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Kimmons LA, Alzayadneh M, Metter EJ, Alsherbini K. Safety and Efficacy of Ketamine Without Intubation in the Management of Refractory Seizures: A Case Series. Neurocrit Care 2024; 40:689-697. [PMID: 37610640 DOI: 10.1007/s12028-023-01811-4] [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: 05/03/2023] [Accepted: 07/11/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Continuous infusion ketamine has demonstrated efficacy in the management of refractory seizures yet does not suppress respiratory drive like other continuous infusion anesthetics (CIAs) used for this indication. The aim of this study is to describe the safety and efficacy of ketamine infusions in patients with refractory seizure without intubation. METHODS We analyzed a retrospective cohort of adult patients who were not intubated at the time of initiation of a ketamine infusion for refractory seizures. Seizure onset was determined to be the first clinical seizure or nonconvulsive seizure reported on electroencephalography (EEG) or the start time of EEG for patients with seizures at EEG initiation. Responders were defined as patients with resolution of seizures within 24 h of initiation without the need for intubation or an additional CIA. RESULTS A total of 28 patients were analyzed (median age 62 years, 64.3% female, 82.1% African American, 82.1% with structural seizure etiology, and 85.7% focal seizures). Of patients, 78.5% received an initial bolus averaging 0.9 mg/kg, and the majority (89.3%) were initiated on an infusion at 10 μg/kg/minute; median duration was 39.8 h. Maximum infusion rates were 10 μg/kg/minute in 16 patients, 20 μg/kg/minute in seven patients, and 30 μg/kg/minute in five patients. Of patients, 71.4% were assessed to be ketamine responders; six of the eight nonresponders required intubation and an additional CIA. Responders were 80% more likely to have received ketamine 5 or more hours earlier than nonresponders. Hypotension (systolic blood pressure < 90 mmHg) occurred in 31.8% of patients receiving only ketamine, which did not correlate with duration or maximum dose of ketamine; hypertension (systolic blood pressure > 180 mmHg) occurred in 39.3%. CONCLUSIONS Ketamine represents a safe and effective treatment option for refractory seizures and has potential to reduce morbidity associated with intubation in a carefully selected patient population. Early initiation may increase the likelihood of success.
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Affiliation(s)
- Lauren A Kimmons
- Methodist University Hospital, 1265 Union Avenue, Memphis, TN, 38104, USA.
- University of Tennessee Health Sciences Center, 910 Madison Avenue, Memphis, TN, 38163, USA.
| | - Mohammad Alzayadneh
- University of Tennessee Health Sciences Center, 910 Madison Avenue, Memphis, TN, 38163, USA
| | - E Jeffrey Metter
- University of Tennessee Health Sciences Center, 910 Madison Avenue, Memphis, TN, 38163, USA
| | - Khalid Alsherbini
- Methodist University Hospital, 1265 Union Avenue, Memphis, TN, 38104, USA
- University of Tennessee Health Sciences Center, 910 Madison Avenue, Memphis, TN, 38163, USA
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Chang JJ, Kepplinger D, Metter EJ, Kim Y, Trankiem CT, Felbaum DR, Mai JC, Mason RB, Armonda RA, Aulisi EF. Time Thresholds for Using Pressure Reactivity Index in Neuroprognostication for Patients With Severe Traumatic Brain Injury. Neurosurgery 2024:00006123-990000000-01059. [PMID: 38376157 DOI: 10.1227/neu.0000000000002876] [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: 07/28/2023] [Accepted: 12/20/2023] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Severe traumatic brain injury (sTBI) represents a diffuse, heterogeneous disease where therapeutic targets for optimizing clinical outcome remain unclear. Mean pressure reactivity index (PRx) values have demonstrated associations with clinical outcome in sTBI. However, the retrospective derivation of a mean value diminishes its bedside significance. We evaluated PRx temporal profiles for patients with sTBI and identified time thresholds suggesting optimal neuroprognostication. METHODS Patients with sTBI and continuous bolt intracranial pressure monitoring were identified. Outcomes were dichotomized by disposition status ("good outcome" was denoted by home and acute rehabilitation). PRx values were obtained every minute by taking moving correlation coefficients of intracranial pressures and mean arterial pressures. Average PRx trajectories for good and poor outcome groups were calculated by extending the last daily averaged PRx value to day 18. Each patient also had smoothed PRx trajectories that were used to generate "candidate features." These "candidate features" included daily average PRx's, cumulative first-order changes in PRx and cumulative second-order changes in PRx. Changes in sensitivity over time for predicting poor outcome was then evaluated by generating penalized logistic regression models that were derived from the "candidate features" and maximized specificity. RESULTS Among 33 patients with sTBI, 18 patients achieved good outcome and 15 patients had poor outcome. Average PRx trajectories for the good and poor outcome groups started on day 6 and consistently diverged at day 9. When targeting a specificity >83.3%, an 85% maximum sensitivity for determining poor outcome was achieved at hospital day 6. Subsequent days of PRx monitoring showed diminishing sensitivities. CONCLUSION Our findings suggest that in a population of sTBI, PRx sensitivities for predicting poor outcome was maximized at hospital day 6. Additional study is warranted to validate this model in larger populations.
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Affiliation(s)
- Jason J Chang
- Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Department of Neurology, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - David Kepplinger
- Department of Statistics, George Mason University, Fairfax, Virginia, USA
| | - E Jeffrey Metter
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Yongwoo Kim
- Department of Neurology, Georgetown University Medical Center, Washington, District of Columbia, USA
- Department of Neurology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Christine T Trankiem
- Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Department of Trauma and Acute Care Surgery, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Daniel R Felbaum
- Department of Neurosurgery, Georgetown University and MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Jeffrey C Mai
- Department of Neurosurgery, Georgetown University and MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Robert B Mason
- Department of Neurosurgery, Georgetown University and MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Rocco A Armonda
- Department of Neurosurgery, Georgetown University and MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Edward F Aulisi
- Department of Neurosurgery, Georgetown University and MedStar Washington Hospital Center, Washington, District of Columbia, USA
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Romito K, Talbot LA, Metter EJ, Smith AL, Hartmann JM, Bradley DF. Perioperative Pressure Injury Prevention Program in a Military Medical Treatment Facility: A Quality Improvement Project. Mil Med 2023; 189:51-56. [PMID: 37956330 DOI: 10.1093/milmed/usad321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/02/2023] [Accepted: 07/31/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION The incidence of perioperative pressure injuries (PPIs) at a military medical treatment facility (MTF) increased from three PPI events in 2018 to five PPI events in the first half of 2019. The purpose of this quality improvement initiative was to determine whether an evidence-based PPI prevention program introduced during the second half of 2019 reduced pressure injuries compared to the previous 1.5 years that followed the standard of care for perioperative patient positioning. METHODS We used a multidisciplinary quality improvement PPI prevention approach that included education, Scott Triggers® patient risk assessment, application of a five-layer silicone dressing to at-risk surgical position sites, and feedback via multidisciplinary postoperative rounding. RESULTS There was an observed decrease in the rate of PPIs from 0.62 to 0.00 per 1,000 patient surgeries during the 26-month period that this protocol was implemented. CONCLUSION This project was conducted at a major MTF using a multidisciplinary PPI prevention approach that may be of value in reducing PPIs in other settings. This approach seems worthy of further investigation and may be applicable to other military MTFs and in deployed settings.
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Affiliation(s)
- Kenneth Romito
- Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Laura A Talbot
- Department of Neurology, University of Tennessee Health Science Center, College of Medicine, Memphis, TN 38163, USA
| | - E Jeffrey Metter
- Department of Neurology, University of Tennessee Health Science Center, College of Medicine, Memphis, TN 38163, USA
| | - Amber L Smith
- Center for Nursing Science and Clinical Inquiry, Tripler Army Medical Center, Honolulu, HI 96859, USA
| | - J Michael Hartmann
- Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - David F Bradley
- Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Hefley J, Talbot LA, Metter EJ, Lorenz ME, Shattuck H, Romito K, Heyne RE, Bradley DF. Advancing Readiness Through Military Programs: An Evidence-Based Practice Perspective. Mil Med 2023; 189:31-38. [PMID: 37956329 DOI: 10.1093/milmed/usad230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/24/2023] [Accepted: 06/14/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION Military nurses comprise the largest percentage of military health care providers. In the current military health care system, they have two roles: (1) Patient care in military treatment facilities (MTFs) and (2) patient care during combat operations. Although in MTFs, the military nurse's roles are similar to those of their civilian counterpart, their roles are unique and varied in the combat operational environment. These combined roles lead to questions regarding readiness training to ensure that nurses are proficient in both MTFs and combat operational settings where treatment requirements may differ. The purpose of this paper is to (1) present the current state of educational readiness programs to maintain a ready medical force that entail formal teaching programs, military-civilian partnerships, and joint exercises of combat simulations, and (2) identify gaps as presented in an evidence-based practice educational panel. METHODS On March 11, 2022, TriService Nursing Research Program hosted the virtual First Military Evidence-Based Practice Summit from the Uniformed Services University of the Health Sciences in Bethesda, MD. As part of the summit, an evidence-based practice education panel discussed the availability of current evidence-driven military medical readiness programs and identified gaps in the integration of military readiness for nursing personnel into the Defense Health Agency and Armed Services. RESULTS The panel participants discussed the separate requirements for training within the MTFs and in combat operational settings. The available training programs identified by the panel were primarily those developed in local MTF settings to meet local needs. Although these programs support the MTFs' peacetime mission, competing roles, limited time, and limited funds contributed to limited preparation of nursing personnel in skills associated with combat-related injuries and illnesses. Prolonged casualty care has become an important focus for the Department of Defense as greater considerations are directed to wartime operations in austere expeditionary environments. Although there is some training available that is specific for prolonged casualty care, the focus has been the adaptation of combat casualty care during contingency operations. A keynote here was the concept that combat casualty care training must include both development of individual skills and integration of the team since maximal care can be achieved only when the individual and the team operate as a unit. A key point was the utility of central repositories for storing information related to training a ready medical force at individual and unit levels and that these repositories could also be used to collect and facilitate the accession of current evidence-based information. DISCUSSION Optimal patient care at all levels of the military health system requires training that maximizes individual and unit skills specific to the environment at an MTF or in a combat operational setting. Training must be designed to incorporate evidence-driven knowledge in all military settings with guidance that is specific to the environment. CONCLUSION Enhanced communication of evidence-based training and knowledge is an important component of maintaining a ready medical force for broader medical support of combat contingency operations.
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Affiliation(s)
- Justin Hefley
- Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Laura A Talbot
- Department of Neurology, University of Tennessee Health Science Center, College of Medicine, Memphis, TN 38163, USA
| | - E Jeffrey Metter
- Department of Neurology, University of Tennessee Health Science Center, College of Medicine, Memphis, TN 38163, USA
| | - Megan E Lorenz
- Landstuhl Regional Medical Center, Unit 33100, APO, Landstuhl 66849, Germany
| | - Heather Shattuck
- Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Kenneth Romito
- Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Rebecca E Heyne
- Lackland Airforce Base, Science and Technology, Center for Clinical Inquiry, JBSA Lackland, TX 78236, USA
| | - David F Bradley
- Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Brand RM, Dudley B, Karloski E, Zyhowski A, Raphael R, Pitlor D, Metter EJ, Pai R, Lee K, Brand RE, Uttam S. Immune microenvironment profiling of normal appearing colorectal mucosa biopsied over repeat patient visits reproducibly separates lynch syndrome patients based on their history of colon cancer. Front Oncol 2023; 13:1174831. [PMID: 37637062 PMCID: PMC10457127 DOI: 10.3389/fonc.2023.1174831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/14/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Lynch syndrome (LS) is the most common hereditary cause of colorectal cancer (CRC), increasing lifetime risk of CRC by up to 70%. Despite this higher lifetime risk, disease penetrance in LS patients is highly variable and most LS patients undergoing CRC surveillance will not develop CRC. Therefore, biomarkers that can correctly and consistently predict CRC risk in LS patients are needed to both optimize LS patient surveillance and help identify better prevention strategies that reduce risk of CRC development in the subset of high-risk LS patients. Methods Normal-appearing colorectal tissue biopsies were obtained during repeat surveillance colonoscopies of LS patients with and without a history of CRC, healthy controls (HC), and patients with a history of sporadic CRC. Biopsies were cultured in an ex-vivo explant system and their supernatants were assayed via multiplexed ELISA to profile the local immune signaling microenvironment. High quality cytokines were identified using the rxCOV fidelity metric. These cytokines were used to perform elastic-net penalized logistic regression-based biomarker selection by computing a new measure - overall selection probability - that quantifies the ability of each marker to discriminate between patient cohorts being compared. Results Our study demonstrated that cytokine based local immune microenvironment profiling was reproducible over repeat visits and sensitive to patient LS-status and CRC history. Furthermore, we identified sets of cytokines whose differential expression was predictive of LS-status in patients when compared to sporadic CRC patients and in identifying those LS patients with or without a history of CRC. Enrichment analysis based on these biomarkers revealed an LS and CRC status dependent constitutive inflammatory state of the normal appearing colonic mucosa. Discussion This prospective pilot study demonstrated that immune profiling of normal appearing colonic mucosa discriminates LS patients with a prior history of CRC from those without it, as well as patients with a history of sporadic CRC from HC. Importantly, it suggests the existence of immune signatures specific to LS-status and CRC history. We anticipate that our findings have the potential to assess CRC risk in individuals with LS and help in preemptively mitigating it by optimizing surveillance and identifying candidate prevention targets. Further studies are required to validate our findings in an independent cohort of LS patients over multiple visits.
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Affiliation(s)
- Rhonda M. Brand
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- Magee Womens Research Institute, Pittsburgh, PA, United States
| | - Beth Dudley
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Eve Karloski
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ashley Zyhowski
- Magee Womens Research Institute, Pittsburgh, PA, United States
| | - Rebecca Raphael
- Department of Computational and Systems Biology, University of Pittsburgh, Pittsburgh, PA, United States
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, United States
| | - Danielle Pitlor
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - E. Jeffrey Metter
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Reet Pai
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kenneth Lee
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Randall E. Brand
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, United States
| | - Shikhar Uttam
- Department of Computational and Systems Biology, University of Pittsburgh, Pittsburgh, PA, United States
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, United States
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Talbot LA, Webb L, Morrell C, Enochs K, Hillner J, Fagan M, Metter EJ. Electromyostimulation With Blood Flow Restriction for Patellofemoral Pain Syndrome in Active Duty Military Personnel: A Randomized Controlled Trial. Mil Med 2023; 188:e1859–e1868. [PMID: 36807977 DOI: 10.1093/milmed/usad029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/13/2023] [Accepted: 01/25/2023] [Indexed: 02/22/2023] Open
Abstract
INTRODUCTION The high prevalence of patellofemoral pain in military service members results in strength loss, pain, and functional limitations during required physical performance tasks. Knee pain is often the limiting factor during high-intensity exercise for strengthening and functional improvement, thus limiting certain therapies. Blood flow restriction (BFR) improves muscle strength when combined with resistance or aerobic exercise and may serve as a possible alternative to high-intensity training during recovery. In our previous work, we showed that Neuromuscular electrical stimulation (NMES) improves pain, strength, and function in patellofemoral pain syndrome (PFPS), which led us to ask whether the addition of BFR to NMES would result in further improvements. This randomized controlled trial compared knee and hip muscle strength, pain, and physical performance of service members with PFPS who received BFR-NMES (80% limb occlusion pressure [LOP]) or BFR-NMES set at 20 mmHg (active control/sham) over 9 weeks. METHODS This randomized controlled trial randomly assigned 84 service members with PFPS to one of the two intervention groups. In-clinic BFR-NMES was performed two times per week, while at-home NMES with exercise and at-home exercise alone were performed on alternating days and omitted on in-clinic days. The outcome measures included strength testing of knee extensor/flexor and hip posterolateral stabilizers, 30-second chair stand, forward step-down, timed stair climb, and 6-minute walk. RESULTS Improvement was observed in knee extensor (treated limb, P < .001) and hip strength (treated hip, P = .007) but not flexor over 9 weeks of treatment; however, there was no difference between high BFR (80% LOP) and BFR-sham. Physical performance and pain measures showed similar improvements over time with no differences between groups. In analyzing the relationship between the number of BFR-NMES sessions and the primary outcomes, we found significant relationships with improvements in treated knee extensor strength (0.87 kg/session, P < .0001), treated hip strength (0.23 kg/session, P = .04), and pain (-0.11/session, P < .0001). A similar set of relationships was observed for the time of NMES usage for treated knee extensor strength (0.02/min, P < .0001) and pain (-0.002/min, P = .002). CONCLUSION NMES strength training offers moderate improvements in strength, pain, and performance; however, BFR did not provide an additive effect to NMES plus exercise. Improvements were positively related to the number of BFR-NMES treatments and NMES usage.
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Affiliation(s)
- Laura A Talbot
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Lee Webb
- Physical Therapy, La Pointe Health Clinic, Fort Campbell, KY 42240, USA
| | - Christopher Morrell
- Department of Mathematics and Statistics, Loyola University Maryland, Baltimore, MD 21210, USA
| | - Kayla Enochs
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Jesse Hillner
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Mathias Fagan
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - E Jeffrey Metter
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
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Chang JJ, Kepplinger D, Metter EJ, Felbaum DR, Mai JC, Armonda RA, Aulisi EF. Pressure reactivity index for early neuroprognostication in poor-grade subarachnoid hemorrhage. J Neurol Sci 2023; 450:120691. [PMID: 37267816 DOI: 10.1016/j.jns.2023.120691] [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: 03/16/2023] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Pressure reactivity index (PRx) utilizes moving correlation coefficients from intracranial pressure (ICP) and mean arterial pressures to evaluate cerebral autoregulation. We evaluated patients with poor-grade subarachnoid hemorrhage (SAH), identified their PRx trajectories over time, and identified threshold time points where PRx could be used for neuroprognostication. METHODS Patients with poor-grade SAH were identified and received continuous bolt ICP measurements. Dichotomized outcomes were based on ninety-day modified Rankin scores and disposition. Smoothed PRx trajectories for each patient were created to generate "candidate features" that looked at daily average PRx, cumulative first-order changes in PRx, and cumulative second-order changes in PRx. "Candidate features" were then used to perform penalized logistic regression analysis using poor outcome as the dependent variable. Penalized logistic regression models that maximized specificity for poor outcome were generated over several time periods and evaluated how sensitivities changed over time. RESULTS 16 patients with poor-grade SAH were evaluated. Average PRx trajectories for the good (PRx < 0.25) and poor outcome groups (PRx > 0.5) started diverging at post-ictus day 8. When targeting specificities ≥88% for poor outcome, sensitivities for poor outcome consistently increased to >70% starting at post-ictus days 12-14 with a maximum sensitivity of 75% occurring at day 18. CONCLUSIONS Our results suggest that by using PRx trends, early neuroprognostication in patients with SAH and poor clinical exams may start becoming apparent at post-ictus day 8 and reach adequate sensitivities by post-ictus days 12-14. Further study is required to validate this in larger poor-grade SAH populations.
