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Kemoun G, Weiss E, El Houari L, Bonny V, Goury A, Caliez O, Picard B, Rudler M, Rhaiem R, Rebours V, Mayaux J, Bachet JB, Belin L, Demoule A, Decavèle M. Clinical features and outcomes of patients with pancreatic cancer requiring unplanned medical ICU admission: A retrospective multicenter study. Dig Liver Dis 2024; 56:514-521. [PMID: 37718226 DOI: 10.1016/j.dld.2023.08.049] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/27/2023] [Accepted: 08/17/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND We sought to describe the reasons for intensive care unit (ICU) admission and outcomes of patients with pancreatic cancer requiring unplanned medical ICU admission. PATIENTS AND METHODS Retrospective cohort study in five ICUs from 2009 to 2020. All patients with pancreatic cancer admitted to the ICU were included. Patients having undergone recent surgery were excluded (< 4 weeks). RESULTS 269 patients were included. Tumors were mainly adenocarcinoma (90%). Main reason for admission was sepsis/septic shock (32%) with a biliary tract infection in 44 (51%) patients. Second reason for admission was gastrointestinal bleeding (28%). ICU and 3-month mortality rates were 26% and 59% respectively. Performance status 3-4 (odds ratio OR 3.58), disease status (responsive/stable -ref-, newly diagnosed OR 3.25, progressive OR 5.99), mechanical ventilation (OR 8.03), vasopressors (OR 4.19), SAPS 2 (OR 1.69) and pH (OR 0.02) were independently associated with ICU mortality. Performance status 3-4 (Hazard ratio HR 1.96) and disease status (responsive/stable -ref-, newly diagnosed HR 2.67, progressive HR 4.14) were associated with 3-month mortality. CONCLUSION Reasons for ICU admissions of pancreatic cancer patients differ from those observed in other solid cancer. Short- and medium-term mortality are strongly influenced by performance status and disease status at ICU admission.
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Affiliation(s)
- G Kemoun
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation (Département R3S), Paris, France.
| | - E Weiss
- AP-HP Nord, Université de Paris, Hôpital Beaujon, Département d'anesthésie-réanimation, Clichy, France; Université de Paris, UMRS1149, Centre de recherche sur l'inflammation, Liver Intensive Care Group of Europe (LICAGE), France
| | - L El Houari
- AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Santé Publique, F-75013, Paris, France
| | - V Bonny
- AP-HP Sorbonne Université, site Saint-Antoine, Service de Médecine Intensive - Réanimation, Paris, France
| | - A Goury
- Unité de médecine intensive et réanimation polyvalente, Hôpital Robert Debré, CHU de Reims, France
| | - O Caliez
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service d'hépato-gastro-entérologie, Paris, France
| | - B Picard
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation (Département R3S), Paris, France
| | - M Rudler
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service d'hépato-gastro-entérologie, Paris, France; Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - R Rhaiem
- Service de chirurgie hépatobiliaire, pancréatique et oncologique digestive, Hôpital Robert Debré, CHU de Reims, France
| | - V Rebours
- AP-HP Nord, Université de Paris, Hôpital Beaujon, Service de Pancréatologie, Clichy, France; Université de Paris, INSERM, UMR 1149, pancreatic rare diseases (PaRaDis), centre de référence de maladies rares, Clichy, France
| | - J Mayaux
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation (Département R3S), Paris, France
| | - J B Bachet
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service d'hépato-gastro-entérologie, Paris, France
| | - L Belin
- Sorbonne-Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Santé Publique, F-75013, Paris, France
| | - A Demoule
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation (Département R3S), Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - M Decavèle
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation (Département R3S), Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
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Kulovic-Sissawo A, Tocantins C, Diniz MS, Weiss E, Steiner A, Tokic S, Madreiter-Sokolowski CT, Pereira SP, Hiden U. Mitochondrial Dysfunction in Endothelial Progenitor Cells: Unraveling Insights from Vascular Endothelial Cells. Biology (Basel) 2024; 13:70. [PMID: 38392289 PMCID: PMC10886154 DOI: 10.3390/biology13020070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 02/24/2024]
Abstract
Endothelial dysfunction is associated with several lifestyle-related diseases, including cardiovascular and neurodegenerative diseases, and it contributes significantly to the global health burden. Recent research indicates a link between cardiovascular risk factors (CVRFs), excessive production of reactive oxygen species (ROS), mitochondrial impairment, and endothelial dysfunction. Circulating endothelial progenitor cells (EPCs) are recruited into the vessel wall to maintain appropriate endothelial function, repair, and angiogenesis. After attachment, EPCs differentiate into mature endothelial cells (ECs). Like ECs, EPCs are also susceptible to CVRFs, including metabolic dysfunction and chronic inflammation. Therefore, mitochondrial dysfunction of EPCs may have long-term effects on the function of the mature ECs into which EPCs differentiate, particularly in the presence of endothelial damage. However, a link between CVRFs and impaired mitochondrial function in EPCs has hardly been investigated. In this review, we aim to consolidate existing knowledge on the development of mitochondrial and endothelial dysfunction in the vascular endothelium, place it in the context of recent studies investigating the consequences of CVRFs on EPCs, and discuss the role of mitochondrial dysfunction. Thus, we aim to gain a comprehensive understanding of mechanisms involved in EPC deterioration in relation to CVRFs and address potential therapeutic interventions targeting mitochondrial health to promote endothelial function.
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Affiliation(s)
- Azra Kulovic-Sissawo
- Perinatal Research Laboratory, Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
- Research Unit Early Life Determinants (ELiD), Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - Carolina Tocantins
- Perinatal Research Laboratory, Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
- Research Unit Early Life Determinants (ELiD), Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
- CNC-UC-Center for Neuroscience and Cell Biology, University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-504 Coimbra, Portugal
- Doctoral Programme in Experimental Biology and Biomedicine (PDBEB), Institute for Interdisciplinary Research (IIIUC), University of Coimbra, 3004-531 Coimbra, Portugal
| | - Mariana S Diniz
- Perinatal Research Laboratory, Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
- Research Unit Early Life Determinants (ELiD), Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
- CNC-UC-Center for Neuroscience and Cell Biology, University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-504 Coimbra, Portugal
- Doctoral Programme in Experimental Biology and Biomedicine (PDBEB), Institute for Interdisciplinary Research (IIIUC), University of Coimbra, 3004-531 Coimbra, Portugal
| | - Elisa Weiss
- Perinatal Research Laboratory, Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
- Research Unit Early Life Determinants (ELiD), Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - Andreas Steiner
- Perinatal Research Laboratory, Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
- Research Unit Early Life Determinants (ELiD), Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - Silvija Tokic
- Research Unit of Analytical Mass Spectrometry, Cell Biology and Biochemistry of Inborn Errors of Metabolism, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34, 8036 Graz, Austria
| | - Corina T Madreiter-Sokolowski
- Division of Molecular Biology and Biochemistry, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria
| | - Susana P Pereira
- CNC-UC-Center for Neuroscience and Cell Biology, University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-504 Coimbra, Portugal
- Laboratory of Metabolism and Exercise (LaMetEx), Research Centre in Physical Activity, Health and Leisure (CIAFEL), Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sports, University of Porto, 4200-450 Porto, Portugal
| | - Ursula Hiden
- Perinatal Research Laboratory, Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
- Research Unit Early Life Determinants (ELiD), Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
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Taylor RJ, Omidi A, Rosu M, Maggioncalda E, Weiss E. Effects of Respiratory and Cardiac Motion on Dose to the Left Anterior Descending Artery in Patients Undergoing Radiation Therapy for Locally Advanced Lung Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e64-e65. [PMID: 37785906 DOI: 10.1016/j.ijrobp.2023.06.788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Radiation dose to the left anterior descending artery (LAD) appears to be an independent predictor of major cardiac events and all-cause mortality following radiation therapy (RT) for lung cancer. In this study, we characterize the dosimetric effects of respiratory (RM) and cardiac (CM) motion on LAD. MATERIALS/METHODS Ten patients with stage IIIA-IVA lung cancer received cine MRIs (25 phases) at expiration which were used to evaluate the CM, and 4D CT scans for the evaluation of RM. Following registration of the expiration images of 4D CTs with MRIs, RT dose was transferred from planning CT datasets to all phases of 4D CTs and cine MRIs. LAD was manually contoured on all scans. The contours from each 4D phase represent LADs over multiple cardiac cycles, thus they are referred to as cLAD from here on. Displacements and dose variations of cLAD between exhale/inhale on 4D CTs and of LAD between systolic and diastolic phases on cine MRIs were analyzed, and paired t-tests were performed to assess the significance of the differences observed. RESULTS The following metrics are reported averaged over all patients. Clinical treatment planning CT metrics and doses: Mean dose, max dose, V5 Gy and V15 Gy were 15.0 (±11.3) Gy, 31.1 (±22.1) Gy, 53 (±33)%, 35 (±30)%. The cLAD metrics and dose variations due to respiratory motion (between exhale and inhale): RM amplitude was 0.3±0.2cm (RL 0.3 ± 0.1 cm, AP 0.2 ± 0.2 cm, SI 0.3 ± 0.2 cm). The variations in mean dose, max dose, V5 and V15 were 4.0 (±4.0) Gy, 1.6 (±1.5) Gy, 4.4 (±3.4)%, 4.0 (±3.4)%. Mean, max, V5 Gy and V15 Gy increased or remained unchanged with expiration in 8, 9, 5 and 5 patients, respectively. LAD metrics and dose variations due to cardiac motion (between systole and diastole): CM amplitude was 0.2 ± 0.1 cm (RL 0.2 ± 0.1 cm, AP 0.2 ± 0.1 cm, SI 0.3 ± 0.1 cm). The variations in mean dose, max dose, V5 and V15 were 1.7 (±1.4) Gy, 1.2 (±0.9) Gy, 5.2 (± 6.7)%, 4.6 (± 4.0)%. Mean, max, V5 Gy and V15 Gy increased or remained unchanged with diastole in 7, 7, 8 and 8 patients respectively. Statistical significance: The differences in displacement and dose between respiration and cardiac motion were not statistically significant. CONCLUSION Respiratory and cardiac-induced physiological variations of the LAD position have dosimetric consequences comparable in magnitude. Expiration and diastole lead to increased LAD doses. This underscores the importance of considering both the respiratory and the cardiac motion when motion management techniques are considered. 4D CTs inherently include the cardiac motion. However, if breath-hold is used for respiratory motion mitigation, CM might not be captured appropriately due to short tube rotation times. In this case, understanding CM characteristics is important for more accurate assessment of LAD dose.
