Maryland School of Medicine, 16 S. Eutaw St., Suite 500, Baltimore, MD 20201, USA
| | - Rodney J Taylor
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Maryland School of Medicine, 16 S. Eutaw St., Suite 500, Baltimore, MD 20201, USA
| | - Kalpesh T Vakharia
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Maryland School of Medicine, 16 S. Eutaw St., Suite 500, Baltimore, MD 20201, USA
| | - Jeffrey S Wolf
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Maryland School of Medicine, 16 S. Eutaw St., Suite 500, Baltimore, MD 20201, USA
| | - Matthew J Ferris
- Department of Radiation Oncology, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD 21201, USA.
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Meltzer WA, Gupta A, Lin PN, Brown RA, Benyamien-Roufaeil DS, Khatri R, Mahurkar AA, Song Y, Taylor RJ, Zalzman M. Reprogramming Chromosome Ends by Functional Histone Acetylation. Int J Mol Sci 2024; 25:3898. [PMID: 38612707 PMCID: PMC11011970 DOI: 10.3390/ijms25073898] [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: 01/30/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Cancers harness embryonic programs to evade aging and promote survival. Normally, sequences at chromosome ends called telomeres shorten with cell division, serving as a countdown clock to limit cell replication. Therefore, a crucial aspect of cancerous transformation is avoiding replicative aging by activation of telomere repair programs. Mouse embryonic stem cells (mESCs) activate a transient expression of the gene Zscan4, which correlates with chromatin de-condensation and telomere extension. Head and neck squamous cell carcinoma (HNSCC) cancers reactivate ZSCAN4, which in turn regulates the phenotype of cancer stem cells (CSCs). Our study reveals a new role for human ZSCAN4 in facilitating functional histone H3 acetylation at telomere chromatin. Next-generation sequencing indicates ZSCAN4 enrichment at telomere chromatin. These changes correlate with ZSCAN4-induced histone H3 acetylation and telomere elongation, while CRISPR/Cas9 knockout of ZSCAN4 leads to reduced H3 acetylation and telomere shortening. Our study elucidates the intricate involvement of ZSCAN4 and its significant contribution to telomere chromatin remodeling. These findings suggest that ZSCAN4 induction serves as a novel link between 'stemness' and telomere maintenance. Targeting ZSCAN4 may offer new therapeutic approaches to effectively limit or enhance the replicative lifespan of stem cells and cancer cells.
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Affiliation(s)
- W. Alex Meltzer
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD 21201, USA (A.G.); (P.N.L.); (R.A.B.); (D.S.B.-R.); (R.K.)
| | - Aditi Gupta
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD 21201, USA (A.G.); (P.N.L.); (R.A.B.); (D.S.B.-R.); (R.K.)
| | - Phyo Nay Lin
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD 21201, USA (A.G.); (P.N.L.); (R.A.B.); (D.S.B.-R.); (R.K.)
| | - Robert A. Brown
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD 21201, USA (A.G.); (P.N.L.); (R.A.B.); (D.S.B.-R.); (R.K.)
| | - Daniel S. Benyamien-Roufaeil
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD 21201, USA (A.G.); (P.N.L.); (R.A.B.); (D.S.B.-R.); (R.K.)
| | - Raju Khatri
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD 21201, USA (A.G.); (P.N.L.); (R.A.B.); (D.S.B.-R.); (R.K.)
| | - Anup A. Mahurkar
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (A.A.M.); (Y.S.)
| | - Yang Song
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (A.A.M.); (Y.S.)
| | - Rodney J. Taylor
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
- Marlene and Stewart Greenbaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Michal Zalzman
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD 21201, USA (A.G.); (P.N.L.); (R.A.B.); (D.S.B.-R.); (R.K.)
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
- Marlene and Stewart Greenbaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- The Center for Stem Cell Biology and Regenerative Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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Symon TE, Murillo-Cisneros DA, Hernández-Camacho CJ, O'Hara TM, Taylor RJ, Rosado-Berrios CA, Vázquez-Medina JP, Zenteno-Savín T. Mercury and selenium concentrations in lanugo of free-ranging California sea lions in the southern Gulf of California, Mexico. Mar Pollut Bull 2023; 197:115712. [PMID: 37922756 DOI: 10.1016/j.marpolbul.2023.115712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Abstract
Total mercury ([THg]) and selenium ([TSe]) concentrations were determined in California sea lion (Zalophus californianus) lanugo from the Gulf of California in 2021 and 2022. Relationships with sex, morphometrics, and year were evaluated. Following toxicological thresholds of concern for piscivorous mammals, most pups had a [THg] < 10 ppm, one pup (2021) had a [THg] > 20 ppm, no pups had a [THg] > 30 ppm. Females had significantly higher [TSe] than males; sex did not influence [THg]. [THg] and [TSe] in 2022 were significantly higher in the general population and male cohorts compared to 2021. Significant negative correlations were observed between [THg], [TSe], and morphometrics (2021). These results indicate that, compared to other pinniped species, regional California sea lions may have a decreased likelihood of experiencing Hg-related adverse health effects. Year-related changes in element concentrations suggest continued monitoring of this population to assess pinniped, environmental, and potentially, human health.
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Affiliation(s)
- T E Symon
- Centro de Investigaciones Biológicas del Noroeste, S. C (CIBNOR), 23096 La Paz, Mexico.
| | - D A Murillo-Cisneros
- Centro de Investigaciones Biológicas del Noroeste, S. C (CIBNOR), 23096 La Paz, Mexico.
| | - C J Hernández-Camacho
- Centro Interdisciplinario de Ciencias Marinas, Instituto Politécnico Nacional, 23096 La Paz, Mexico.
| | - T M O'Hara
- School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station 77843, United States of America.
| | - R J Taylor
- School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station 77843, United States of America.
| | - C A Rosado-Berrios
- School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station 77843, United States of America.
| | - J P Vázquez-Medina
- Department of Integrative Biology, University of California, Berkeley, 94720 Berkeley, United States of America.
| | - T Zenteno-Savín
- Centro de Investigaciones Biológicas del Noroeste, S. C (CIBNOR), 23096 La Paz, Mexico.
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Isaac E, Taylor RJ, Fields EC. How the Underlying Etiology of Cirrhosis Impacts Response to SBRT. Int J Radiat Oncol Biol Phys 2023; 117:e305-e306. [PMID: 37785111 DOI: 10.1016/j.ijrobp.2023.06.2327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) In the US, incidence rates of hepatocellular carcinoma (HCC) have more than tripled and death rates have doubled since 1980. In 2022, it is expected for 41,260 new cases to be diagnosed with 30,520 deaths. Many etiologies contribute to the development of HCC including alcoholic cirrhosis, cryptogenic cirrhosis, HCV, HBV, NASH, and genetic disorders like hereditary hemochromatosis. An increasing number of patients are not candidates for curative options such as resection or transplant and the role of alternative liver directed as therapies has increased. SBRT has emerged as a safe and effective option, but there is little known about the outcomes related to the etiology of the HCC. The purpose of this study is to characterize the rates of toxicity and efficacy between different HCC etiologies in patients who were treated with SBRT. MATERIALS/METHODS A single institutional database was compiled of all patients with HCC who were treated with SBRT. Patients with HCC etiologies of HCV, alcoholic cirrhosis, or NASH cirrhosis who received SBRT and monitored with liver function tests and imaging (MRI or CT) and were not transplanted were included Demographic information, disease etiology, all treatment courses, lab values, radiologic response, and follow-up were collected on all patients. SPSS was used to analyze the data. RESULTS Consecutive patients (n = 37, 43 courses of radiation) who received SBRT between 2013- January 2022 were included. Most patients were male (n = 32, 86.5%) and average age was 64.73 ± 7.42 years (range: 50-82 years). A majority of patients had either HCV or HCV and alcoholic cirrhosis (n = 28, 75.7%) and there were no baseline difference in child Pugh score, tumor size, or number of prior treatments. Most patients were treated with 50Gy/5 fx (n = 26, 70.3%) with 5 others being treated with 45Gy/5fx to meet mean liver constraints. Most patients had a decrease in ALT (n = 22, 59.5%) while almost half of patients had a decrease in AFP (n = 14, 48.3%) at average follow-up of 11.84 ± 5.35 months. There was a significant correlation between HCC etiology and change in bilirubin with patients with HCV being more likely to have increases in total bilirubin (χ2 (6) = 17.5, p < 0.01). CONCLUSION Patients with HCV induced cirrhosis may be more fragile and have a significant increased risk of toxicity after SBRT based on total bilirubin changes. Most patients did have a decrease in ALT showing potential for some improvement in liver function with SBRT. However, almost half of patients have some biologic efficacy with SBRT independent of HCC etiology. Further studies should include looking at the biologic differences in the etiologies and what treatment liver-directed therapies may be best for each population.
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Affiliation(s)
- E Isaac
- Virginia Commonwealth University, School of Medicine, Richmond, VA
| | - R J Taylor
- Virginia Commonwealth University, Department of Radiation Oncology, Richmond, VA
| | - E C Fields
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Massey Cancer Center, Richmond, VA
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5
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Taylor RJ, Omidi A, Rosu M, Maggioncalda E, Weiss E. Effects of Respiratory and Cardiac Motion on Dose to the Left Anterior Descending Artery in Patients Undergoing Radiation Therapy for Locally Advanced Lung Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e64-e65. [PMID: 37785906 DOI: 10.1016/j.ijrobp.2023.06.788] [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) Radiation dose to the left anterior descending artery (LAD) appears to be an independent predictor of major cardiac events and all-cause mortality following radiation therapy (RT) for lung cancer. In this study, we characterize the dosimetric effects of respiratory (RM) and cardiac (CM) motion on LAD. MATERIALS/METHODS Ten patients with stage IIIA-IVA lung cancer received cine MRIs (25 phases) at expiration which were used to evaluate the CM, and 4D CT scans for the evaluation of RM. Following registration of the expiration images of 4D CTs with MRIs, RT dose was transferred from planning CT datasets to all phases of 4D CTs and cine MRIs. LAD was manually contoured on all scans. The contours from each 4D phase represent LADs over multiple cardiac cycles, thus they are referred to as cLAD from here on. Displacements and dose variations of cLAD between exhale/inhale on 4D CTs and of LAD between systolic and diastolic phases on cine MRIs were analyzed, and paired t-tests were performed to assess the significance of the differences observed. RESULTS The following metrics are reported averaged over all patients. Clinical treatment planning CT metrics and doses: Mean dose, max dose, V5 Gy and V15 Gy were 15.0 (±11.3) Gy, 31.1 (±22.1) Gy, 53 (±33)%, 35 (±30)%. The cLAD metrics and dose variations due to respiratory motion (between exhale and inhale): RM amplitude was 0.3±0.2cm (RL 0.3 ± 0.1 cm, AP 0.2 ± 0.2 cm, SI 0.3 ± 0.2 cm). The variations in mean dose, max dose, V5 and V15 were 4.0 (±4.0) Gy, 1.6 (±1.5) Gy, 4.4 (±3.4)%, 4.0 (±3.4)%. Mean, max, V5 Gy and V15 Gy increased or remained unchanged with expiration in 8, 9, 5 and 5 patients, respectively. LAD metrics and dose variations due to cardiac motion (between systole and diastole): CM amplitude was 0.2 ± 0.1 cm (RL 0.2 ± 0.1 cm, AP 0.2 ± 0.1 cm, SI 0.3 ± 0.1 cm). The variations in mean dose, max dose, V5 and V15 were 1.7 (±1.4) Gy, 1.2 (±0.9) Gy, 5.2 (± 6.7)%, 4.6 (± 4.0)%. Mean, max, V5 Gy and V15 Gy increased or remained unchanged with diastole in 7, 7, 8 and 8 patients respectively. Statistical significance: The differences in displacement and dose between respiration and cardiac motion were not statistically significant. CONCLUSION Respiratory and cardiac-induced physiological variations of the LAD position have dosimetric consequences comparable in magnitude. Expiration and diastole lead to increased LAD doses. This underscores the importance of considering both the respiratory and the cardiac motion when motion management techniques are considered. 4D CTs inherently include the cardiac motion. However, if breath-hold is used for respiratory motion mitigation, CM might not be captured appropriately due to short tube rotation times. In this case, understanding CM characteristics is important for more accurate assessment of LAD dose.