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Affiliation(s)
- Jason J Chang
- Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC, USA; Department of Neurology, Georgetown University Medical Center, Washington, DC, USA.
| | - David Kepplinger
- Department of Statistics, George Mason University, Fairfax, VA, USA
| | - E Jeffrey Metter
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Daniel R Felbaum
- Department of Neurosurgery, Georgetown University and MedStar Washington Hospital Center, Washington, DC, USA
| | - Jeffrey C Mai
- Department of Neurosurgery, Georgetown University and MedStar Washington Hospital Center, Washington, DC, USA
| | - Rocco A Armonda
- Department of Neurosurgery, Georgetown University and MedStar Washington Hospital Center, Washington, DC, USA
| | - Edward F Aulisi
- Department of Neurosurgery, Georgetown University and MedStar Washington Hospital Center, Washington, DC, USA
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Brand RM, Dudley B, Karloski E, Zyhowski A, Raphael R, Pitlor D, Metter EJ, Pai R, Lee K, Brand RE, Uttam S. Immune Microenvironment Profiling of Normal Appearing Colorectal Mucosa Biopsied Over Repeat Patient Visits Reproduciably Separates Lynch Syndrome Patients Based on Their History of Colon Cancer. medRxiv 2023:2023.03.03.23286594. [PMID: 36945451 PMCID: PMC10029019 DOI: 10.1101/2023.03.03.23286594] [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] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Introduction Lynch syndrome (LS) is the most common hereditary cause of colorectal cancer (CRC), increasing lifetime risk of CRC by up to 70%. Despite this higher lifetime risk, disease penetrance in LS patients is highly variable and most LS patients undergoing CRC surveillance will not develop CRC. Therefore, biomarkers that can correctly and consistently predict CRC risk in LS patients are needed to both optimize LS patient surveillance and help identify better prevention strategies that reduce risk of CRC development in the subset of high-risk LS patients. Methods Normal-appearing colorectal tissue biopsies were obtained during repeat surveillance colonoscopies of LS patients with and without a history of CRC, healthy controls (HC), and patients with a history of sporadic CRC. Biopsies were cultured in an ex-vivo explant system and their supernatants were assayed via multiplexed ELISA to profile the local immune signaling microenvironment. High quality cytokine signatures were identified using rx COV fidelity metric. These signatures were used to perform biomarker selection by computing their selection probability based on penalized logistic regression. Results Our study demonstrated that cytokine based local immune microenvironment profiling was reproducible over repeat visits and sensitive to patient LS-status and CRC history. Furthermore, we identified sets of biomarkers whose differential expression was predictive of LS-status in patients when compared to sporadic CRC patients and in identifying those LS patients with or without a history of CRC. Enrichment analysis based on these biomarkers revealed an LS and CRC status dependent constitutive inflammatory state of the normal appearing colonic mucosa. Discussion This prospective pilot study demonstrated that immune profiling of normal appearing colonic mucosa discriminates LS patients with a prior history of CRC from those without it, as well as patients with a history of sporadic CRC from HC. Importantly, it suggests existence of immune signatures specific to LS-status and CRC history. We anticipate that our findings have the potential to assess CRC risk in individuals with LS and help in preemptively mitigating it by optimizing surveillance and identifying candidate prevention targets. Further studies are required to validate our findings in an independent cohort of LS patients over multiple visits.
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Watts EL, Perez-Cornago A, Fensom GK, Smith-Byrne K, Noor U, Andrews CD, Gunter MJ, Holmes MV, Martin RM, Tsilidis KK, Albanes D, Barricarte A, Bueno-de-Mesquita HB, Cohn BA, Deschasaux-Tanguy M, Dimou NL, Ferrucci L, Flicker L, Freedman ND, Giles GG, Giovannucci EL, Haiman CA, Hankey GJ, Holly JMP, Huang J, Huang WY, Hurwitz LM, Kaaks R, Kubo T, Le Marchand L, MacInnis RJ, Männistö S, Metter EJ, Mikami K, Mucci LA, Olsen AW, Ozasa K, Palli D, Penney KL, Platz EA, Pollak MN, Roobol MJ, Schaefer CA, Schenk JM, Stattin P, Tamakoshi A, Thysell E, Tsai CJ, Touvier M, Van Den Eeden SK, Weiderpass E, Weinstein SJ, Wilkens LR, Yeap BB. Circulating insulin-like growth factors and risks of overall, aggressive and early-onset prostate cancer: a collaborative analysis of 20 prospective studies and Mendelian randomization analysis. Int J Epidemiol 2023; 52:71-86. [PMID: 35726641 PMCID: PMC9908067 DOI: 10.1093/ije/dyac124] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous studies had limited power to assess the associations of circulating insulin-like growth factors (IGFs) and IGF-binding proteins (IGFBPs) with clinically relevant prostate cancer as a primary endpoint, and the association of genetically predicted IGF-I with aggressive prostate cancer is not known. We aimed to investigate the associations of IGF-I, IGF-II, IGFBP-1, IGFBP-2 and IGFBP-3 concentrations with overall, aggressive and early-onset prostate cancer. METHODS Prospective analysis of biomarkers using the Endogenous Hormones, Nutritional Biomarkers and Prostate Cancer Collaborative Group dataset (up to 20 studies, 17 009 prostate cancer cases, including 2332 aggressive cases). Odds ratios (OR) and 95% confidence intervals (CI) for prostate cancer were estimated using conditional logistic regression. For IGF-I, two-sample Mendelian randomization (MR) analysis was undertaken using instruments identified using UK Biobank (158 444 men) and outcome data from PRACTICAL (up to 85 554 cases, including 15 167 aggressive cases). Additionally, we used colocalization to rule out confounding by linkage disequilibrium. RESULTS In observational analyses, IGF-I was positively associated with risks of overall (OR per 1 SD = 1.09: 95% CI 1.07, 1.11), aggressive (1.09: 1.03, 1.16) and possibly early-onset disease (1.11: 1.00, 1.24); associations were similar in MR analyses (OR per 1 SD = 1.07: 1.00, 1.15; 1.10: 1.01, 1.20; and 1.13; 0.98, 1.30, respectively). Colocalization also indicated a shared signal for IGF-I and prostate cancer (PP4: 99%). Men with higher IGF-II (1.06: 1.02, 1.11) and IGFBP-3 (1.08: 1.04, 1.11) had higher risks of overall prostate cancer, whereas higher IGFBP-1 was associated with a lower risk (0.95: 0.91, 0.99); these associations were attenuated following adjustment for IGF-I. CONCLUSIONS These findings support the role of IGF-I in the development of prostate cancer, including for aggressive disease.
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Affiliation(s)
- Eleanor L Watts
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Aurora Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Georgina K Fensom
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Karl Smith-Byrne
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Urwah Noor
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Colm D Andrews
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Marc J Gunter
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France
| | - Michael V Holmes
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK
| | - Richard M Martin
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research (NIHR) Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Konstantinos K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Demetrius Albanes
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Aurelio Barricarte
- Group of Epidemiology of Cancer and Other Chronic Diseases, Navarra Public Health Institute, Pamplona, Spain
- Group of Epidemiology of Cancer and Other Chronic Diseases, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain
| | - H Bas Bueno-de-Mesquita
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Utrecht, The Netherlands
| | - Barbara A Cohn
- Child Health and Development Studies, Public Health Institute, Berkeley, CA, USA
| | - Melanie Deschasaux-Tanguy
- Sorbonne Paris Nord University, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center, University of Paris, Bobigny, France
| | - Niki L Dimou
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France
| | | | - Leon Flicker
- WA Centre for Health & Ageing, Medical School, University of Western Australia, Perth, WA, Australia
- Western Australian Centre for Health and Ageing, University of Western Australia, Perth, WA, Australia
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Graham G Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Edward L Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Christopher A Haiman
- Department of Preventive Medicine, Center for Genetic Epidemiology, Keck School of Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Graham J Hankey
- WA Centre for Health & Ageing, Medical School, University of Western Australia, Perth, WA, Australia
| | - Jeffrey M P Holly
- IGFs & Metabolic Endocrinology Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jiaqi Huang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Wen-Yi Huang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lauren M Hurwitz
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tatsuhiko Kubo
- Department of Public Health and Health Policy, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | | | - Robert J MacInnis
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Satu Männistö
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - E Jeffrey Metter
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kazuya Mikami
- Departmemt of Urology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Lorelei A Mucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Anja W Olsen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Danish Cancer Society, Research Center, Copenhagen, Denmark
| | - Kotaro Ozasa
- Departmemt of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Domenico Palli
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network, Florence, Italy
| | - Kathryn L Penney
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Elizabeth A Platz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael N Pollak
- Departments of Medicine and Oncology, McGill University, Montreal, QC, Canada
| | - Monique J Roobol
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Jeannette M Schenk
- Cancer Prevention Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Akiko Tamakoshi
- Department of Public Health, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Elin Thysell
- Department of Medical Biosciences, Umeå University, Umeå, Sweden
| | - Chiaojung Jillian Tsai
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mathilde Touvier
- Sorbonne Paris Nord University, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center, University of Paris, Bobigny, France
| | - Stephen K Van Den Eeden
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Department of Urology, University of CaliforniaSan Francisco, San Francisco, CA, USA
| | - Elisabete Weiderpass
- Director’s Office, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Stephanie J Weinstein
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Bu B Yeap
- WA Centre for Health & Ageing, Medical School, University of Western Australia, Perth, WA, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, WA, Australia
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10
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Brand RM, Pitlor D, Metter EJ, Dudley B, Karloski E, Zyhowski A, Brand RE, Uttam S. rxCOV is a quantitative metric for assessing immunoassay analyte fidelity. Sci Rep 2023; 13:88. [PMID: 36596931 PMCID: PMC9810650 DOI: 10.1038/s41598-022-27309-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023] Open
Abstract
Immunoassay based bioanalytical measurements are widely used in a variety of biomedical research and clinical settings. In these settings they are assumed to faithfully represent the experimental conditions being tested and the sample groups being compared. Although significant technical advances have been made in improving sensitivity and quality of the measurements, currently no metrics exist that objectively quantify the fidelity of the measured analytes with respect to noise associated with the specific assay. Here we introduce ratio of cross-coefficient-of-variation (rxCOV), a fidelity metric for objectively assessing immunoassay analyte measurement quality when comparing its differential expression between different sample groups or experimental conditions. We derive the metric from first principles and establish its feasibility and applicability using simulated and experimental data. We show that rxCOV assesses fidelity independent of statistical significance, and importantly, identifies when latter is meaningful. We also discuss its importance in the context of averaging experimental replicates for increasing signal to noise ratio. Finally, we demonstrate its application in a Lynch Syndrome case study. We conclude by discussing its applicability to multiplexed immunoassays, other biosensing assays, and to paired and unpaired data. We anticipate rxCOV to be adopted as a simple and easy-to-use fidelity metric for performing robust and reproducible biomedical research.
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Affiliation(s)
- Rhonda M. Brand
- grid.21925.3d0000 0004 1936 9000Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA ,grid.21925.3d0000 0004 1936 9000Magee Women’s Research Institute, University of Pittsburgh, Pittsburgh, PA USA
| | - Danielle Pitlor
- grid.21925.3d0000 0004 1936 9000Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA USA
| | - E. Jeffrey Metter
- grid.267301.10000 0004 0386 9246Department of Neurology, University of Tennessee, Memphis, TN USA
| | - Beth Dudley
- grid.21925.3d0000 0004 1936 9000Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Eve Karloski
- grid.21925.3d0000 0004 1936 9000Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Ashley Zyhowski
- grid.21925.3d0000 0004 1936 9000Magee Women’s Research Institute, University of Pittsburgh, Pittsburgh, PA USA
| | - Randall E. Brand
- grid.21925.3d0000 0004 1936 9000Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA ,grid.21925.3d0000 0004 1936 9000UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA USA
| | - Shikhar Uttam
- grid.21925.3d0000 0004 1936 9000UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA USA ,grid.21925.3d0000 0004 1936 9000Department of Computational and Systems Biology, University of Pittsburgh, Pittsburgh, PA USA
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11
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Watts EL, Perez‐Cornago A, Fensom GK, Smith‐Byrne K, Noor U, Andrews CD, Gunter MJ, Holmes MV, Martin RM, Tsilidis KK, Albanes D, Barricarte A, Bueno‐de‐Mesquita B, Chen C, Cohn BA, Dimou NL, Ferrucci L, Flicker L, Freedman ND, Giles GG, Giovannucci EL, Goodman GE, Haiman CA, Hankey GJ, Huang J, Huang W, Hurwitz LM, Kaaks R, Knekt P, Kubo T, Langseth H, Laughlin G, Le Marchand L, Luostarinen T, MacInnis RJ, Mäenpää HO, Männistö S, Metter EJ, Mikami K, Mucci LA, Olsen AW, Ozasa K, Palli D, Penney KL, Platz EA, Rissanen H, Sawada N, Schenk JM, Stattin P, Tamakoshi A, Thysell E, Tsai CJ, Tsugane S, Vatten L, Weiderpass E, Weinstein SJ, Wilkens LR, Yeap BB, Allen NE, Key TJ, Travis RC. Circulating free testosterone and risk of aggressive prostate cancer: Prospective and Mendelian randomisation analyses in international consortia. Int J Cancer 2022; 151:1033-1046. [PMID: 35579976 PMCID: PMC7613289 DOI: 10.1002/ijc.34116] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/18/2022] [Accepted: 02/28/2022] [Indexed: 11/30/2022]
Abstract
Previous studies had limited power to assess the associations of testosterone with aggressive disease as a primary endpoint. Further, the association of genetically predicted testosterone with aggressive disease is not known. We investigated the associations of calculated free and measured total testosterone and sex hormone-binding globulin (SHBG) with aggressive, overall and early-onset prostate cancer. In blood-based analyses, odds ratios (OR) and 95% confidence intervals (CI) for prostate cancer were estimated using conditional logistic regression from prospective analysis of biomarker concentrations in the Endogenous Hormones, Nutritional Biomarkers and Prostate Cancer Collaborative Group (up to 25 studies, 14 944 cases and 36 752 controls, including 1870 aggressive prostate cancers). In Mendelian randomisation (MR) analyses, using instruments identified using UK Biobank (up to 194 453 men) and outcome data from PRACTICAL (up to 79 148 cases and 61 106 controls, including 15 167 aggressive cancers), ORs were estimated using the inverse-variance weighted method. Free testosterone was associated with aggressive disease in MR analyses (OR per 1 SD = 1.23, 95% CI = 1.08-1.40). In blood-based analyses there was no association with aggressive disease overall, but there was heterogeneity by age at blood collection (OR for men aged <60 years 1.14, CI = 1.02-1.28; Phet = .0003: inverse association for older ages). Associations for free testosterone were positive for overall prostate cancer (MR: 1.20, 1.08-1.34; blood-based: 1.03, 1.01-1.05) and early-onset prostate cancer (MR: 1.37, 1.09-1.73; blood-based: 1.08, 0.98-1.19). SHBG and total testosterone were inversely associated with overall prostate cancer in blood-based analyses, with null associations in MR analysis. Our results support free testosterone, rather than total testosterone, in the development of prostate cancer, including aggressive subgroups.
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Affiliation(s)
- Eleanor L. Watts
- Cancer Epidemiology Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Aurora Perez‐Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Georgina K. Fensom
- Cancer Epidemiology Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Karl Smith‐Byrne
- Genomic Epidemiology BranchInternational Agency for Research on CancerLyonFrance
| | - Urwah Noor
- Cancer Epidemiology Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Colm D. Andrews
- Cancer Epidemiology Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Marc J. Gunter
- Section of Nutrition and MetabolismInternational Agency for Research on CancerLyonFrance
| | - Michael V. Holmes
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- Medical Research Council Population Health Research Unit at the University of OxfordOxfordUK
| | - Richard M. Martin
- Department of Population Health Sciences, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- MRC Integrative Epidemiology Unit (IEU), Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- National Institute for Health Research (NIHR) Bristol Biomedical Research CentreUniversity Hospitals Bristol NHS Foundation Trust and Weston NHS Foundation Trust and the University of BristolBristolUK
| | - Konstantinos K. Tsilidis
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina School of MedicineIoanninaGreece
| | - Demetrius Albanes
- Division of Cancer Epidemiology and Genetics, National Cancer InstituteNational Institutes of HealthBethesdaMarylandUSA
| | - Aurelio Barricarte
- Navarra Public Health InstitutePamplonaSpain
- Navarra Institute for Health Research (IdiSNA)PamplonaSpain
- CIBER Epidemiology and Public Health CIBERESPMadridSpain
| | - Bas Bueno‐de‐Mesquita
- Centre for Nutrition, Prevention and Health ServicesNational Institute for Public Health and the Environment (RIVM)The Netherlands
| | - Chu Chen
- Program in Epidemiology, Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
- Department of Epidemiology, School of Public HealthUniversity of WashingtonSeattleWashingtonUSA
- Department of Otolaryngology: Head and Neck Surgery, School of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Barbara A. Cohn
- Child Health and Development StudiesPublic Health InstituteBerkeleyCaliforniaUSA
| | - Niki L. Dimou
- Section of Nutrition and MetabolismInternational Agency for Research on CancerLyonFrance
| | | | - Leon Flicker
- Medical SchoolUniversity of Western AustraliaPerthWestern AustraliaAustralia
- Western Australian Centre for Health and AgeingUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Neal D. Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer InstituteNational Institutes of HealthBethesdaMarylandUSA
| | - Graham G. Giles
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneVictoriaAustralia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia
- Precision Medicine, School of Clinical Sciences at Monash HealthMonash UniversityMelbourneVictoriaAustralia
| | - Edward L. Giovannucci
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Channing Division of Network MedicineBrigham and Women's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Gary E. Goodman
- Program in Epidemiology, Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | - Christopher A. Haiman
- Center for Genetic Epidemiology, Department of Preventive Medicine, Keck School of MedicineUniversity of Southern California/Norris Comprehensive Cancer CenterLos AngelesCaliforniaUSA
| | - Graeme J. Hankey
- Medical SchoolUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Jiaqi Huang
- Division of Cancer Epidemiology and Genetics, National Cancer InstituteNational Institutes of HealthBethesdaMarylandUSA
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and EndocrinologyThe Second Xiangya Hospital of Central South UniversityChangshaHunanChina
| | - Wen‐Yi Huang
- Division of Cancer Epidemiology and Genetics, National Cancer InstituteNational Institutes of HealthBethesdaMarylandUSA
| | - Lauren M. Hurwitz
- Division of Cancer Epidemiology and Genetics, National Cancer InstituteNational Institutes of HealthBethesdaMarylandUSA
| | - Rudolf Kaaks
- Division of Cancer EpidemiologyGerman Cancer Research Center (DKFZ)HeidelbergGermany
| | - Paul Knekt
- Department of Public Health and WelfareNational Institute for Health and WelfareHelsinkiFinland
| | - Tatsuhiko Kubo
- Department of Public Health and Health Policy, Graduate School of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | - Hilde Langseth
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
- Department of ResearchCancer Registry of NorwayOsloNorway
| | - Gail Laughlin
- Herbert Wertheim School of Public Health and Human Longevity ScienceUniversity of California San DiegoSan DiegoCaliforniaUSA
| | | | - Tapio Luostarinen
- Finnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer ResearchHelsinkiFinland
| | - Robert J. MacInnis
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneVictoriaAustralia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia
| | - Hanna O. Mäenpää
- Department of OncologyHelsinki University Central HospitalHelsinkiFinland
| | - Satu Männistö
- Department of Public Health and WelfareFinnish Institute for Health and WelfareHelsinkiFinland
| | - E. Jeffrey Metter
- Department of NeurologyThe University of Tennessee Health Science Center, College of MedicineMemphisTennesseeUSA
| | - Kazuya Mikami
- Departmemt of UrologyJapanese Red Cross Kyoto Daiichi HospitalKyotoJapan
| | - Lorelei A. Mucci
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Anja W. Olsen
- Department of Public HealthAarhus UniversityAarhusDenmark
- Danish Cancer SocietyResearch CenterCopenhagenDenmark
| | - Kotaro Ozasa
- Departmemt of EpidemiologyRadiation Effects Research FoundationHiroshimaJapan
| | - Domenico Palli
- Cancer Risk Factors and Life‐Style Epidemiology Unit, Institute for Cancer ResearchPrevention and Clinical Network – ISPROFlorenceItaly
| | - Kathryn L. Penney
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Channing Division of Network MedicineBrigham and Women's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Elizabeth A. Platz
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Harri Rissanen
- Department of Public Health and WelfareNational Institute for Health and WelfareHelsinkiFinland
| | - Norie Sawada
- Epidemiology and Prevention Group, Center for Public Health SciencesNational Cancer CenterTokyoJapan
| | - Jeannette M. Schenk
- Cancer Prevention Program, Public Health Sciences DivisionFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | - Pär Stattin
- Department of Surgical SciencesUppsala UniversityUppsalaSweden
| | | | - Elin Thysell
- Department of Medical BiosciencesUmeå UniversityUmeåSweden
| | - Chiaojung Jillian Tsai
- Department of Radiation OncologyMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Center for Public Health SciencesNational Cancer CenterTokyoJapan
| | - Lars Vatten
- Department of Public Health and Nursing, Faculty of MedicineNorwegian University of Science and TechnologyTrondheimNorway
| | - Elisabete Weiderpass
- Director Office, International Agency for Research on CancerWorld Health OrganizationLyonFrance
| | - Stephanie J. Weinstein
- Division of Cancer Epidemiology and Genetics, National Cancer InstituteNational Institutes of HealthBethesdaMarylandUSA
| | | | - Bu B. Yeap
- Medical SchoolUniversity of Western AustraliaPerthWestern AustraliaAustralia
- Department of Endocrinology and DiabetesFiona Stanley HospitalPerthWestern AustraliaAustralia
| | | | | | | | | | | | - Naomi E. Allen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- UK Biobank LtdStockportUK
| | - Timothy J. Key
- Cancer Epidemiology Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Ruth C. Travis
- Cancer Epidemiology Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
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12
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Weir BS, Vordtriede C, Lee JE, Metter EJ, Talbot LA. An Interdisciplinary Dashboard to Streamline Medication Processing at Patient Discharge: A Quality Improvement Initiative. Mil Med 2021; 188:usab526. [PMID: 34950952 DOI: 10.1093/milmed/usab526] [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: 10/18/2021] [Revised: 12/01/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The purpose of this quality improvement project was to develop and evaluate the use of an electronic medication request dashboard to reduce the amount of time required for medication processing and decrease time lost to workflow interruptions during patient discharge. Delayed discharges are associated with increased health care costs and adverse patient outcomes. Processing of medication requests at discharge contributes to these delays and to workflow interruptions for nursing and pharmacy staff at the project site. Electronic dashboards have been successfully implemented in multiple medical settings to streamline patient processing and enhance communication. MATERIALS AND METHODS The Human Protections Office at Carl R. Darnall Army Medical Center (Fort Hood, TX) reviewed and approved the project with a non-human research determination. A multi-disciplinary workgroup with representatives from nursing, pharmacy, and health information technology (HIT) was formed to develop the dashboard. Based on a logic flow diagram of the desired communication, HIT created a medication request form and status dashboard using SharePoint and Nintex workflows. The dashboard was implemented for a 30-day pilot on a 25-bed medical/surgical nursing unit. The time required for medication processing, the time from discharge order to patient exit, the number of phone calls between nursing and pharmacy, and the usability of the medication request process were measured before and after implementation. The results were analyzed with descriptive statistics and evaluated for statistical significance with a P value ≤.05. RESULTS With implementation of the dashboard, the average medication processing time decreased from 125 minutes to 48 minutes (P < .0001), and the average patient discharge time decreased from 137 minutes to 117 minutes (P = .002). The usability score of the medication request process increased from 40 to 87 for nursing (P < .0001) and from 62 to 85 for pharmacy (P = .003). The total number of voice calls between nursing and pharmacy decreased from 1,115 to 434, while the total time on voice calls decreased from 33 hours and 50 minutes to 13 hours and 19 minutes (P < .0001). CONCLUSIONS The electronic dashboard is an effective method to enhance interdisciplinary communication during patient discharge and significantly reduces medication processing times. However, despite the medication processing time decreasing by over an hour, the discharge time only decreased by 20 minutes. Additional investigation is needed to evaluate other contributors to delayed discharge. A key limitation of this study was the convenience sampling used over a 30-day pilot on a single unit. The process has since been adopted by the entire hospital, and additional analysis could better reveal the impact to the organization. This communication system shows high usability and reduces phone call interruptions for both nursing and pharmacy staff. Additionally, this technology could easily be applied to other communication pathways or request processes across military medicine.