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Affiliation(s)
- R J Taylor
- Virginia Commonwealth University, Department of Radiation Oncology, Richmond, VA
| | - A Omidi
- Virginia Commonwealth University, Department of Radiation Oncology, Richmond, VA
| | - M Rosu
- Virginia Commonwealth University, Department of Radiation Oncology, Richmond, VA
| | | | - E Weiss
- Virginia Commonwealth University, Department of Radiation Oncology, Richmond, VA
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Vasquez TS, Eggly S, Sae-Hau M, DeMairo K, Figueroa L, Gambatese M, Ortiz-Ravick L, Carpenter C, Sadler MD, Weiss E, Bylund CL. Preparing Patients to Communicate with Their Doctors About Clinical Trials as a Treatment Option: Impact of a Novel Video Intervention for Patients with a Blood Cancer and Their Caregivers. J Cancer Educ 2023; 38:1562-1570. [PMID: 37097340 DOI: 10.1007/s13187-023-02300-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 06/19/2023]
Abstract
Cancer clinical trials (CCTs) are imperative for advancing cancer treatment and providing treatment options for patients; however, many barriers exist to offering and enrolling interested and eligible patients. It is crucial to equip patients and caregivers with communication skills that help them initiate and navigate conversations about the option of receiving treatment within a CCT. The aim was to assess the acceptability and impact of a novel video training for patients and caregivers that models strategies for patient-provider communication using the PACES method of healthcare communication and provides information about CCTs. The three-module training was implemented among blood cancer patients and caregivers. Using a single-arm pre-post study design, self-report surveys assessed changes in knowledge, confidence in using the PACES method, and perceived importance of, confidence in, and behavioral intention related to talking with doctors about CCTs. The Patient Report of Communication Behavior (PRCB) scale was administered. Among 192 participants, post-intervention knowledge gains were evident (p < 0.001). Confidence, importance, and likelihood to communicate about CCTs and confidence about using PACES also increased (p < 0.001); females who had never previously spoken to a provider about CCTs demonstrated greater impact (p = 0.045) than other genders. PRCB mean scores increased among patients 65+ who had never spoken to a provider about CCTs, with greater change than patients <65 (p = 0.001). This educational intervention for patients and caregivers increased knowledge about CCTs, skills in communicating with doctors about care and CCTs, and readiness to initiate conversations about CCTs as a potential treatment option.
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Affiliation(s)
- Taylor S Vasquez
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA.
| | | | | | | | | | | | | | | | | | - Elisa Weiss
- The Leukemia & Lymphoma Society, Rye Brook, NY, USA
| | - Carma L Bylund
- College of Medicine, University of Florida, Gainesville, FL, USA
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Weiss E, Schrüfer A, Tocantins C, Diniz MS, Novakovic B, van Bergen AS, Kulovic‐Sissawo A, Saffery R, Boon RA, Hiden U. Higher gestational weight gain delays wound healing and reduces expression of long non-coding RNA KLRK1-AS1 in neonatal endothelial progenitor cells. J Physiol 2023; 601:3961-3974. [PMID: 37470310 PMCID: PMC10952284 DOI: 10.1113/jp284871] [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: 04/12/2023] [Accepted: 07/03/2023] [Indexed: 07/21/2023] Open
Abstract
High gestational weight gain (GWG) is a cardiovascular risk factor and may disturb neonatal endothelial function. Long non-coding RNAs (lncRNAs) regulate gene expression epigenetically and can modulate endothelial function. Endothelial colony forming cells (ECFCs), circulating endothelial precursors, are a recruitable source of endothelial cells and sustain endothelial function, vascular growth and repair. We here investigated whether higher GWG affects neonatal ECFC function and elucidated the role of lncRNAs herein. Wound healing of umbilical cord blood-derived ECFCs after pregnancies with GWG <13 kg versus >13 kg was determined in a scratch assay and based on monolayer impedance after electric wounding (electric cell-substrate impedance sensing, ECIS). LncRNA expression was analysed by RNA sequencing. The function of killer cell lectin-like receptor K1 antisense RNA (KLRK1-AS1) was investigated after siRNA-based knockdown. Closure of the scratch was delayed by 25% (P = 0.041) in the higher GWG group and correlated inversely with GWG (R = -0.538, P = 0.012) in all subjects (n = 22). Similarly, recovery of the monolayer barrier after electric wounding was delayed (-11% after 20 h; P = 0.014; n = 15). Several lncRNAs correlated with maternal GWG, the most significant one being KLRK1-AS1 (log2 fold change = -0.135, P < 0.001, n = 35). KLRK1-AS1 knockdown (n = 4) reduced barrier recovery after electric wounding by 21% (P = 0.029) and KLRK1-AS1 expression correlated with the time required for wound healing for both scratch (R = 0.447, P = 0.033) and impedance-based assay (R = 0.629, P = 0.014). Higher GWG reduces wound healing of neonatal ECFCs, and lower levels of the lncRNA KLRK1-AS1 may underlie this. KEY POINTS: Maternal cardiovascular risk factors such as diabetes, obesity and smoking in pregnancy disturb fetal endothelial function, and we here investigated whether also high gestational weight gain (GWG) has an impact on fetal endothelial cells. Circulating endothelial progenitor cells (endothelial colony forming cells, ECFCs) are highly abundant in the neonatal blood stream and serve as a circulating pool for vascular growth and repair. We revealed that higher GWG delays wound healing capacity of ECFCs in vitro. We identified the regulatory RNA lncRNA KLRK1-AS1 as a link between GWG and delayed ECFC wound healing. Our data show that high GWG, independent of pre-pregnancy BMI, affects neonatal ECFC function.
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Affiliation(s)
- Elisa Weiss
- Perinatal Research Laboratory, Department of Obstetrics and GynaecologyMedical University of GrazGrazAustria
- Research Unit Early Life Determinants (ELiD)Medical University of GrazGrazAustria
| | - Anna Schrüfer
- Perinatal Research Laboratory, Department of Obstetrics and GynaecologyMedical University of GrazGrazAustria
| | - Carolina Tocantins
- Perinatal Research Laboratory, Department of Obstetrics and GynaecologyMedical University of GrazGrazAustria
- CNC‐Center for Neuroscience and Cell Biology, CIBB‐Centre for Innovative Biomedicine and BiotechnologyUniversity of CoimbraCoimbraPortugal
- PhD Programme in Experimental Biology and Biomedicine (PDBEB), Institute for Interdisciplinary Research (IIIUC)University of CoimbraCoimbraPortugal
| | - Mariana Simoes Diniz
- Perinatal Research Laboratory, Department of Obstetrics and GynaecologyMedical University of GrazGrazAustria
- CNC‐Center for Neuroscience and Cell Biology, CIBB‐Centre for Innovative Biomedicine and BiotechnologyUniversity of CoimbraCoimbraPortugal
- PhD Programme in Experimental Biology and Biomedicine (PDBEB), Institute for Interdisciplinary Research (IIIUC)University of CoimbraCoimbraPortugal
| | - Boris Novakovic
- Molecular Immunity, Infection and Immunity ThemeMurdoch Children's Research InstituteParkvilleVictoriaAustralia
- Department of PaediatricsUniversity of MelbourneParkvilleVictoriaAustralia
| | - Anke S. van Bergen
- Department of PhysiologyAmsterdam University Medical Centers, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Amsterdam Cardiovascular SciencesMicrocirculationAmsterdamThe Netherlands
| | - Azra Kulovic‐Sissawo
- Perinatal Research Laboratory, Department of Obstetrics and GynaecologyMedical University of GrazGrazAustria
- Research Unit Early Life Determinants (ELiD)Medical University of GrazGrazAustria
| | - Richard Saffery
- Molecular Immunity, Infection and Immunity ThemeMurdoch Children's Research InstituteParkvilleVictoriaAustralia
- Department of PaediatricsUniversity of MelbourneParkvilleVictoriaAustralia
| | - Reinier A. Boon
- Department of PhysiologyAmsterdam University Medical Centers, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Amsterdam Cardiovascular SciencesMicrocirculationAmsterdamThe Netherlands
- Institute for Cardiovascular Regeneration, Centre for Molecular MedicineGoethe University Frankfurt am MainFrankfurt am MainGermany
- German Centre for Cardiovascular Research DZHKPartner site Frankfurt Rhein/MainFrankfurt am MainGermany
| | - Ursula Hiden
- Perinatal Research Laboratory, Department of Obstetrics and GynaecologyMedical University of GrazGrazAustria
- Research Unit Early Life Determinants (ELiD)Medical University of GrazGrazAustria
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Mara A, Rader R, Bylund C, Eggly S, Weiss E, Szumita L, Sitlinger A, Friedman D. QIM23-139: Creating a Fellowship Curriculum: Clinical Trial Patient Conversations. J Natl Compr Canc Netw 2023. [DOI: 10.6004/jnccn.2022.7195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Linendoll N, Murphy-Banks R, Sae-Hau M, Rodday AM, DiFilippo C, Jain A, Reinhart C, Rapkin B, Weiss E, Parsons SK. Evaluating the role of financial navigation in alleviating financial distress among young adults with a history of blood cancer: A hybrid type 2 randomized effectiveness-implementation design. Contemp Clin Trials 2023; 124:107019. [PMID: 36414208 PMCID: PMC9839613 DOI: 10.1016/j.cct.2022.107019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Young adulthood (YA) is a complex phase of life, marked by key developmental goals, including educational and vocational attainment, housing independence, maintenance of social relationships, and financial stability. A cancer diagnosis during, or prior to, this phase of life can compromise the achievement of these milestones. Studies of adults with cancer have demonstrated that >70% report experiencing financial side-effects, which are associated with increased mortality, diminished health-related quality of life, and forgone medical care. The goal of this project is to evaluate financial distress of YA-aged survivors of blood cancers, and the impact of financial navigation on alleviating this distress. METHODS This three-arm, multi-site, hybrid type 2 randomized effectiveness-implementation design (EID) study will be conducted through remote consent, remote data capture and telephone-based/virtual financial navigation. Participants will be aged 18-39, and more than three years from their blood cancer diagnosis. In this six-month intervention, the study will compare the primary outcome of financial distress in three arms: (1) usual care (2) participant-initiated, ad hoc navigation, and (3) study-directed proactive navigation. The study will be evaluated via the five-component Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) outcome strategy with a mixed-methods approach through quantitative assessment of participant-reported financial distress using the Personal Financial Wellness Scale™, as the primary outcome measure, and qualitative assessment through interviews. CONCLUSION The study will address many unanswered questions regarding financial navigation within the YA survivor population and will inform the most successful strategies to mitigate financial distress in this vulnerable population.