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Affiliation(s)
- R J Taylor
- Virginia Commonwealth University, Department of Radiation Oncology, Richmond, VA
| | - A Omidi
- Virginia Commonwealth University, Department of Radiation Oncology, Richmond, VA
| | - M Rosu
- Virginia Commonwealth University, Department of Radiation Oncology, Richmond, VA
| | | | - E Weiss
- Virginia Commonwealth University, Department of Radiation Oncology, Richmond, VA
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Byron W, Harrington H, Taylor RJ, DeGraw W, Buzinsky N, Dodson B, Fertl M, García A, Garvey G, Graner B, Guigue M, Hayen L, Huyan X, Khaw KS, Knutsen K, McClain D, Melconian D, Müller P, Novitski E, Oblath NS, Robertson RGH, Rybka G, Savard G, Smith E, Stancil DD, Sternberg M, Storm DW, Swanson HE, Tedeschi JR, VanDevender BA, Wietfeldt FE, Young AR, Zhu X. First Observation of Cyclotron Radiation from MeV-Scale e^{±} following Nuclear β Decay. Phys Rev Lett 2023; 131:082502. [PMID: 37683153 DOI: 10.1103/physrevlett.131.082502] [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] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 05/03/2023] [Accepted: 07/12/2023] [Indexed: 09/10/2023]
Abstract
We present an apparatus for detection of cyclotron radiation yielding a frequency-based β^{±} kinetic energy determination in the 5 keV to 2.1 MeV range, characteristic of nuclear β decays. The cyclotron frequency of the radiating β particles in a magnetic field is used to determine the β energy precisely. Our work establishes the foundation to apply the cyclotron radiation emission spectroscopy (CRES) technique, developed by the Project 8 Collaboration, far beyond the 18-keV tritium endpoint region. We report initial measurements of β^{-}'s from ^{6}He and β^{+}'s from ^{19}Ne decays to demonstrate the broadband response of our detection system and assess potential systematic uncertainties for β spectroscopy over the full (MeV) energy range. To our knowledge, this is the first direct observation of cyclotron radiation from individual highly relativistic β's in a waveguide. This work establishes the application of CRES to a variety of nuclei, opening its reach to searches for new physics beyond the TeV scale via precision β-decay measurements.
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Affiliation(s)
- W Byron
- Department of Physics, University of Washington, Seattle, Washington 98195, USA
- Center for Nuclear Physics and Astrophysics, University of Washington, Seattle, Washington 98195, USA
| | - H Harrington
- Department of Physics, University of Washington, Seattle, Washington 98195, USA
- Center for Nuclear Physics and Astrophysics, University of Washington, Seattle, Washington 98195, USA
| | - R J Taylor
- Physics Department, North Carolina State University, Raleigh, North Carolina 27695, USA
- The Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - W DeGraw
- Department of Physics, University of Washington, Seattle, Washington 98195, USA
- Center for Nuclear Physics and Astrophysics, University of Washington, Seattle, Washington 98195, USA
| | - N Buzinsky
- Department of Physics, University of Washington, Seattle, Washington 98195, USA
- Center for Nuclear Physics and Astrophysics, University of Washington, Seattle, Washington 98195, USA
| | - B Dodson
- Department of Physics, University of Washington, Seattle, Washington 98195, USA
- Center for Nuclear Physics and Astrophysics, University of Washington, Seattle, Washington 98195, USA
| | - M Fertl
- Institute for Physics, Johannes-Gutenberg University Mainz, 55128 Mainz, Germany
| | - A García
- Department of Physics, University of Washington, Seattle, Washington 98195, USA
- Center for Nuclear Physics and Astrophysics, University of Washington, Seattle, Washington 98195, USA
| | - G Garvey
- Department of Physics, University of Washington, Seattle, Washington 98195, USA
- Center for Nuclear Physics and Astrophysics, University of Washington, Seattle, Washington 98195, USA
| | - B Graner
- Department of Physics, University of Washington, Seattle, Washington 98195, USA
- Center for Nuclear Physics and Astrophysics, University of Washington, Seattle, Washington 98195, USA
| | - M Guigue
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - L Hayen
- Physics Department, North Carolina State University, Raleigh, North Carolina 27695, USA
- The Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - X Huyan
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - K S Khaw
- Department of Physics, University of Washington, Seattle, Washington 98195, USA
- Center for Nuclear Physics and Astrophysics, University of Washington, Seattle, Washington 98195, USA
| | - K Knutsen
- Department of Physics, University of Washington, Seattle, Washington 98195, USA
- Center for Nuclear Physics and Astrophysics, University of Washington, Seattle, Washington 98195, USA
| | - D McClain
- Department of Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
- Cyclotron Institute, Texas A&M University, College Station, Texas 77843, USA
| | - D Melconian
- Department of Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
- Cyclotron Institute, Texas A&M University, College Station, Texas 77843, USA
| | - P Müller
- Physics Division, Argonne National Laboratory, 9700 South Cass Avenue, Argonne, Illinois 60439, USA
| | - E Novitski
- Department of Physics, University of Washington, Seattle, Washington 98195, USA
- Center for Nuclear Physics and Astrophysics, University of Washington, Seattle, Washington 98195, USA
| | - N S Oblath
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - R G H Robertson
- Department of Physics, University of Washington, Seattle, Washington 98195, USA
- Center for Nuclear Physics and Astrophysics, University of Washington, Seattle, Washington 98195, USA
| | - G Rybka
- Department of Physics, University of Washington, Seattle, Washington 98195, USA
- Center for Nuclear Physics and Astrophysics, University of Washington, Seattle, Washington 98195, USA
| | - G Savard
- Physics Division, Argonne National Laboratory, 9700 South Cass Avenue, Argonne, Illinois 60439, USA
| | - E Smith
- Department of Physics, University of Washington, Seattle, Washington 98195, USA
- Center for Nuclear Physics and Astrophysics, University of Washington, Seattle, Washington 98195, USA
| | - D D Stancil
- Department of Electrical and Computer Engineering, North Carolina State University, Raleigh, North Carolina 27695, USA
| | - M Sternberg
- Department of Physics, University of Washington, Seattle, Washington 98195, USA
- Center for Nuclear Physics and Astrophysics, University of Washington, Seattle, Washington 98195, USA
| | - D W Storm
- Department of Physics, University of Washington, Seattle, Washington 98195, USA
- Center for Nuclear Physics and Astrophysics, University of Washington, Seattle, Washington 98195, USA
| | - H E Swanson
- Department of Physics, University of Washington, Seattle, Washington 98195, USA
- Center for Nuclear Physics and Astrophysics, University of Washington, Seattle, Washington 98195, USA
| | - J R Tedeschi
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - B A VanDevender
- Department of Physics, University of Washington, Seattle, Washington 98195, USA
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - F E Wietfeldt
- Department of Physics and Engineering Physics, Tulane University, New Orleans, Louisiana 70118, USA
| | - A R Young
- Physics Department, North Carolina State University, Raleigh, North Carolina 27695, USA
- The Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - X Zhu
- Department of Physics, University of Washington, Seattle, Washington 98195, USA
- Center for Nuclear Physics and Astrophysics, University of Washington, Seattle, Washington 98195, USA
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7
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Pollock AE, Arons D, Alexander GS, Alicia D, Birkman KM, Molitoris JK, Mehra R, Cullen KJ, Hatten KM, Taylor RJ, Wolf JS, Regine WF, Witek ME. Gross tumor volume margin and local control in p16-positive oropharynx cancer patients treated with intensity modulated proton therapy. Head Neck 2023; 45:1088-1096. [PMID: 36840723 DOI: 10.1002/hed.27308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 01/24/2023] [Accepted: 02/06/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND To determine if the extent of high-dose gross tumor volume (GTV) to clinical target volume (CTV) expansion is associated with local control in patients with p16-positive oropharynx cancer (p16+ OPC) treated with definitive intensity modulated proton therapy (IMPT). METHODS We performed a retrospective analysis of patients with p16+ OPC treated with IMPT at a single institution between 2016 and 2021. Patients with a pre-treatment PET-CT and restaging PET-CT within 4 months following completion of IMPT were analyzed. RESULTS Sixty patients were included for analysis with a median follow-up of 17 months. The median GTV to CTV expansion was 5 mm (IQR: 2 mm). Thirty-three percent of patients (20 of 60) did not have a GTV to CTV expansion. There was one local failure within the expansion group (3%). CONCLUSION Excellent local control was achieved using IMPT for p16+ OPC independent of GTV expansion. IMPT with minimal target expansions represent a potential harm-minimization technique for p16-positive oropharynx cancer.
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Affiliation(s)
- Ariel E Pollock
- Department of Radiation Oncology, University of Maryland, School of Medicine, Baltimore, Maryland, USA
| | - Danielle Arons
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Gregory S Alexander
- Department of Radiation Oncology, University of Maryland, School of Medicine, Baltimore, Maryland, USA
| | - David Alicia
- Department of Radiation Oncology, University of Maryland, School of Medicine, Baltimore, Maryland, USA
| | - Kayla M Birkman
- Department of Radiation Oncology, University of Maryland, School of Medicine, Baltimore, Maryland, USA
| | - Jason K Molitoris
- Department of Radiation Oncology, University of Maryland, School of Medicine, Baltimore, Maryland, USA
| | - Ranee Mehra
- Department of Medicine, University of Maryland, School of Medicine, Baltimore, Maryland, USA
| | - Kevin J Cullen
- Department of Medicine, University of Maryland, School of Medicine, Baltimore, Maryland, USA
| | - Kyle M Hatten
- Department of Otolaryngology, Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Rodney J Taylor
- Department of Otolaryngology, Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jeffrey S Wolf
- Department of Otolaryngology, Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - William F Regine
- Department of Radiation Oncology, University of Maryland, School of Medicine, Baltimore, Maryland, USA
| | - Matthew E Witek
- Department of Radiation Oncology, University of Maryland, School of Medicine, Baltimore, Maryland, USA
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Amin NB, Bridgham KM, Brown JP, Moyer KF, Taylor RJ, Wolf JS, Witek ME, Molitoris JK, Mehra R, Cullen KJ, Papadimitriou JC, Raghavan P, Hatten KM. Regionalization of Head and Neck Oncology Tumor Boards: Perspectives of Collaborating Physicians. OTO Open 2023; 7:e18. [PMID: 36998543 PMCID: PMC10046717 DOI: 10.1002/oto2.18] [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: 09/26/2022] [Accepted: 10/15/2022] [Indexed: 03/05/2023] Open
Abstract
Objectives To survey academic and community physician preferences regarding the virtual multidisciplinary tumor board (MTB) for further improvement and expansion. Study Design This anonymous 14-question survey was sent to individuals that participated in the head and neck virtual MTBs. The survey was sent via email beginning August 3, 2021, through October 5, 2021. Setting The University of Maryland Medical Center and regional practices in the state of Maryland. Methods Survey responses were recorded and presented as percentages. Subset analysis was performed to obtain frequency distributions by facility and provider type. Results There were 50 survey responses obtained with a response rate of 56%. Survey participants included 11 surgeons (22%), 19 radiation oncologists (38%), and 8 medical oncologists (16%), amongst others. More than 96% of participants found the virtual MTB to be useful when discussing complex cases and impactful to future patient care. A majority of respondents perceived a reduction in time to adjuvant care (64%). Community and academic physician responses strongly agreed that the virtual MTB improved communication (82% vs 73%), provided patient-specific information for cancer care (82% vs 73%), and improved access to other specialties (66% vs 64%). Academic physicians, more so than community physicians, strongly agreed that the virtual MTB improves access to clinical trial enrollment (64% vs 29%) and can be useful in obtaining CME (64% vs 55%). Conclusion Academic and community physicians view the virtual MTB favorably. This platform can be adapted regionally and further expanded to improve communication between physicians and improve multidisciplinary care for patients.
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Affiliation(s)
- Neha B. Amin
- University of Maryland School of Medicine Baltimore Maryland USA
| | | | - Jessica P. Brown
- Department of Epidemiology and Public Health University of Maryland School of Medicine Baltimore Maryland USA
| | - Kelly F. Moyer
- Department of Otorhinolaryngology–Head and Neck Surgery University of Maryland School of Medicine Baltimore Maryland USA
| | - Rodney J. Taylor
- Department of Otorhinolaryngology–Head and Neck Surgery University of Maryland School of Medicine Baltimore Maryland USA
| | - Jeffrey S. Wolf
- Department of Otorhinolaryngology–Head and Neck Surgery University of Maryland School of Medicine Baltimore Maryland USA
| | - Matthew E. Witek
- Department of Radiation Oncology University of Maryland School of Medicine, Maryland Proton Treatment Center Baltimore Maryland USA
| | - Jason K. Molitoris
- Department of Radiation Oncology University of Maryland School of Medicine, Maryland Proton Treatment Center Baltimore Maryland USA
| | - Ranee Mehra
- Marlene and Stewart Greenebaum Comprehensive Cancer Center University of Maryland School of Medicine Maryland Baltimore USA
| | - Kevin J. Cullen
- Marlene and Stewart Greenebaum Comprehensive Cancer Center University of Maryland School of Medicine Maryland Baltimore USA
| | - John C. Papadimitriou
- Department of Pathology University of Maryland School of Medicine Baltimore Maryland USA
| | - Prashant Raghavan
- Department of Otorhinolaryngology–Head and Neck Surgery University of Maryland School of Medicine Baltimore Maryland USA
- Department of Diagnostic Radiology and Nuclear Medicine University of Maryland School of Medicine Baltimore Maryland USA
| | - Kyle M. Hatten
- Department of Otorhinolaryngology–Head and Neck Surgery University of Maryland School of Medicine Baltimore Maryland USA
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9
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Amin N, Thompson J, Goloubeva O, Witek M, Taylor RJ, Wolf JS, Moyer K, Mehra R, Hatten KM. Human Papillomavirus Impact on Temporal Treatment Trends in Oropharyngeal Carcinoma: 2010-2016. ORL J Otorhinolaryngol Relat Spec 2022; 84:438-446. [PMID: 36067748 DOI: 10.1159/000524752] [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: 01/11/2022] [Accepted: 04/17/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The study objective was to identify practice patterns in oropharyngeal cancer management from 2010 to 2016 among human papillomavirus (HPV)-associated and non-HPV-associated oropharyngeal squamous-cell carcinoma (OPSCC) patients. METHODS The National Cancer Database was utilized to identify OPSCC patients from 2010 to 2016. Frequency distributions and multivariable analyses were generated to identify practice patterns and predictors of treatment modality. RESULTS A total of 35,956 patients with nonmetastatic OPSCC were included. HPV status was not associated with a treatment modality preference. At academic centers, the proportion of HPV-associated OPSCC patients versus non-HPV-associated OPSCC patients undergoing surgical management was similar (35.7%; 35.9%). Community cancer programs treated patients less often surgically but with no significant treatment preference based on HPV status. Within each facility type, HPV status was not a predictor of surgical or nonsurgical management. CONCLUSION HPV association does not appear to significantly influence treatment modality preference among OPSCC patients. The proportion of OPSCC patients undergoing surgical treatment declined from 2010 to 2016.