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Affiliation(s)
- Brett S Weir
- Nursing Operations, Pharmacy Department, Carl R. Darnall Army Medical Center, Fort Hood, TX 76544, USA
| | - Caitrin Vordtriede
- Nursing Operations, Pharmacy Department, Carl R. Darnall Army Medical Center, Fort Hood, TX 76544, USA
| | | | - E Jeffrey Metter
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Laura A Talbot
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
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13
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Alexandrov AW, Arthur AS, Bryndziar T, Swatzell VM, Dusenbury W, Hardage K, McCormick S, Rhudy JP, Maleki AHZ, Singh S, Krishnaiah B, Nearing K, Rubin MN, Malkoff MD, McKendry C, Metter EJ, Alexandrov AV. High-resolution CT with arch/neck/head CT angiography on a mobile stroke unit. J Neurointerv Surg 2021; 14:623-627. [PMID: 34433646 DOI: 10.1136/neurintsurg-2021-017697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/06/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Mobile stroke units (MSUs) performance dependability and diagnostic yield of 16-slice, ultra-fast CT with auto-injection angiography (CTA) of the aortic arch/neck/circle of Willis has not been previously reported. METHODS We performed a prospective observational study of the first-of-its kind MSU equipped with high resolution, 16-slice CT with multiphasic CTA. Field CT/CTA was performed on all suspected stroke patients regardless of symptom severity or resolution. Performance dependability, efficiency and diagnostic yield over 365 days was quantified. RESULTS 1031 MSU emergency activations occurred; of these, 629 (61%) were disregarded with unrelated diagnoses, and 402 patients transported: 245 (61%) ischemic or hemorrhagic stroke, 17 (4%) transient ischemic attack, 140 (35%) other neurologic emergencies. Total time from non-contrast CT/CTA start to images ready for viewing was 4.0 (IQR 3.5-4.5) min. Hemorrhagic stroke totaled 24 (10%): aneurysmal subarachnoid hemorrhage 3, hemorrhagic infarct 1, and 20 intraparenchymal hemorrhages (median intracerebral hemorrhage score was 2 (IQR 1-3), 4 (20%) spot sign positive). In 221 patients with ischemic stroke, 73 (33%) received alteplase with 31.5% treated within 60 min of onset. CTA revealed large vessel occlusion in 66 patients (30%) of which 9 (14%) were extracranial; 27 (41%) underwent thrombectomy with onset to puncture time averaging 141±90 min (median 112 (IQR 90-139) min) with full emergency department (ED) bypass. No imaging needed to be repeated for image quality; all patients were triaged correctly with no inter-hospital transfer required. CONCLUSIONS MSU use of advanced imaging including multiphasic head/neck CTA is feasible, offers high LVO yield and enables full ED bypass.
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Affiliation(s)
| | - Adam S Arthur
- Neurosurgery, UTHSC COM, Memphis, Tennessee, USA.,Vascular Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
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14
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Talbot LA, Brede E, Metter EJ. Influence of Self-managed Rehabilitation on Work Efficiency in Active Duty Military With a Knee Injury. Mil Med 2021; 186:486-492. [PMID: 33242071 DOI: 10.1093/milmed/usaa513] [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: 07/16/2020] [Accepted: 11/07/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Knee injuries associated with intense physical training are one of the most frequent injuries associated with medical encounters for military members. The purpose of this study was to evaluate four approaches to physiotherapy rehabilitation and their effects on work efficiency in active duty military with a knee injury. The four groups included neuromuscular electrical stimulation (NMES), walking with a weighted vest (WALK), combined NMES/Walk, and standard physiotherapy rehabilitation. All groups received standard physiotherapy rehabilitation.We have previously reported that quadriceps muscle strength improved over 18 weeks in the study for the three interventions relative to standard rehabilitation alone. This report presents results from an examination of work efficiency as evaluated during a step test while measuring oxygen utilization. METHODS A randomized controlled trial was conducted, with repeated outcome measures of work efficiency assessed at baseline, 3, 6, 12, and 18 weeks. The sample consisted of 67 active duty service members between the ages of 18 and 50 years with a knee injury. Participants were randomized to one of the four approaches to physiotherapy rehabilitation: (1) NMES was applied to the quadriceps muscle four times per week, for 30 minutes (15 minutes to each leg), consisting of 15 quadriceps muscle contractions per leg; (2) graduated strength walking using a weighted vest (WALK) was for 30 minutes, 3 to 4 days a week; (3) combined NMES with strength walking received both the NMES therapy and the weighted vest walking; and (4) standard physiotherapy consisted of progressive exercise with the number and type of sessions not controlled by the study. All four groups received the standard physiotherapy for a knee injury. The primary outcome was work efficiency, as measured by oxygen utilization during a 2-minute self-paced step test over 18 weeks. The primary analysis used repeated measures, linear mixed-effects models with a random effect for subject. RESULTS Both the number of steps performed and gross work efficiency improved during the study for all three intervention groups. For gross work efficiency, standard rehabilitation improved 12%, WALK showed a 19% improvement, NMES increased by 24%, and the NMES/Walk group improved by 40%. CONCLUSIONS All groups showed improved submaximal exercise efficiency based on oxygen utilization, with the intervention groups showing a greater improvement in work efficiency as compared to standard rehabilitation. Knee injuries can be problematic for active duty members because of reduced mobility leading to deconditioning and associated declines in work efficiency. Rehabilitative programs, including those described in this study, may minimize loss of work efficiency and fitness and promote a quicker recovery.
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Affiliation(s)
- Laura A Talbot
- College of Medicine, University of Tennessee Health Science Center, Department of Neurology, Memphis, TN 38163, USA
| | - Emily Brede
- College of Medicine, University of Tennessee Health Science Center, Department of Neurology, Memphis, TN 38163, USA
| | - E Jeffrey Metter
- College of Medicine, University of Tennessee Health Science Center, Department of Neurology, Memphis, TN 38163, USA
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15
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Brand RM, Moore BA, Zyhowski A, Siegel A, Uttam S, Metter EJ, Engstrom J, Brand RE, Biswas N, Whitcomb DC, Binion DG, Schwartz M, McGowan I. Tofacitinib inhibits inflammatory cytokines from ulcerative colitis and healthy mucosal explants and is associated with pSTAT1/3 reduction in T-cells. Am J Physiol Gastrointest Liver Physiol 2021; 320:G396-G410. [PMID: 33355506 PMCID: PMC8202239 DOI: 10.1152/ajpgi.00383.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Poor translatability of animal disease models has hampered the development of new inflammatory bowel disorder (IBD) therapeutics. We describe a preclinical, ex vivo system using freshly obtained and well-characterized human colorectal tissue from patients with ulcerative colitis (UC) and healthy control (HC) participants to test potential therapeutics for efficacy and target engagement, using the JAK/STAT inhibitor tofacitinib (TOFA) as a model therapeutic. Colorectal biopsies from HC participants and patients with UC were cultured and stimulated with multiple mitogens ± TOFA. Soluble biomarkers were detected using a 29-analyte multiplex ELISA. Target engagement in CD3+CD4+ and CD3+CD8+ T-cells was determined by flow cytometry in peripheral blood mononuclear cells (PBMCs) and isolated mucosal mononuclear cells (MMCs) following the activation of STAT1/3 phosphorylation. Data were analyzed using linear mixed-effects modeling, t test, and analysis of variance. Biomarker selection was performed using penalized and Bayesian logistic regression modeling, with results visualized using uniform manifold approximation and projection. Under baseline conditions, 27 of 29 biomarkers from patients with UC were increased versus HC participants. Explant stimulation increased biomarker release magnitude, expanding the dynamic range for efficacy and target engagement studies. Logistic regression analyses identified the most representative UC baseline and stimulated biomarkers. TOFA inhibited biomarkers dependent on JAK/STAT signaling. STAT1/3 phosphorylation in T-cells revealed compartmental differences between PBMCs and MMCs. Immunogen stimulation increases biomarker release in similar patterns for HC participants and patients with UC, while enhancing the dynamic range for pharmacological effects. This work demonstrates the power of ex vivo human colorectal tissue as preclinical tools for evaluating target engagement and downstream effects of new IBD therapeutic agents.NEW & NOTEWORTHY Using colorectal biopsy material from healthy volunteers and patients with clinically defined IBD supports translational research by informing the evaluation of therapeutic efficacy and target engagement for the development of new therapeutic entities. Combining experimental readouts from intact and dissociated tissue enhances our understanding of the tissue-resident immune system that contribute to disease pathology. Bayesian logistic regression modeling is an effective tool for predicting ex vivo explant biomarker release patterns.
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Affiliation(s)
- Rhonda M. Brand
- 1University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania,2Magee-Womens Research Institute and Foundation, Pittsburgh, Pennsylvania
| | - Beverley A. Moore
- 1University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania,3B.A. Moore Pharmaceutical Consulting, LLC, Collegeville, Pennsylvania
| | - Ashley Zyhowski
- 2Magee-Womens Research Institute and Foundation, Pittsburgh, Pennsylvania
| | - Aaron Siegel
- 2Magee-Womens Research Institute and Foundation, Pittsburgh, Pennsylvania
| | - Shikhar Uttam
- 5University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Jarret Engstrom
- 2Magee-Womens Research Institute and Foundation, Pittsburgh, Pennsylvania
| | - Randall E. Brand
- 1University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Nabanita Biswas
- 1University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - David C. Whitcomb
- 1University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - David G. Binion
- 1University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Marc Schwartz
- 1University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ian McGowan
- 1University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania,2Magee-Womens Research Institute and Foundation, Pittsburgh, Pennsylvania
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16
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Talbot LA, Metter EJ, King H. History of the Military Nurse Corps and the 1918 Influenza Pandemic: Lessons for the 2019 Coronavirus Pandemic. Mil Med 2021; 186:27-32. [PMID: 33313889 PMCID: PMC7798950 DOI: 10.1093/milmed/usaa544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/07/2020] [Indexed: 11/25/2022] Open
Abstract
During World War I, the 1918 influenza pandemic struck the fatigued combat troops serving on the Western Front. Medical treatment options were limited; thus, skilled military nursing care was the primary therapy and the best indicator of patient outcomes. This article examines the military nursing’s role in the care of the soldiers during the 1918 flu pandemic and compares this to the 2019 coronavirus pandemic.
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Affiliation(s)
- Laura A Talbot
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - E Jeffrey Metter
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Heather King
- TriService Nursing Research Program, Uniform Services University of the Health Sciences, Bethesda, MD 20814, USA
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17
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Arnold CG, Walker JR, Metter EJ, Young S, Brady MF. Pulse oximeter plethysmograph waveform and automated oscillometric sphygmomanometer for ankle-brachial index measurement. Am J Emerg Med 2020; 40:162-165. [PMID: 33143956 DOI: 10.1016/j.ajem.2020.10.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/18/2020] [Accepted: 10/23/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES There are limited non-invasive methods to assess lower extremity arterial injuries in the emergency department (ED) and pre-hospital setting. The ankle-brachial index (ABI) requires careful auscultation by Doppler, an approach made difficult in noisy environments. We sought to determine the agreement of the ABI measured using the pulse oximeter plethysmograph waveform (Pleth) with auscultation by Doppler in a controlled setting. A secondary outcome sought to examine the agreement of ABI by automated oscillometric sphygmomanometer (AOS) with Doppler. METHODS We measured blood pressure in the right upper and lower extremities of healthy volunteers using: (1) Doppler and manual sphygmomanometer; (2) Pleth and manual sphygmomanometer; and (3) AOS. The Bland-Altman approach to assessing agreement between methods was used comparing mean differences between ABI pairs to their means for Doppler versus Pleth and Doppler versus AOS. The intraclass correlation coefficient (ICC) from mixed effects models examined intra- and inter-rater reliability. RESULTS Among 100 participants with normal ABI the mean ABI (95%CI) were Doppler 1.11 (0.90-1.33), Pleth 1.10 (0.91-1.30), and AOS 1.10 (0.90-1.30). The ABI difference (95% CI for limits of agreement) were 0.01 (-0.20,0.18) for Doppler-Pleth and 0.02 (-0.26, 0.22) for Doppler-AOS. The ICC for the Doppler-Pleth comparison (ICC = 0.56, 95% CI 0.47-0.63) was greater than for the Doppler-AOS (ICC = 0.32, 95% CI 0.19-0.43). CONCLUSIONS The ABI measured using the Pleth has a high level of agreement with measurement by Doppler. The AOS and Doppler have good agreement with greater measurement variability. Pleth and AOS may be reasonable alternatives to Doppler for ABI.
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Affiliation(s)
- Cosby G Arnold
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO, USA.
| | - J Richard Walker
- Department of Emergency Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - E Jeffrey Metter
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Shane Young
- Department of Emergency Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mark F Brady
- Department of Emergency Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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18
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Talbot LA, Solomon Z, Webb L, Morrell C, Metter EJ. Electrical Stimulation Therapies for Active Duty Military with Patellofemoral Pain Syndrome: A Randomized Trial. Mil Med 2020; 185:e963-e971. [PMID: 32248227 DOI: 10.1093/milmed/usaa037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Patellofemoral pain syndrome (PFPS) is a common musculoskeletal disorder among military service members that causes knee pain, quadriceps strength loss, and impaired motor performance in otherwise healthy individuals. PFPS poses a threat to the health, fitness, and subsequent readiness of the total force. The goal of rehabilitation for military service members with PFPS is to regain physical capacity of strength and function and to reduce pain, in order to restore readiness in this population. The randomized controlled trial reported here compared an active home exercise program (HEP) alone with three different electrical stimulation treatment regimens implemented concurrently with HEP postulated improvements in lower extremity strength and physical functional performance while also reducing pain in active duty military diagnosed with PFPS. MATERIALS AND METHODS After baseline testing, 130 active duty military members with PFPS were randomized to 1 of 4 treatment groups: (1) neuromuscular electrical stimulation (NMES) with HEP; (2) transcutaneous electrical nerve stimulation (TENS) with HEP; (3) combined NMES/TENS with HEP; (4) active HEP only. The primary outcome measure was degree of change in knee flexion and extension strength over 9 weeks. Secondary outcomes were physical functional performance and knee pain. The primary analyses used repeated measures, linear mixed-effects models with a random effect for subject, time as a continuous variable, group as a categorical variable, and a group and time interaction to test for differences in change over time among the groups. RESULTS All three electrical stimulation treatment groups improved in knee extension strength in the PFPS limb to a greater extent than the HEP alone group over the 9-week treatment period. The NMES and NMES/TENS groups improved to a greater extent than the HEP alone group in knee flexion strength in the PFPS limb. The reported pain improved over time for all treatment groups with no significant group differences. All three stimulation groups performed better on the 6-min walk test than the HEP alone group. CONCLUSION The findings from this study showed that all three electrical stimulation with HEP treatment groups showed greater improvement in strength compared to the HEP alone group. These findings could offer alternative forms of rehabilitation for AD military with PFPS as these treatment regimens can be easily implemented at home station or during deployment.
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Affiliation(s)
- Laura A Talbot
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, 855 Monroe Ave, Suite 415, Memphis, TN 38163
| | - Zack Solomon
- Physical Therapy Services, Dunham U.S. Army Health Clinic, Carlisle Barracks, PA 17013
| | - Lee Webb
- Byrd Clinic Physical Therapy, Fort Campbell, KY 42240
| | - Christopher Morrell
- Department of Mathematics and Statistics, Loyola University Maryland, Baltimore, MD 21210-2699
| | - E Jeffrey Metter
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, 855 Monroe Ave, Suite 415, Memphis, TN 38163
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19
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Kalyani RR, Metter EJ, Xue QL, Egan JM, Chia CW, Studenski S, Shaffer NC, Golden S, Al-Sofiani M, Florez H, Ferrucci L. The Relationship of Lean Body Mass With Aging to the Development of Diabetes. J Endocr Soc 2020; 4:bvaa043. [PMID: 32666006 PMCID: PMC7334003 DOI: 10.1210/jendso/bvaa043] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 04/16/2020] [Indexed: 12/22/2022] Open
Abstract
CONTEXT Older adults have the greatest burden of diabetes; however, the contribution of age-related muscle loss to its development remains unclear. OBJECTIVE We assessed the relationship of lean body mass with aging to incident diabetes in community-dwelling adults. DESIGN AND SETTING We studied participants in the Baltimore Longitudinal Study of Aging with median follow-up of 7 years (range 1-16). Cox proportional hazard models with age as the time scale were used. Time-dependent lean body mass measures were updated at each follow-up visit available. PARTICIPANTS Participants included 871 men and 984 women without diabetes who had ≥ 1 assessment of body composition using dual x-ray absorptiometry. MAIN OUTCOMES Incident diabetes, defined as self-reported history and use of glucose-lowering medications; or fasting plasma glucose ≥ 126 mg/dL and 2-hour oral glucose tolerance test glucose ≥ 200 mg/dL either at the same visit or 2 consecutive visits. RESULTS The baseline mean [standard deviation] age was 58.9 [17.3] years. Men and women with a higher percentage of total lean body mass had lower fasting and 2-hour glucose levels, and less prediabetes (all P < 0.01). Among men, comparing highest versus lowest quartiles, percentage of total lean body mass (hazard ratio [HR], 0.46; 95% confidence interval, 0.22-0.97), percentage leg lean mass (HR, 0.38; 0.15-0.96), and lean-to-fat mass ratio (HR, 0.39; 0.17-0.89) were inversely associated with incident diabetes after accounting for race and attenuated after adjustment for height and weight. Conversely, absolute total lean body mass was positively associated with incident diabetes among women, with similar trends in men. No associations were observed with muscle strength or quality. CONCLUSIONS Relatively lower lean body mass with aging is associated with incident diabetes in men and partially related to anthropometrics, but not so in women.