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Affiliation(s)
- Nadine Linendoll
- Reid R. Sacco Adolescent and Young Adult Cancer Program, Tufts Medical Center, Boston, MA, USA; Division of Hematology/Oncology, Tufts Medical Center Cancer Center, Boston, MA, USA; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA.
| | - Rachel Murphy-Banks
- Reid R. Sacco Adolescent and Young Adult Cancer Program, Tufts Medical Center, Boston, MA, USA; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | | | - Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Courtney DiFilippo
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Annika Jain
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Crystal Reinhart
- Center for Prevention Research and Development, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Bruce Rapkin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Elisa Weiss
- The Leukemia & Lymphoma Society, Rye Brook, NY, USA
| | - Susan K Parsons
- Reid R. Sacco Adolescent and Young Adult Cancer Program, Tufts Medical Center, Boston, MA, USA; Division of Hematology/Oncology, Tufts Medical Center Cancer Center, Boston, MA, USA; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
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Wang S, Mahon R, Weiss E, Jan N, Taylor R, McDonagh P, Quinn B, Yuan L. Automated Lung Cancer Segmentation Using a Dual-Modality Deep Learning Network with PET and CT Images. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bylund CL, Wollney EN, Campbell-Salome G, Applebaum AJ, Paige SR, DeGruccio K, Weiss E, Sae-Hau M, Arnold J, Durante D, Amin TB, Hampton CN, Fisher CL. Improving Clinical and Family Communication for Adult Child Caregivers of a Parent With a Blood Cancer: Single-Arm Pre-Post Pilot Intervention. JMIR Cancer 2022; 8:e38722. [PMID: 35788019 PMCID: PMC9297135 DOI: 10.2196/38722] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 04/27/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/14/2022] Open
Abstract
Background Adult child caregivers of parents with cancer may face challenges when communicating with the patient and other family members, communicating during clinical interactions, and navigating web-based information seeking. Objective We developed and pilot-tested the Healthy Communication Practice program for adult child caregivers of parents with a blood cancer, which aims to help participants learn and implement communication skills central to caregiving. We assessed the feasibility and acceptability of the training. Methods Eligible participants completed a preprogram survey. We assessed the feasibility of participants completing the intervention in the allotted time. Participants had 2 weeks to complete the 2-part, 90-minute online program and completed a postprogram survey that included program evaluation items and the Acceptability of Intervention Measure (AIM) using a 1-5 rating scale (5=strongly agree). Results Of 50 caregivers who initially expressed interest, 34 consented, and 30 completed the program and both surveys (88% completion rate). Caregivers had a mean age of 45.07 (SD 11.96) years and provided care for parents who had a mean age of 73.31 (SD 9.38) years. Caregivers were primarily daughters (n=22, 73%). Overall, scores on the AIM scale were high (mean 4.48, SD 0.67). Specifically, caregivers felt the content met their communication needs (mean 4.58, SD 0.62) and their own needs as a caregiver of a parent with a blood cancer (mean 4.39, SD 0.72). Conclusions We demonstrated the feasibility and acceptability of the Healthy Communication Practice program, which aims to enhance family and clinical communication skills among caregivers of a parent with a blood cancer. Future studies will examine the efficacy of the program and its impact on both caregiver and patient communication and health outcomes.
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Affiliation(s)
- Carma L Bylund
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, United States
| | - Easton N Wollney
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, United States
| | | | | | - Samantha R Paige
- STEM Translational Communication Center, University of Florida, Gainesville, FL, United States
| | - Kennan DeGruccio
- School of Social Work, Columbia University, New York, NY, United States
| | - Elisa Weiss
- The Leukemia & Lymphoma Society, Rye Brook, NY, United States
| | - Maria Sae-Hau
- The Leukemia & Lymphoma Society, Rye Brook, NY, United States
| | - Jason Arnold
- E-Learning, Technology and Communications, University of Florida, Gainesville, FL, United States
| | - Domenic Durante
- E-Learning, Technology and Communications, University of Florida, Gainesville, FL, United States
| | - Tithi B Amin
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, United States
| | - Chelsea N Hampton
- Department of Advertising, University of Florida, Gainesville, FL, United States
| | - Carla L Fisher
- Department of Advertising, University of Florida, Gainesville, FL, United States
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10
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Abbassi F, Gero D, Muller X, Bueno A, Figiel W, Robin F, Laroche S, Picard B, Shankar S, Ivanics T, van Reeven M, van Leeuwen OB, Braun HJ, Monbaliu D, Breton A, Vachharajani N, Bonaccorsi Riani E, Nowak G, McMillan RR, Abu-Gazala S, Nair A, Bruballa R, Paterno F, Weppler Sears D, Pinna AD, Guarrera JV, de Santibañes E, de Santibañes M, Hernandez-Aleja R, Olthoff K, Ghobrial RM, Ericzon BG, Ciccarelli O, Chapman WC, Mabrut JY, Pirenne J, Müllhaupt B, Ascher NL, Porte RJ, de Meier VE, Polak WG, Sapisochin G, Attia M, Weiss E, Adam RA, Cherqui D, Boudjema K, Zienewicz K, Jassem W, Puhan M, Dutkowski P, Clavien PA. Novel benchmark values for redo liver transplantation – does the outcome justify the effort? Br J Surg 2022. [DOI: 10.1093/bjs/znac178.001] [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: 11/12/2022]
Abstract
Abstract
Objective
In the era of organ shortage, redo liver transplantation (reLT) is frequently discussed in terms of expected poor outcome, high cost and therefore wasteful resources. However, there is a lack of benchmark data to reliably assess outcomes after reLT. The aim of this study was to define the ideal reLT case, and to establish clinically relevant benchmark values for best achievable outcome in reLT.
Methods
We collected data on reLT between January 2010 and December 2018 from 22 high volume transplant centers on three continents. Benchmark cases were defined as recipients with model of end-stage liver disease score <=25, absence of portal vein thrombosis, no mechanical ventilation before surgery, receiving a graft from a donor after brain death. In addition, early reLT including those for primary non-function (PNF) were excluded. Clinically relevant endpoints covering intra- and postoperative course were selected and complications were graded by severity using the Clavien-Dindo classification and the comprehensive complication index (CCI). The benchmark cutoff for each outcome was derived from the 75th percentile of the median values of all benchmark centers, indicating the “best achievable” result. To assess the utility of the newly established benchmark values, we analyzed patients who received reLT for PNF (non-benchmark patients).
Results
Out of 1110 reLT 413 (37.2%) qualified as benchmark cases. Benchmark values included: Length of intensive care unit and hospital stay: <=6 and <=24 days, respectively; Clavien-Dindo grade >=3a complications and the CCI at 1 year: <=76% and <=72.2, respectively; in-hospital and 1-year mortality rates: <=14.0% and <=14.3%, respectively. The cutoffs for transplant-specific complications such as biliary complications at 1 year, outflow problems at 1 year and hepatic artery thrombosis at discharge were <=27.3%, <=2.5% and <=4.8%, respectively. Patients receiving a reLT for PNF showed mean outcome values all outside the reLT benchmark values. In-hospital mortality rate was 34.4% and the mean CCI at discharge 68.8.
Conclusion
ReLT remains associated with high morbidity and mortality. The availability of benchmark values for outcome parameters of reLT may serve for comparison in any future analyses of individuals, patient groups, or centers, but also in the evaluation of new therapeutic strategies and principles.