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Affiliation(s)
- Neha Amin
- University of Maryland, School of Medicine, Baltimore, Maryland, USA,
| | - Joshua Thompson
- Department of Otorhinolaryngology - Head and Neck Surgery, Univeristy of Maryland, School of Medicine, Batimore, Maryland, USA
| | - Olga Goloubeva
- Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore, Maryland, USA
| | - Matthew Witek
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland, School of Medicine, Baltimore, Maryland, USA
| | - Rodney J Taylor
- Department of Otorhinolaryngology - Head and Neck Surgery, Univeristy of Maryland, School of Medicine, Batimore, Maryland, USA
| | - Jeffrey S Wolf
- Department of Otorhinolaryngology - Head and Neck Surgery, Univeristy of Maryland, School of Medicine, Batimore, Maryland, USA
| | - Kelly Moyer
- Department of Otorhinolaryngology - Head and Neck Surgery, Univeristy of Maryland, School of Medicine, Batimore, Maryland, USA
| | - Ranee Mehra
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland, School of Medicine, Baltimore, Maryland, USA
| | - Kyle M Hatten
- Department of Otorhinolaryngology - Head and Neck Surgery, Univeristy of Maryland, School of Medicine, Batimore, Maryland, USA
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10
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Redman JM, Friedman J, Robbins Y, Sievers C, Yang X, Lassoued W, Sinkoe A, Papanicolau-Sengos A, Lee CCR, Marte JL, Turkbey EB, Mydlarz W, Joshi AS, London NR, Pierce M, Taylor RJ, Hong S, Nguyen A, Soon-Shiong P, Schlom J, Gulley JL, Allen CT. Enhanced neoepitope-specific immunity following neoadjuvant PD-L1 and TGF-b blockade in HPV-unrelated head and neck cancer. J Clin Invest 2022; 132:161400. [PMID: 35727629 PMCID: PMC9479764 DOI: 10.1172/jci161400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/16/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Head and neck squamous cell carcinoma not associated with human papillomavirus (HPV-unrelated HNSCC) is associated with high rates of recurrence and poor survival. METHODS We conducted a clinical trial in 14 patients with newly diagnosed, HPV-unrelated HNSCC to evaluate the safety and efficacy of neoadjuvant bintrafusp alfa, a bifunctional fusion protein that blocks programmed death-ligand 1 (PD-L1) and neutralizes transforming growth factor-beta (TGF-). RESULTS Bintrafusp alfa was well tolerated, and no treatment-associated surgical delays or complications occurred. Objective pathologic responses were observed and 12 of 14 patients (86%) were alive and disease free at one year. Alterations in regulatory T cell infiltration and spatial distribution relative to proliferating CD8 T cells indicated reversal of Treg immunosuppression in the primary tumor. Detection of neoepitope-specific tumor T cell responses, but not viral-specific responses, correlated with development of a pathologic response. Detection of neoepitope-specific responses and pathologic responses in tumors was not correlated with genomic features or tumor antigenicity but was associated with reduced pre-treatment myeloid cell tumor infiltration. These results indicate that dual PD-L1 and TGF- blockade can safely enhance tumor antigen-specific immunity and highlight the feasibility of multi-mechanism neoadjuvant immunotherapy in patients with HPV-unrelated HNSCC. CONCLUSION Our studies provide new insight into the ability of neoadjuvant immunotherapy to induce polyclonal neoadjuvant-specific T cell responses in tumors and suggest that features of the tumor microenvironment, such as myeloid cell infiltration, may be a major determinant of enhanced anti-tumor immunity following such treatment.
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Affiliation(s)
- Jason M Redman
- Genitourinary Malignancy Branch, NCI, CCR. NIH, Bethesda, United States of America
| | - Jay Friedman
- Section on Translational Tumor Immunology, National Institute on Deafness a, NIH, Bethesda, United States of America
| | - Yvette Robbins
- Section on Translational Tumor Immunology, National Institute on Deafness a, NIH, Bethesda, United States of America
| | - Cem Sievers
- Section on Translational Tumor Immunology, National Institute on Deafness a, NIH, Bethesda, United States of America
| | - Xinping Yang
- Section on Translational Tumor Immunology, National Institute on Deafness a, NIH, Bethesda, United States of America
| | - Wiem Lassoued
- Tumor Immune Microenvironment Laboratory, Genitourinary Malignancy Branch, NCI, CCR. NIH, Bethesda, United States of America
| | - Andrew Sinkoe
- Genitourinary Malignancy Branch, NCI, CCR. NIH, Bethesda, United States of America
| | | | - Chyi-Chia R Lee
- Laboratory of Pathology, CCR, NCI, NIH, Bethesda, United States of America
| | - Jennifer L Marte
- Genitourinary Malignancies Branch, NCI, CCR. NIH, Bethesda, United States of America
| | - Evrim B Turkbey
- Radiology and Imaging Sciences, NIH, Bethedsda, United States of America
| | - Wojciech Mydlarz
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, United States of America
| | - Arjun S Joshi
- Department of Surgery, George Washington University, Washington, DC, United States of America
| | - Nyall R London
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, United States of America
| | - Matthew Pierce
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University School of Medicine, Washington, DC, United States of America
| | - Rodney J Taylor
- Department of Otolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, United States of America
| | - Steven Hong
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed Army Medical Center, Bethesda, United States of America
| | | | | | - Jeffrey Schlom
- Laboratory of Tumor Immunology and Biology, NCI, CCR, NIH, Bethesda, United States of America
| | - James L Gulley
- Genitourinary Malignancy Branch, NCI, CCR, NIH, Bethesda, United States of America
| | - Clint T Allen
- Section on Translational Tumor Immunology, National Institute on Deafness a, NIH, Bethesda, United States of America
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11
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McCusker MG, Mehra R, Amr S, Taylor RJ, Cullen KJ, Goloubeva OG. Comparison of efficacy and toxicity of chemoradiation regimens for head and neck squamous cell carcinoma primary treatment. Head Neck 2021; 44:749-759. [PMID: 34931731 DOI: 10.1002/hed.26965] [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: 09/22/2021] [Revised: 11/19/2021] [Accepted: 12/10/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The best chemoradiation regimen to treat locally and regionally advanced head and neck squamous cell carcinoma (HNSCC) is yet to be established. METHODS We compared overall survival (OS) and adverse events following chemoradiation regimens (high-dose [HDC] or low-dose [LDC] cisplatin, or carboplatin [CB]) in HNSCC cases selected from SEER-Medicare linked database. RESULTS Of the 1335 cases who underwent radiotherapy, 264 received HDC, 259 received LDC, and 353 received CB, concurrently. Compared to chemoradiation with HDC, using LDC or CB, or radiotherapy alone were associated with an increasingly worse OS; hazard ratios were 1.33, p = 0.03; 1.35, p = 0.02; and 2.12, p < 0.001; respectively. There were no differences in the rates of adverse events between the three chemoradiation regimens. CONCLUSION Chemoradiation regimen using HDC appears to be the best primary treatment for locally and regionally advanced HNSCC. Nonetheless, prospective large studies are warranted to further determine its absolute benefit.
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Affiliation(s)
- Michael G McCusker
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Ranee Mehra
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Sania Amr
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, Maryland, USA.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Rodney J Taylor
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, Maryland, USA.,Department of Otorhinolaryngology - Head & Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kevin J Cullen
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Olga G Goloubeva
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, Maryland, USA.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
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12
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Wolf JS, Papadimitriou JC, Morales RE, Califano JA, Kline NL, Bhatnagar K, Hebert AM, Taylor RJ. The association of active and passive tobacco smoke exposure with chronic rhinosinusitis symptom severity: A cross-sectional study. Int Forum Allergy Rhinol 2021; 12:278-285. [PMID: 34510792 DOI: 10.1002/alr.22887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/16/2021] [Revised: 07/31/2021] [Accepted: 08/02/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) causes a great deal of morbidity. There are a multitude of causal factors, though their precise contribution to symptom severity has yet to be defined. We hypothesized that exposure to both primary and secondhand tobacco smoke would correlate with more severe symptoms of CRS. METHODS This is a prospective cross-sectional study performed at an academic tertiary care medical center from 2010 to 2013. A total of 85 consecutive patients with chronic sinusitis were screened; 70 with medically refractory CRS requiring functional Endoscopic sinus surgery (FESS) were enrolled. Recent tobacco exposure was assessed using serum cotinine levels. Sinonasal mucosa was biopsied to assess ciliary architecture. Demographics, medical history, tobacco and environmental exposures, and computed tomography (CT) imaging were also collected. Two quality of life (QOL) surveys were administered: one disease specific, Sinonasal Outcomes Test-20 (SNOT-20), and one general, Short Form-12 (SF-12). Results were correlated with the aforementioned exposures. RESULTS The 70 patients had an average age of 46 years, and 42% were male. Variables that correlated with worse SNOT-20 scores included serum cotinine (r = 0.43, p = 0.002), number of cigarettes smoked daily (r = 0.27, p = 0.03), and number of secondhand cigarettes exposed to per day (r = 0.29, p = 0.04). There were no significant correlations between SNOT-20 scores and Lund-MacKay or axonemal ultrastructural abnormalities (AUA)-ciliary scores. The two five-variable models best predicted disease-specific QOL. CONCLUSIONS Increased amounts of serum cotinine and primary and secondhand smoke exposure were associated with worse sinonasal QOL. This study establishes an objective relationship between smoke exposure and patient-perceived severity of CRS, emphasizing the importance of tobacco cessation counseling as part of management.
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Affiliation(s)
- Jeffrey S Wolf
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - John C Papadimitriou
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Robert E Morales
- Department of Radiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Joseph A Califano
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Diego, California, USA
| | - Neila L Kline
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kavita Bhatnagar
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Andrea M Hebert
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Rodney J Taylor
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
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13
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Arad M, Brown RA, Khatri R, Taylor RJ, Zalzman M. Direct differentiation of tonsillar biopsy-derived stem cells to the neuronal lineage. Cell Mol Biol Lett 2021; 26:38. [PMID: 34407767 PMCID: PMC8371824 DOI: 10.1186/s11658-021-00279-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 07/27/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Neurological disorders are considered one of the greatest burdens to global public health and a leading cause of death. Stem cell therapies hold great promise for the cure of neurological disorders, as stem cells can serve as cell replacement, while also secreting factors to enhance endogenous tissue regeneration. Adult human multipotent stem cells (MSCs) reside on blood vessels, and therefore can be found in many tissues throughout the body, including palatine tonsils. Several studies have reported the capacity of MSCs to differentiate into, among other cell types, the neuronal lineage. However, unlike the case with embryonic stem cells, it is unclear whether MSCs can develop into mature neurons. METHODS Human tonsillar MSCs (T-MSCs) were isolated from a small, 0.6-g sample, of tonsillar biopsies with high viability and yield as we recently reported. Then, these cells were differentiated by a rapid, multi-stage procedure, into committed, post-mitotic, neuron-like cells using defined conditions. RESULTS Here we describe for the first time the derivation and differentiation of tonsillar biopsy-derived MSCs (T-MSCs), by a rapid, multi-step protocol, into post-mitotic, neuron-like cells using defined conditions without genetic manipulation. We characterized our T-MSC-derived neuronal cells and demonstrate their robust differentiation in vitro. CONCLUSIONS Our procedure leads to a rapid neuronal lineage commitment and loss of stemness markers, as early as three days following neurogenic differentiation. Our studies identify biopsy-derived T-MSCs as a potential source for generating neuron-like cells which may have potential use for in vitro modeling of neurodegenerative diseases or cell replacement therapies.