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Affiliation(s)
- Rita R Kalyani
- Division of Endocrinology, Diabetes & Metabolism, The Johns Hopkins University, Baltimore, Maryland
- Center on Aging and Health, The Johns Hopkins University, Baltimore, Maryland
| | - E Jeffrey Metter
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Qian-Li Xue
- Center on Aging and Health, The Johns Hopkins University, Baltimore, Maryland
- Division of Geriatrics, The Johns Hopkins University, Baltimore, Maryland
| | | | - Chee W Chia
- National Institute on Aging, Baltimore, Maryland
| | | | | | - Sherita Golden
- Division of Endocrinology, Diabetes & Metabolism, The Johns Hopkins University, Baltimore, Maryland
- The Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, Maryland
| | - Mohammed Al-Sofiani
- Division of Endocrinology, Diabetes & Metabolism, The Johns Hopkins University, Baltimore, Maryland
- Division of Endocrinology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hermes Florez
- Division of Geriatrics & Endocrinology, University of Miami Miller School of Medicine, Miami, Florida
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Scallan RM, Gerathy S, Price J, Lazarus AM, Metter EJ, Talbot LA. Preoperative Chlorhexidine Gluconate Bathing on a Military Medical-Surgical Unit. Mil Med 2020; 185:15-20. [PMID: 32561930 DOI: 10.1093/milmed/usz186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION AND SCOPE OF THE PROBLEM Surgical site infections (SSIs) are associated with increased length of hospital stays, poor patient outcomes, and increased health care costs making prevention of SSI a high priority for the U.S. Military Health Care System. The focus of this project was to develop and pilot a preoperative antiseptic bathing regimen on an inpatient medical-surgical telemetry unit using 4% chlorhexidine gluconate (CHG), and to compare SSI rates with this new protocol to previous SSI rates on the unit. MATERIALS AND METHODS A literature review guided the development of the protocol and clinical question. A unit project was conducted using SSI rates from an inpatient military medical-surgical telemetry unit over 4 yr. From 2014 to 2016, 3 yr before implementing the protocol, a non-standardized CHG scrub was compared to 12 mo after implementing the standardized 4% CHG protocol in 2017 using up to four daily washings (three evenings and one morning surgery) on inpatient admissions to the unit. SSI rates were compared. RESULTS After implementing a 4-d preoperative bathing regimen with 4% CHG for patients scheduled for surgery, SSI rates decreased from an average rate of 0.0072 infections (7.2 infections per 1,000 surgeries) to 0.0035 infections (3.5 infections per 1,000 surgeries) in the subsequent year of data collection. Although not a statistically significant change, further analysis using a Bayesian Poisson regression model found an 84% probability the new protocol would lower SSI rate by 1 or more cases per 1,000 surgeries on this inpatient unit. CONCLUSION The findings suggest the proposed approach to control infection that may reduce the number of SSIs on a military medical-surgical unit, but this needs to be demonstrated through further longitudinal research on military surgical units.
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Affiliation(s)
- Ross M Scallan
- Department of Nursing, Surgical Section, San Antonio Military Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234
| | - Stephanie Gerathy
- Department of Nursing, Surgical Section, San Antonio Military Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234
| | - Joyce Price
- Department of Nursing, Surgical Section, San Antonio Military Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234
| | - Ann Marie Lazarus
- Department of Nursing, Center for Nursing Science & Clinical Inquiry, San Antonio Military Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234
| | - E Jeffrey Metter
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, 855 Monroe Avenue, Suite 415, Memphis, TN 38163
| | - Laura A Talbot
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, 855 Monroe Avenue, Suite 415, Memphis, TN 38163
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21
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Talbot LA, Wilson C, Nayback-Beebe A, Metter EJ, Hatzfeld J. Nursing's Role in Preventing and Managing Back Pain in Military Members: Proceedings of the First Back Pain Summit. Mil Med 2020; 185:43-49. [PMID: 32561931 DOI: 10.1093/milmed/usz238] [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: 11/14/2022] Open
Abstract
This is a review of the proceedings of the first Military Nursing Back Pain Summit focusing on nursing's role in preventing and managing back pain. The purpose of the summit was to present the state of the science in back pain and to identify key gaps in research, policy, education, and treatment that could be undertaken by military nurses, nurse leaders, nurse practitioners, and nurse scientists. Several key points were highlighted during the summit: (1) back pain is multifactorial and preventable; (2) military service members have unique risk factors for developing back pain; (3) both acute and chronic back pain impact readiness and sustaining readiness is the primary mission of military medicine; (4) back pain is most effectively managed with multiple treatment approaches; (5) military culture must pivot away from an attitude of ignoring persistent pain or "toughing it out" to prevent acute back pain from becoming chronic; (6) integrating military nurses within operational units will be important for effective prevention, education, screening, and treatment within dispersed Multi-Domain Operations; and (7) early self-management is an important area for nursing research and intervention to empower service members to maintain and sustain their back health. The various presentations and panels from the meeting are summarized.
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Affiliation(s)
- Laura A Talbot
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, 855 Monroe Ave, Suite 415, Memphis, TN 38163
| | - Candy Wilson
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Ann Nayback-Beebe
- Clinical & Rehabilitative Medicine Research Program (CRMRP), US Army Medical Research and Materiel Command (USAMRMC), 504 Scott Street, Fort Detrick, MD 21702-5012
| | - E Jeffrey Metter
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, 855 Monroe Ave, Suite 415, Memphis, TN 38163
| | - Jennifer Hatzfeld
- TriService Nursing Research Program, Uniform Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
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Watts EL, Perez‐Cornago A, Appleby PN, Albanes D, Ardanaz E, Black A, Bueno‐de‐Mesquita HB, Chan JM, Chen C, Chubb SP, Cook MB, Deschasaux M, Donovan JL, English DR, Flicker L, Freedman ND, Galan P, Giles GG, Giovannucci EL, Gunter MJ, Habel LA, Häggström C, Haiman C, Hamdy FC, Hercberg S, Holly JM, Huang J, Huang W, Johansson M, Kaaks R, Kubo T, Lane JA, Layne TM, Le Marchand L, Martin RM, Metter EJ, Mikami K, Milne RL, Morris HA, Mucci LA, Neal DE, Neuhouser ML, Oliver SE, Overvad K, Ozasa K, Pala V, Pernar CH, Pollak M, Rowlands M, Schaefer CA, Schenk JM, Stattin P, Tamakoshi A, Thysell E, Touvier M, Trichopoulou A, Tsilidis KK, Van Den Eeden SK, Weinstein SJ, Wilkens L, Yeap BB, Key TJ, Allen NE, Travis RC. The associations of anthropometric, behavioural and sociodemographic factors with circulating concentrations of IGF-I, IGF-II, IGFBP-1, IGFBP-2 and IGFBP-3 in a pooled analysis of 16,024 men from 22 studies. Int J Cancer 2019; 145:3244-3256. [PMID: 30873591 PMCID: PMC6745281 DOI: 10.1002/ijc.32276] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/28/2019] [Accepted: 02/04/2019] [Indexed: 12/24/2022]
Abstract
Insulin-like growth factors (IGFs) and insulin-like growth factor binding proteins (IGFBPs) have been implicated in the aetiology of several cancers. To better understand whether anthropometric, behavioural and sociodemographic factors may play a role in cancer risk via IGF signalling, we examined the cross-sectional associations of these exposures with circulating concentrations of IGFs (IGF-I and IGF-II) and IGFBPs (IGFBP-1, IGFBP-2 and IGFBP-3). The Endogenous Hormones, Nutritional Biomarkers and Prostate Cancer Collaborative Group dataset includes individual participant data from 16,024 male controls (i.e. without prostate cancer) aged 22-89 years from 22 prospective studies. Geometric means of protein concentrations were estimated using analysis of variance, adjusted for relevant covariates. Older age was associated with higher concentrations of IGFBP-1 and IGFBP-2 and lower concentrations of IGF-I, IGF-II and IGFBP-3. Higher body mass index was associated with lower concentrations of IGFBP-1 and IGFBP-2. Taller height was associated with higher concentrations of IGF-I and IGFBP-3 and lower concentrations of IGFBP-1. Smokers had higher concentrations of IGFBP-1 and IGFBP-2 and lower concentrations of IGFBP-3 than nonsmokers. Higher alcohol consumption was associated with higher concentrations of IGF-II and lower concentrations of IGF-I and IGFBP-2. African Americans had lower concentrations of IGF-II, IGFBP-1, IGFBP-2 and IGFBP-3 and Hispanics had lower IGF-I, IGF-II and IGFBP-3 than non-Hispanic whites. These findings indicate that a range of anthropometric, behavioural and sociodemographic factors are associated with circulating concentrations of IGFs and IGFBPs in men, which will lead to a greater understanding of the mechanisms through which these factors influence cancer risk.
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Affiliation(s)
- Eleanor L. Watts
- Cancer Epidemiology UnitNuffield Department of Population Health, University of OxfordOxfordUnited Kingdom
| | - Aurora Perez‐Cornago
- Cancer Epidemiology UnitNuffield Department of Population Health, University of OxfordOxfordUnited Kingdom
| | - Paul N. Appleby
- Cancer Epidemiology UnitNuffield Department of Population Health, University of OxfordOxfordUnited Kingdom
| | - Demetrius Albanes
- Division of Cancer Epidemiology and Genetics, Department of Health and Human ServicesNational Cancer Institute, National Institutes of HealthBethesdaMD
| | - Eva Ardanaz
- Navarra Public Health InstitutePamplonaSpain
| | - Amanda Black
- Division of Cancer Epidemiology and Genetics, Department of Health and Human ServicesNational Cancer Institute, National Institutes of HealthBethesdaMD
| | - H. Bas Bueno‐de‐Mesquita
- Department for Determinants of Chronic DiseasesNational Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
- Department of Gastroenterology and HepatologyUniversity Medical CentreUtrechtThe Netherlands
- Department of Epidemiology and BiostatisticsImperial College LondonLondonUnited Kingdom
- Department of Social & Preventive MedicineUniversity of MalayaKuala LumpurMalaysia
| | - June M. Chan
- Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoCA
- Department UrologyUniversity of California‐San FranciscoSan FranciscoCA
| | - Chu Chen
- Public Health Sciences Division, Program in EpidemiologyFred Hutchinson Cancer Research CenterSeattleWA
| | - S.A. Paul Chubb
- PathWest Laboratory MedicineFiona Stanley HospitalPerthWAAustralia
- Medical SchoolUniversity of Western AustraliaPerthWAAustralia
| | - Michael B. Cook
- Division of Cancer Epidemiology and Genetics, Department of Health and Human ServicesNational Cancer Institute, National Institutes of HealthBethesdaMD
| | - Mélanie Deschasaux
- Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS)Nutritional Epidemiology Research Team (EREN), Inserm U1153/Inra U1125/Cnam/Paris 13 UniversityParisFrance
| | - Jenny L. Donovan
- Department of Population Health SciencesBristol Medical School, University of BristolBristolUnited Kingdom
| | - Dallas R. English
- Cancer Epidemiology and Intelligence DivisionCancer Council VictoriaMelbourneVICAustralia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, The University of MelbourneMelbourneVICAustralia
| | - Leon Flicker
- Medical SchoolUniversity of Western AustraliaPerthWAAustralia
- WA Centre for Health & Ageing, Centre for Medical ResearchHarry Perkins Institute of Medical ResearchPerthWAAustralia
- Department of Geriatric MedicineRoyal Perth HospitalPerthWAAustralia
| | - Neal D. Freedman
- Division of Cancer Epidemiology and Genetics, Department of Health and Human ServicesNational Cancer Institute, National Institutes of HealthBethesdaMD
| | - Pilar Galan
- Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS)Nutritional Epidemiology Research Team (EREN), Inserm U1153/Inra U1125/Cnam/Paris 13 UniversityParisFrance
| | - Graham G. Giles
- Cancer Epidemiology and Intelligence DivisionCancer Council VictoriaMelbourneVICAustralia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, The University of MelbourneMelbourneVICAustralia
| | - Edward L. Giovannucci
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMA
- Channing Division of Network MedicineBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMA
| | - Marc J. Gunter
- Section of Nutrition and MetabolismInternational Agency for Research on CancerLyonFrance
| | - Laurel A. Habel
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCA
| | | | | | - Freddie C. Hamdy
- Nuffield Department of SurgeryUniversity of OxfordOxfordUnited Kingdom
| | - Serge Hercberg
- Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS)Nutritional Epidemiology Research Team (EREN), Inserm U1153/Inra U1125/Cnam/Paris 13 UniversityParisFrance
| | - Jeff M. Holly
- IGFs & Metabolic Endocrinology Group, Translational Health SciencesBristol Medical School, Faculty of Health Sciences, University of BristolBristolUnited Kingdom
| | - Jiaqi Huang
- Division of Cancer Epidemiology and Genetics, Department of Health and Human ServicesNational Cancer Institute, National Institutes of HealthBethesdaMD
| | - Wen‐Yi Huang
- Division of Cancer Epidemiology and Genetics, Department of Health and Human ServicesNational Cancer Institute, National Institutes of HealthBethesdaMD
| | - Mattias Johansson
- Genetic Epidemiology GroupInternational Agency for Research on CancerLyonFrance
| | - Rudolf Kaaks
- Division of Cancer EpidemiologyGerman Cancer Research Center (DKFZ)HeidelbergGermany
| | - Tatsuhiko Kubo
- Department of Environmental EpidemiologyUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - J. Athene Lane
- Department of Population Health SciencesBristol Medical School, University of BristolBristolUnited Kingdom
- National Institute for Health Research Bristol Biomedical Research Unit in NutritionBristolUnited Kingdom
| | | | | | - Richard M. Martin
- Department of Population Health SciencesBristol Medical School, University of BristolBristolUnited Kingdom
- National Institute for Health Research Bristol Biomedical Research Unit in NutritionBristolUnited Kingdom
- Medical Research Council/University of Bristol Integrative Epidemiology Unit, University of BristolBristolUnited Kingdom
| | - E. Jeffrey Metter
- Department of NeurologyUniversity of Tennessee Health Science CenterMemphisTN
| | | | - Roger L. Milne
- Cancer Epidemiology and Intelligence DivisionCancer Council VictoriaMelbourneVICAustralia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, The University of MelbourneMelbourneVICAustralia
| | | | - Lorelei A. Mucci
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMA
- Channing Division of Network MedicineBrigham and Women's Hospital and Harvard Medical SchoolBostonMA
| | - David E. Neal
- Nuffield Department of SurgeryUniversity of OxfordOxfordUnited Kingdom
| | - Marian L. Neuhouser
- Cancer Prevention Program, Public Health Sciences DivisionFred Hutchinson Cancer Research CenterSeattleWA
| | - Steven E. Oliver
- Department of Health SciencesUniversity of York and the Hull York Medical SchoolYorkUK
| | - Kim Overvad
- Department of Public HealthSection for Epidemiology, Aarhus UniversityAarhusDenmark
| | - Kotaro Ozasa
- Radiation Effects Research FoundationHiroshimaJapan
| | - Valeria Pala
- Epidemiology and Prevention UnitFondazione IRCCS Istituto Nazionale dei Tumori di MilanoMilanItaly
| | - Claire H. Pernar
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMA
| | - Michael Pollak
- Department of Medicine and OncologyMcGill UniversityMontrealQCCanada
- Segal Cancer CentreJewish General HospitalMontrealQCCanada
| | - Mari‐Anne Rowlands
- Department of Population Health SciencesBristol Medical School, University of BristolBristolUnited Kingdom
| | | | - Jeannette M. Schenk
- Cancer Prevention Program, Public Health Sciences DivisionFred Hutchinson Cancer Research CenterSeattleWA
| | - Pär Stattin
- Department of Surgical SciencesUppsala UniversityUppsalaSweden
| | | | - Elin Thysell
- Department of Medical Biosciences and PathologyUmea UniversityUmeaSweden
| | - Mathilde Touvier
- Sorbonne Paris Cité Epidemiology and Statistics Research Center (CRESS)Nutritional Epidemiology Research Team (EREN), Inserm U1153/Inra U1125/Cnam/Paris 13 UniversityParisFrance
| | | | - Konstantinos K. Tsilidis
- Department of Epidemiology and BiostatisticsImperial College LondonLondonUnited Kingdom
- Department of Hygiene and Epidemiology, School of MedicineUniversity of IoanninaIoanninaGreece
| | | | - Stephanie J. Weinstein
- Division of Cancer Epidemiology and Genetics, Department of Health and Human ServicesNational Cancer Institute, National Institutes of HealthBethesdaMD
| | | | - Bu B. Yeap
- Medical SchoolUniversity of Western AustraliaPerthWAAustralia
- Department of Endocrinology and DiabetesFiona Stanley HospitalPerthWAAustralia
| | - Timothy J. Key
- Cancer Epidemiology UnitNuffield Department of Population Health, University of OxfordOxfordUnited Kingdom
| | - Naomi E. Allen
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population Health, University of OxfordOxfordUnited Kingdom
| | - Ruth C. Travis
- Cancer Epidemiology UnitNuffield Department of Population Health, University of OxfordOxfordUnited Kingdom
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Jain A, Shah H, Simonsick EM, Metter EJ, Mangold L, Humphreys E, Partin A, Fedarko NS. Angiotensin receptor autoantibodies as exposures that modify disease progression: Cross sectional, longitudinal and in vitro studies of prostate cancer. J Transl Autoimmun 2019; 2:100008. [PMID: 31930191 PMCID: PMC6953913 DOI: 10.1016/j.jtauto.2019.100008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 07/28/2019] [Accepted: 07/29/2019] [Indexed: 12/23/2022] Open
Abstract
Circulating angiotensin type I receptor (AT1R) agonistic autoantibodies (AT1RaAbs) that bind and chronically activate the receptor have been associated with a number of diseases suggesting that while the autoantibodies are not necessarily causative they may promote disease progression. The prostate has a local renin angiotensin system. The current study examines associations between AT1RaAbs and prostate cancer (PCA), disease-free survival (DFS), overall survival (OS) and AT1RaAb effects on PCA cell phenotype. In a cross-sectional set of serum obtained from 151 men diagnosed with PCA, nonmalignant prostate disease or no disease, higher serum AT1RaAb levels were associated with PCA and non-organ confined PCA. The odds ratio for PCA was 6.3 (95% confidence interval 2.2 to 18) for a positive 1:1600 titer and 18 (95% confidence interval 6.9 to 45) at AT1RaAb levels > 1.04 μg/ml, (p < 0.0001). In a longitudinal set of pre-diagnosis samples from 109 men, DFS hazard ratios of 2.2 (95% confidence interval 1.4 to 3.5) and 1.6 (95% confidence interval 1.0 to 2.5) for most proximal to diagnosis and most distal to diagnosis samples, respectively, were found for high versus low AT1RaAb groups. Hazard ratios for OS in most proximal and distal samples were 2.4 (95% confidence interval 1.6 to 3.6) and 1.8 (95% confidence interval 1.1 to 2.8), respectively. Accelerated failure modeling of survival indicated that a 1 μg/ml increase in AT1RaAb levels was associated with a reduction of DFS and OS by 20% at the most proximal time point and by 15% at the most distal time points. Adjusting for age, did not affect the association with DFS in proximal samples but changed distal time point DFS and OS to a 10% decrease for every 1 μg/ml increase in AT1RaAb. Additional adjustments for body mass index, systolic blood pressure and prostate-specific antigen did not appreciably alter these associations. AT1RaAb treatment of PC3, DU145, and LNCaP cells significantly increased the maximal growth rate approximately 2-fold and invasiveness approximately 3-fold. Conclusions: These observations provide evidence supporting AT1RaAbs as exposures that may modify prostate cancer progression and indicate they may be predictive markers for risk stratification.