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Affiliation(s)
- F Abbassi
- Department of Surgery and Transplantation, University Hospital Zurich , Zurich, Switzerland
| | - D Gero
- Department of Surgery and Transplantation, University Hospital Zurich , Zurich, Switzerland
| | - X Muller
- Department of General, Abdominal and Transplant Surgery, Croix-Rousse Hospital , Lyon, France
| | - A Bueno
- Department of Liver Studies, Kings’ College Hospital , London, United Kingdom
| | - W Figiel
- Department of General, Abdominal and Transplant Surgery, Medical University of Warsaw , Warsaw, Poland
| | - F Robin
- Department of HPB Surgery and Transplantation, University Hospital Rennes , Rennes, France
| | - S Laroche
- Department of Surgery and Transplanation at the HPB Center, Paul Brousse Hospital , Villejuif, France
| | - B Picard
- Department of Anesthesiology and Critical Care, Beaujon Teaching Hospital , Clinchy, France
| | - S Shankar
- Department of Abdominal Transplant and Hepatobiliary Surgery, The Leeds Teaching Hospital trust , Leeds, United Kingdom
| | - T Ivanics
- University Health Network Toronto Multi-Organ Transplant Program, , Toronto, Canada
| | - M van Reeven
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam , Rotterdam, The Netherlands
| | - O B van Leeuwen
- Division of HPB Surgery and Liver Transplantation, University of Groningen and University Medical Center Groningen , Groningen, The Netherlands
| | - H J Braun
- Division of Transplant Surgery, University of California , San Francisco, USA
| | - D Monbaliu
- Department of Abdominal Transplant Surgery and Transplant Coordination, University Hospitals Leuven , Leuven, Belgium
| | - A Breton
- Department of General, Abdominal and Transplant Surgery, Croix-Rousse Hospital , Lyon, France
| | - N Vachharajani
- Department of Surgery, Division of Abdominal Transplantation, Washington University in St. Louis School of Medicine , St. Louis, USA
| | - E Bonaccorsi Riani
- Department of Abdominal and Transplant Surgery, University Hospital St. Luc , Brussels, Belgium
| | - G Nowak
- Department of Transplantation Surgery, Karolinska University Hospital Huddinge , Stockholm, Sweden
| | - R R McMillan
- Weill Cornell Medical Center, Houston Methodist Hospital , Houston, USA
| | - S Abu-Gazala
- Department of Surgery, Penn Transplant Institute, Hospital of the University of Pennsylvania , Philadelphia, USA
| | - A Nair
- Division of Transplantation and Hepatobiliary Surgery, University of Rochester , Rochester, USA
| | - R Bruballa
- Hospital Italiano de Buenos Aires HPB and Liver Transplant Unit, , Buenos Aires, Brazil
| | - F Paterno
- Division of Liver Transplant, Rutgers New Jersey Medical School University Hospital , Newark, USA
| | - D Weppler Sears
- Department of Abdominal and Transplant Surgery , Cleveland Clinic Florida, Weston, USA
| | - A D Pinna
- Department of Abdominal and Transplant Surgery , Cleveland Clinic Florida, Weston, USA
| | - J V Guarrera
- Division of Liver Transplant, Rutgers New Jersey Medical School University Hospital , Newark, USA
| | - E de Santibañes
- Hospital Italiano de Buenos Aires HPB and Liver Transplant Unit, , Buenos Aires, Brazil
| | - M de Santibañes
- Hospital Italiano de Buenos Aires HPB and Liver Transplant Unit, , Buenos Aires, Brazil
| | - R Hernandez-Aleja
- Division of Transplantation and Hepatobiliary Surgery, University of Rochester , Rochester, USA
| | - K Olthoff
- Department of Surgery, Penn Transplant Institute, Hospital of the University of Pennsylvania , Philadelphia, USA
| | - R M Ghobrial
- Weill Cornell Medical Center, Houston Methodist Hospital , Houston, USA
| | - B-G Ericzon
- Department of Transplantation Surgery, Karolinska University Hospital Huddinge , Stockholm, Sweden
| | - O Ciccarelli
- Department of Abdominal and Transplant Surgery, University Hospital St. Luc , Brussels, Belgium
| | - W C Chapman
- Department of Surgery, Division of Abdominal Transplantation, Washington University in St. Louis School of Medicine , St. Louis, USA
| | - J-Y Mabrut
- Department of General, Abdominal and Transplant Surgery, Croix-Rousse Hospital , Lyon, France
| | - J Pirenne
- Department of Abdominal Transplant Surgery and Transplant Coordination, University Hospitals Leuven , Leuven, Belgium
| | - B Müllhaupt
- Department of Gastroenterology and Hepatology, University Hospital Zurich , Zurich, Switzerland
| | - N L Ascher
- Division of Transplant Surgery, University of California , San Francisco, USA
| | - R J Porte
- Division of HPB Surgery and Liver Transplantation, University of Groningen and University Medical Center Groningen , Groningen, The Netherlands
| | - V E de Meier
- Division of HPB Surgery and Liver Transplantation, University of Groningen and University Medical Center Groningen , Groningen, The Netherlands
| | - W G Polak
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam , Rotterdam, The Netherlands
| | - G Sapisochin
- University Health Network Toronto Multi-Organ Transplant Program, , Toronto, Canada
| | - M Attia
- Department of Abdominal Transplant and Hepatobiliary Surgery, The Leeds Teaching Hospital trust , Leeds, United Kingdom
| | - E Weiss
- Department of Anesthesiology and Critical Care, Beaujon Teaching Hospital , Clinchy, France
| | - R A Adam
- Department of Surgery and Transplanation at the HPB Center, Paul Brousse Hospital , Villejuif, France
| | - D Cherqui
- Department of Surgery and Transplanation at the HPB Center, Paul Brousse Hospital , Villejuif, France
| | - K Boudjema
- Department of HPB Surgery and Transplantation, University Hospital Rennes , Rennes, France
| | - K Zienewicz
- Department of General, Abdominal and Transplant Surgery, Medical University of Warsaw , Warsaw, Poland
| | - W Jassem
- Department of Liver Studies, Kings’ College Hospital , London, United Kingdom
| | - M Puhan
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University Hospital Zurich , Zurich, Switzerland
| | - P Dutkowski
- Department of Surgery and Transplantation, University Hospital Zurich , Zurich, Switzerland
| | - P-A Clavien
- Department of Surgery and Transplantation, University Hospital Zurich , Zurich, Switzerland
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11
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Ashaye A, Thomas C, Dalal M, Kota V, Krucien N, Sae-Hau M, Weiss E, Campbell S, Marsh K. Patient preferences for frontline therapies for Philadelphia chromosome-positive acute lymphoblastic leukemia: a discrete choice experiment. Future Oncol 2022; 18:2075-2085. [PMID: 35209721 DOI: 10.2217/fon-2022-0082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Aim: We examined the preferences of adults with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) for benefits and risks of tyrosine kinase inhibitors combined with chemotherapy for first-line treatment. Methods: In a discrete choice experiment, 201 patients chose between hypothetical treatment alternatives with varied levels of remission duration and overall survival (OS), and risks of major cardiovascular (CV) events and myelosuppression. Results: Although OS was the most important attribute to patients with Ph+ ALL, they were willing to tolerate a 2.9% increase in CV risk for 1 additional month of OS. Older patients (>59 years) and patients not in remission were less likely to tolerate increased CV risk. Conclusion: Preferences and risk tolerance varied between patients, highlighting the importance of shared decision making when selecting treatments for Ph+ ALL.
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Affiliation(s)
- Ajibade Ashaye
- Takeda Development Center Americas, Inc., Lexington, MA 02421, USA
| | | | - Mehul Dalal
- Takeda Development Center Americas, Inc., Lexington, MA 02421, USA
| | - Vamsi Kota
- Section of Hematology & Oncology, Georgia Cancer Center at Augusta University, Augusta, GA 30912, USA
| | | | - Maria Sae-Hau
- The Leukemia & Lymphoma Society, Rye Brook, NY 10573, USA
| | - Elisa Weiss
- The Leukemia & Lymphoma Society, Rye Brook, NY 10573, USA
| | - Scott Campbell
- Takeda Development Center Americas, Inc., Lexington, MA 02421, USA
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12
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Kastrinos AL, Bylund CL, Mullis MD, Wollney E, Sae-Hau M, Weiss E, Fisher CL. Parents Caring for Children Diagnosed with a Blood Cancer from Infancy to Emerging Adulthood: A Life span Perspective. J Adolesc Young Adult Oncol 2022; 11:61-67. [PMID: 34647791 PMCID: PMC9464088 DOI: 10.1089/jayao.2021.0070] [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] [Indexed: 02/03/2023] Open
Abstract
Purpose: Pediatric blood cancer diagnosis is a stressful experience for families as it can involve urgent treatment that can be life-threatening and require extended hospital stays. Little is known about the experiences of parent caregivers of children with a blood cancer during the diagnosis period and how families' needs may differ in light of the patient's developmental phase in the life span. Methods: We conducted semistructured in-depth interviews with 20 parent caregivers (aged 30-65) of children diagnosed with a blood cancer, recruited through The Leukemia & Lymphoma Society's (LLS) constituency. Interview transcripts were thematically analyzed using the constant comparative method. To elucidate similarities and differences in caregiving experiences, findings were compared across parents with children diagnosed in three developmental periods: infancy-early childhood, age 0-6 (n = 9); pre-early adolescence, aged 9-14 (n = 5); and late adolescence-emerging adulthood, aged 16-27 (n = 6). Results: Across all developmental periods, parents described three similar caregiving experiences during the diagnosis period: being persistent to obtain a diagnosis, attending to the child's quality of life challenges, and attending to their other children's well-being. Among caregivers of younger children, persistence was motivated by parental intuition and challenges included coping with traumatic physical and psychological impacts of treatment procedures. For caregivers of late adolescents-early adults, persistence was motivated by the child's self-assessment and fertility-related concerns emerged. Conclusion: Results illustrate core issues for parent blood cancer caregivers and highlight ways to tailor supportive resources that facilitate good communication practices and shared decision-making to children's distinct developmental needs.