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Affiliation(s)
- Michal Arad
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, 108 N. Greene Street, Baltimore, MD, 21201, USA
| | - Robert A Brown
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, 108 N. Greene Street, Baltimore, MD, 21201, USA
| | - Raju Khatri
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, 108 N. Greene Street, Baltimore, MD, 21201, USA
| | - Rodney J Taylor
- Marlene and Stewart Greenbaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.,Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Michal Zalzman
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, 108 N. Greene Street, Baltimore, MD, 21201, USA. .,The Center for Stem Cell Biology and Regenerative Medicine, University of Maryland School of Medicine, Baltimore, MD, 21201, USA. .,Marlene and Stewart Greenbaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, 21201, USA. .,Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
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14
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Kline NL, Bhatnagar K, Eisenman DJ, Taylor RJ. Survival outcomes of lateral skull base tumors following temporal bone resection. Head Neck 2021; 43:2414-2422. [PMID: 33851465 DOI: 10.1002/hed.26707] [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: 07/19/2020] [Revised: 03/05/2021] [Accepted: 04/01/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Lateral skull base tumors often necessitate temporal bone resection (TBR), although clinical outcomes can be unfavorable. Factors influencing survival and recurrence after TBR for cutaneous and salivary malignancies were evaluated. METHODS Twenty-six TBR subjects were included. Survival and recurrence outcomes were estimated at 1, 2, and 5 years postresection. Prognostic factors were analyzed using univariate and multivariate Cox regression. RESULTS Two years postresection, the overall survival (OS), disease-specific survival (DSS) and recurrence-free survival (RFS) rates were 61%, 74%, and 49%, respectively, and 51%, 63%, and 45% at 5 years. On univariate analysis, preoperative facial nerve dysfunction and intraoperative nerve sacrifice worsened OS, DSS, and RFS. Prior surgery and adjuvant radiation independently predicted reduced OS, DSS, and RFS on multivariate analysis. CONCLUSIONS Mortality is highest in the first 2 years following resection. Preoperative facial nerve dysfunction, facial nerve sacrifice, and prior radiation are negative predictors of survival and recurrence.
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Affiliation(s)
- Neila L Kline
- Department of Otorhinolaryngology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kavita Bhatnagar
- Department of Otorhinolaryngology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - David J Eisenman
- Department of Otorhinolaryngology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Rodney J Taylor
- Department of Otorhinolaryngology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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15
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Thompson JA, Lubek JE, Amin N, Joy R, Dyalram D, Ord RA, Taylor RJ, Wolf JS, Mehra R, Cullen KJ, Molitoris JK, Witek M, Papadimitriou JC, Morales RE, Hatten KM. Impact of the Novel Coronavirus 2019 (COVID-19) Pandemic on Head and Neck Cancer Care. Otolaryngol Head Neck Surg 2021; 166:93-100. [PMID: 33784206 PMCID: PMC8010374 DOI: 10.1177/01945998211004544] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Objective The study aimed to assess the impact of the coronavirus disease 2019
(COVID-19) pandemic on head and neck oncologic care at a tertiary care
facility. Study Design This was a cross-sectional study conducted between March 18, 2020, and May
20, 2020. The primary planned outcome was the rate of treatment
modifications during the study period. Secondary outcome measures were tumor
conference volume, operative volume, and outpatient patient procedure and
clinic volumes. Setting This single-center study was conducted at a tertiary care academic hospital
in a large metropolitan area. Methods The study included a consecutive sample of adult subjects who were presented
at a head and neck interdepartmental tumor conference during the study
period. Patients were compared to historical controls based on review of
operative data, outpatient procedures, and clinic volumes. Results In total, 117 patients were presented during the review period in 2020,
compared to 69 in 2019. There was an 8.4% treatment modification rate among
cases presented at the tumor conference. There was a 61.3% (347 from 898)
reduction in outpatient clinic visits and a 63.4% (84 from 230) reduction in
procedural volume compared to the prior year. Similarly, the operative
volume decreased by 27.0% (224 from 307) compared to the previous year. Conclusion Restrictions related to the COVID-19 pandemic resulted in limited treatment
modifications. Transition to virtual tumor board format observed an increase
in case presentations. While there were reductions in operative volume,
there was a larger proportion of surgical cases for malignancy, reflecting
the prioritization of oncologic care during the pandemic.
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Affiliation(s)
- Joshua Adam Thompson
- Department of Otorhinolaryngology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Joshua E Lubek
- Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Neha Amin
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Reju Joy
- Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Donita Dyalram
- Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Robert A Ord
- Department of Oral and Maxillofacial Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Rodney J Taylor
- Department of Otorhinolaryngology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jeffrey S Wolf
- Department of Otorhinolaryngology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ranee Mehra
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Kevin J Cullen
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Jason K Molitoris
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Matthew Witek
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - John C Papadimitriou
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Robert E Morales
- Department of Diagnostic Radiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kyle M Hatten
- Department of Otorhinolaryngology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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16
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Thompson JA, Joy R, Lubek JE, Mehra R, Molitoris JK, Taylor RJ, Wolf JS, Witek ME, Hatten KM. Abstract PO-017: Evaluating the impact of the coronavirus (COVID-19) pandemic on treatment paradigms in head and neck cancer at a tertiary care hospital. Clin Cancer Res 2020. [DOI: 10.1158/1557-3265.covid-19-po-017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objective: The study aimed to assess the impact of the coronavirus (COVID-19) pandemic on head and neck oncologic care at a tertiary care hospital. The pandemic caused by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) has led to policies designed to limit its spread. Policies including eliminating routine appointments, statewide stay-at-home orders, and restricting surgical cases to emergent surgeries have limited access to care. Therefore, we hypothesized that treatment modifications would be implemented for patients and cancer consultations would decrease compared to historical data.
Methods: Information regarding treatment modifications was collected prospectively during interdepartmental tumor conferences from March 18, 2020 to May 20, 2020. Information regarding patient demographics, tumor characteristics, and incidence of new cancer consultations was collected via chart review. Treatment modifications were categorized as follows: Elimination of Systemic Therapy, Treatment Delay, Change to Non-Surgical Management, or Alteration in Adjuvant Therapy. Rationales for modification were similarly grouped as follows: Operating Room Limitations, Medical Co-Morbidities, COVID-19 positive, Patient concern, or System limitations. We determined the rate of treatment modifications and the frequencies of rationales and modification types. Demographic and tumor characteristics were compared between this population and a retrospectively collected cohort from 2019.
Results: 117 patients were presented during the review period in 2020. There were 69 patients presented across the same time period in 2019. There were no differences in demographic characteristics between the groups. There was no difference between the tumor or nodal stages of the presented cases year over year. During the 2020 time period there were more total case presentations and new cancer cases compared to the 2019 time period. Of the 117 cases presented during the study period, there were 10/117 (8.4%) treatment modifications. The most common reason for modification was limited PPE supply. The most common modification was treatment delay. The second most common modification was change from primary surgical management to nonsurgical management. Treatment modifications occurred most commonly early in the review period and declined subsequently.
Conclusions: Despite the ongoing pandemic and resulting state and institutional restrictions, there was no appreciable reduction in new cancer consultations for head and neck cancer. There were a small number of treatment modifications, particularly early in the course of our state and institutional response to the virus. However, over the 2-month period examined, patient care for these patients remained largely unaffected. While the restriction in elective surgical care was implemented across the state of Maryland, the oncologic triage and emergency surgery prioritization sustained the volume of oncologic practice.
Citation Format: Joshua A. Thompson, Reju Joy, Joshua E. Lubek, Ranee Mehra, Jason K. Molitoris, Rodney J. Taylor, Jeffrey S. Wolf, Matthew E. Witek, Kyle M. Hatten. Evaluating the impact of the coronavirus (COVID-19) pandemic on treatment paradigms in head and neck cancer at a tertiary care hospital [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-017.
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Affiliation(s)
| | - Reju Joy
- University of Maryland Medical Center, Baltimore, MD
| | | | - Ranee Mehra
- University of Maryland Medical Center, Baltimore, MD
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Affiliation(s)
- M O Hope
- Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI 48109
| | - R J Taylor
- School of Social Work and Institute for Social Research, University of Michigan, Ann Arbor, MI 48109
| | - A W Nguyen
- Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH 44106
| | - L M Chatters
- School of Social Work, School of Public Health and Institute for Social Research, University of Michigan, Ann Arbor, MI 48109
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Fried MP, Kleefield J, Jolesz FA, Hsu L, Gopal HV, Deshmukh V, Taylor RJ, Morrison PR. Intraoperative Image Guidance during Endoscopic Sinus Surgery. ACTA ACUST UNITED AC 2018. [DOI: 10.2500/105065896781794860] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Endoscopic sinus surgery (ESS) is one of the most commonly performed procedures in otorhinolaryngology and is associated with a definite risk for both intraoperative and postoperative complications. Intraoperative image guidance is expected to have a major effect on procedures such as ESS by allowing the clinician to more efficiently remove pathology and by improving surgeon confidence and knowledge of anatomy, particularly in revision procedures or in patients with altered anatomy. As a consequence, complications during these pro-’ cedures will decrease and patient safety will increase. Several guidance modalities are available including computed tomography (CT), magnetic resonance imaging (MRI), and fluoroscopy. This article will describe current applications of each of these three techniques with respect to ESS while focusing on innovative techniques that use MRI and CT to provide intraoperative guidance with unmatched convenience, reliability, and utility.
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Affiliation(s)
- Marvin P. Fried
- Department of Otology & Laryngology, Harvard Medical School, Joint Center for Otolaryngology, Beth Israel Health Care, and Brigham & Women's Hospital, Boston, Massachusetts
| | - Jonathan Kleefield
- Department of Radiology, Beth Israel Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ferenc A. Jolesz
- Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, and Consultant Visualization Technology, Boston, Massachusetts
| | - Liangge Hsu
- Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, and Consultant Visualization Technology, Boston, Massachusetts
| | - Harsha V. Gopal
- Department of Otology & Laryngology, Harvard Medical School, Joint Center for Otolaryngology, Beth Israel Health Care, and Brigham & Women's Hospital, Boston, Massachusetts
| | - Vivek Deshmukh
- University of Florida College of Medicine, Gainesville, Florida
| | | | - Paul R. Morrison
- Department of Otology & Laryngology, Harvard Medical School, Joint Center for Otolaryngology, Beth Israel Health Care, and Brigham & Women's Hospital, Boston, Massachusetts
- Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, and Consultant Visualization Technology, Boston, Massachusetts
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Tkaczuk AT, Taylor RJ, Wolf JS. A Novel Device for Placement of a Secondary Tracheoesophageal Voice Prosthesis: A Preliminary Feasibility Study. ORL J Otorhinolaryngol Relat Spec 2018; 80:36-40. [PMID: 29590652 DOI: 10.1159/000485513] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 11/20/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Tracheoesophageal puncture (TEP) for post-laryngectomy speech rehabilitation can be performed at the time of laryngectomy (primary) or at a subsequent time (secondary). Traditionally, the secondary procedure is performed using a rigid esophagoscope. Diseases like esophageal stricture, limited neck extension, and soft-tissue fibrosis can make this procedure technically challenging or impossible. We developed a novel device to perform a secondary tracheoesophageal puncture using a flexible esophagoscope. OBJECTIVE To test the feasibility of a novel device used to create a secondary TEP in post-laryngectomy cadavers. METHODS In this study, we performed a total laryngectomy on 3 fresh cadavers to establish the feasibility of our prototype. In each cadaver, a flexible esophagoscope was passed into the pharynx with the prototype. The prototype was passed through a working port and deployed to distend the esophagus. The puncture was visualized and a wire was passed via the newly established fistula. The device was activated, securing the wire, and then the esophagoscope and device were removed. RESULTS There was 100% successful deployment of the prototype device, allowing rapid creation of the puncture and security of the guide wire in each cadaver. There was no evidence of collateral mucosal injury or esophageal perforation. CONCLUSIONS The prototype device offers an alternative method to safely and efficiently perform a secondary TEP without the requirement of rigid esophagoscopy which can sometimes be technically impossible in this patient population.