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Affiliation(s)
- Alka Jain
- Department of Medicine, Johns Hopkins University, Baltimore, MD, 21224, USA
| | - Haikoo Shah
- Department of Medicine, Johns Hopkins University, Baltimore, MD, 21224, USA
- Department of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Eleanor M. Simonsick
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, 21225, USA
| | - E. Jeffrey Metter
- Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD, 21225, USA
- Current Address: Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Leslie Mangold
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Elizabeth Humphreys
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Alan Partin
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Neal S. Fedarko
- Department of Medicine, Johns Hopkins University, Baltimore, MD, 21224, USA
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Talbot, Col, Usafr (Ret) LA, Brede E, Price MN, Zuber PD, Metter EJ. Self-Managed Strength Training for Active Duty Military With a Knee Injury: A Randomized Controlled Pilot Trial. Mil Med 2019; 184:e174-e183. [PMID: 30690578 DOI: 10.1093/milmed/usy347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/07/2018] [Accepted: 11/05/2018] [Indexed: 11/08/2023] Open
Abstract
INTRODUCTION Knee injuries among active duty military are one of the most frequent musculoskeletal injuries and are often caused by exercise or intense physical activity or combat training. These injuries pose a threat to force readiness. Our objective was to assess feasibility (including recruitment and retention rates) of three self-managed strengthening strategies for knee injuries and determine if they resulted in improvements in lower extremity strength, function, pain, and activity compared to usual physical therapy (PT) in military members. METHODS A pilot study using a randomized controlled trial was conducted at three outpatient military medical treatment facilities. After baseline testing, 78 active duty military members with a knee injury were randomized to 1-4 trial arms: (1) neuromuscular electrical stimulation (NMES) applied to the quadriceps muscle; (2) graduated strength walking using a weighted vest (WALK); (3) combined NMES with strength walking (COMBO); (4) usual PT alone. All groups received usual PT. The primary outcome was the rates of change in knee extensor and flexor strength over 18 weeks. Secondary outcomes explored the rates of change in functional performance, pain, and activities of daily living scale (ADLS). The primary analysis for the endpoints used repeated measures, linear mixed-effects models. This study was approved by Institutional Review Boards at all facilities. RESULTS The randomized sample (N = 78) included 19 participants in the PT-only, 20 in the WALK, 19 in the NMES and 20 in the COMBO groups. At baseline, there were no group differences. Fifty of the participants completed the 18-week study. The completers and non-completers differed at baseline on injury mechanism, with more completers injured during sports (45% vs 29%), and more non-completers during military training (36% vs 18%). Also, they differed in uninjured knee extension (completers 28% weaker), and uninjured knee flexion (completers 22% weaker). Adherence for self-reported daily step logs showed that the WALK group was 15% below goal and COMBO group 6% below goal. The 300 PV muscle stimulator showed the NMES group completed 34% of recommended stimulation sessions and the COMBO group 30%.Knee extension strength in the injured knee found only the COMBO group having a statistically higher improvement compared to PT-only (Change over 18 weeks: 10.6 kg in COMBO; 2.1 kg in PT-only). For the injured knee flexion changes, only the COMBO showed significant difference from PT-only (Change over 18 weeks: 7.5 kg in COMBO; -0.2 kg in PT-only). Similarly, for the uninjured knee, only the COMBO showed significant difference from PT-only in knee extension (Change over 18 weeks: 14.7 Kg in COMBO; 2.7 kg in PT-only) and knee flexion (Change over 18 weeks: 6.5 kg in COMBO; -0.2 kg in PT-only). Overall pain improved during the study for all groups with no significant group differences. Similarly, function and ADLS significantly improved over 18 weeks, with no significant group differences. CONCLUSIONS Knee extensor strength improvements in the COMBO group were significantly higher compared to usual PT. Pain, functional measures, and ADLS all improved during the study with no group differences. Further research is required to confirm these findings.
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Affiliation(s)
- Laura A Talbot, Col, Usafr (Ret)
- College of Medicine, University of Tennessee Health Science Center, Department of Neurology, 855 Monroe Ave, Suite 415, Memphis, TN
| | - Emily Brede
- College of Medicine, University of Tennessee Health Science Center, Department of Neurology, 855 Monroe Ave, Suite 415, Memphis, TN
| | - Marquita N Price
- Commander, 20th Medical Operations Squadron, 20th Medical Group, Shaw AFB, SC, DSN
| | - Pilar D Zuber
- College of Health and Human Services, University of North Carolina at Charlotte, Department of Public Health Sciences, 9201 University City Blvd, Charlotte, NC
| | - E Jeffrey Metter
- College of Medicine, University of Tennessee Health Science Center, Department of Neurology, 855 Monroe Ave, Suite 415, Memphis, TN
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Watts EL, Appleby PN, Perez-Cornago A, Bueno-de-Mesquita HB, Chan JM, Chen C, Cohn BA, Cook MB, Flicker L, Freedman ND, Giles GG, Giovannucci E, Gislefoss RE, Hankey GJ, Kaaks R, Knekt P, Kolonel LN, Kubo T, Le Marchand L, Luben RN, Luostarinen T, Männistö S, Metter EJ, Mikami K, Milne RL, Ozasa K, Platz EA, Quirós JR, Rissanen H, Sawada N, Stampfer M, Stanczyk FZ, Stattin P, Tamakoshi A, Tangen CM, Thompson IM, Tsilidis KK, Tsugane S, Ursin G, Vatten L, Weiss NS, Yeap BB, Allen NE, Key TJ, Travis RC. Low Free Testosterone and Prostate Cancer Risk: A Collaborative Analysis of 20 Prospective Studies. Eur Urol 2018; 74:585-594. [PMID: 30077399 PMCID: PMC6195673 DOI: 10.1016/j.eururo.2018.07.024] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/13/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Experimental and clinical evidence implicates testosterone in the aetiology of prostate cancer. Variation across the normal range of circulating free testosterone concentrations may not lead to changes in prostate biology, unless circulating concentrations are low. This may also apply to prostate cancer risk, but this has not been investigated in an epidemiological setting. OBJECTIVE To examine whether men with low concentrations of circulating free testosterone have a reduced risk of prostate cancer. DESIGN, SETTING, AND PARTICIPANTS Analysis of individual participant data from 20 prospective studies including 6933 prostate cancer cases, diagnosed on average 6.8 yr after blood collection, and 12 088 controls in the Endogenous Hormones, Nutritional Biomarkers and Prostate Cancer Collaborative Group. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Odds ratios (ORs) of incident overall prostate cancer and subtypes by stage and grade, using conditional logistic regression, based on study-specific tenths of calculated free testosterone concentration. RESULTS AND LIMITATIONS Men in the lowest tenth of free testosterone concentration had a lower risk of overall prostate cancer (OR=0.77, 95% confidence interval [CI] 0.69-0.86; p<0.001) compared with men with higher concentrations (2nd-10th tenths of the distribution). Heterogeneity was present by tumour grade (phet=0.01), with a lower risk of low-grade disease (OR=0.76, 95% CI 0.67-0.88) and a nonsignificantly higher risk of high-grade disease (OR=1.56, 95% CI 0.95-2.57). There was no evidence of heterogeneity by tumour stage. The observational design is a limitation. CONCLUSIONS Men with low circulating free testosterone may have a lower risk of overall prostate cancer; this may be due to a direct biological effect, or detection bias. Further research is needed to explore the apparent differential association by tumour grade. PATIENT SUMMARY In this study, we looked at circulating testosterone levels and risk of developing prostate cancer, finding that men with low testosterone had a lower risk of prostate cancer.
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Affiliation(s)
- Eleanor L Watts
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Paul N Appleby
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Aurora Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - H Bas Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands; Department of Epidemiology and Biostatistics, Imperial College London, London, UK; Department of Social & Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - June M Chan
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA, USA; Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Chu Chen
- Public Health Sciences Division, Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Barbara A Cohn
- Child Health and Development Studies, Public Health Institute, Berkeley, CA, USA
| | - Michael B Cook
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Bethesda, MD, USA
| | - Leon Flicker
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia; Western Australian Centre for Health and Ageing, Centre for Medical Research, University of Western Australia, Perth, Western Australia, Australia
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Bethesda, MD, USA
| | - Graham G Giles
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Edward Giovannucci
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; The Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Randi E Gislefoss
- Cancer Registry of Norway, Institute for Epidemiological Cancer Research, Oslo, Norway
| | - Graeme J Hankey
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany
| | - Paul Knekt
- National Institute for Health and Welfare, Helsinki, Finland
| | | | - Tatsuhiko Kubo
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, Japan
| | | | - Robert N Luben
- Strangeways Research Laboratory, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Tapio Luostarinen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Satu Männistö
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - E Jeffrey Metter
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kazuya Mikami
- Department of Urology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Roger L Milne
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Kotaro Ozasa
- Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Elizabeth A Platz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Harri Rissanen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Norie Sawada
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Meir Stampfer
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; The Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Frank Z Stanczyk
- Division of Reproductive Endocrinology and Infertility, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Akiko Tamakoshi
- Department of Public Health, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Catherine M Tangen
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Cancer Prevention Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ian M Thompson
- Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, TX, USA
| | - Konstantinos K Tsilidis
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK; Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Giske Ursin
- Cancer Registry of Norway, Institute for Epidemiological Cancer Research, Oslo, Norway; Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lars Vatten
- Department of Public Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Noel S Weiss
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Bu B Yeap
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia; Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Naomi E Allen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Timothy J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ruth C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Brand RM, Biswas N, Siegel A, Myerski A, Engstrom J, Jeffrey Metter E, Brand RE, Cranston RD, McGowan I. Immunological responsiveness of intestinal tissue explants and mucosal mononuclear cells to ex vivo stimulation. J Immunol Methods 2018; 463:39-46. [PMID: 30218652 DOI: 10.1016/j.jim.2018.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/14/2018] [Accepted: 08/20/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND There are limited data on the immunological responsiveness of healthy intestinal tissue when it is cultured and stimulated ex vivo. Such an ex vivo model has the potential to be a valuable tool in understanding disease pathogenesis and as a preclinical tool for the assessment of candidate therapeutic agents used to treat inflammatory bowel disease (IBD). AIM We undertook a comprehensive study to evaluate ex vivo immunological responses of intestinal tissue and isolated mucosal mononuclear cells (MMC) to a broad range of stimuli. METHODS Colorectal biopsies (explants) were obtained from healthy participants by flexible sigmoidoscopy and were placed either directly into culture or digested to isolate MMC prior to placement in culture. Explants or MMC were treated with polyinosinic:polycytidylic acid (Poly IC), phytohemagglutinin (PHA), lipopolysacccharides from E Coli (LPS), anti-CD3/CD28 antibodies, or IL-1β/TNF-α for 24 h. Supernatants were assayed for 40 inflammatory biomarkers using multiplexed enzyme-linked immunosorbent assay (ELISA). The isolated MMCs were further characterized using twelve color flow cytometry. RESULTS Explants have greater weight adjusted constitutive expression of inflammatory biomarkers than MMCs. Biomarker responses varied as a function of immunogen and use of intact tissue or isolated cells. PHA applied to intact explants was the most effective agent in inducing biomarker changes. Stimulation induced activated and memory cellular phenotypes in both explants and MMCs. CONCLUSIONS The breadth and magnitude of responses from intact and enzymatically digested intestinal tissue explants stimulated with exogenous immunogens are complex and vary by tissue form and treatment. Overall, PHA stimulation of intact explants produced the most robust responses in normal human colorectal tissue. This system could potentially serve as a preliminary model of the disease state, suitable for small scale screening of new therapeutic agents prior to using IBD patient derived tissue.
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Affiliation(s)
- Rhonda M Brand
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Magee-Womens Research Institute and Foundation, Pittsburgh, PA, USA.
| | - Nabanita Biswas
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Aaron Siegel
- Magee-Womens Research Institute and Foundation, Pittsburgh, PA, USA
| | - Ashley Myerski
- Magee-Womens Research Institute and Foundation, Pittsburgh, PA, USA
| | - Jarret Engstrom
- Magee-Womens Research Institute and Foundation, Pittsburgh, PA, USA
| | | | - Randall E Brand
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ross D Cranston
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ian McGowan
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Magee-Womens Research Institute and Foundation, Pittsburgh, PA, USA
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27
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Rhudy JP, Alexandrov AW, Rike J, Bryndziar T, Hossein Zadeh Maleki A, Swatzell V, Dusenbury W, Metter EJ, Alexandrov AV. Geospatial Visualization of Mobile Stroke Unit Dispatches: A Method to Optimize Service Performance. Interv Neurol 2018; 7:464-470. [PMID: 30410526 DOI: 10.1159/000490581] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 06/02/2018] [Indexed: 01/01/2023]
Abstract
Background Timely treatment of acute ischemic stroke is crucial to optimize outcomes. Mobile stroke units (MSU) have demonstrated ultrafast treatment compared to standard emergency care. Geospatial analysis of the distribution of MSU cases to optimize service delivery has not been reported. Methods We aggregated all first-year MSU dispatch occurrences and all cases classified by clinical teams as true stroke by zip code and calculated dispatch and true stroke incidence rates. We mapped dispatch and stroke cases and symbolized incidence rates by standard deviation. We confirmed visual impressions of clusters from map inspection by local Moran's I, boxplot inspection, and t test. We calculated service areas using drive times to meet dispatch and true stroke need. Results A significant cluster of high dispatch incident rate was confirmed around our MSU base in urban Memphis within a 5-min driving area supporting the initial placement of the MSU based on 911 activation. A significant cluster of high true stroke rate was confirmed to the east of our MSU base in suburban Memphis within a 10-min driving area. Mean incident longitude of cases of true stroke versus disregarded status was significantly eastward (p = 0.001785). Conclusion Our findings will facilitate determination of socio-spatial antecedents of neighborhood overutilization of 911 and MSU services in our urban neighborhoods and service delivery optimization to reach neighborhoods with true stroke burden.
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Affiliation(s)
- James P Rhudy
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Anne W Alexandrov
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,College of Nursing, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Joseph Rike
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Tomas Bryndziar
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Ana Hossein Zadeh Maleki
- Internal Medicine Residency Program, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Victoria Swatzell
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,College of Nursing, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Wendy Dusenbury
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,College of Nursing, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Wichita State University School of Nursing, Wichita, Kansas, USA
| | - E Jeffrey Metter
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Andrei V Alexandrov
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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28
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Talbot LA, Brede E, Metter EJ. Psychological and Physical Health in Military Amputees During Rehabilitation: Secondary Analysis of a Randomized Controlled Trial. Mil Med 2018; 182:e1619-e1624. [PMID: 29087903 DOI: 10.7205/milmed-d-16-00328] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Service members who have experienced combat trauma with resulting amputation are at risk for compromised quality of life postamputation. Monitoring mental and physical health in amputees returning from the war is of paramount importance. This study examined changes in physical and mental health-related quality of life in service members following traumatic unilateral, transtibial amputation (TTA) during a 12-week period of rehabilitation before and after receiving a prosthesis. METHOD This study is a secondary analysis from a randomized controlled trial (RCT) of military service members starting Military Amputee Rehabilitation Program (MARP) following a traumatic TTA. The study examined change in SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores as two aspects of health-related quality of life. Forty-four injured service members, aged 19 to 46, were recruited into the RCT. Participants were randomized into 12 weeks of MARP plus home neuromuscular electrical stimulation therapy (n = 23) or MARP alone (N = 21) and compared at baseline, 6, and 12 weeks on: SF-36 PCS and MCS scores. Linear mixed models examined time and group differences and their interaction for the MCS and PCS scores. A multivariate mixed model tested whether MCS and PCS scores differed. RESULTS For the combined rehabilitation cohort, MCS did not differ over 12 weeks (p = 0.27) with scores at week 0 of M = 56.7 (SD = 11.9) and at week 12 of M = 52.7 (SD = 11.4), similar to healthy controls (age = 25-34, M = 51.0, SD = 7.6). Scores did not differ between treatment groups (p = 0.28) with no group by time interaction (p = 0.34). The MCS significantly declined over time (p = 0.05) after adjustment for covariates. PCS improved over 12 weeks (p < 0.0001) in the total rehabilitation group with scores at week 0 of M = 34.0 (SD = 8.1) to M = 41.8 (SD = 8.4) at week 12, significantly lower than healthy controls (age = 25-34, M = 54.1, SD = 6.6). Scores did not differ between treatment groups (p = 0.89), and there was no group by time interaction (p = 0.34). An interaction between the PCS and MCS was observed such that the PCS improved over time, whereas the MCS did not significantly change (p = 0.0005). DISCUSSION War-injured transtibial amputees are at risk for compromised quality of life during rehabilitation. Self-perceived physical health improved as might be expected from rehabilitation. Self-perceived mental health did not. During rehabilitation, physical healing, psychological adjustment, and lifestyle adaptation are occurring simultaneously. However, more attention may need to be directed toward mental health during rehabilitation.
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Affiliation(s)
- Laura A Talbot
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, 855 Monroe Avenue, Suite 415, Memphis, TN 38163
| | - Emily Brede
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, 855 Monroe Avenue, Suite 415, Memphis, TN 38163
| | - E Jeffrey Metter
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, 855 Monroe Avenue, Suite 415, Memphis, TN 38163
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Alexandrov AW, Bryndziar T, Rike J, Swatzell V, Dusenbury W, Rhudy J, Hossein Zadeh Maleki A, Koury D, Chulpayev B, Krishnaiah B, Nearing K, Malkoff M, Metter EJ, Alexandrov AV. Abstract TP357: BP Management on the Mobile Stroke Unit for Ultra-Early Treatment of ICH and Acute Ischemic Stroke. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.tp357] [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
Background:
Lowering of blood pressure (BP) is discouraged in current ASA guidelines for emergency medical service (EMS) personnel. However, ultra-early treatment with IVtPA and BP lowering in ICH are possible on mobile stroke units (MSU). We examined the effectiveness and safety of two antihypertensive agents for MSU treatment.
Methods:
Consecutive MSU patients were treated with target ICH BP parameters less than 140/90, and IVtPA BP parameters by current guidelines. BP was measured by noninvasive oscillometric cuff, and cycled every 5 minutes per EMS MSU protocol. Available agents were labetalol IV 10-20mg and/or nicardipine double-strength premix infusion started at 5mg/hour and titrated. Preference in usage, and effect were recorded and analyzed for the first year of MSU operation.
Results:
During 168 service days, 127 acute stroke patients were transported (68±16, range 23-96 years; 58% women; 65% African American, 34% White; 1% Hispanic). Fifteen (12%) had hemorrhage on CT (1 aneurysmal SAH, 1 SDH, 1 subacute AIS with HT-2; 12 HTN ICH [median ICH score 2, IQR 1-3] of which 1 had a positive spot sign on CTA). AIS cases (n=100) had median NIHSS 9 (IQR 7-17); 38% were treated with IVtPA at a median 13 (IQR 11-16) minutes from scene arrival, one of these by IO route, with 1 angioedema and 0 sICH. Labetalol was used for 9 patients, with all but one (89%) requiring the addition of nicardipine infusion. In 24 patients nicardipine was the first agent selected, with 100% achieving target BP control prior to hospital arrival.
Conclusions:
MSU use of nicardipine double-strength premix infusions provides rapid, reliable, and safe BP control. When time is of the essence, elimination of labetalol, in favor of a dihydropyridine calcium channel blocker infusion may provide the most rapid achievement of prescribed BP parameters.
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Rhudy JP, Alexandrov AW, Rike J, Bryndziar T, Hossein Zadeh Maleki A, Swatzell V, Dusenbury W, Metter EJ, Alexandrov AV. Abstract WP215: Geospatial Visualization of Mobile Stroke Unit Dispatches: A Method to Optimize Service Performance. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.wp215] [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
Background:
Understanding geospatial regional stroke burden and emergency medical services (EMS) response locations may benefit attainment and distribution of prehospital resources, enabling rapid diagnosis and treatment. We sought to understand the spatial distribution of all Mobile Stroke Unit (MSU) dispatches and diagnosed strokes during the first year of operation.
Methods:
All MSU dispatched cases from July 2016 to July 2017 were assembled and aggregated into groups based on stroke diagnosis status. The raw count of incidents was aggregated by zip code, normalized to population, and geocoded. The resulting incidence rate was symbolized by standard deviation and mapped by zip code for inspection. Five- and ten-minute drive time service areas were defined around our MSU base.