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Affiliation(s)
- Amanda L. Kastrinos
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Address correspondence to: Amanda L. Kastrinos, PhD, Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY 10022, USA
| | - Carma L. Bylund
- College of Journalism and Communications, University of Florida, Gainesville, Florida, USA.,College of Medicine, University of Florida, Gainesville, Florida, USA.,University of Florida Health Cancer Center, Gainesville, Florida, USA
| | - Michaela D. Mullis
- College of Journalism and Communications, University of Florida, Gainesville, Florida, USA
| | - Easton Wollney
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Maria Sae-Hau
- The Leukemia & Lymphoma Society, Rye Brook, New York, USA
| | - Elisa Weiss
- The Leukemia & Lymphoma Society, Rye Brook, New York, USA
| | - Carla L. Fisher
- College of Journalism and Communications, University of Florida, Gainesville, Florida, USA.,University of Florida Health Cancer Center, Gainesville, Florida, USA
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13
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Ye J, Rizvi F, Welch G, Thomas T, Weiss E, Chandra R, Gutiontov S, Motwani S, Mattes M. Implementation of Standardized Lecture to Improve Radiation Oncology Knowledge in Multidisciplinary Lung Cancer Care Team: Initial Results of a Multi-Institutional Pilot Study. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.10.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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14
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Weiss E, Leopold-Posch B, Schrüfer A, Cvitic S, Hiden U. Fetal sex and maternal fasting glucose affect neonatal cord blood-derived endothelial progenitor cells. Pediatr Res 2022; 92:1590-1597. [PMID: 35184136 PMCID: PMC9771817 DOI: 10.1038/s41390-022-01966-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Maternal cardiovascular risk factors (CVRF) in pregnancy, i.e., obesity and hyperglycemia, transmit to the fetus and affect placental and fetal endothelial function. Moreover, a sex dimorphism in endothelial function and susceptibility towards CVRF exists already in utero. Endothelial colony-forming cells (ECFC) are circulating endothelial progenitors highly present in neonatal cord blood and sensitive to CVRF. This study investigated whether fetal sex or subtle maternal metabolic changes within healthy range alter fetal ECFC outgrowth. METHODS Outgrowth of ECFC from cord blood of male (n = 31) and female (n = 26) neonates was analyzed after healthy pregnancies and related to fetal sex and maternal metabolic parameters. RESULTS Male ECFC grew out earlier (-20.57% days; p = 0.031) than female. Although all women were non-diabetic, higher levels of fasting plasma glucose (FPG) at midpregnancy increased the time required for colony outgrowth (OR: 1.019; p = 0.030), which, after stratifying for fetal sex, was significant only in the males. Gestational weight gain and BMI did not affect outgrowth. Colony number was unchanged by all parameters. CONCLUSIONS Fetal sex and maternal FPG within normal range alter ECFC function in utero. A role of ECFC in postnatal angiogenesis and vasculogenesis has been suggested, which may be affected by altered outgrowth dynamics. IMPACT This study is the first to report that a sexual dimorphism exists in ECFC function, as cells of female progeny require a longer period of time until colony outgrowth than ECFC of male progeny. Our data show that ECFC function is highly sensitive and affected by maternal glucose levels even in a normal, non-diabetic range. Our data raise the question of whether maternal plasma glucose in pregnancy should be considered to play a critical role even in the non-diabetic setting.
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Affiliation(s)
- Elisa Weiss
- grid.11598.340000 0000 8988 2476Perinatal Research Laboratory, Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
| | - Barbara Leopold-Posch
- grid.11598.340000 0000 8988 2476Perinatal Research Laboratory, Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
| | - Anna Schrüfer
- grid.11598.340000 0000 8988 2476Perinatal Research Laboratory, Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
| | - Silvija Cvitic
- grid.11598.340000 0000 8988 2476Research Unit of Analytical Mass Spectrometry, Cell Biology and Biochemistry of Inborn Errors of Metabolism, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Ursula Hiden
- Perinatal Research Laboratory, Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria.
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15
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Weiss E, Vlahos A, Kim B, Wijegunasekara S, Shanmuganathan D, Aitken T, Joo JHE, Imran S, Shepherd R, Craig JM, Green M, Hiden U, Novakovic B, Saffery R. Transcriptomic Remodelling of Fetal Endothelial Cells During Establishment of Inflammatory Memory. Front Immunol 2021; 12:757393. [PMID: 34867995 PMCID: PMC8640490 DOI: 10.3389/fimmu.2021.757393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/03/2021] [Indexed: 12/11/2022] Open
Abstract
Inflammatory memory involves the molecular and cellular ‘reprogramming’ of innate immune cells following exogenous stimuli, leading to non-specific protection against subsequent pathogen exposure. This phenomenon has now also been described in non-hematopoietic cells, such as human fetal and adult endothelial cells. In this study we mapped the cell-specific DNA methylation profile and the transcriptomic remodelling during the establishment of inflammatory memory in two distinct fetal endothelial cell types – a progenitor cell (ECFC) and a differentiated cell (HUVEC) population. We show that both cell types have a core transcriptional response to an initial exposure to a viral-like ligand, Poly(I:C), characterised by interferon responsive genes. There was also an ECFC specific response, marked by the transcription factor ELF1, suggesting a non-canonical viral response pathway in progenitor endothelial cells. Next, we show that both ECFCs and HUVECs establish memory in response to an initial viral exposure, resulting in an altered subsequent response to lipopolysaccharide. While the capacity to train or tolerize the induction of specific sets of genes was similar between the two cell types, the progenitor ECFCs show a higher capacity to establish memory. Among tolerized cellular pathways are those involved in endothelial barrier establishment and leukocyte migration, both important for regulating systemic immune-endothelial cell interactions. These findings suggest that the capacity for inflammatory memory may be a common trait across different endothelial cell types but also indicate that the specific downstream targets may vary by developmental stage.
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Affiliation(s)
- Elisa Weiss
- Perinatal Research Laboratory, Department of Obstetrics & Gynaecology, Medical University of Graz, Graz, Austria
| | - Amanda Vlahos
- Molecular Immunity, Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Bowon Kim
- Molecular Immunity, Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Sachintha Wijegunasekara
- Molecular Immunity, Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Dhanya Shanmuganathan
- Molecular Immunity, Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Thomas Aitken
- Molecular Immunity, Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Biosciences, University of Melbourne, Parkville, VIC, Australia
| | - Ji-Hoon E Joo
- Colorectal Oncogenomics Group, Department of Clinical Pathology, University of Melbourne, Melbourne, VIC, Australia.,University of Melbourne Centre for Cancer Research, University of Melbourne, Melbourne, VIC, Australia
| | - Samira Imran
- Molecular Immunity, Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, VIC, Australia
| | - Rebecca Shepherd
- Molecular Immunity, Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Jeffrey M Craig
- Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, VIC, Australia.,Molecular Epidemiology, Murdoch Children's Research Institute, Parkville, VIC, Australia.,The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Mark Green
- Department of Biosciences, University of Melbourne, Parkville, VIC, Australia
| | - Ursula Hiden
- Perinatal Research Laboratory, Department of Obstetrics & Gynaecology, Medical University of Graz, Graz, Austria
| | - Boris Novakovic
- Molecular Immunity, Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, VIC, Australia
| | - Richard Saffery
- Molecular Immunity, Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, VIC, Australia
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16
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Cooper D, Padilla L, Watson A, Neiderer K, Smith B, Weiss E. Determining Radiation Doses of Critical Normal Tissues for Stereotactic Body Radiotherapy (SBRT) of Central Lung Tumors. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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17
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Cooper D, Guy C, Weiss E. P29.01 Deformable vs. Rigid Registration in Evaluating Composite Doses to Central Organs at Risk in Thoracic Reirradiation. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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18
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Crotty K, Lee M, Treiman K, Sae-Hau M, Wines C, Viator C, Weiss E. Health insurance, blood cancer, and outcomes: a literature review. Am J Manag Care 2021; 27:SP241-SP244. [PMID: 34407362 DOI: 10.37765/ajmc.2021.88733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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19
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Treiman K, Husick C, Sarris-Esquivel N, Sae-Hau M, Barnhart M, Disare K, Gupta C, Halpern M, Suvada K, Weiss E. Meeting the Information and Support Needs of Blood Cancer Patients and Caregivers: A Longitudinal Study of a Model of Patient-Centered Information Delivery. J Cancer Educ 2021; 36:538-546. [PMID: 31820416 DOI: 10.1007/s13187-019-01662-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Access to reliable, up-to-date information and resources can assist individuals managing and living with cancer. The Leukemia & Lymphoma Society, through its Information Resource Center, provides personalized information and support to individuals affected by blood cancer. To examine its value and impact, we conducted qualitative interviews (n = 18) and an online survey of patients and caregivers (N = 515) after they talked with an Information Resource Center Information Specialist by phone, with a follow-up survey about 6 months later. Respondents most commonly contacted the Information Resource Center to get referrals to support programs (40.4%) and to obtain information about getting a second opinion (36.5%) and financial assistance (36.2%). After talking with an Information Specialist, respondents felt more hopeful (85.9%), more confident in managing care (82.9%), and more knowledgeable about their diagnosis (49.5%) and financial resources (42.4%). After speaking with an Information Specialist, respondents changed how they advocated for themselves/loved one (23.8%), changed how they communicated with doctors/other providers and family/friends (both 15.9%), received financial assistance (22.2%), and took other actions. Among respondents who took actions, most said that the conversation(s) had positively impacted the action. Respondents who spoke with an Information Specialist more than once were more likely to report positive impacts, including changing how they advocate for themselves/loved one and communicate with providers (both p < 0.05). Respondents diagnosed more recently were also more likely to report positive impact, including changing the way they communicate with providers (p < 0.05). Findings highlight the value of cancer helplines and suggest ways they can be most effective.