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Zegard A, Umar F, Taylor RJ, Acquaye E, Gubran C, Chalil S, Patel K, Panting J, Marshall H, Qiu T, Leyva F. 667Long-term clinical outcomes of cardiac resynchronization therapy with or without defibrillation: impact of the aetiology of cardiomyopathy. Europace 2018. [DOI: 10.1093/europace/euy015.341] [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: 11/12/2022] Open
Affiliation(s)
- A Zegard
- Aston University, Birmingham, United Kingdom
| | - F Umar
- Centre for Cardiovascular Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - R J Taylor
- Centre for Cardiovascular Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - E Acquaye
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - C Gubran
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - S Chalil
- Centre for Cardiovascular Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - K Patel
- Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - J Panting
- Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - H Marshall
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - T Qiu
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - F Leyva
- Aston University, Birmingham, United Kingdom
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Khatri R, Arad M, Ortlip T, Portney BA, Meltzer WA, Diaconu S, Silipino LE, Wang Y, Kaetzel DM, Taylor RJ, Zalzman M. Harvesting multipotent progenitor cells from a small sample of tonsillar biopsy for clinical applications. Stem Cell Res Ther 2017; 8:174. [PMID: 28750664 PMCID: PMC5531028 DOI: 10.1186/s13287-017-0619-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 02/13/2017] [Revised: 05/19/2017] [Accepted: 06/23/2017] [Indexed: 12/31/2022] Open
Abstract
Background Human adult stem cells hold the potential for the cure of numerous conditions and degenerative diseases. They possess major advantages over pluripotent stem cells as they can be derived from donors at any age, and therefore pose no ethical concerns or risk of teratoma tumor formation in vivo. Furthermore, they have a natural ability to differentiate and secrete factors that promote tissue healing without genetic manipulation. However, at present, clinical applications of adult stem cells are limited by a shortage of a reliable, standardized, and easily accessible tissue source which does not rely on specimens discarded from unrelated surgical procedures. Method Human tonsil-derived mesenchymal progenitor cells (MPCs) were isolated from a small sample of tonsillar tissue (average 0.88 cm3). Our novel procedure poses a minimal mechanical and enzymatic insult to the tissue, and therefore leads to high cell viability and yield. We characterized these MPCs and demonstrated robust multipotency in vitro. We further show that these cells can be propagated and maintained in xeno-free conditions. Results We have generated tonsillar biopsy-derived MPC (T-MPC) lines from multiple donors across a spectrum of age, sex, and race, and successfully expanded them in culture. We characterized them by cell surface markers, as well as in vitro expansion and differentiation potential. Our procedure provides a robust yield of tonsillar biopsy-derived T-MPCs. Conclusions Millions of MPCs can be harvested from a sample smaller than 1 g, which can be collected from a fully awake donor in an outpatient setting without the need for general anesthesia or hospitalization. Our study identifies tonsillar biopsy as an abundant source of adult MPCs for regenerative medicine. Electronic supplementary material The online version of this article (doi:10.1186/s13287-017-0619-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Raju Khatri
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Michal Arad
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Timothy Ortlip
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.,Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, 108 N. Greene Street, Baltimore, MD, 21201, USA
| | - Benjamin A Portney
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - W Alex Meltzer
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Silviu Diaconu
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.,Division of Plastic, Reconstructive, & Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, Baltimore, MD, 21201, USA
| | - Lorna E Silipino
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, 108 N. Greene Street, Baltimore, MD, 21201, USA
| | - Ying Wang
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - David M Kaetzel
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.,The Center for Stem Cell Biology and Regenerative Medicine, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.,Marlene and Stewart Greenbaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Rodney J Taylor
- Marlene and Stewart Greenbaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.,Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, 108 N. Greene Street, Baltimore, MD, 21201, USA
| | - Michal Zalzman
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA. .,The Center for Stem Cell Biology and Regenerative Medicine, University of Maryland School of Medicine, Baltimore, MD, 21201, USA. .,Marlene and Stewart Greenbaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD, 21201, USA. .,Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, 108 N. Greene Street, Baltimore, MD, 21201, USA.
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Abstract
OBJECTIVES To determine the accuracy of weighing ventilated infants on incubator scales and whether the accuracy can be improved by the addition of a ventilator tube compensator (VTC) device to counterbalance the force exerted by the ventilator tubing. STUDY DESIGN Body weights on integral incubator scales were compared in ventilated infants (with and without a VTC), with body weights on standalone electronic scales (true weight). Individual and series of trend weights were obtained on the infants. The method of Bland and Altman was used to assess the introduced bias. RESULTS The study included 60 ventilated infants; 66% of them weighed <1000 g. A total of 102 paired-weight datasets for 30 infants undergoing conventional ventilation and 30 undergoing high frequency oscillator ventilation (HFOV) supported by a SensorMedics oscillator, (with and without a VTC) were obtained. The mean differences and (95% CI for the bias) between the integral and true scale weighing methods was 60.8 g (49.1 g to 72.5 g) without and -2.8 g (-8.9 g to 3.3 g) with a VTC in HFOV infants; 41.0 g (32.1 g to 50.0 g) without and -5.1 g (-9.3 g to -0.8 g) with a VTC for conventionally ventilated infants. Differences of greater than 2% were considered clinically relevant and occurred in 93.8% without and 20.8% with a VTC in HFOV infants and 81.5% without and 27.8% with VTC in conventionally ventilated infants. CONCLUSIONS The use of the VTC device represents a substantial improvement on the current practice for weighing ventilated infants, particularly in the extreme preterm infants where an over- or underestimated weight can have important clinical implications for treatment. A large-scale clinical trial to validate these findings is needed.
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Affiliation(s)
- Ula El-Kafrawy
- Neonatal Intensive Care Unit, Royal Bolton Hospital, Bolton, UK
| | - R J Taylor
- Department of Medical Physics, Salford Royal NHS Foundation Trust, Salford, UK
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Emons MF, Bae JP, Hoogwerf BJ, Kindermann SL, Taylor RJ, Nathanson BH. Risk factors for 30-day readmission following hypoglycemia-related emergency room and inpatient admissions. BMJ Open Diabetes Res Care 2016; 4:e000160. [PMID: 27110366 PMCID: PMC4838663 DOI: 10.1136/bmjdrc-2015-000160] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 01/29/2016] [Accepted: 03/04/2016] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Hypoglycemia is a serious complication of diabetes treatment. This retrospective observational study characterized hypoglycemia-related hospital emergency room (ER) and inpatient (in-pt) admissions and identified risk factors for 30-day all-cause and hypoglycemia-related readmission. RESEARCH DESIGN AND METHODS 4476 hypoglycemia-related ER and in-pt encounters with discharge dates from 1/1/2009 to 3/31/2014 were identified in a large, multicenter electronic health record database. Outcomes were 30-day all-cause ER/hospital readmission and hypoglycemia-related readmission. Multivariable logistic regression methods identified risk factors for both outcomes. RESULTS 1095 (24.5%) encounters had ER/hospital all-cause readmission within 30 days and 158 (14.4%) of these were hypoglycemia-related. Predictors of all-cause 30-day readmission included recent exposure to a hospital/nursing home (NH)/skilled nursing facility (SNF; OR 1.985, p<0.001); age 25-34 and 35-44 (OR 2.334 and 1.996, respectively, compared with age 65-74, both p<0.001); and African-American (AA) race versus all other race categories (OR 1.427, p=0.011). Other factors positively associated with readmission include chronic obstructive pulmonary disease, cerebrovascular disease, cardiac dysrhythmias, congestive heart disease, hypertension, and mood disorders. Predictors of readmissions attributable to hypoglycemia included recent exposure to a hospital/NH/SNF (OR 2.299, p<0.001), AA race (OR 1.722, p=0.002), age 35-44 (OR 3.484, compared with age 65-74, p<0.001), hypertension (OR 1.891, p=0.019), and delirium/dementia and other cognitive disorders (OR 1.794, p=0.038). Obesity was protective against 30-day hypoglycemia-related readmission (OR 0.505, p=0.017). CONCLUSIONS Factors associated with 30-day all-cause and hypoglycemia-related readmission among patients with diabetic hypoglycemia include recent exposure to hospital/SNF/NH, adults <45 years, AAs, and several cardiovascular and respiratory-related comorbid conditions.
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Abstract
BACKGROUND Non-freezing cold injury (NFCI) is a syndrome in which damage to peripheral tissues occurs without the tissues freezing following exposure to low ambient temperatures. AIMS To assess the test-retest reliability of a cold stress test (CST) used to assess cold sensitization. METHODS Volunteers with no self-reported history of NFCI undertook the CST on three occasions. Thermal images were taken of the foot and hand before, immediately after and 5min after immersion of the limb in cold water for 2min. Cold sensitization was graded by the two clinicians and the lead author. Spot temperatures from the toe and finger pads were recorded. RESULTS There were 30 white and 19 black male participants. The ratings indicated substantial agreement [a Cohen's kappa (κ) value of 0.61-0.8] to within ± one grading category for the hands and feet of the white volunteers and the hands of the black volunteers. Limits of agreement (LoA) analysis for toe and finger pad temperatures indicated high agreement (absolute 95% LoA < 5.5°C). Test-retest reliability for the feet of the black volunteers was not supported by the gradings (κ = 0.38) and toe pad temperatures (absolute 95% LoA = 9.5°C and coefficient of variation = 11%). CONCLUSIONS The test-retest reliability of the CST is considered adequate for the assessment of the cold sensitization of the hands and feet of white and the hands of black healthy non-patients. The study should be repeated with patients who have suffered a NFCI.
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Affiliation(s)
- C M House
- Environmental Medicine and Science, Institute of Naval Medicine, Gosport PO12 2EG, UK,
| | - R J Taylor
- Environmental Medicine and Science, Institute of Naval Medicine, Gosport PO12 2EG, UK, Navy Physical Development, HMS Temeraire, Portsmouth PO1 2HB, UK
| | - E H N Oakley
- Environmental Medicine and Science, Institute of Naval Medicine, Gosport PO12 2EG, UK
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25
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Taylor RJ, Saloura V, Jain A, Goloubeva O, Wong S, Kronsberg S, Nagilla M, Silpino L, de Souza J, Seiwert T, Vokes E, Villaflor V, Cohen EEW. Ex vivo antibody-dependent cellular cytotoxicity inducibility predicts efficacy of cetuximab. Cancer Immunol Res 2015; 3:567-74. [PMID: 25769300 PMCID: PMC4681575 DOI: 10.1158/2326-6066.cir-14-0188] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 01/29/2015] [Indexed: 01/14/2023]
Abstract
We conducted in vitro studies and a clinical trial for patients with squamous cell carcinoma of the head and neck (SCCHN) to study the relationship between FcγRIIIa polymorphisms and antibody-dependent cellular cytotoxicity (ADCC). In vitro, FcγRIIIa genotype was correlated with ADCC and innate cytotoxicity using natural killer (NK) cells harvested from healthy donors. In the phase II study, patients with recurrent or metastatic SCCHN were treated with cetuximab (500 mg/m(2) i.v. every 2 weeks) and lenalidomide (25 mg daily). FcγRIIIa genotype and ex vivo ADCC were correlated with clinical response, progression-free survival (PFS), and overall survival (OS). In vitro, healthy donors with a FcγRIIIa 158-V allele demonstrated more effective ADCC against two colon cancer cell lines HT29 and SW480, mean cytotoxicity: FF 16.1%, VF/VV 24.3% (P = 0.015) and FF 11.7%, VF/VV 21.0% (P = 0.008), respectively. We observed a linear relationship between ADCC response and innate cytotoxicity. In the phase II trial, 40 patients received cetuximab and lenalidomide with median PFS of 7.2 weeks and OS of 16.4 weeks. Thirty-six patients had FcγRIIIa genotype: VV (2), VF (20), and FF (14), and 25 patients had sufficient NK-cell yield to perform ex vivo ADCC. FcγRIIIa genotype was not associated with any clinical outcomes. Patients mounting ex vivo ADCC response had a higher likelihood of stable disease (P = 0.01) and showed a trend toward increased PFS: 14 weeks versus 6.8 weeks, respectively (P = 0.13). Enhanced ex vivo ADCC and innate immunity responses were more predictive of clinical response than FcγRIIIa and may offer a functional assay to select patients suitable for cetuximab therapy.