Results:
A total of 420 dispatches for suspected stroke occurred, of which 394 were able to be geocoded. On the initial analysis of all 394 cases, a five-minute service area was sufficient to rapidly reach areas with high rates of suspected stroke burden (> 1.5 SD) (figure 1). However, repeating the analysis on 123 cases diagnosed as
true strokes
redefined the areas that were strongly positive for high stroke burden requiring a ten-minute service area from our MSU base (figure 2).
Conclusions:
Use of geospatial findings helps plan EMS and MSU dispatch to high burden regional pockets of stroke, and may assist in improving dispatch scripting for 911 calls.
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31
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Watts EL, Appleby PN, Albanes D, Black A, Chan JM, Chen C, Cirillo PM, Cohn BA, Cook MB, Donovan JL, Ferrucci L, Garland CF, Giles GG, Goodman PJ, Habel LA, Haiman CA, Holly JMP, Hoover RN, Kaaks R, Knekt P, Kolonel LN, Kubo T, Le Marchand L, Luostarinen T, MacInnis RJ, Mäenpää HO, Männistö S, Metter EJ, Milne RL, Nomura AMY, Oliver SE, Parsons JK, Peeters PH, Platz EA, Riboli E, Ricceri F, Rinaldi S, Rissanen H, Sawada N, Schaefer CA, Schenk JM, Stanczyk FZ, Stampfer M, Stattin P, Stenman UH, Tjønneland A, Trichopoulou A, Thompson IM, Tsugane S, Vatten L, Whittemore AS, Ziegler RG, Allen NE, Key TJ, Travis RC. Circulating sex hormones in relation to anthropometric, sociodemographic and behavioural factors in an international dataset of 12,300 men. PLoS One 2017; 12:e0187741. [PMID: 29281666 PMCID: PMC5744924 DOI: 10.1371/journal.pone.0187741] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 10/25/2017] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Sex hormones have been implicated in the etiology of a number of diseases. To better understand disease etiology and the mechanisms of disease-risk factor associations, this analysis aimed to investigate the associations of anthropometric, sociodemographic and behavioural factors with a range of circulating sex hormones and sex hormone-binding globulin. METHODS Statistical analyses of individual participant data from 12,330 male controls aged 25-85 years from 25 studies involved in the Endogenous Hormones Nutritional Biomarkers and Prostate Cancer Collaborative Group. Analysis of variance was used to estimate geometric means adjusted for study and relevant covariates. RESULTS Older age was associated with higher concentrations of sex hormone-binding globulin and dihydrotestosterone and lower concentrations of dehydroepiandrosterone sulfate, free testosterone, androstenedione, androstanediol glucuronide and free estradiol. Higher body mass index was associated with higher concentrations of free estradiol, androstanediol glucuronide, estradiol and estrone and lower concentrations of dihydrotestosterone, testosterone, sex hormone-binding globulin, free testosterone, androstenedione and dehydroepiandrosterone sulfate. Taller height was associated with lower concentrations of androstenedione, testosterone, free testosterone and sex hormone-binding globulin and higher concentrations of androstanediol glucuronide. Current smoking was associated with higher concentrations of androstenedione, sex hormone-binding globulin and testosterone. Alcohol consumption was associated with higher concentrations of dehydroepiandrosterone sulfate, androstenedione and androstanediol glucuronide. East Asians had lower concentrations of androstanediol glucuronide and African Americans had higher concentrations of estrogens. Education and marital status were modestly associated with a small number of hormones. CONCLUSION Circulating sex hormones in men are strongly associated with age and body mass index, and to a lesser extent with smoking status and alcohol consumption.
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Affiliation(s)
- Eleanor L. Watts
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Paul N. Appleby
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Demetrius Albanes
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Bethesda, MD, United States of America
| | - Amanda Black
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Bethesda, MD, United States of America
| | - June M. Chan
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA, United States of America
- Department of Urology, University of California-San Francisco, San Francisco, CA, United States of America
| | - Chu Chen
- Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Piera M. Cirillo
- Child Health and Development Studies, Public Health Institute, Berkeley, CA, United States of America
| | - Barbara A. Cohn
- Child Health and Development Studies, Public Health Institute, Berkeley, CA, United States of America
| | - Michael B. Cook
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Bethesda, MD, United States of America
| | - Jenny L. Donovan
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Luigi Ferrucci
- Intramural Research Program, National Institute on Aging, Bethesda, MD, United States of America
| | - Cedric F. Garland
- Department of Family Medicine and Public Health, University of California, San Diego, CA, United States of America
| | - Graham G. Giles
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Phyllis J. Goodman
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Laurel A. Habel
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Christopher A. Haiman
- Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Jeff M. P. Holly
- School of Clinical Sciences, Faculty of Health Science, University of Bristol, Bristol, United Kingdom
| | - Robert N. Hoover
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Bethesda, MD, United States of America
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany
| | - Paul Knekt
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Laurence N. Kolonel
- University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI, United States of America
| | - Tatsuhiko Kubo
- Department of Public Health, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Loïc Le Marchand
- University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI, United States of America
| | - Tapio Luostarinen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Robert J. MacInnis
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Hanna O. Mäenpää
- Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland
| | - Satu Männistö
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - E. Jeffrey Metter
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Roger L. Milne
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Abraham M. Y. Nomura
- Japan-Hawaii Cancer Study, Kuakini Medical Center, Honolulu, HI, United States of America
| | - Steven E. Oliver
- Department of Health Sciences, University of York, York, United Kingdom
| | - J. Kellogg Parsons
- Division of Urologic Oncology, University of California San Diego Moores Cancer Center, San Diego, CA, United States of America
| | - Petra H. Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Netherlands
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
| | - Elizabeth A. Platz
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Elio Riboli
- School of Public Health, Imperial College London, London, United Kingdom
| | - Fulvio Ricceri
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
- Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco, Italy
| | - Sabina Rinaldi
- Biomarkers Group, International Agency for Research on Cancer, Lyon, France
| | - Harri Rissanen
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Norie Sawada
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Catherine A. Schaefer
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Jeannette M. Schenk
- Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Frank Z. Stanczyk
- Division of Reproductive Endocrinology and Infertility, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States of America
| | - Meir Stampfer
- Departments of Nutrition and Epidemiology, Harvard University T.H. Chan School of Public Health, Boston, MA, United States of America
- The Channing Division of Network Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Pär Stattin
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Ulf-Håkan Stenman
- Department of Clinical Chemistry, Medicum, University of Helsinki, Helsinki, Finland
| | - Anne Tjønneland
- Department of Diet, Genes and Environment, The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Antonia Trichopoulou
- Hellenic Health Foundation, Athens, Greece
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Ian M. Thompson
- CHRISTUS Medical Center Hospital, San Antonio, TX, United States of America
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Lars Vatten
- Department of Public Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Alice S. Whittemore
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, United States of America
- Department of Biomedical Data Science, Stanford University, Stanford, CA, United States of America
| | - Regina G. Ziegler
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Bethesda, MD, United States of America
| | - Naomi E. Allen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Timothy J. Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Ruth C. Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Lustig A, Liu HB, Metter EJ, An Y, Swaby MA, Elango P, Ferrucci L, Hodes RJ, Weng NP. Telomere Shortening, Inflammatory Cytokines, and Anti-Cytomegalovirus Antibody Follow Distinct Age-Associated Trajectories in Humans. Front Immunol 2017; 8:1027. [PMID: 28970831 PMCID: PMC5609584 DOI: 10.3389/fimmu.2017.01027] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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: 06/30/2017] [Accepted: 08/09/2017] [Indexed: 01/09/2023] Open
Abstract
A number of biological parameters have been cited as hallmarks of immune aging. However, it is not clear whether these multiple biological changes are the result of common underlying aging processes and follow correlated trajectories, or whether the patterns of change for multiple parameters vary across individuals and reflect heterogeneity in the aging process. Here, we have studied parameters of immune system aging through longitudinal analysis of telomere length, inflammatory cytokines, and antibody titer to cytomegalovirus (CMV) in 465 subjects ranging in age from 21 to 88 years at the first visit, with an average of 13 years (7-19 years) follow-up. We observed a highly variable rate of change in telomere length of PBMCs with a relatively slow average rate of telomere shortening (-16 bp/year). Similarly, there were significant increases with age in vivo in three inflammation-related cytokines (interferon gamma, IL-6, and IL-10) and in anti-CMV IgG titer, which varied widely across individuals as well. We further observed positive correlative changes among different inflammatory cytokines. However, we did not find significant correlations among the rate of changes in telomere length, inflammatory cytokines, and anti-CMV IgG titers. Our findings thus reveal that age-related trajectories of telomere attrition, elevated circulating inflammatory cytokines, and anti-CMV IgG are independent and that aging individuals do not show a uniform pattern of change in these variables. Immune aging processes are complex and vary across individuals, and the use of multiple biomarkers is essential to evaluation of biological aging of the immune system.
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Affiliation(s)
- Ana Lustig
- Laboratory of Molecular Biology and Immunology, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States
| | - Hans B. Liu
- Laboratory of Molecular Biology and Immunology, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States
| | - E. Jeffrey Metter
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Yang An
- Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States
| | - Melissa A. Swaby
- Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States
| | - Palchamy Elango
- Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States
| | - Luigi Ferrucci
- Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States
| | - Richard J. Hodes
- Experimental Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Nan-ping Weng
- Laboratory of Molecular Biology and Immunology, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States
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Talbot LA, Brede E, Price M, Metter EJ. Health-related quality of life in active duty military: A secondary data analysis of two randomized controlled trials. Nurs Outlook 2017; 65:S53-S60. [PMID: 28830632 DOI: 10.1016/j.outlook.2017.07.010] [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: 03/12/2017] [Revised: 07/11/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Military service members with lower extremity injuries are at risk for compromised health-related quality of life during rehabilitation. PURPOSE The purpose of this secondary data analysis was to examine changes in self-perceived physical and mental health in two clinical trials of military service members during rehabilitation for a lower extremity injury. METHODS This study is a secondary analysis of existing data from two cohorts of active duty military service members with lower extremity injuries as they participated in separate randomized controlled trials. DISCUSSION A similar pattern for both physical and mental health was observed in both groups of participants. Perceptions of physical health improved significantly in both studies, whereas mental health perceptions may or may not have declined. CONCLUSION Increased attention to mental health may be important during rehabilitation after major and minor lower extremity injuries. Although perceptions of physical health improve, corresponding changes may not occur in mental health perceptions.
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Affiliation(s)
- Laura A Talbot
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN.
| | - Emily Brede
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Marquita Price
- Office of the Surgeon General/Medical Force Development (SG1/8AN), Falls Church, VA
| | - E Jeffrey Metter
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN
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Alexandrov AV, Tsivgoulis G, Nearing K, Malkoff M, Kargiotis O, Metter EJ, Wahba M, Alexandrov AW, Elijovich L. Abstract WP64: City-wide Stroke Team in the U.S. Delivers the Highest Intravenous Thrombolysis Treatment Rate. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.wp64] [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
Background:
An increasing shortage of vascular neurologists forced an academic provider to find a city-wide solution to offer 24x7 access to intravenous thrombolysis (IVT) across independent and competing health care systems in the area. We sought to prospectively evaluate the annual IVT treatment delivery in our population and compare it to leading stroke centers worldwide.
Methods:
The largest single ER system and 3 other independent hospital providers in the area agreed to work with a single practice plan vascular neurology team (catchment area of 1,344,127 individuals). All acute ischemic stroke patients that were treated with IVT across all primary or tertiary care centers in our area were prospectively documented over a 12-month period (January-December 2015). A literature search was performed using narrative review methodology to document similar population-based treatment rates across leading stroke centers in North America, Europe and Australasia.
Results:
A total of 552 patients received IVT with tissue plasminogen activator (tPA) in 2015. Single ER system delivered 433 IV tPA treatments and 119 more patients were treated in the remaining hospitals. The annual tPA treatment rate was 41 per 100.000 individuals (95%CI: 38-44) favorably comparable to published annual treatment rates from leading international stroke centers (Table, 1998 thru 2015).
Conclusions:
A city-wide vascular neurology team can attend to patient populations across competing health care systems in the U.S. and deliver IVT at volumes and rates above those reported by leading treatment centers worldwide. Communities with competing systems can improve tPA delivery by sharing vascular neurology resources.
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Affiliation(s)
| | - Georgios Tsivgoulis
- Neurology, Univ of Tennessee Health Science Cntr, Memphis and Athens, Greece, TN
| | | | - Marc Malkoff
- Neurology, Univ of Tennessee Health Science Cntr, Memphis, TN
| | | | | | - Mervat Wahba
- Neurology, Univ of Tennessee Health Science Cntr, Memphis, TN
| | | | - Lucas Elijovich
- Neurology, Univ of Tennessee Health Science Cntr, Memphis, TN
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35
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Talbot LA, Brede E, Metter EJ. Effects of Adding Neuromuscular Electrical Stimulation to Traditional Military Amputee Rehabilitation. Mil Med 2017; 182:e1528-e1535. [DOI: 10.7205/milmed-d-16-00037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Laura A. Talbot
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, 855 Monroe Avenue, Suite 415, Memphis, TN 38163
| | - Emily Brede
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, 855 Monroe Avenue, Suite 415, Memphis, TN 38163
| | - E. Jeffrey Metter
- Department of Neurology, College of Medicine, University of Tennessee Health Science Center, 855 Monroe Avenue, Suite 415, Memphis, TN 38163
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Simpkin AJ, Donovan JL, Tilling K, Athene Lane J, Martin RM, Albertsen PC, Bill-Axelson A, Ballentine Carter H, Bosch JLHR, Ferrucci L, Hamdy FC, Holmberg L, Jeffrey Metter E, Neal DE, Parker CC, Metcalfe C. Prostate-specific antigen patterns in US and European populations: comparison of six diverse cohorts. BJU Int 2016; 118:911-918. [PMID: 26799945 DOI: 10.1111/bju.13422] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether there are differences in prostate-specific antigen (PSA) levels at diagnosis or changes in PSA levels between US and European populations of men with and without prostate cancer (PCa). SUBJECTS AND METHODS We analysed repeated measures of PSA from six clinically and geographically diverse cohorts of men: two cohorts with PSA-detected PCa, two cohorts with clinically detected PCa and two cohorts without PCa. Using multilevel models, average PSA at diagnosis and PSA change over time were compared among study populations. RESULTS The annual percentage PSA change of 4-5% was similar between men without cancer and men with PSA-detected cancer. PSA at diagnosis was 1.7 ng/mL lower in a US cohort of men with PSA-detected PCa (95% confidence interval 1.3-2.0 ng/mL), compared with a UK cohort of men with PSA-detected PCa, but there was no evidence of a different rate of PSA change between these populations. CONCLUSION We found that PSA changes over time are similar in UK and US men diagnosed through PSA testing and even in men without PCa. Further development of PSA models to monitor men on active surveillance should be undertaken in order to take advantage of these similarities. We found no evidence that guidelines for using PSA to monitor men cannot be passed between US and European studies.
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Affiliation(s)
- Andrew J Simpkin
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jenny L Donovan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Kate Tilling
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - J Athene Lane
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Richard M Martin
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- NIHR Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK
| | - Peter C Albertsen
- Division of Urology, University of Connecticut Health Center, Farmington, CT, USA
| | - Anna Bill-Axelson
- Institution of Surgical Sciences, Department of Urology, Uppsala University, Uppsala, Sweden
| | | | - J L H Ruud Bosch
- Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Luigi Ferrucci
- National Institute on Aging, National Institutes of Health, Baltimore, MA, USA
| | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Lars Holmberg
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Regional Cancer Centre, Uppsala/Örebro Region, Uppsala, Sweden
| | - E Jeffrey Metter
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - David E Neal
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Christopher C Parker
- Academic Urology Unit, Royal Marsden Hospital, Institute of Cancer Research, London, UK
| | - Chris Metcalfe
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Allen NE, Travis RC, Appleby PN, Albanes D, Barnett MJ, Black A, Bueno-de-Mesquita HB, Deschasaux M, Galan P, Goodman GE, Goodman PJ, Gunter MJ, Heliövaara M, Helzlsouer KJ, Henderson BE, Hercberg S, Knekt P, Kolonel LN, Lasheras C, Linseisen J, Metter EJ, Neuhouser ML, Olsen A, Pala V, Platz EA, Rissanen H, Reid ME, Schenk JM, Stampfer MJ, Stattin P, Tangen CM, Touvier M, Trichopoulou A, van den Brandt PA, Key TJ. Selenium and Prostate Cancer: Analysis of Individual Participant Data From Fifteen Prospective Studies. J Natl Cancer Inst 2016; 108:djw153. [PMID: 27385803 PMCID: PMC5241899 DOI: 10.1093/jnci/djw153] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/15/2016] [Accepted: 05/17/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Some observational studies suggest that a higher selenium status is associated with a lower risk of prostate cancer but have been generally too small to provide precise estimates of associations, particularly by disease stage and grade. METHODS Collaborating investigators from 15 prospective studies provided individual-participant records (from predominantly men of white European ancestry) on blood or toenail selenium concentrations and prostate cancer risk. Odds ratios of prostate cancer by selenium concentration were estimated using multivariable-adjusted conditional logistic regression. All statistical tests were two-sided. RESULTS Blood selenium was not associated with the risk of total prostate cancer (multivariable-adjusted odds ratio [OR] per 80 percentile increase = 1.01, 95% confidence interval [CI] = 0.83 to 1.23, based on 4527 case patients and 6021 control subjects). However, there was heterogeneity by disease aggressiveness (ie, advanced stage and/or prostate cancer death, Pheterogeneity = .01), with high blood selenium associated with a lower risk of aggressive disease (OR = 0.43, 95% CI = 0.21 to 0.87) but not with nonaggressive disease. Nail selenium was inversely associated with total prostate cancer (OR = 0.29, 95% CI = 0.22 to 0.40, Ptrend < .001, based on 1970 case patients and 2086 control subjects), including both nonaggressive (OR = 0.33, 95% CI = 0.22 to 0.50) and aggressive disease (OR = 0.18, 95% CI = 0.11 to 0.31, Pheterogeneity = .08). CONCLUSIONS Nail, but not blood, selenium concentration is inversely associated with risk of total prostate cancer, possibly because nails are a more reliable marker of long-term selenium exposure. Both blood and nail selenium concentrations are associated with a reduced risk of aggressive disease, which warrants further investigation.
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Affiliation(s)
- Naomi E Allen
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Ruth C Travis
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Paul N Appleby
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Demetrius Albanes
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Matt J Barnett
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Amanda Black
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - H Bas Bueno-de-Mesquita
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Mélanie Deschasaux
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Pilar Galan
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Gary E Goodman
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Phyllis J Goodman
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Marc J Gunter
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Markku Heliövaara
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Kathy J Helzlsouer
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Brian E Henderson
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Serge Hercberg
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Paul Knekt
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Laurence N Kolonel
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Christina Lasheras
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Jakob Linseisen
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - E Jeffrey Metter
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Marian L Neuhouser
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Anja Olsen
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Valeria Pala
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Elizabeth A Platz
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Harri Rissanen
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Mary E Reid
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Jeannette M Schenk
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Meir J Stampfer
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Pär Stattin
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Catherine M Tangen
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Mathilde Touvier
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Antonia Trichopoulou
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Piet A van den Brandt
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
| | - Timothy J Key
- Affiliations of authors: Clinical Trial Service Unit and Epidemiological Studies Unit (NEA) and Cancer Epidemiology Unit (RCT, PNA, TJK), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Division of Cancer Epidemiology and Genetics, US National Cancer Institute, Bethesda, MD (DA, AB); Division of Public Health Science (MJB, GEG, MLN), SWOG (formerly the Southwest Oncology Group) Statistical Center (PJG, CMT), and Cancer Prevention Program (JMS), Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Epidemiology (JMS) and Department of Biostatistics (CMT), University of Washington, Seattle, WA; Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (HBBdM, MJG); Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia (HBBdM); Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, Bobigny, France (MD, PG, SH, MT); National Institute for Health and Welfare, Helsinki, Finland (MH, PK, HR); The Prevention and Research Center Mercy Medical Center, Baltimore, MD (KJH); Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA (BEH); University of Hawaii Cancer Center, Honolulu, HI (LNK); Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain (CL); Institute of Epidemiology II, Helmholtz-Zentrum München, Neuherberg, Germany (formerly of Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany) (JL); Intramural Research Program, National Institute on Aging, Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (EJM); Danish Cancer Society Research Center, Copenhagen, Denmark (AO); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy (VP); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (EAP); Roswell Park Cancer Institute, New York, NY (MER); Department of Epidemiology, Harvard School of Public Health, Boston, MA (MJS); Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (MJS); Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden (PS); Hellenic Health Foundation, Athens, Greece (AT); Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands (PAvdB)
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Goyal N, Tsivgoulis G, Male S, Metter EJ, Iftikhar S, Kerro A, Chang JJ, Frey JL, Triantafyllou S, Papadimitropoulos G, Abedi V, Alexandrov AW, Alexandrov AV, Zand R. FABS. Stroke 2016; 47:2216-20. [DOI: 10.1161/strokeaha.116.013842] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 07/07/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
A large number of patients with symptoms of acute cerebral ischemia are stroke mimics (SMs). In this study, we sought to develop a scoring system (FABS) for screening and stratifying SM from acute cerebral ischemia and to identify patients who may require magnetic resonance imaging to confirm or refute a diagnosis of stroke in the emergency setting.