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Affiliation(s)
- Katherine Treiman
- RTI International, 6001 Executive Blvd., Rockville, MD, 20852-3907, USA.
| | - Caroline Husick
- RTI International, 3040 Cornwallis Rd., Research Triangle Park, NC, 27709-2194, USA
| | | | - Maria Sae-Hau
- The Leukemia & Lymphoma Society, 3 International Drive, Suite 200, Rye Brook, NY, 10573, USA
| | - Meredith Barnhart
- The Leukemia & Lymphoma Society, 3 International Drive, Suite 200, Rye Brook, NY, 10573, USA
| | - Kate Disare
- The Leukemia & Lymphoma Society, 3 International Drive, Suite 200, Rye Brook, NY, 10573, USA
| | - Catherine Gupta
- RTI Health Solutions, 3040 Cornwallis Rd., Research Triangle Park, NC, 27709-2194, USA
| | - Michael Halpern
- Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Dr., Room 3E4342, Bethesda, MD, 20892-9762, USA
| | - Kara Suvada
- RTI International, 3040 Cornwallis Rd., Research Triangle Park, NC, 27709-2194, USA
| | - Elisa Weiss
- The Leukemia & Lymphoma Society, 3 International Drive, Suite 200, Rye Brook, NY, 10573, USA
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Hobeika C, Cauchy F, Weiss E, Chopinet S, Sepulveda A, Dondero F, Khoy-Ear L, Grigoresco B, Dokmak S, Durand F, Le Roy B, Paugam-Burtz C, Soubrane O. Practical model to identify liver transplant recipients at low risk of postoperative haemorrhage, bile leakage and ascites. BJS Open 2021; 5:6073666. [PMID: 33609380 PMCID: PMC7893463 DOI: 10.1093/bjsopen/zraa031] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 12/13/2022] Open
Abstract
Background This study aimed to identify a subgroup of recipients at low risk of haemorrhage, bile leakage and ascites following liver transplantation (LT). Methods Factors associated with significant postoperative ascites (more than 10 ml/kg on postoperative day 5), bile leakage and haemorrhage after LT were identified using three separate multivariable analyses in patients who had LT in 2010–2019. A model predicting the absence of all three outcomes was created and validated internally using bootstrap procedure. Results Overall, 944 recipients underwent LT. Rates of ascites, bile leakage and haemorrhage were 34.9, 7.7 and 6.0 per cent respectively. The 90-day mortality rate was 7.0 per cent. Partial liver graft (relative risk (RR) 1.31; P = 0.021), intraoperative ascites (more than 10 ml/kg suctioned after laparotomy) (RR 2.05; P = 0.001), malnutrition (RR 1.27; P = 0.006), portal vein thrombosis (RR 1.56; P = 0.024) and intraoperative blood loss greater than 1000 ml (RR 1.39; P = 0.003) were independently associated with postoperative ascites and/or bile leak and/or haemorrhage, and were introduced in the model. The model was well calibrated and predicted the absence of all three outcomes with an area under the curve of 0.76 (P = 0.001). Of the 944 patients, 218 (23.1 per cent) fulfilled the five criteria of the model, and 9.6 per cent experienced postoperative ascites (RR 0.22; P = 0.001), 1.8 per cent haemorrhage (RR 0.21; P = 0.033), 4.1 per cent bile leak (RR 0.54; P = 0.048), 40.4 per cent severe complications (RR 0.70; P = 0.001) and 1.4 per cent 90-day mortality (RR 0.13; P = 0.004). Conclusion A practical model has been provided to identify patients at low risk of ascites, bile leakage and haemorrhage after LT; these patients could potentially qualify for inclusion in non-abdominal drainage protocols.
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Affiliation(s)
- C Hobeika
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - F Cauchy
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - E Weiss
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - S Chopinet
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - A Sepulveda
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - F Dondero
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - L Khoy-Ear
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - B Grigoresco
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - S Dokmak
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - F Durand
- Department of Hepatology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - B Le Roy
- Department of Digestive and Oncological Surgery, Centre Hospitalier Universitaire Nord Saint-Etienne, Saint-Priest en Jarez, France
| | - C Paugam-Burtz
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
| | - O Soubrane
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Clichy, France
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Tobin JN, Cassells A, Weiss E, Lin TJ, Holder T, Carrozzi G, Barsanti F, Morales A, Maling A, Espejo M, Ascher A, Gilbert E, Casiano L, O-Hara-Cicero E, Weed J, Dietrich A. Integrating Cancer Screening and Mental Health Services in Primary Care: Protocol and Baseline Results of a Patient-Centered Outcomes Intervention Study. J Health Care Poor Underserved 2021; 32:1907-1934. [PMID: 34803050 PMCID: PMC10999254 DOI: 10.1353/hpu.2021.0173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Low-income and minority women are significantly more likely to be diagnosed with preventable, late-stage cancers and suffer from depression than the general population. Intervention studies aiming to reduce depression to increase cancer screening among underserved minority women are sparse. METHODS This patient-centered outcomes trial compared Collaborative Care Intervention plus Cancer Prevention Care Management (CCI+PCM) versus PCM alone. Participants from six Federally Qualified Health Centers (FQHCs) were interviewed at baseline, 6-and 12-month follow-up to monitor adherence to screening guidelines, depressive symptoms, quality of life, barriers to screening, and other psychosocial and health-related variables. RESULTS Participants included 757 English-or Spanish-speaking women (ages 50-64) who screened positive for depression on the Patient Health Questionnaire (PHQ)-9 and were not up-to-date for breast, cervical, and/or colorectal cancer screening. CONCLUSIONS Study methodology and baseline participant characteristics are reported to contribute to the literature on evidence-based interventions for cancer screening among underserved, depressed women.
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Ricco A, Allen A, Mukhopadhyay N, Kalman N, Weiss E. The Association Between Laboratory Pretreatment Immune Parameters and Radiographic Lung Changes in Early Stage Lung Cancer Patients Undergoing Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Jan N, Mukhopadhyay N, Weiss E. Target Volume Definition for Radiotherapy of Staple Line Recurrences of Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cooper D, Ricco A, Rezai Gharai L, Guy C, Weiss E. Risk of Radiation Pneumonitis in Locally Advanced Lung Cancer Patients: Role of Interstitial Lung Disease Subtypes and Severity of Pulmonary Emphysema. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ricco A, Rezai Gharai L, Kalman N, Weiss E. Interstitial Lung Disease Subtypes and Severity of Pulmonary Emphysema: Relation to Radiographic Lung Changes and Radiation Pneumonitis after Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ricco A, Kim A, Canada J, Grizzard J, Dana F, Rezai Gharai L, Abbate A, Weiss E. Extracellular Volume Fraction of Cardiac MRI in the Detection of Cardiac Toxicity from Radiotherapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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27
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Mahon R, Jan N, Hugo G, Muscu S, Weiss E. Accuracy of Deformable Image Registration for Reirradiation of Lung Cancer Following Stereotactic Body Radiotherapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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28
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Hinterberger C, Weiss E, Whelan M, Sen A. Food and Beverage Marketing to Children on YouTube: An Advertisement Content Analysis and Nutritional Comparison. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.06.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vodovar D, Ricard JD, Zafrani L, Weiss E, Desrentes E, Roux D. [Assessment of a newly-implemented blended teaching of intensive care and emergency medicine at Paris-Diderot University]. Rev Med Interne 2020; 41:368-374. [PMID: 32008801 DOI: 10.1016/j.revmed.2019.12.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/28/2019] [Accepted: 12/23/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Blended-learning methods could be a response to student nonattendance. Non-compulsory teaching combining e-learning/interactive face-to-face sessions has been implemented at Paris-Diderot Medical School for the teaching of intensive care and emergency medicine during the 2018/2019 university period. The aim of the study was to assess this newly-implemented blended teaching. METHODS Questionnaire submitted to the 388 DFASM3 medical students present at the faculty exam of intensive care/emergency medicine. Attendance at a teaching modality was defined by the follow-up of more than half of this teaching modality. Correlations between attendance at e-learning and/or interactive face-to-face sessions, and grade were performed. RESULTS A total of 358/388 (92%) students participated in this survey. A quarter of the students (88/321 - 25%) reported they usually attended at traditional lectures. Regarding blended-learning, 210/317 (67%) students reported having attended at e-learning courses and 84/321 (27%) attended at interactive face-to-face sessions. The distribution of students according to their attendance at e-learning and/or interactive face-to-face sessions was significantly different (P<0.01). There was a significant correlation (P<0.001) between attendance at e-learning and grade obtained at the faculty exam. Nevertheless, this correlation was also found for these students in another course taught traditionally. Overall, 309/315 (98%) students were satisfied with the blended teaching, 297/318 (93%) wanted its extent to the whole medical school's curriculum. CONCLUSION The use of combined learning methods reached more students than traditional teachings and allowed the University to focus on its role of knowledge transfer.