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Affiliation(s)
- Rodney J Taylor
- University of Maryland School of Medicine Greenebaum Cancer Center, Baltimore, Maryland.
| | | | - Ajay Jain
- University of Maryland School of Medicine Greenebaum Cancer Center, Baltimore, Maryland
| | - Olga Goloubeva
- University of Maryland School of Medicine Greenebaum Cancer Center, Baltimore, Maryland
| | - Stuart Wong
- Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Shari Kronsberg
- University of Maryland School of Medicine Greenebaum Cancer Center, Baltimore, Maryland
| | - Madhavi Nagilla
- University of Chicago Department of Medicine, Chicago, Illinois
| | - Lorna Silpino
- University of Maryland School of Medicine Greenebaum Cancer Center, Baltimore, Maryland
| | - Jonas de Souza
- University of Chicago Department of Medicine, Chicago, Illinois. University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | - Tanguy Seiwert
- University of Chicago Department of Medicine, Chicago, Illinois. University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | - Everett Vokes
- University of Chicago Department of Medicine, Chicago, Illinois. University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | - Victoria Villaflor
- University of Chicago Department of Medicine, Chicago, Illinois. University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | - Ezra E W Cohen
- University of California San Diego Moores Cancer Center, La Jolla, California
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Moody WE, Edwards NC, Chue CD, Taylor RJ, Ferro CJ, Townend JN, Steeds RP. Variability in cardiac MR measurement of left ventricular ejection fraction, volumes and mass in healthy adults: defining a significant change at 1 year. Br J Radiol 2015; 88:20140831. [PMID: 25710361 DOI: 10.1259/bjr.20140831] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Variability in the measurement of left ventricular (LV) parameters in cardiovascular imaging has typically been assessed over a short time interval, but clinicians most commonly compare results from studies performed a year apart. To account for variation in technical, procedural and biological factors over this time frame, we quantified the within-subject changes in LV volumes, LV mass (LVM) and LV ejection fraction (EF) in a well-defined cohort of healthy adults at 12 months. METHODS Cardiac MR (CMR) was performed in 42 healthy control subjects at baseline and at 1 year (1.5 T Magnetom® Avanto; Siemens Healthcare, Erlangen, Germany). Analysis of steady-state free precession images was performed manually offline (Argus software; Siemens Healthcare) for assessment of LV volumes, LVM and EF by a single blinded observer. A random subset of 10 participants also underwent repeat imaging within 7 days to determine short-term interstudy reproducibility. RESULTS There were no significant changes in any LV parameter on repeat CMR at 12 months. The short-term interstudy biases were not significantly different from the long-term changes observed at 1 year. The smallest detectable change (SDC) for LVEF, end-diastolic volume, end-systolic volume and LVM that could be recognized with 95% confidence were 6%, 13 ml, 7 ml and 6 g, respectively. CONCLUSION The variability in CMR-derived LV measures arising from technical, procedural and biological factors remains minimal at 12 months. Thus, for patients undergoing repeat annual assessment by CMR, even small differences in LV function, size and LVM (which are greater than the SDC) may be attributed to disease-related factors. ADVANCES IN KNOWLEDGE The reproducibility and reliability of CMR data at 12 months is excellent allowing clinicians to be confident that even small changes in LV structure and function over this time frame are real.
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Affiliation(s)
- W E Moody
- 1 Birmingham CardioRenal Group, Centre for Clinical Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, UK
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Patel AP, Gandhi D, Taylor RJ, Woodworth G. Use of Dyna CT in evaluation and treatment of pseudoaneurysm secondary to craniofacial tumor resection: Case report and diagnostic implications. Surg Neurol Int 2014; 5:48. [PMID: 24818055 PMCID: PMC4014819 DOI: 10.4103/2152-7806.130561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 02/18/2014] [Indexed: 11/08/2022] Open
Abstract
Background: Digital subtraction angiography (DSA) is considered the gold standard for the evaluation of head and neck vascular abnormalities. It serves as a useful diagnostic and, in many cases, therapeutic tool for treatment of acute head and neck bleeding. Case Description: We report the case of a patient who presented with life threatening, uncontrollable epistaxis several weeks after resection of a large recurrent chondrosarcoma of the nasal cavity and anterior skull base. A DSA study, with an adjunctive C-arm computed tomography (CT) (Dyna CT), was ultimately helpful in revealing and precisely localizing a large anterior ethmoidal artery pseudoaneurysm adjacent to the tumor resection cavity. Conclusion: This additional information helped define the arterial anatomy in postoperative region, allowed precise localization and direct ligation of the pseudoaneurysm to resolve the bleeding with a favorable patient outcome.
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Affiliation(s)
- Akil P Patel
- Department of Neurosurgery, University of Maryland, Medical Center, Baltimore, Maryland, USA
| | - Dheeraj Gandhi
- Department of Neuro-Interventional Radiology, University of Maryland, Medical Center, Baltimore, Maryland, USA
| | - Rodney J Taylor
- Department of Otolaryngology, University of Maryland, Medical Center, Baltimore, Maryland, USA
| | - Graeme Woodworth
- Department of Neurological Surgery, University of Maryland, School of Medicine, Baltimore, Maryland, USA
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Thomas AN, Taylor RJ. An analysis of patient safety incidents associated with medications reported from critical care units in the North West of England between 2009 and 2012. Anaesthesia 2014; 69:735-45. [PMID: 24810765 DOI: 10.1111/anae.12670] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2014] [Indexed: 11/28/2022]
Abstract
Incident reporting is promoted as a key tool for improving patient safety in healthcare. We analysed 2238 patient safety incidents involving medications submitted from up to 29 critical care units each year in the North West of England between 2009 and 2012; 452 (20%) of these incidents led to harm to patients. Although 1461 (65%) incidents were judged to have been preventable, there was no reduction in the rate of incidents per 1000 days between 2009 and 2012 (5.9 in 2009, 6.6 in 2012). Furthermore, in the 2012 data, there were wide variations in the incident rates between units, the median (IQR [range]) rate per 1000 patient days for individual units being 6.8 (3.8-11.0 [1.3-37.1]). The variation in the percentage that could have been avoided was narrower, with a median (IQR [range]) of 70% (61-80% [38-100%]). The most commonly reported drugs were noradrenaline (161 incidents, 92 with harm), heparins (153 incidents, 29 with harm), morphine (131 incidents, 14 with harm) and insulin (111 incidents, 54 with harm). The administration of drugs was the stage in the process where incidents were most commonly reported; it was also the stage most likely to harm patients. We conclude that the wide range in reported rates between units, and the scope for preventing many incidents, suggest that quality improvement initiatives could improve medication safety in the units studied.
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Affiliation(s)
- A N Thomas
- Salford Royal NHS Foundation Trust, Salford, UK
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Taylor RJ, Umar F, Moody WE, Townend J, Steeds RP, Leyva F. 102 THE REPRODUCIBILITY AND ANALYSIS TIME OF CARDIAC MAGNETIC RESONANCE FEATURE TRACKING: POTENTIAL FOR CLINICAL APPLICATION. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Moody WE, Taylor RJ, Edwards NC, Chue CD, Umar F, Ferro CJ, Townend JN, Leyva F, Steeds RP. 101 VALIDATION OF MAGNETIC RESONANCE FEATURE TRACKING FOR LONGITUDINAL SYSTOLIC AND DIASTOLIC STRAIN CALCULATION WITH SPATIAL MODULATION OF MAGNETISATION IMAGING ANALYSIS. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Umar F, Taylor RJ, Vakharia A, Marshall H, Leyva FL. 002 IMPLANTABLE CARDIOVERTER DEFIBRILLATOR THERAPY OR CARDIAC RESYNCHRONISATION THERAPY WITH DEFIBRILLATION IN PATIENTS WITH LEFT VENTRICULAR DYSFUNCTION: A COST-IMPACT STUDY. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ambro BT, Goodstein LA, Morales RE, Taylor RJ. Evaluation of superficial musculoaponeurotic system flap and fat graft outcomes for benign and malignant parotid disease. Otolaryngol Head Neck Surg 2013; 148:949-54. [PMID: 23358951 DOI: 10.1177/0194599812474969] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE (1) To evaluate the effectiveness of the superficial musculoaponeurotic system (SMAS) flap and free fat graft in reconstructing the parotidectomy defect. (2) To evaluate the long-term viability of the free fat graft following parotidectomy for benign and malignant disease, including in the postradiation setting. STUDY DESIGN Prospective study of consecutive patients. SETTING Academic tertiary care medical center. Subjects and Methods Thirty-one consecutive patients underwent parotidectomy with SMAS flap and free fat graft reconstruction from 2006 to 2012. Data were compiled through a manual chart review. RESULTS Twenty-three of the 31 total patients had benign disease, including pleomorphic adenoma, oncocytoma, and Warthin tumor. The 8 remaining patients (9 parotidectomies) underwent surgery for malignant disease, followed by postoperative radiation. The average age was 56 years (range, 16-84 years). The mean follow-up was 22.5 months. Satisfactory volumetric symmetry was achieved in all procedures for benign and malignant disease. Magnetic resonance imaging confirmed long-term fat graft viability in the postradiation setting. There was 1 case of Frey syndrome and no cases of unexpected, permanent facial nerve weakness among the patients. CONCLUSION The combined technique of SMAS flap and free fat graft is effective for immediate reconstruction of the parotidectomy defect with minimal morbidity and low complication rates. This study demonstrates long-term viability of the free fat graft even in the setting of postoperative radiation.
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Affiliation(s)
- Bryan T Ambro
- Department of Otorhinolaryngology, University of Maryland, Baltimore, Maryland, USA
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Goodstein L, Ambro BT, Morales RE, Taylor RJ. Use of SMAS Flap and Fat Graft: Viability and Effectiveness. Otolaryngol Head Neck Surg 2012. [DOI: 10.1177/0194599812451438a24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: 1) Evaluate the effectiveness of the superficial musculoaponeurotic system (SMAS) flap and free fat graft in reconstructing the parotidectomy defect. 2) Evaluate the long-term viability of the free fat graft, including in the setting of postoperative radiation. Method: A prospective, consecutive analysis of patients undergoing parotidectomy for benign and malignant disease from 2006-2011 was performed at an academic university setting. The main outcome measures were the effectiveness of achieving symmetric volume of the ipsilateral parotid defect, long-term viability of the free fat graft, and presence of Frey’s syndrome. Results: Twenty-four consecutive patients received parotidectomy with SMAS flap and free fat graft from 2006-2011. The average age was 56 (range 16-84). Nineteen patients had benign disease, including pleomorphic adenoma, oncocytoma, and Warthin tumor. Five procedures were done for malignant disease, and, in each instance, postoperative radiation was administered. Satisfactory volumetric symmetry was achieved in all procedures for benign and malignant disease. MRI imaging confirmed graft viability even in the setting of postoperative radiation. There was 1 case of Frey’s syndrome and no instances of long-term facial weakness among the patients. Conclusion: The SMAS flap and free fat graft are an effective approach to reconstructing the parotidectomy defect with minimal morbidity and complication. This study demonstrates long-term viability of the free fat graft in the setting of postoperative radiation. Reconstruction reduces the rate of Frey’s syndrome compared to historic rates following surgery.
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Abstract
We categorised and established the rates of patient safety incidents reported during 2009 and 2010 from critical care units in 12 hospital trusts in North-West England. We identified a total of 4219 incidents reported during 127, 467 calendar days of critical care with a median (IQR [range]) of 31 (26-45 [20-57]) incidents per 1000 days per trust. A median (IQR [range]) of 10 (7-13 [3.5-27]) incidents per 1000 days were associated with harm. Pressure sores were the most common cause of harm, with a median (IQR [range]) of 3.9 (1.0-6.6 [0-20.4]) incidents per 1000 days. Only 89 (2.1%) incidents described more than temporary harm, of which 12 were airway related incidents. Five incidents described the use of inappropriate arterial flush solutions. It is possible to compare rates of incident reporting in different trusts over time to determine if different methods of care are associated with different reporting rates. The wide range of reported pressure sore rates suggests that their incidence could be reduced.
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Affiliation(s)
- A N Thomas
- Department of Medical Physics, Salford Royal NHS Foundation Trust, Salford, UK.
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Chaffin MK, Fajt V, Martens RJ, Arnold CE, Cohen ND, O'Conor M, Taylor RJ, Bernstein LR. Pharmacokinetics of an orally administered methylcellulose formulation of gallium maltolate in neonatal foals. J Vet Pharmacol Ther 2011; 33:376-82. [PMID: 20646200 DOI: 10.1111/j.1365-2885.2009.01150.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Gallium is a trivalent semi-metal with anti-microbial effects because of its incorporation into crucial iron-dependent reproductive enzyme systems. Gallium maltolate (GaM) provides significant gallium bioavailability to people and mice following oral administration and to neonatal foals following intragastric administration. To study the prophylactic and therapeutic effects of GaM against Rhodococcus equi pneumonia in foals, we developed a methylcellulose formulation of GaM (GaM-MCF) for oral administration to neonatal foals. Normal neonatal foals were studied. Six foals received 20 mg/kg and another six foals received 40 mg/kg of GaM-MCF orally. Serial serum samples were collected and serum gallium concentrations were determined using inductively coupled plasma mass spectroscopy. Gallium was rapidly absorbed (T(max) of 4 h), and a mean C(max) of 0.90 or 1.8 microg/mL was achieved in foals receiving 20 or 40 mg/kg respectively. Marked variability existed in C(max) among foals: only half of the foals receiving 20 mg/kg attained serum concentrations of >0.7 microg/mL, a level suggested to be therapeutic against R. equi by previous studies. Mean elimination half-life was 32.8 or 32.4 h for foals receiving 20 or 40 mg/kg respectively. The results of this study suggest that at least 30 mg/kg orally every 24 h should be considered in future pharmacodynamic and efficacy studies.
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Affiliation(s)
- M K Chaffin
- Department of Large Animal Clinical Sciences, Equine Infectious Disease Laboratory, Texas A&M University, College Station, TX, USA.