Methods—
We designed a scoring system: FABS (6 variables with 1 point for each variable present): absence of Facial droop, negative history of Atrial fibrillation, Age <50 years, systolic Blood pressure <150 mm Hg at presentation, history of Seizures, and isolated Sensory symptoms without weakness at presentation. We evaluated consecutive patients with symptoms of acute cerebral ischemia and a negative head computed tomography for any acute finding within 4.5 hours after symptom onset in 2 tertiary care stroke centers for validation of FABS.
Results—
A total of 784 patients (41% SMs) were evaluated. Receiver operating characteristic curve (C statistic, 0.95; 95% confidence interval [CI], 0.93–0.98) indicated that FABS≥3 could identify patients with SM with 90% sensitivity (95% CI, 86%–93%) and 91% specificity (95% CI, 88%–93%). The negative predictive value and positive predictive value were 93% (95% CI, 90%–95%) and 87% (95% CI, 83%–91%), respectively.
Conclusions—
FABS seems to be reliable in stratifying SM from acute cerebral ischemia cases among patients in whom the head computed tomography was negative for any acute findings. It can help clinicians consider advanced imaging for further diagnosis.
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Affiliation(s)
- Nitin Goyal
- From the Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G., G.T., S.M., E.J.M., S.I., A.K., J.J.C., A.W.A., A.V.A., R.Z.); Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Greece (G.T., S.T., G.P.); Department of Neurology, International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic (G.T.); Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (J.L.F.); and
| | - Georgios Tsivgoulis
- From the Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G., G.T., S.M., E.J.M., S.I., A.K., J.J.C., A.W.A., A.V.A., R.Z.); Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Greece (G.T., S.T., G.P.); Department of Neurology, International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic (G.T.); Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (J.L.F.); and
| | - Shailesh Male
- From the Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G., G.T., S.M., E.J.M., S.I., A.K., J.J.C., A.W.A., A.V.A., R.Z.); Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Greece (G.T., S.T., G.P.); Department of Neurology, International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic (G.T.); Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (J.L.F.); and
| | - E. Jeffrey Metter
- From the Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G., G.T., S.M., E.J.M., S.I., A.K., J.J.C., A.W.A., A.V.A., R.Z.); Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Greece (G.T., S.T., G.P.); Department of Neurology, International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic (G.T.); Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (J.L.F.); and
| | - Sulaiman Iftikhar
- From the Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G., G.T., S.M., E.J.M., S.I., A.K., J.J.C., A.W.A., A.V.A., R.Z.); Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Greece (G.T., S.T., G.P.); Department of Neurology, International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic (G.T.); Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (J.L.F.); and
| | - Ali Kerro
- From the Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G., G.T., S.M., E.J.M., S.I., A.K., J.J.C., A.W.A., A.V.A., R.Z.); Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Greece (G.T., S.T., G.P.); Department of Neurology, International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic (G.T.); Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (J.L.F.); and
| | - Jason J. Chang
- From the Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G., G.T., S.M., E.J.M., S.I., A.K., J.J.C., A.W.A., A.V.A., R.Z.); Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Greece (G.T., S.T., G.P.); Department of Neurology, International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic (G.T.); Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (J.L.F.); and
| | - James L. Frey
- From the Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G., G.T., S.M., E.J.M., S.I., A.K., J.J.C., A.W.A., A.V.A., R.Z.); Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Greece (G.T., S.T., G.P.); Department of Neurology, International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic (G.T.); Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (J.L.F.); and
| | - Sokratis Triantafyllou
- From the Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G., G.T., S.M., E.J.M., S.I., A.K., J.J.C., A.W.A., A.V.A., R.Z.); Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Greece (G.T., S.T., G.P.); Department of Neurology, International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic (G.T.); Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (J.L.F.); and
| | - Georgios Papadimitropoulos
- From the Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G., G.T., S.M., E.J.M., S.I., A.K., J.J.C., A.W.A., A.V.A., R.Z.); Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Greece (G.T., S.T., G.P.); Department of Neurology, International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic (G.T.); Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (J.L.F.); and
| | - Vida Abedi
- From the Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G., G.T., S.M., E.J.M., S.I., A.K., J.J.C., A.W.A., A.V.A., R.Z.); Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Greece (G.T., S.T., G.P.); Department of Neurology, International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic (G.T.); Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (J.L.F.); and
| | - Anne W. Alexandrov
- From the Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G., G.T., S.M., E.J.M., S.I., A.K., J.J.C., A.W.A., A.V.A., R.Z.); Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Greece (G.T., S.T., G.P.); Department of Neurology, International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic (G.T.); Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (J.L.F.); and
| | - Andrei V. Alexandrov
- From the Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G., G.T., S.M., E.J.M., S.I., A.K., J.J.C., A.W.A., A.V.A., R.Z.); Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Greece (G.T., S.T., G.P.); Department of Neurology, International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic (G.T.); Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (J.L.F.); and
| | - Ramin Zand
- From the Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G., G.T., S.M., E.J.M., S.I., A.K., J.J.C., A.W.A., A.V.A., R.Z.); Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Greece (G.T., S.T., G.P.); Department of Neurology, International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic (G.T.); Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (J.L.F.); and
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Lin Y, Kim J, Metter EJ, Nguyen H, Truong T, Lustig A, Ferrucci L, Weng NP. Changes in blood lymphocyte numbers with age in vivo and their association with the levels of cytokines/cytokine receptors. Immun Ageing 2016; 13:24. [PMID: 27547234 PMCID: PMC4990976 DOI: 10.1186/s12979-016-0079-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Indexed: 01/09/2023]
Abstract
Background Alterations in the number and composition of lymphocytes and their subsets in blood are considered a hallmark of immune system aging. However, it is unknown whether the rates of change of lymphocytes are stable or change with age, or whether the inter-individual variations of lymphocyte composition are stable over time or undergo different rates of change at different ages. Here, we report a longitudinal analysis of T- and B-cells and their subsets, and NK cells in the blood of 165 subjects aged from 24 to 90 years, with each subject assessed at baseline and an average of 5.6 years follow-up. Results The rates of change of T-(CD4+ and CD8+) and B-cells, and NK cells were relative stable throughout the adult life. A great degree of individual variations in numbers of lymphocytes and their subsets and in the rates of their changes with age was observed. Among them, CD4+ T cells exhibited the highest degree of individual variation followed by NK cells, CD8+ T cells, and B cells. Different types of lymphocytes had distinct trends in their rates of change which did not appear to be influenced by CMV infection. Finally, the rates of CD4+, CD8+ T cells, naive CD4+ and naïve CD8+ T cells were closely positively correlated. Conclusion Our findings provide evidence that the age-associated changes in circulating lymphocytes were at relative stable rates in vivo in a highly individualized manner and the levels of selected cytokines/cytokine receptors in serum might influence these age-associated changes of lymphocytes in circulation. Electronic supplementary material The online version of this article (doi:10.1186/s12979-016-0079-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yun Lin
- Laboratory of Molecular Biology & Immunology, National Institute on Aging, 251 Bayview Blvd., Baltimore, MD 21224 USA
| | - Jiewan Kim
- Laboratory of Molecular Biology & Immunology, National Institute on Aging, 251 Bayview Blvd., Baltimore, MD 21224 USA
| | - E Jeffrey Metter
- Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224 USA.,Department of Neurology, University of Tennessee Health Science Center, Memphis, TN 38111 USA
| | - Huy Nguyen
- Laboratory of Molecular Biology & Immunology, National Institute on Aging, 251 Bayview Blvd., Baltimore, MD 21224 USA
| | - Thai Truong
- Laboratory of Molecular Biology & Immunology, National Institute on Aging, 251 Bayview Blvd., Baltimore, MD 21224 USA
| | - Ana Lustig
- Laboratory of Molecular Biology & Immunology, National Institute on Aging, 251 Bayview Blvd., Baltimore, MD 21224 USA
| | - Luigi Ferrucci
- Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224 USA
| | - Nan-Ping Weng
- Laboratory of Molecular Biology & Immunology, National Institute on Aging, 251 Bayview Blvd., Baltimore, MD 21224 USA
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Deshpande N, Simonsick E, Metter EJ, Ko S, Ferrucci L, Studenski S. Ankle proprioceptive acuity is associated with objective as well as self-report measures of balance, mobility, and physical function. Age (Dordr) 2016; 38:53. [PMID: 27146830 PMCID: PMC5005915 DOI: 10.1007/s11357-016-9918-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 04/29/2016] [Indexed: 05/13/2023]
Abstract
Ankle proprioceptive information is integrated by the central nervous system to generate and modulate muscle contractions for maintaining standing balance. This study evaluated the association of ankle joint proprioception with objective and self-report measures of balance, mobility, and physical function across the adult life span. Seven hundred and ninety participants (age range 24-97 years, 362 women) who completed ankle proprioception assessment between 2010 and 2014 were included in the present study from the population-based cohort of the Baltimore Longitudinal Study of Aging (BLSA), USA. Outcome measures included ankle joint proprioception measured as threshold for perception of passive movement (TPPM); single leg stance time; perceived difficulty for standing balance; usual, fastest, and narrow-path gait speed; walking index; short physical performance battery score; and self-reported activity restriction due to fear of falling. Descriptive variables included age, sex, body mass index, education, strength, and cognition. Analyses of covariance (ANCOVA) in general linear model (GLM) or multinomial logistic regression analyses were performed, as appropriate, to test the hypothesis that balance, mobility, and physical function were significantly different according to TPPM quintiles even after adjusting for relevant covariates. Those with TPPM >2.2° consistently demonstrated poor balance, mobility, and physical function. However, with increase in challenge (single leg stance, fastest walking speed, and SPPB), TPPM >1.4° was associated with significantly worse performance. In conclusion, ankle proprioceptive acuity has an overall graded relationship with objective and self-report measures of balance, mobility, and physical function. However, the cutoff proprioceptive acuity associated with substantial decline or inability to perform could depend on the challenge induced.
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Affiliation(s)
- Nandini Deshpande
- Faculty of Health Sciences, Queen's University, Louise D Acton Building, 31 George Street, Kingston, ON, K7L 3N6, Canada.
| | - Eleanor Simonsick
- Clinical Research Branch, National Institute on Aging, Baltimore, MD, USA
| | - E Jeffrey Metter
- Department of Neurology, University of Tennessee Medical Center, Memphis, TN, USA
| | - Seunguk Ko
- Department of Mechanical Engineering, Chonnam National University, Gwangju, Jeonnam, South Korea
| | - Luigi Ferrucci
- Clinical Research Branch, National Institute on Aging, Baltimore, MD, USA
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Travis RC, Appleby PN, Martin RM, Holly JM, Albanes D, Black A, Bueno-de-Mesquita H, Chan JM, Chen C, Chirlaque MD, Cook MB, Deschasaux M, Donovan JL, Ferrucci L, Galan P, Giles GG, Giovannucci EL, Gunter MJ, Habel LA, Hamdy FC, Helzlsouer KJ, Hercberg S, Hoover RN, Janssen JA, Kaaks R, Kubo T, Le Marchand L, Metter EJ, Mikami K, Morris JK, Neal DE, Neuhouser ML, Ozasa K, Palli D, Platz EA, Pollak M, Price AJ, Roobol MJ, Schaefer C, Schenk JM, Severi G, Stampfer MJ, Stattin P, Tamakoshi A, Tangen CM, Touvier M, Wald NJ, Weiss NS, Ziegler RG, Key TJ, Allen NE. A Meta-analysis of Individual Participant Data Reveals an Association between Circulating Levels of IGF-I and Prostate Cancer Risk. Cancer Res 2016; 76:2288-2300. [PMID: 26921328 PMCID: PMC4873385 DOI: 10.1158/0008-5472.can-15-1551] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [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: 06/04/2015] [Accepted: 12/22/2015] [Indexed: 11/16/2022]
Abstract
The role of insulin-like growth factors (IGF) in prostate cancer development is not fully understood. To investigate the association between circulating concentrations of IGFs (IGF-I, IGF-II, IGFBP-1, IGFBP-2, and IGFBP-3) and prostate cancer risk, we pooled individual participant data from 17 prospective and two cross-sectional studies, including up to 10,554 prostate cancer cases and 13,618 control participants. Conditional logistic regression was used to estimate the ORs for prostate cancer based on the study-specific fifth of each analyte. Overall, IGF-I, IGF-II, IGFBP-2, and IGFBP-3 concentrations were positively associated with prostate cancer risk (Ptrend all ≤ 0.005), and IGFBP-1 was inversely associated weakly with risk (Ptrend = 0.05). However, heterogeneity between the prospective and cross-sectional studies was evident (Pheterogeneity = 0.03), unless the analyses were restricted to prospective studies (with the exception of IGF-II, Pheterogeneity = 0.02). For prospective studies, the OR for men in the highest versus the lowest fifth of each analyte was 1.29 (95% confidence interval, 1.16-1.43) for IGF-I, 0.81 (0.68-0.96) for IGFBP-1, and 1.25 (1.12-1.40) for IGFBP-3. These associations did not differ significantly by time-to-diagnosis or tumor stage or grade. After mutual adjustment for each of the other analytes, only IGF-I remained associated with risk. Our collaborative study represents the largest pooled analysis of the relationship between prostate cancer risk and circulating concentrations of IGF-I, providing strong evidence that IGF-I is highly likely to be involved in prostate cancer development. Cancer Res; 76(8); 2288-300. ©2016 AACR.
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Affiliation(s)
- Ruth C. Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Paul N. Appleby
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Richard M. Martin
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Medical Research Council/University of Bristol Integrative Epidemiology Unit, University of Bristol, and National Institute for Health Research, Bristol Biomedical Research Unit in Nutrition, Bristol, UK
| | - Jeff M.P. Holly
- School of Clinical Science, Faculty of Medicine, University of Bristol, Bristol, UK
| | - Demetrius Albanes
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Bethesda, MD, USA
| | - Amanda Black
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Bethesda, MD, USA
| | - H.B(as). Bueno-de-Mesquita
- Dt. for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, and Dt. of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands, and Dt. of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - June M. Chan
- Departments of Epidemiology & Biostatistics and Urology, University of California San Francisco, CA, USA
| | - Chu Chen
- Division of Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Maria-Dolores Chirlaque
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, and CIBER Epidemiología y Salud Pública, Spain
| | - Michael B. Cook
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Bethesda, MD, USA
| | - Mélanie Deschasaux
- Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, F-93017, Bobigny, France
| | - Jenny L. Donovan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Luigi Ferrucci
- Intramural Research Program, National Institute on Aging, Baltimore, MD, USA
| | - Pilar Galan
- Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, F-93017, Bobigny, France
| | - Graham G. Giles
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, and Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Edward L. Giovannucci
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Department of Nutrition and Department of Medicine, Harvard School of Public Health, Boston, MA, USA
| | - Marc J. Gunter
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Laurel A. Habel
- Division of Research, Kaiser Permanente, Northern California, Oakland, California, USA
| | | | - Kathy J. Helzlsouer
- The Prevention and Research Center, Mercy Medical Center, Baltimore, MD, USA
| | - Serge Hercberg
- Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, F-93017, Bobigny, France
| | - Robert N. Hoover
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Bethesda, MD, USA
| | | | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany
| | - Tatsuhiko Kubo
- University of Occupational and Environmental Health, Kitakyushu, Japan
| | | | - E. Jeffrey Metter
- Intramural Research Program, National Institute on Aging, Baltimore, MD, USA
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN
| | - Kazuya Mikami
- Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Joan K. Morris
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, UK
| | | | - Marian L. Neuhouser
- Division of Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Kotaro Ozasa
- Radiation Effects Research Foundation, Hiroshima, Japan
| | - Domenico Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute – ISPO, Florence, Italy
| | - Elizabeth A. Platz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael Pollak
- Departments of Medicine and Oncology, McGill University, Montreal, QC, Canada
| | - Alison J. Price
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Catherine Schaefer
- Division of Research, Kaiser Permanente, Northern California, Oakland, California, USA
| | - Jeannette M. Schenk
- Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Gianluca Severi
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, and Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
- Human Genetics Foundation, Torino, Italy
| | - Meir J. Stampfer
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Pär Stattin
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Akiko Tamakoshi
- Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Catherine M. Tangen
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, and Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Mathilde Touvier
- Sorbonne Paris Cité Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team, Inserm U1153, Inra U1125, Cnam, University Paris 13, University Paris 5, University Paris 7, F-93017, Bobigny, France
| | | | | | - Regina G. Ziegler
- Division of Cancer Epidemiology and Genetics, U.S. National Cancer Institute, Bethesda, MD, USA
| | - Timothy J. Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Naomi E. Allen
- Clinical Trials Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Vaz Fragoso CA, McAvay G, Van Ness PH, Metter EJ, Ferrucci L, Yaggi HK, Concato J, Gill TM. Aging-Related Considerations When Evaluating the Forced Expiratory Volume in 1 Second (FEV1) Over Time. J Gerontol A Biol Sci Med Sci 2015; 71:929-34. [PMID: 26525091 DOI: 10.1093/gerona/glv201] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 08/10/2015] [Accepted: 10/08/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Forced expiratory volume in 1 second (FEV1) over time is commonly expressed in liters and percent predicted (%Pred), or alternatively in L/m(3) and Z-scores-which approach is more clinically meaningful has not been evaluated. Because it uniquely accounts for the effect of aging on FEV1 and spirometric performance, we hypothesized that the Z-score approach is more clinically meaningful, based on associations between cardiopulmonary predictors and FEV1 over time. METHODS Using linear mixed-effects models and data from the Baltimore Longitudinal Study on Aging, including 501 white participants aged 40-95 who had completed at least three longitudinal spirometric assessments, we evaluated the associations between cardiopulmonary predictors (obesity, smoking status, hypertension, chronic bronchitis, diabetes mellitus, and myocardial infarction) and FEV1 over time, in liters, %Pred, L/m(3), and Z-scores. RESULTS Mean baseline values for FEV1 were 3.240L, 96.4%Pred, 0.621L/m(3), and -0.239 as a Z-score (40.6th percentile). The annual decline in FEV1 was 0.040L, 0.234 %Pred, 0.007L/m(3), and 0.008 Z-score units. Baseline age was associated with FEV1 over time in liters and L/m(3) (p < .001), and included a time interaction for %Pred (p < .001), but was not associated with Z-scores (p = .933). The associations of cardiopulmonary predictors with FEV1 over time were all significant when using Z-scores (p < .05), but varied for other methods of expressing FEV1. CONCLUSION A Z-score approach is more clinically meaningful when evaluating FEV1 over time, as it accounted for the effect of aging and was more frequently associated with multiple cardiopulmonary predictors.