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Affiliation(s)
- D Vodovar
- UFR de médecine Paris-Diderot, université de Paris, 75010 Paris, France; FeTox, centre antipoison et de toxicovigilance de Paris, hôpital Fernand-Widal, AP-HP, 200, rue du Faubourg Saint-Denis, 75010 Paris, France.
| | - J D Ricard
- UFR de médecine Paris-Diderot, université de Paris, 75010 Paris, France; Service de médecine intensive et réanimation, hôpital Louis Mourier, AP-HP, 92700 Colombes, France
| | - L Zafrani
- UFR de médecine Paris-Diderot, université de Paris, 75010 Paris, France; Service de médecine intensive et réanimation, hôpital Saint-Louis, AP-HP, 75010 Paris, France
| | - E Weiss
- UFR de médecine Paris-Diderot, université de Paris, 75010 Paris, France; Département d'anesthésie-réanimation, hôpital Beaujon, AP-HP, 92110 Clichy, France
| | - E Desrentes
- UFR de médecine Paris-Diderot, service MédiTICE, université de Paris, 75010 Paris, France
| | - D Roux
- UFR de médecine Paris-Diderot, université de Paris, 75010 Paris, France; Service de médecine intensive et réanimation, hôpital Louis Mourier, AP-HP, 92700 Colombes, France
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Mahon RN, Ghita M, Hugo GD, Weiss E. ComBat harmonization for radiomic features in independent phantom and lung cancer patient computed tomography datasets. ACTA ACUST UNITED AC 2020; 65:015010. [DOI: 10.1088/1361-6560/ab6177] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Weiss E, Facchini R, Zwerling J. Cognitive Test Differences Between our Bronx English and Spanish Speaking Patients: Lessons Learned Through the Expansion of Neuropsychological Services. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz029.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
To demonstrate the differences between the English-speaking and Spanish-speaking patients evaluated at a Memory Disorders Clinic.
Participants and Method
Through a foundation grant to reduce barriers to appropriate neurological care, we established a bilingual/bicultural neuropsychology post-doctoral fellowship. In the initial 2 years, 405 new patients were seen at our multidisciplinary memory disorders clinics for neuropsychological and neurological evaluations. These patients were 63% female (n = 256), and had a mean age of 73.09 (SD = 10.63, range 52-98). Fifty-eight percent of our population identified as Hispanic/Latino (primarily Puerto Rican and Dominican) and 42% were evaluated in Spanish.
Results
Patients evaluated in Spanish had less education (p < .001) and were younger (p = .03) than those evaluated in English (including our Hispanic/Latino English speaking patients). Individuals evaluated in Spanish performed worse on a mental status exam (Blessed) than those evaluated in English (p = .001) even after controlling for age and education (p = .048). However, those evaluated in Spanish were more likely to do better on memory tasks than those evaluated in English, compared to their respective normative peers. Higher levels of anxiety and depression were evident in Hispanics/Latinos compared to non-Hispanics with highest levels in Hispanics evaluated in English.
Conclusions
Through a grant to expand services to the previously underserved Spanish-only speaking population of the Bronx, we were able to validate the need for appropriate language and cultural resources in our robust medical community. We demonstrated that our Spanish speaking population is diverse and requires different resources from their English-speaking counterparts. Our data supports the establishment of additional studies (including improved cultural and language specific normative data) and further education of providers working with our diverse populations.
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Cooper D, Conrad S, Padilla L, Weiss E. Comparing Maximum Dose to Central Airways in Mid-Ventilation Versus Average Intensity Projection-Based 4DCT Planning for Lung Stereotactic Body Radiation Therapy (SBRT). Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ricco A, Slade A, Canada J, Grizzard J, Dana F, Gharai LR, Neiderer K, Vera A, Abbate A, Weiss E. T1 Mapping and Cardiac MRI in the Detection of Cardiac Toxicity from Radiotherapy. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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34
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Slade A, Weiss E. Diabetes Self-Management among Cancer Survivors: Differences by Diagnosis and Treatment. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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35
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Schneider S, Weiss E. AGR - 1 The Use of Repeat Neuropsychological Assessment to Guide Treatment of Possible Normal Pressure Hydrocephalus in a Complex Case. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz037.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
Normal Pressure Hydrocephalus (NPH) is a condition that is characterized by the buildup of cerebrospinal fluid (CSF) in the brain that can cause urinary incontinence, gait disturbance, and cognitive impairment. NPH can be progressive but may be managed or reversed with shunt placement. External Lumbar Drainage (ELD) trials in determining if shunt placement is appropriate are common, but the role of repeat neuropsychological assessments during ELD procedures is not well documented in the literature. Repeat, pre, peri and post- ELD trial, assessment in a complex case of possible NPH is presented.
Method
33-year-old Hispanic English-Speaking female with cognitive/memory complaints following intraventricular hemorrhage (IVH) secondary to vasculopathy was initially seen for post IVH outpatient neuropsychological evaluation. MRI showed enlarged ventricles/communicating hydrocephalus and workup for NPH was initiated. Repeat inpatient evaluations were completed during the ELD trial, with annual outpatient neuropsychological follow-up.
Results
Gait evaluation was inconclusive. Inpatient testing demonstrated minor improvement immediately following ELD opening, but performances were variable across the 4 days of re-evaluation. Shunt placement was rejected due to neuropsychological findings. Outpatient follow-up of patient over several years has demonstrated mild improvement and not evidence of cognitive decline since ELD trial.
Conclusions
Assessment of cognitive functioning in outpatient and inpatient settings before, during, and for several years following ELD testing was beneficial to ascertain the decision not to place a shunt. Repeat neuropsychological assessment in inpatient and outpatient settings provided crucial information for guiding treatment decisions.
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Shagalow S, Facchini R, Masur D, Weiss E, Schneider S, Jacobs S, Yozawitz E, McGinley J. A-58 Rare Case of Klinefelter Syndrome with 13/14 Balanced Translocation and Absence Epilepsy: Impact of Combined Genotypes on Cognitive Neuropsychological Phenotype. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
Klinefelter syndrome (KS) and Robertsonian translocation of 13/14 [rob t(13;14)] are the most common sex-chromosome disorder and chromosome rearrangement, respectively (Engels et al., 2008; Skakkebæk, Wallentin, & Gravholt, 2015). Both are associated with increased risk of cognitive/intellectual disability (ID). A case of KS and de novo (i.e., unbalanced) rob t(13;14) was previously reported (Gül & Şayli, 1994). A case of KS with balanced rob t(13;14) and well-controlled generalized absence epilepsy will be presented with consideration for pediatric neuropsychological practice.
Method
Neuropsychological evaluation of a 12-year-old, right-handed boy diagnosed with comorbid KS, rob t(13;14), and generalized absence epilepsy. Particular attention was given to language given his KS diagnosis. The patient is in a 12:1:1 self-contained classroom with speech-language therapy and social skills groups in place. The patient’s mother is confirmed to have rob t(13;14), whereas paternal contribution is unknown.
Results
Adolescent with a history of language difficulties, especially comprehension. Recent school-based WISC-V FSIQ was in the extremely low range (SS = 53), with weaker verbal comprehension and working memory. Academic achievement was globally very low. Expressive and receptive language, visual perception and motor coordination were extremely low to low average. Verbal list learning and visual attention were near average to average.
Conclusions
This case contributes to the very limited body of pediatric neuropsychological data on the combined genotype of KS with rob t(13;14) and absence epilepsy. Both the KS and rob t(13;14) cognitive phenotypes have been characterized as highly variable, with the comorbidity a likely increased risk for ID.
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Schneider S, Weiss E, Facchini R, Shagalow S, Jacobs S, McGinley J, Masur D. B-32 The Use of Repeat Neuropsychological Assessment to Guide Treatment of Possible Normal Pressure Hydrocephalus in a Complex Case. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
Normal Pressure Hydrocephalus (NPH) is a condition that is characterized by the buildup of cerebrospinal fluid (CSF) in the brain that can cause urinary incontinence, gait disturbance, and cognitive impairment. NPH can be progressive but may be managed or reversed with shunt placement. External Lumbar Drainage (ELD) trials in determining if shunt placement is appropriate are common, but the role of repeat neuropsychological assessments during ELD procedures is not well documented in the literature. Repeat, pre-, peri and post- ELD trial, assessment in a complex case of possible NPH is presented.
Method
33-year-old Hispanic English-Speaking female with cognitive/memory complaints following intraventricular hemorrhage (IVH) secondary to vasculopathy was initially seen for post IVH outpatient neuropsychological evaluation. MRI showed enlarged ventricles/communicating hydrocephalus and workup for NPH was initiated. Repeat inpatient evaluations were completed during the ELD trial, with annual outpatient neuropsychological follow-up.
Results
Gait evaluation was inconclusive. Inpatient testing demonstrated minor improvement immediately following ELD opening, but performances were variable across the 4 days of re-evaluation. Shunt placement was rejected due to neuropsychological findings. Outpatient follow-up of patient over several years has demonstrated mild improvement and not evidence of cognitive decline since ELD trial.