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Woolfson LM, Taylor RJ, Mooney L. Parental attributions of controllability as a moderator of the relationship between developmental disability and behaviour problems. Child Care Health Dev 2011; 37:184-94. [PMID: 20533916 DOI: 10.1111/j.1365-2214.2010.01103.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Children with developmental disabilities present behaviour problems to a greater extent than do typically developing children. Psychosocial models of child development suggest that parental attributions of child and adult controllability could moderate this relationship between child disability status and behaviour. METHODS The influence of parental attributions of adult and child controllability on the relationship between problem behaviours and disability was explored in mothers of children with developmental disabilities (DD) (N = 20) with a mean age of 9 years 3 months (SD 24.6 months), and in mothers of typically developing (TD) children (N = 26) with a mean age of 9 years 4 months (standard deviation 23.7 months). The DD group comprised 11 children with autistic spectrum disorders or other communication impairments, three children with Down Syndrome, one with cerebral palsy, one with attentional problems, and four with specific or complex developmental problems. Child behaviour was measured by the Child Behaviour Checklist. Parental attributions were measured using a modified version of the Parent Attribution Test and mothers were divided into higher and lower controllability groups on the basis of their responses on this test. RESULTS Multivariate analysis of variance found significant group × adult controllability interaction effects for 'aggressive behaviour', 'rule-breaking behaviour', as well as borderline significant effects for 'social problems' and 'other problems'. Simple effects analysis suggested that when mothers had lower attributions of adult controllability, there were indeed significantly more problem behaviours in the DD group, but when mothers had attributions of higher adult controllability there was no longer any significant difference in problematic behaviour between the two groups. CONCLUSIONS Parental attributions of controllability may moderate the well-established effect of disability on problem behaviour. Implications for parent intervention programmes are discussed.
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Affiliation(s)
- L M Woolfson
- Department of Psychology, University of Strathclyde, Glasgow, UK.
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Bond CM, Sinclair HK, Winfield AJ, Taylor RJ. Community pharmacists' attitudes to their advice-giving role and to the deregulation of medicines. International Journal of Pharmacy Practice 2011. [DOI: 10.1111/j.2042-7174.1993.tb00715.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abstract
The attitudes of pharmacists towards their advisory role and to the further deregulation of medicines have been surveyed using a postal questionnaire distributed to a randomly selected 20 per cent (227) of all community pharmacies in Scotland (response rate 90 per cent). Half the pharmacists thought that their role had changed since the publication of the Nuffield report in 1987, 81 per cent that their role was restricted by the range of drugs available for over-the-counter sale, and 93 per cent that they would like to see their role extended by the further deregulation of medicines; fifty eight per cent agreed that there should be a nursing formulary and 74 per cent that a corresponding pharmacists' formulary should be established. Pharmacists were also asked to suggest target preparations for deregulation: ninety per cent suggested at least one preparation, with chloramphenicol eye ointment and drops being the most frequently cited.
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Affiliation(s)
- C M Bond
- Department of General Practice, University of Aberdeen
| | - H K Sinclair
- Department of General Practice, University of Aberdeen
| | - A J Winfield
- School of Pharmacy, Robert Gordon's Institute of Technology, Aberdeen
| | - R J Taylor
- Department of General Practice, University of Aberdeen
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Martens RJ, Cohen ND, Fajt VR, Nerren JR, Chaffin MK, Taylor RJ, Bernstein LR. Gallium maltolate: safety in neonatal foals following multiple enteral administrations. J Vet Pharmacol Ther 2010; 33:208-12. [PMID: 20444048 DOI: 10.1111/j.1365-2885.2009.01121.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- R J Martens
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA.
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Pasche JS, Taylor RJ, Gudmestad NC. Colonization of Potato by Colletotrichum coccodes: Effect of Soil Infestation and Seed Tuber and Foliar Inoculation. Plant Dis 2010; 94:905-914. [PMID: 30743559 DOI: 10.1094/pdis-94-7-0905] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Colonization of potato (Solanum tuberosum) tissue, including roots, stolons, and above and below ground stems, by Colletotrichum coccodes, the causal agent of black dot, was evaluated following soil infestation, inoculation of seed tubers and foliage, and every combination thereof, in field trials over two growing seasons in North Dakota and Minnesota. A total of 107,520 isolations for C. coccodes performed across four site-years allowed for an extensive comparison of fungal colonization of the host plant and disease severity. The black dot pathogen was detected in potato stems at the first sampling date in all four site-years, as early as 14 days prior to emergence. Colonization of above and below ground stems occurred at a higher frequency than in roots and stolons in all four site-years, resulting in significantly higher relative area under the colonization progress curves (RAUCPCs) (α = 0.05). Although fungal colonization and disease incidence were higher in inoculated and/or infested treatments, sufficient natural inoculum was present to result in substantial levels of disease in noninoculated and noninfested plots. However, noninoculated and noninfested plots displayed the lowest RAUCPC values across three of four site-years and those treatments with multiple inoculation events tended to have higher RAUCPC values. Isolates belonging to vegetative compatibility group (VCG)2 and -5 were recovered from plants sampled in 2004 more frequently than isolates belonging to VCG1 and -3. A significant difference in disease incidence on stems was observed only in North Dakota in 2004 and Minnesota in 2003 (α = 0.05). Noninoculated and noninfested plots displayed the lowest disease incidence, whereas those treatments with more than one inoculation and/or infestation event tended to have higher disease incidence. Results of this study, including the disease severity and yield data, provide a better understanding of colonization of potato plants by C. coccodes and its impact.
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Affiliation(s)
- J S Pasche
- Department of Plant Pathology, North Dakota State University, Fargo 58102
| | - R J Taylor
- Department of Plant Pathology, North Dakota State University, Fargo 58102
| | - N C Gudmestad
- Department of Plant Pathology, North Dakota State University, Fargo 58102
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Thomas AN, Panchagnula U, Taylor RJ. Review of patient safety incidents submitted from Critical Care Units in England & Wales to the UK National Patient Safety Agency. Anaesthesia 2009; 64:1178-85. [PMID: 19825051 DOI: 10.1111/j.1365-2044.2009.06065.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We reviewed and classified all patient safety incidents submitted from critical care units in England and Wales to the National Patient Safety Agency for the first quarter of 2008. A total of 6649 incidents were submitted from 141 organisations (median (range) 23 (1-268 incidents)); 786 were unrelated to the critical care episode and 248 were repeat entries. Of the remaining 5615 incidents, 1726 occurred in neonates or babies, 1298 were associated with temporary harm, 15 with permanent harm and 59 required interventions to maintain life or may have contributed to the patient's death. The most common main incident groups were medication (1450 incidents), infrastructure and staffing (1289 incidents) and implementation of care (1047 incidents). There were 2789 incidents classified to more than one main group. The incident analysis highlights ways to improve patient safety and to improve the classification of incidents.
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Affiliation(s)
- A N Thomas
- Intensive Care Unit, Salford Royal Hospitals NHS Foundation Trust, Salford, UK.
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Taylor RJ, Chan SL, Wood A, Voskens CJ, Wolf JS, Lin W, Chapoval A, Schulze DH, Tian G, Strome SE. FcγRIIIa polymorphisms and cetuximab induced cytotoxicity in squamous cell carcinoma of the head and neck. Cancer Immunol Immunother 2009. [DOI: 10.1007/s00262-009-0720-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Taylor RJ, Chan SL, Wood A, Voskens CJ, Wolf JS, Lin W, Chapoval A, Schulze DH, Tian G, Strome SE. FcgammaRIIIa polymorphisms and cetuximab induced cytotoxicity in squamous cell carcinoma of the head and neck. Cancer Immunol Immunother 2009; 58:997-1006. [PMID: 18979096 PMCID: PMC11030953 DOI: 10.1007/s00262-008-0613-3] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Accepted: 10/08/2008] [Indexed: 01/11/2023]
Abstract
PURPOSE The interaction of Fc fragments of antibodies with the Fcgamma receptors is an essential checkpoint in antibody-dependent cellular cytotoxicity (ADCC). Specific polymorphisms at position 158 enhance FcgammaRIIIa affinity for IgG1 and are associated with improved clinical outcome in lymphoma patients treated with IgG1 anti-CD20 antibody. The role of ADCC in the therapeutic effects of the alpha-epidermal growth factor receptor (EGFR) mAb, cetuximab, in patients with squamous cell carcinoma of the head and neck (SCCHN) is poorly defined. We employed three SCCHN cell lines to test two hypotheses: (1) SCCHN is susceptible to cetuximab-mediated ADCC, (2) efficacy of ADCC is associated with polymorphisms at position 158 of FcgammaRIIIa. EXPERIMENTAL DESIGN FcgammaRIIIa-158 polymorphisms were determined for healthy donors, and their purified NK cells were used as effector cells against three SCCHN cell lines in ADCC assays. Cytotoxicity levels were compared for each polymorphism class. Proliferation and cell cycle assays were done to examine the direct effects of cetuximab. RESULTS Our results indicate that SCCHN is susceptible to cetuximab-mediated ADCC in vitro. NK cytotoxic efficiency correlates with donor 158-polymorphisms in FcgammaRIIIa. Overall cytotoxicity was greatest for individuals having a single V allele when compared to homozygous F/F individuals; the cumulative percent cytotoxicity for each polymorphism among the cell lines was 58.2% V/V, 50.6% V/F, and 26.1% F/F (P < 0.001). Additionally, the presence of a V allele correlated with superior natural cytotoxicity against NK sensitive targets. CONCLUSION These data have both prognostic and therapeutic relevance and support the design of a prospective trial to determine the influence of FcgammaRIIIa polymorphisms on the clinical outcome of patients with SCCHN treated with alpha-EGFR mAbs.
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MESH Headings
- Alleles
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antibody-Dependent Cell Cytotoxicity/genetics
- Antibody-Dependent Cell Cytotoxicity/immunology
- Antineoplastic Agents/immunology
- Antineoplastic Agents/therapeutic use
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/immunology
- Cell Line, Tumor
- Cell Proliferation/drug effects
- Cetuximab
- Head and Neck Neoplasms/drug therapy
- Head and Neck Neoplasms/immunology
- Humans
- Killer Cells, Natural/immunology
- Killer Cells, Natural/metabolism
- Polymorphism, Genetic
- Receptors, IgG/genetics
- Receptors, IgG/immunology
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Affiliation(s)
- Rodney J Taylor
- Department of Otorhinolaryngology/Head and Neck Surgery, Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, University of Maryland, Baltimore, MD 21201, USA.
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Chan SL, Voskens CJ, Lin W, Schindler DG, Azimzadeh A, Wang LX, Taylor RJ, Strome SE, Schulze DH. Epitope mapping of a chimeric CD137 mAb: a necessary step for assessing the biologic relevance of non-human primate models. J Mol Recognit 2009; 22:242-9. [PMID: 19177494 DOI: 10.1002/jmr.937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Antibody based manipulation of the CD137 (4-1BB) co-signaling pathway is an attractive option for the treatment of cancer and autoimmune disease. We developed a chimeric anti-human CD137 monoclonal antibody (GG) and characterized its function. As a component of planned preclinical studies, we evaluated the binding of GG to activated peripheral blood mononuclear cells (PBMCs) from cynomolgus macaque and baboon against human. Interestingly, GG only recognized human CD137, while a commercial anti-CD137 mAb (4B4-1), recognized activated PBMCs from both human and non-human primates (NHP). Subsequent analysis revealed that the amino acid sequence of CD137 is largely conserved between primate species ( approximately 95% identical), with the extracellular domain differing by only 9-10 amino acids. Based on these data, we generated mutant constructs in the extracellular domain, replacing NHP with human CD137 sequences, and identified 3 amino acids critical for GG binding. These residues are likely part of a conformational epitope, as a peptide spanning this region is unable to block mAb binding. These data demonstrate that subtle sequence variations of defined co-stimulatory molecules amongst primate species can be employed as a strategy for mapping residues necessary for antibody binding to conformational epitopes.
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Affiliation(s)
- Siaw-Lin Chan
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, 685 West Baltimore Street, HSFI Rm332, Baltimore, MD 21201, USA
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Canes D, Mandeville JA, Taylor RJ, Sorcini A, Tuerk IA. Pure Laparoscopic Donor Nephrectomy: 3-Year Experience and Analysis of a Refined Technique to Maximize Graft Function. J Endourol 2008; 22:2275-82; discussion 2282-3. [DOI: 10.1089/end.2008.9722] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- David Canes
- Department of Urology, Lahey Clinic Medical Center, Burlington, Massachusetts
| | | | - Rodney J. Taylor
- Department of Urology, Lahey Clinic Medical Center, Burlington, Massachusetts
| | - Andrea Sorcini
- Department of Urology, Lahey Clinic Medical Center, Burlington, Massachusetts
| | - Ingolf A. Tuerk
- Department of Urology, Lahey Clinic Medical Center, Burlington, Massachusetts
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Zafereo ME, Taylor RJ, Pereira KD. S248 – Supraglottoplasty for Laryngomalacia with Sleep Apnea. Otolaryngol Head Neck Surg 2008. [DOI: 10.1016/j.otohns.2008.05.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives To determine if supraglottoplasty is effective in reversing abnormal respiratory parameters in children with laryngomalacia and obstructive sleep apnea. Methods 10 patients with laryngomalacia and obstructive sleep apnea as documented by polysomnography underwent supraglottoplasty at a tertiary referral children's hospital between 2005 and 2007. Retrospective data collection included age, findings on flexible and rigid endoscopy, type of procedure performed, and postoperative course. The postoperative polysomnographies were reviewed to identify changes in obstructive apnea index (OAI), obstructive apnea/hypopnea index (OAHI), respiratory disturbance index (RDI), and low arterial oxygen saturation (O2 nadir) after supraglottoplasty. Pre- and postoperative mean data were calculated, and comparisons were made with a Student's T-test. Results All 10 patients were successfully extubated following supraglottoplasty. There were no perioperative or postoperative complications, and no patient required a subsequent airway procedure. Each patient had a postoperative nocturnal polysomnography performed following supraglottoplasty at 11 weeks (range 2–29 weeks). Caregivers reported mild improvement (10%), significant improvement (70%), and complete resolution (20%) of stridor and nocturnal snoring at a follow-up visit 4 weeks after hospital discharge. Marked improvements were observed in OAI, OAHI, RDI and O2 nadir, all of which were statistically significant (p<0.05). Conclusions Polysomnography should be included in the initial evaluation of infants with laryngomalacia to rule out obstructive sleep apnea. Supraglottoplasty is an effective treatment for infants with laryngomalacia and obstructive sleep apnea. The significant benefits of the procedure outweigh the low morbidity. Improvement after surgery can be reliably confirmed by polysomnography.