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Affiliation(s)
- Carlos A Vaz Fragoso
- Veterans Affairs Clinical Epidemiology Research Center, West Haven, Connecticut. Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
| | - Gail McAvay
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Peter H Van Ness
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - E Jeffrey Metter
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Luigi Ferrucci
- Harbor Hospital, National Institute on Aging, Baltimore, Maryland
| | - H Klar Yaggi
- Veterans Affairs Clinical Epidemiology Research Center, West Haven, Connecticut. Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - John Concato
- Veterans Affairs Clinical Epidemiology Research Center, West Haven, Connecticut. Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Thomas M Gill
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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43
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Najarro K, Nguyen H, Chen G, Xu M, Alcorta S, Yao X, Zukley L, Metter EJ, Truong T, Lin Y, Li H, Oelke M, Xu X, Ling SM, Longo DL, Schneck J, Leng S, Ferrucci L, Weng NP. Telomere Length as an Indicator of the Robustness of B- and T-Cell Response to Influenza in Older Adults. J Infect Dis 2015; 212:1261-9. [PMID: 25828247 PMCID: PMC4577042 DOI: 10.1093/infdis/jiv202] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 03/23/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Telomeres provide a key mechanism for protecting the integrity of chromosomes and their attrition after cell division and during aging are evident in lymphocytes. However, the significance of telomere shortening in age-associated decline of immune function is unknown. METHODS We selected 22 HLA-A2-positive healthy older adults who have relatively short or long telomere lengths to compare their antibody response against the influenza vaccine, and their CD8(+) T-cell response against an influenza antigen. RESULTS B cells from individuals with a robust antibody response to the influenza vaccine had significantly longer telomeres than those with a poor antibody response. Monocyte-derived antigen-presenting cells of both short and long telomere groups induced similar expansions of influenza M1-specific CD8(+) T cells. Vaccination did not increase M1-specific CD8(+) T cells in blood, but M1-specific CD8(+) T cells from the long telomere group exhibited significantly greater expansion in vitro than those from the short telomere group. Finally, M1-specific CD8(+) T cells that underwent more expansions had significantly longer telomeres than cells with fewer divisions. CONCLUSIONS Telomere length is positively associated with a robust lymphocyte response, and telomere attrition may contribute to the age-associated decline of adaptive immunity.
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Affiliation(s)
| | - Huy Nguyen
- Laboratory of Molecular Biology and Immunology
| | | | - Mai Xu
- Laboratory of Molecular Biology and Immunology
| | | | | | | | | | - Thai Truong
- Laboratory of Molecular Biology and Immunology
| | - Yun Lin
- Laboratory of Molecular Biology and Immunology
| | | | - Mathias Oelke
- Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xiyan Xu
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Dan L. Longo
- Laboratory of Genetics, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Jonathan Schneck
- Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Li HM, Hiroi T, Zhang Y, Shi A, Chen G, De S, Metter EJ, Wood WH, Sharov A, Milner JD, Becker KG, Zhan M, Weng NP. TCRβ repertoire of CD4+ and CD8+ T cells is distinct in richness, distribution, and CDR3 amino acid composition. J Leukoc Biol 2015; 99:505-13. [PMID: 26394815 DOI: 10.1189/jlb.6a0215-071rr] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 02/25/2015] [Accepted: 09/08/2015] [Indexed: 11/24/2022] Open
Abstract
The TCR repertoire serves as a reservoir of TCRs for recognizing all potential pathogens. Two major types of T cells, CD4(+) and CD8(+), that use the same genetic elements and process to generate a functional TCR differ in their recognition of peptide bound to MHC class II and I, respectively. However, it is currently unclear to what extent the TCR repertoire of CD4(+) and CD8(+) T cells is different. Here, we report a comparative analysis of the TCRβ repertoires of CD4(+) and CD8(+) T cells by use of a 5' rapid amplification of cDNA ends-PCR-sequencing method. We found that TCRβ richness of CD4(+) T cells ranges from 1.2 to 9.8 × 10(4) and is approximately 5 times greater, on average, than that of CD8(+) T cells in each study subject. Furthermore, there was little overlap in TCRβ sequences between CD4(+) (0.3%) and CD8(+) (1.3%) T cells. Further analysis showed that CD4(+) and CD8(+) T cells exhibited distinct preferences for certain amino acids in the CDR3, and this was confirmed further by a support vector machine classifier, suggesting that there are distinct and discernible differences between TCRβ CDR3 in CD4(+) and CD8(+) T cells. Finally, we identified 5-12% of the unique TCRβs that share an identical CDR3 with different variable genes. Together, our findings reveal the distinct features of the TCRβ repertoire between CD4(+) and CD8(+) T cells and could potentially be used to evaluate the competency of T cell immunity.
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Affiliation(s)
- Hoi Ming Li
- Laboratories of *Molecular Biology and Immunology and Genetics, Gene Expression and Genomics and Bioinformatics Units, and Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA; and Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Toyoko Hiroi
- Laboratories of *Molecular Biology and Immunology and Genetics, Gene Expression and Genomics and Bioinformatics Units, and Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA; and Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Yongqing Zhang
- Laboratories of *Molecular Biology and Immunology and Genetics, Gene Expression and Genomics and Bioinformatics Units, and Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA; and Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Alvin Shi
- Laboratories of *Molecular Biology and Immunology and Genetics, Gene Expression and Genomics and Bioinformatics Units, and Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA; and Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Guobing Chen
- Laboratories of *Molecular Biology and Immunology and Genetics, Gene Expression and Genomics and Bioinformatics Units, and Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA; and Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Supriyo De
- Laboratories of *Molecular Biology and Immunology and Genetics, Gene Expression and Genomics and Bioinformatics Units, and Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA; and Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - E Jeffrey Metter
- Laboratories of *Molecular Biology and Immunology and Genetics, Gene Expression and Genomics and Bioinformatics Units, and Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA; and Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - William H Wood
- Laboratories of *Molecular Biology and Immunology and Genetics, Gene Expression and Genomics and Bioinformatics Units, and Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA; and Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Alexei Sharov
- Laboratories of *Molecular Biology and Immunology and Genetics, Gene Expression and Genomics and Bioinformatics Units, and Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA; and Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Joshua D Milner
- Laboratories of *Molecular Biology and Immunology and Genetics, Gene Expression and Genomics and Bioinformatics Units, and Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA; and Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Kevin G Becker
- Laboratories of *Molecular Biology and Immunology and Genetics, Gene Expression and Genomics and Bioinformatics Units, and Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA; and Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Ming Zhan
- Laboratories of *Molecular Biology and Immunology and Genetics, Gene Expression and Genomics and Bioinformatics Units, and Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA; and Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Nan-ping Weng
- Laboratories of *Molecular Biology and Immunology and Genetics, Gene Expression and Genomics and Bioinformatics Units, and Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA; and Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
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Cohen AA, Milot E, Li Q, Bergeron P, Poirier R, Dusseault-Bélanger F, Fülöp T, Leroux M, Legault V, Metter EJ, Fried LP, Ferrucci L. Detection of a novel, integrative aging process suggests complex physiological integration. PLoS One 2015; 10:e0116489. [PMID: 25761112 PMCID: PMC4356614 DOI: 10.1371/journal.pone.0116489] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 12/10/2014] [Indexed: 12/21/2022] Open
Abstract
Many studies of aging examine biomarkers one at a time, but complex systems theory and network theory suggest that interpretations of individual markers may be context-dependent. Here, we attempted to detect underlying processes governing the levels of many biomarkers simultaneously by applying principal components analysis to 43 common clinical biomarkers measured longitudinally in 3694 humans from three longitudinal cohort studies on two continents (Women's Health and Aging I & II, InCHIANTI, and the Baltimore Longitudinal Study on Aging). The first axis was associated with anemia, inflammation, and low levels of calcium and albumin. The axis structure was precisely reproduced in all three populations and in all demographic sub-populations (by sex, race, etc.); we call the process represented by the axis "integrated albunemia." Integrated albunemia increases and accelerates with age in all populations, and predicts mortality and frailty--but not chronic disease--even after controlling for age. This suggests a role in the aging process, though causality is not yet clear. Integrated albunemia behaves more stably across populations than its component biomarkers, and thus appears to represent a higher-order physiological process emerging from the structure of underlying regulatory networks. If this is correct, detection of this process has substantial implications for physiological organization more generally.
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Affiliation(s)
- Alan A. Cohen
- Groupe de recherche PRIMUS, Department of Family Medicine, University of Sherbrooke, 3001 12e Ave N, Sherbrooke, QC, J1H 5N4, Canada
| | - Emmanuel Milot
- Department of Chemistry, Biochemistry and Physics, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada
| | - Qing Li
- Groupe de recherche PRIMUS, Department of Family Medicine, University of Sherbrooke, 3001 12e Ave N, Sherbrooke, QC, J1H 5N4, Canada
| | - Patrick Bergeron
- Groupe de recherche PRIMUS, Department of Family Medicine, University of Sherbrooke, 3001 12e Ave N, Sherbrooke, QC, J1H 5N4, Canada
| | - Roxane Poirier
- Department of Biology, University of Sherbrooke, 2500 boulevard de l'Université, Sherbrooke, QC, J1K 2R1, Canada
| | - Francis Dusseault-Bélanger
- Department of Mathematics, University of Sherbrooke, 2500 boulevard de l'Université, Sherbrooke, QC, J1K 2R1, Canada
| | - Tamàs Fülöp
- Department of Geriatrics, University of Sherbrooke, 3001 12e Ave N, Sherbrooke, QC, J1H 5N4, Canada
| | - Maxime Leroux
- Economics Department, ESG, Université du Québec à Montréal, 315 rue Sainte-Catherine Est, Montréal, QC, H2X 3X2, Canada
| | - Véronique Legault
- Groupe de recherche PRIMUS, Department of Family Medicine, University of Sherbrooke, 3001 12e Ave N, Sherbrooke, QC, J1H 5N4, Canada
| | - E. Jeffrey Metter
- Translational Gerontology Branch, Longitudinal Studies Section, National Institute on Aging, National Institutes of Health, MedStar Harbor Hospital, 3001 S. Hanover Street, Baltimore, Maryland 21225, United States of America
| | - Linda P. Fried
- Mailman School of Public Health, Columbia University, 722 W. 168th Street, R1408, New York, New York 10032, United States of America
| | - Luigi Ferrucci
- Translational Gerontology Branch, Longitudinal Studies Section, National Institute on Aging, National Institutes of Health, MedStar Harbor Hospital, 3001 S. Hanover Street, Baltimore, Maryland 21225, United States of America
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Lin Y, Damjanovic A, Metter EJ, Nguyen H, Truong T, Najarro K, Morris C, Longo DL, Zhan M, Ferrucci L, Hodes RJ, Weng NP. Age-associated telomere attrition of lymphocytes in vivo is co-ordinated with changes in telomerase activity, composition of lymphocyte subsets and health conditions. Clin Sci (Lond) 2015; 128:367-77. [PMID: 25317735 PMCID: PMC5421624 DOI: 10.1042/cs20140481] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Telomeres are essential in maintaining chromosome integrity and in controlling cellular replication. Attrition of telomere length in peripheral blood mononuclear cells (PBMCs) with age is well documented from cross-sectional studies. But the actual in vivo changes in telomere lengths and its relationship with the contributing factors within the individuals with age have not been fully addressed. In the present paper, we report a longitudinal analysis of telomere length in the PBMCs, lymphocytes and monocytes of 216 human subjects aged from 20-90 years assessed at 0-, 5- and 12-year follow-up. For the 5- and 12-year follow-up, telomere length in the PBMCs decreased in 34% and 46%, exhibited no detectable change in 56% and 47% and increased in 10% and 7% of the subjects respectively. The rate of telomere change was distinct for T-cells, B-cells and monocytes for any given subject. Telomerase activity declined with age in the resting T-cells and B-cells and the activated T-cells. Finally, a significant portion of telomere attrition in T-cells with age was explained by a decline in the telomerase activity, decreased naïve cells and the change in physiological conditions such as elevated blood glucose and interleukin (IL)-6 levels. These findings show that changes in the telomere length of the PBMCs with age in vivo occur at different rates in different individuals and cell types and reveal that changes in the telomere length in the T-cells with age is influenced by the telomerase activity, naïve T-cell percentage and changes in health conditions.
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Affiliation(s)
- Yun Lin
- Laboratory of Molecular Biology and Immunology, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, U.S.A
| | - Amanda Damjanovic
- Laboratory of Molecular Biology and Immunology, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, U.S.A
| | - E. Jeffrey Metter
- Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224,U.S.A
| | - Huy Nguyen
- Laboratory of Molecular Biology and Immunology, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, U.S.A
| | - Thai Truong
- Laboratory of Molecular Biology and Immunology, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, U.S.A
| | - Kevin Najarro
- Laboratory of Molecular Biology and Immunology, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, U.S.A
| | - Christa Morris
- Flow Cytometry Unit, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, U.S.A
| | - Dan L. Longo
- Laboratory of Genetics, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, U.S.A
| | - Ming Zhan
- Bioinformatics Unit, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, U.S.A
| | - Luigi Ferrucci
- Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224,U.S.A
| | - Richard J. Hodes
- National Institute on Aging and Experimental Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, U.S.A
| | - Nan-ping Weng
- Laboratory of Molecular Biology and Immunology, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, U.S.A
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Abstract
OBJECTIVE Persons with diabetes have accelerated muscle loss compared with their counterparts. The relationship of hyperglycemia per se to declines in muscle function has not been explored yet has implications for developing appropriate intervention strategies to prevent muscle loss. RESEARCH DESIGN AND METHODS We examined 984 participants aged 25-96 years in the Baltimore Longitudinal Study of Aging (2003-2011) with HbA1c, knee extensor strength (isokinetic dynamometer), and lean body mass (DEXA) measured at baseline. Participants had repeated measurements up to 7.5 years later. Muscle quality was defined as knee extensor strength/leg lean mass. Participants were categorized by HbA1c quartile (<5.5, 5.5-5.79, 5.8-6.09, and ≥6.1% or <37, 37-40, 40-43, and ≥43 mmol/mol). Mixed-effects regression models were used to examine the regression of muscle outcomes on HbA1c. RESULTS Muscle strength and quality were significantly lower across HbA1c quartiles (both P < 0.001), without differences in muscle mass at baseline. Comparing highest versus lowest HbA1c quartiles and adjusting for age, race, sex, weight, and height, strength was significantly lower (-4.70 ± 2.30 N · m; P value trend = 0.02) and results were unchanged after adjustment for physical activity (P value trend = 0.045) but of borderline significance after additional adjustment for peripheral neuropathy (P value trend = 0.05). Adjusting for demographics, muscle quality was significantly lower (-0.32 ± 0.15 N · m/kg; P value trend = 0.02) in the highest versus lowest HbA1c quartiles, but differences were attenuated after adjusting for weight and height (-0.25 ± 0.15 N · m/kg; P value trend = 0.07). Muscle mass measures were similar across HbA1c quartiles. CONCLUSIONS Hyperglycemia is associated with persistently lower muscle strength with aging, but this effect may be mediated, at least in part, by peripheral neuropathy. Future studies should explore if better glycemic control can preserve muscle function in diabetes.
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Affiliation(s)
- Rita Rastogi Kalyani
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - E Jeffrey Metter
- Clinical Research Branch, National Institute on Aging, Baltimore, MD
| | - Josephine Egan
- Clinical Research Branch, National Institute on Aging, Baltimore, MD
| | - Sherita H Golden
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Luigi Ferrucci
- Clinical Research Branch, National Institute on Aging, Baltimore, MD
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Abstract
Repeated failure in the Army Physical Fitness Test (APFT) is associated with lower fitness level, premature discharge, and significant career disruption, at high economic and health costs to the individual soldier and the U.S. Army. We used cost-effectiveness analysis to estimate the health and economic implications of two exercise interventions for Army National Guard (ARNG) soldiers who had failed the APFT, a traditional remediation program and a new pedometer-based program called Fitness for Life, involving individual counseling and follow-up telephone calls. Effectiveness of the interventions was analyzed in terms of APFT pass rates and calculated 10-year coronary heart disease risk. Costs were calculated based on tracking of resources used in the programs. APFT pass rates were 54.3% and 47.9%, respectively, for traditional and Fitness for Life programs, p = not significant. Neither program affected 10-year coronary heart disease risk. For assumed APFT pass rates up to 40% without any formal remediation, both the traditional remediation program and the ARNG Fitness for Life intervention had cost savings without significant group differences. Depending on the ARNG unit and personnel preference, although the Fitness for Life Program was more expensive and thus less cost-effective, either program could be cost-effective and of benefit to the military.
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Affiliation(s)
- Laura A Talbot
- University of Tennessee Health Science Center,College of Nursing, 920 Madison Avenue, Suite 1045,Memphis, TN 38163
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Lin FR, Ferrucci L, An Y, Goh JO, Doshi J, Metter EJ, Davatzikos C, Kraut MA, Resnick SM. Association of hearing impairment with brain volume changes in older adults. Neuroimage 2014. [PMID: 24412398 DOI: 10.1016/j.neuroimage.2013.12.059.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022] Open
Abstract
Hearing impairment in older adults is independently associated in longitudinal studies with accelerated cognitive decline and incident dementia, and in cross-sectional studies, with reduced volumes in the auditory cortex. Whether peripheral hearing impairment is associated with accelerated rates of brain atrophy is unclear. We analyzed brain volume measurements from magnetic resonance brain scans of individuals with normal hearing versus hearing impairment (speech-frequency pure tone average>25 dB) followed in the neuroimaging substudy of the Baltimore Longitudinal Study of Aging for a mean of 6.4 years after the baseline scan (n=126, age 56-86 years). Brain volume measurements were performed with semi-automated region-of-interest (ROI) algorithms, and brain volume trajectories were analyzed with mixed-effect regression models adjusted for demographic and cardiovascular factors. We found that individuals with hearing impairment (n=51) compared to those with normal hearing (n=75) had accelerated volume declines in whole brain and regional volumes in the right temporal lobe (superior, middle, and inferior temporal gyri, parahippocampus, p<.05). These results were robust to adjustment for multiple confounders and were consistent with voxel-based analyses, which also implicated right greater than left temporal regions. These findings demonstrate that peripheral hearing impairment is independently associated with accelerated brain atrophy in whole brain and regional volumes concentrated in the right temporal lobe. Further studies investigating the mechanistic basis of the observed associations are needed.
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Affiliation(s)
- F R Lin
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University, Baltimore, MD, USA; Department of Geriatric Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Mental Health, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | - L Ferrucci
- Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, Baltimore, MD, USA
| | - Y An
- Laboratory of Behavioral Neuroscience, Intramural Research Program, National Institute on Aging, Baltimore, MD, USA
| | - J O Goh
- Laboratory of Behavioral Neuroscience, Intramural Research Program, National Institute on Aging, Baltimore, MD, USA; Graduate Institute of Brain and Mind Sciences, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jimit Doshi
- Section for Biomedical Image Analysis, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - E J Metter
- Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, Baltimore, MD, USA
| | - C Davatzikos
- Section for Biomedical Image Analysis, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - M A Kraut
- Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - S M Resnick
- Laboratory of Behavioral Neuroscience, Intramural Research Program, National Institute on Aging, Baltimore, MD, USA
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Moore AZ, Caturegli G, Metter EJ, Makrogiannis S, Resnick SM, Harris TB, Ferrucci L. Difference in muscle quality over the adult life span and biological correlates in the Baltimore Longitudinal Study of Aging. J Am Geriatr Soc 2014; 62:230-6. [PMID: 24438020 DOI: 10.1111/jgs.12653] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [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: 12/25/2022]
Abstract
OBJECTIVES To examine differences in a proxy measure of muscle quality across the adult life span and explore potential mechanisms of muscle quality change through identification of cross-sectional correlates of muscle quality. DESIGN Cross-sectional study. SETTING Baltimore Longitudinal Study of Aging. PARTICIPANTS Seven hundred eighty-six individuals with a mean age of 66.3 (range 26-96) (N = 786). A sensitivity analysis was conducted in a subset of participants matched according to sex, muscle mass, and body size. MEASUREMENTS Muscle quality was operationalized as the ratio of knee-extension strength (isokinetic dynamometry) to thigh muscle cross-sectional area (computed tomography). Differences in muscle strength, muscle area, and muscle quality ratio with age were evaluated, and the association between the muscle quality ratio and measures reflecting domains of cognitive function, motor control, peripheral nerve function, adiposity, glucose homeostasis, and inflammation were assessed through multivariate regression analyses. RESULTS A linear relationship between age and muscle quality ratio was observed, suggesting a gradual decline in muscle quality over the adult life course. Associations were observed between muscle quality ratio and measures of adiposity, as well as peroneal nerve motor conduction velocity, finger tapping speed, and memory performance (P < .01). The association between muscle quality ratio and nerve conduction velocity was maintained after adjustment for anthropometric measurements (P < .05). CONCLUSION Muscle quality declines progressively with age over the adult life span and is affected by obesity and neurological factors. Studies are needed to clarify the mechanisms of these associations and their implications for functional outcomes.
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Affiliation(s)
- Ann Zenobia Moore
- Longitudinal Studies Section, Translational Gerontology Branch, Baltimore, Maryland
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