Conclusions
Assessment of cognitive functioning in outpatient and inpatient settings before, during, and for several years following ELD testing was beneficial to ascertain the decision not to place a shunt. Repeat neuropsychological assessment in inpatient and outpatient settings provided crucial information for guiding treatment decisions.
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Jacobs S, Facchini R, Weiss E, McGinley J, Masur D. A-34 An Atypical Case of Primary Progressive Aphasia: Implications for Differentiating the Semantic Variant. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
Primary progressive aphasia is a neurodegenerative condition consisting of three primary variants. The semantic variant (svPPA) is typically associated with anomia and word-finding issues paired with fluent speech, although other symptoms can arise over time including non-verbal deficits and behavioral changes. A complex case of svPPA with evidence of robust impairment across multiple domains in the presence of notable psychosocial and medical factors is presented.
Method
Sixty-year-old woman with complaints of worsening memory and language changes in the context of marked behavioral disinhibition, deterioration of daily functioning, and indication of delusions was seen for outpatient neuropsychological evaluation. Medical history includes severe depression, anxiety, hypertension, and rheumatic heart disease. CT scan was significant for frontal and temporal atrophy and chronic right cerebellar infarct.
Results
Neuropsychological evaluation revealed uniformly extremely low scores. Presentation was notable for inappropriate behaviors, and expressive and receptive language difficulties. Significant confusion and functional impairment were evident. Her time awareness varied and she at some moments spoke about events from 20-30 years ago as if they were recent. Global language impairment was evident on formal testing and clearly moderated all other performances, including tasks of memory which were impaired. Notable weakness in visual-spatial processing and executive function were also present.
Conclusions
Complex medical and psychosocial history, and atypical decline patterns complicated the diagnosis of a patient with profound progressive expressive language impairment. SvPPA is offered as the diagnosis.
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Gonzalez D, Facchini R, Marquez C, Masur D, McGinley J, Weiss E, Zwerling J. A-83 The Applicability of the Word Accentuation Test (WAT) in a Diverse Spanish Speaking Population: A Pilot Study. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
A valid estimate of premorbid ability (PA) is important when attempting to identify cognitive decline. Measures of PA in English have been widely validated, but there is a lack of PA instruments for Spanish speakers. The findings of a pilot study assessing the feasibility of using the Word Accentuation Test (WAT) as a PA measure in a diverse, traditionally underserved, Spanish speaking population are described.
Method
The WAT was administered as part of comprehensive neuropsychological evaluations and neurobehavioral status exams (NBSE) completed with Spanish speaking patients at Montefiore Medical Center (MMC) in a 6-month period. Sixty-one patients completed the WAT- 12 as part of comprehensive testing (mean age 60 (SD 11.05) range 43-80, 67% female) and 49 during NBSEs within the context of multidisciplinary memory disorders clinics (mean age 74.35 (SD 8.60) range 51-93, 80% female). T-tests and correlations with WAT performances were completed.
Results
Overall, our population correctly read an average of 19.67 (SD 7.61) words. There was no statistical difference by gender or age, but years of education predicted WAT performance (p = .004). For those individuals who had comprehensive cognitive evaluations, WAT scores were correlated with performance on the vocabulary subtest of the EIWA-III (p = .003). All patients without severe dementia were able to complete the task.
Conclusions
Analysis of pilot data from our diverse Spanish population demonstrated that the WAT is an PA appropriate task that appears to have good correlation with years of education and vocabulary performance. Additional research is necessary to validate the measure in this cohort and other cohorts.
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Dawson K, Mange B, Torney PA, Gonzalez V, Sae-Hau M, Weiss E, Price M, Mansfield C, Comenencia-Ortíz E, Masaquel A, Ravelo A. PATIENT-REPORTED EXPERIENCE AND PREFERENCES WITH TREATMENT OF CHRONIC LYMPHOCYTIC LEUKEMIA (CLL), DIFFUSE LARGE B-CELL LYMPHOMA (DLBCL) AND FOLLICULAR LYMPHOMA (FL). Hematol Oncol 2019. [DOI: 10.1002/hon.225_2631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- K. Dawson
- US Medical Affairs, Genentech, Inc.; South San Francisco CA United States
| | - B. Mange
- Health Preference Assessment; RTI Health Solutions, Research Triangle Park; NC United States
| | - P. A. Torney
- Education and Support Services; Lymphoma Research Foundation; New York NY United States
| | - V. Gonzalez
- Support Services; Lymphoma Research Foundation; New York NY United States
| | - M. Sae-Hau
- Patient Access; The Leukemia & Lymphoma Society; Rye Brook NY United States
| | - E. Weiss
- Patient Access; The Leukemia & Lymphoma Society; Rye Brook NY United States
| | - M. Price
- Surveys and Observational Studies; RTI Health Solutions, Research Triangle Park; NC United States
| | - C. Mansfield
- Health Preference Assessment; RTI Health Solutions, Research Triangle Park; NC United States
| | - E. Comenencia-Ortíz
- Alliance & Advocacy Relations, Genentech, Inc.; South San Francisco CA United States
| | - A. Masaquel
- US Medical Affairs, Genentech, Inc.; South San Francisco CA United States
| | - A. Ravelo
- US Medical Affairs, Genentech, Inc.; South San Francisco CA United States
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Van Zandt M, Weiss E, Almyasheva A, Lipior S, Maisel S, Naegele JR. Adeno-associated viral overexpression of neuroligin 2 in the mouse hippocampus enhances GABAergic synapses and impairs hippocampal-dependent behaviors. Behav Brain Res 2018; 362:7-20. [PMID: 30605713 DOI: 10.1016/j.bbr.2018.12.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 08/02/2018] [Revised: 12/14/2018] [Accepted: 12/29/2018] [Indexed: 10/27/2022]
Abstract
The cell adhesion molecule neuroligin2 (NLGN2) regulates GABAergic synapse development, but its role in neural circuit function in the adult hippocampus is unclear. We investigated GABAergic synapses and hippocampus-dependent behaviors following viral-vector-mediated overexpression of NLGN2. Transducing hippocampal neurons with AAV-NLGN2 increased neuronal expression of NLGN2 and membrane localization of GABAergic postsynaptic proteins gephyrin and GABAARγ2, and presynaptic vesicular GABA transporter protein (VGAT) suggesting trans-synaptic enhancement of GABAergic synapses. In contrast, glutamatergic postsynaptic density protein-95 (PSD-95) and presynaptic vesicular glutamate transporter (VGLUT) protein were unaltered. Moreover, AAV-NLGN2 significantly increased parvalbumin immunoreactive (PV+) synaptic boutons co-localized with postsynaptic gephyrin+ puncta. Furthermore, these changes were demonstrated to lead to cognitive impairments as shown in a battery of hippocampal-dependent mnemonic tasks and social behaviors.
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Affiliation(s)
- M Van Zandt
- Wesleyan University, Department of Biology, Program in Neuroscience and Behavior, Middletown, CT, United States
| | - E Weiss
- Wesleyan University, Department of Biology, Program in Neuroscience and Behavior, Middletown, CT, United States
| | - A Almyasheva
- Wesleyan University, Department of Biology, Program in Neuroscience and Behavior, Middletown, CT, United States
| | - S Lipior
- Wesleyan University, Department of Biology, Program in Neuroscience and Behavior, Middletown, CT, United States
| | - S Maisel
- Wesleyan University, Department of Biology, Program in Neuroscience and Behavior, Middletown, CT, United States
| | - J R Naegele
- Wesleyan University, Department of Biology, Program in Neuroscience and Behavior, Middletown, CT, United States.
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Zhao S, Mahon R, Mukhopadhyay N, Hugo G, Weiss E. Changes in Radiomic Features During Radiation Therapy as Predictors for Outcome in Locally Advanced Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Weiss E, Jan N. Recurrence Pattern after SBRT for Stage I Lung Cancer – Impact on Patient Outcome. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Zhao S, Sima A, Mahon R, Tennyson N, Weiss E. Tumor Volume Changes During and after Radiation Therapy as a Predictor for Local Recurrence in Locally Advanced Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gockel-Blessing E, Weiss E, Ramel M, Wright K. Heart Rate Response to Caffeine Ingestion as a Predictor of Magnitude and Direction of Blood Pressure Changes. J Acad Nutr Diet 2018. [DOI: 10.1016/j.jand.2018.08.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Golbek A, Reafsnyder S, Rancourt D, Kelly P, Rahman R, Weiss E. Peppermint Oil Fails to Improve Exercise Performance. J Acad Nutr Diet 2018. [DOI: 10.1016/j.jand.2018.06.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mandolfo C, Baumgart C, Weiss E, Stephen F. Consuming An Anti-Inflammatory Diet to Alleviate Chronic Pain. J Acad Nutr Diet 2018. [DOI: 10.1016/j.jand.2018.06.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Weiss E, Wroble K, Trott M, Schweitzer G, Rahman R, Kelly P. Low-carbohydrate, Ketogenic Diet Impairs Anaerobic Exercise Performance. J Acad Nutr Diet 2018. [DOI: 10.1016/j.jand.2018.06.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lowe A, Eliot K, Kelly P, Weiss E. Sodium Bicarbonate Loading: Effects on Exercise BP and GI Distress. J Acad Nutr Diet 2018. [DOI: 10.1016/j.jand.2018.06.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lee J, Facchini R, Cohen J, Weiss E, McGinley J, Pakray H, Vissicchio N, Masur D. B - 37Case Study of Possible PSP with Severe Functional Impairment in a 59-Year-Old Woman. Arch Clin Neuropsychol 2018. [DOI: 10.1093/arclin/acy061.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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