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Veverka V, Crabbe T, Bird I, Lennie G, Muskett FW, Taylor RJ, Carr MD. Structural characterization of the interaction of mTOR with phosphatidic acid and a novel class of inhibitor: compelling evidence for a central role of the FRB domain in small molecule-mediated regulation of mTOR. Oncogene 2007; 27:585-95. [PMID: 17684489 DOI: 10.1038/sj.onc.1210693] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.2] [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: 12/21/2022]
Abstract
The mammalian target of rapamycin (mTOR) is a large, multidomain protein kinase, which plays a central role in the regulation of cell growth and has recently emerged as an essential target of survival signals in many types of human cancer cells. Here, we report the solution structures of complexes formed between the FKBP12-rapamycin binding (FRB) domain of mTOR and phosphatidic acid, an important cellular activator of the kinase, and between the FRB domain and a novel inhibitor (HTS-1). The overall structure of the FRB domain is very similar to that seen in the ternary complex formed with FKBP12 and the immunosuppressive drug rapamycin; however, there are significant changes within the rapamycin-binding site with important consequences for rational drug design. The surface of the FRB domain contains a number of distinctive features that have previously escaped attention, including a potential new regulatory site on the opposite face to that involved in the binding of rapamycin, which displays the features expected for a specific binding site for a small molecule. The interaction sites for phosphatidic acid and HTS-1 were found to closely match the site responsible for rapamycin binding. In addition, the structures determined for the FRB-phosphatidic acid and FRB-HTS-1 complexes revealed a striking similarity between the conformations of buried portions of the ligands and that seen for the rapamycin backbone in contact with the domain. Our findings further highlight the importance of the FRB domain in small molecule-mediated regulation of mTOR, demonstrate the ability to identify novel inhibitors of mTOR that bind tightly to the rapamycin-binding site in the absence of FKBP12, and identify a potential new regulatory site that may be exploited in the design of new anticancer drugs.
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Affiliation(s)
- V Veverka
- Department of Biochemistry, University of Leicester, Leicester, UK
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Wolf JS, Li G, Varadhachary A, Petrak K, Schneyer M, Li D, Ongkasuwan J, Zhang X, Taylor RJ, Strome SE, O'Malley BW. Oral lactoferrin results in T cell-dependent tumor inhibition of head and neck squamous cell carcinoma in vivo. Clin Cancer Res 2007; 13:1601-10. [PMID: 17332307 PMCID: PMC1810394 DOI: 10.1158/1078-0432.ccr-06-2008] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [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: 12/28/2022]
Abstract
PURPOSE Human lactoferrin is a naturally occurring glycoprotein that inhibits cancer growth. Our purpose was to evaluate recombinant human lactoferrin as a chemotherapeutic agent against head and neck squamous cell carcinoma. EXPERIMENTAL DESIGN Controlled experiments both in vitro and in the murine model evaluating both the effect and mechanism of lactoferrin on cancer growth. RESULTS In both human and murine cell lines, lactoferrin induced dose-dependent growth inhibition. Using flow cytometric analysis, lactoferrin was shown to induce G(1)-G(0) growth arrest. This arrest seemed to be modulated by down-regulation of cyclin D1. In the in vitro model, luminex data revealed that lactoferrin inhibited cellular release of proinflammatory and prometastatic cytokines, including interleukin-8, interleukin-6, granulocyte macrophage colony-stimulating factor, and tumor necrosis factor-alpha. Lactoferrin up-regulated the cellular activation of nuclear factor-kappaB within 4 h of cellular exposure. In C3h/HeJ mice implanted with SCCVII tumors, orally delivered lactoferrin inhibited tumor growth by 75% compared with control mice. Immunohistochemical analysis of harvested tumors revealed up to 20-fold increases of lymphocytes within treated animals. When mice were depleted of CD3(+) cells, all lactoferrin-induced tumor inhibition was abrogated. CONCLUSION We conclude that human recombinant lactoferrin can inhibit the growth of head and neck squamous cell carcinoma via direct cellular inhibition as well as systemically via immunomodulation. Our data support the study of human lactoferrin as an immunomodulatory compound with therapeutic potential.
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Affiliation(s)
- Jeffrey S Wolf
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
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Kinsella G, Thomas AN, Taylor RJ. Electronic surveillance of wall-mounted soap and alcohol gel dispensers in an intensive care unit. J Hosp Infect 2007; 66:34-9. [PMID: 17434238 DOI: 10.1016/j.jhin.2007.02.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Accepted: 02/10/2007] [Indexed: 10/23/2022]
Abstract
We describe a battery-powered recording device incorporating a force-sensitive resistor and a microcontroller that records depressions of wall-mounted soap and alcohol gel dispensers. The device has a two-second (2 s) lockout built into it, so that a single record is associated with a single hand-hygiene episode. Recorders were implanted within the wall-mounted dispensers found in two bed areas and the entrance of a 16-bedded intensive care unit. The use of the bed area dispensers was correlated (r) with the dependency of the patient in the open bed area (r=0.5, P<0.01), as assessed using the UK Department of Health critical care minimum data set. Both bed areas and the entrance dispensers showed wide but different fluctuations in use throughout the 24h day. The recording device may help in feedback about soap and gel use for hand-hygiene quality improvement and educational initiatives.
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Affiliation(s)
- G Kinsella
- Department of Intensive Care, Salford NHS Foundation Trust, Hope Hospital, Salford, UK
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Connock M, Juarez-Garcia A, Jowett S, Frew E, Liu Z, Taylor RJ, Fry-Smith A, Day E, Lintzeris N, Roberts T, Burls A, Taylor RS. Methadone and buprenorphine for the management of opioid dependence: a systematic review and economic evaluation. Health Technol Assess 2007; 11:1-171, iii-iv. [PMID: 17313907 DOI: 10.3310/hta11090] [Citation(s) in RCA: 282] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of buprenorphine maintenance therapy (BMT) and methadone maintenance therapy (MMT) for the management of opioid-dependent individuals. DATA SOURCES Major electronic databases were searched from inception to August 2005. Industry submissions to the National Institute for Health and Clinical Excellence were accessed. REVIEW METHODS The assessment of clinical effectiveness was based on a review of existing reviews plus an updated search for randomised controlled trials (RCTs). A decision tree with Monte Carlo simulation model was developed to assess the cost-effectiveness of BMT and MMT. Retention in treatment and opiate abuse parameters were sourced from the meta-analysis of RCTs directly comparing flexible MMT with flexible dose BMT. Utilities were derived from a panel representing a societal perspective. RESULTS Most of the included systematic reviews and RCTs were of moderate to good quality, and focused on short-term (up to 1-year follow-up) outcomes of retention in treatment and the level of opiate use (self-report or urinalysis). Most studies employed a trial design that compared a fixed-dose strategy (i.e. all individuals received a standard dose) of MMT or BMT and were conducted in predominantly young men who fulfilled criteria as opiate-dependent or heroin-dependent users, without significant co-morbidities. RCT meta-analyses have shown that a fixed dose of MMT or BMT has superior levels of retention in treatment and opiate use than placebo or no treatment, with higher fixed doses being more effective than lower fixed doses. There was evidence, primarily from non-randomised observational studies, that fixed-dose MMT reduces mortality, HIV risk behaviour and levels of crime compared with no therapy and one small RCT has shown the level of mortality with fixed-dose BMT to be significantly less than with placebo. Flexible dosing (i.e. individualised doses) of MMT and BMT is more reflective of real-world practice. Retention in treatment was superior for flexible MMT than flexible BMT dosing but there was no significant difference in opiate use. Indirect comparison of data from population cross-sectional studies suggests that mortality with BMT may be lower than that with MMT. A pooled RCT analysis showed no significant difference in serious adverse events with MMT compared with BMT. Although treatment modifier evidence was limited, adjunct psychosocial and contingency interventions (e.g. financial incentives for opiate-free urine samples) appeared to enhance the effects of both MMT and BMT. Also, MMT and BMT appear to be similarly effective whether delivered in a primary care or outpatient clinic setting. Although most of the included economic evaluations were considered to be of high quality, none used all of the appropriate parameters, effectiveness data, perspective and comparators required to make their results generalisable to the NHS context. One company (Schering-Plough) submitted cost-effectiveness evidence based on an economic model that had a 1-year time horizon and sourced data from a single RCT of flexible-dose MMT compared with flexible-dose BMT and utility values obtained from the literature; the results showed that for MMT vs no drug therapy, the incremental cost-effectiveness ratio (ICER) was pound 12,584/quality-adjusted life-year (QALY), for BMT versus no drug therapy, the ICER was pound 30,048/QALY and in a direct comparison, MMT was found to be slightly more effective and less costly than BMT. The assessment group model found for MMT versus no drug therapy that the ICER was pound 13,697/QALY, for BMT versus no drug therapy that the ICER was pound 26,429/QALY and, as with the industry model, in direct comparison, MMT was slightly more effective and less costly than BMT. When considering social costs, both MMT and BMT gave more health gain and were less costly than no drug treatment. These findings were robust to deterministic and probabilistic sensitivity analyses. CONCLUSIONS Both flexible-dose MMT and BMT are more clinically effective and more cost-effective than no drug therapy in dependent opiate users. In direct comparison, a flexible dosing strategy with MMT was found be somewhat more effective in maintaining individuals in treatment than flexible-dose BMT and therefore associated with a slightly higher health gain and lower costs. However, this needs to be balanced by the more recent experience of clinicians in the use of buprenorphine, the possible risk of higher mortality of MMT and individual opiate-dependent users' preferences. Future research should be directed towards the safety and effectiveness of MMT and BMT; potential safety concerns regarding methadone and buprenorphine, specifically mortality and key drug interactions; efficacy of substitution medications (in particular patient subgroups, such as within the criminal justice system, or within young people); and uncertainties in cost-effectiveness identified by current economic models.
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Affiliation(s)
- M Connock
- Department of Public Health and Epidemiology, University of Birmingham, UK
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Masayesva BG, Mambo E, Taylor RJ, Goloubeva OG, Zhou S, Cohen Y, Minhas K, Koch W, Sciubba J, Alberg AJ, Sidransky D, Califano J. Mitochondrial DNA content increase in response to cigarette smoking. Cancer Epidemiol Biomarkers Prev 2006; 15:19-24. [PMID: 16434581 DOI: 10.1158/1055-9965.epi-05-0210] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
An increase in mitochondrial DNA (mtDNA) content and decline in mitochondrial function occurs with aging and in response to DNA-damaging agents, including tobacco smoke. We did a cross-sectional study and quantified changes in mtDNA content in a population of individuals with varied smoking and alcohol exposure. Age, smoking history, ethanol intake, and other demographic data were characterized for 604 individuals participating in a screening study for smoking-related upper aerodigestive malignancy. Total DNA was extracted from exfoliated cells in saliva. DNA from a nuclear gene, beta-actin, and two mitochondrial genes, cytochrome c oxidase I and II (Cox I and Cox II), were quantified by real-time PCR. mtDNA content was correlated with age, exposure history, and other variables using multivariate regression analyses. A significant increase (P<0.001) in mtDNA content was noted in smokers (31% and 29% increase for Cox I and Cox II, respectively) and former smokers (31% and 34%) when compared with never smokers. This association persisted after adjustment for other significant factors including age, alcohol drinking, and income (P<0.001). Increased mtDNA content was positively associated with pack-years of smoking (P=0.02). Despite an average smoking cessation interval of 21 years in former smokers, tobacco cessation interval was not statistically significantly associated with mtDNA content. Smoking is associated with increased mtDNA content in a dose-dependent fashion. Mitochondrial DNA alterations in response to smoking persist for several decades after smoking cessation, consistent with long-term, smoking-related damage.
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Affiliation(s)
- Brett G Masayesva
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, MD 21287-0910, USA
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