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Zhang W, Windsor K, Jones R, Taunton DO. Hypermobile type Ehlers-Danlos syndrome associated with hypogammaglobulinemia and fibromyalgia: A case-based review on new classification, diagnosis, and multidisciplinary management. Clin Case Rep 2019; 7:680-685. [PMID: 30997063 PMCID: PMC6452458 DOI: 10.1002/ccr3.2070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 11/23/2018] [Accepted: 02/03/2019] [Indexed: 12/21/2022] Open
Abstract
Hypermobile type Ehlers-Danlos syndrome (hEDS) is an underdiagnosed connective tissue disorder characterized by generalized joint hypermobility, chronic fatigue, widespread joints pain, and impaired quality of life. Here, we reported the first hEDS complicated by hypogammaglobulinemia. New insights into classification, diagnosis, and proper management of hEDS are also reviewed.
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Affiliation(s)
- Wei Zhang
- Internal Medicine Residency ProgramBrookwood Baptist HealthBirminghamAlabama
| | - Kevin Windsor
- Alabama Oncology at Grandview Medical CenterBirminghamAlabama
| | - Richard Jones
- Internal Medicine Residency ProgramBrookwood Baptist HealthBirminghamAlabama
- Clinic for Rheumatic DiseasesTuscaloosaAlabama
| | - David Oscar Taunton
- Internal Medicine Residency ProgramBrookwood Baptist HealthBirminghamAlabama
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Shah MA, Starodub A, Sharma S, Berlin J, Patel M, Wainberg ZA, Chaves J, Gordon M, Windsor K, Brachmann CB, Huang X, Vosganian G, Maltzman JD, Smith V, Silverman JA, Lenz HJ, Bendell JC. Andecaliximab/GS-5745 Alone and Combined with mFOLFOX6 in Advanced Gastric and Gastroesophageal Junction Adenocarcinoma: Results from a Phase I Study. Clin Cancer Res 2018; 24:3829-3837. [PMID: 29691300 DOI: 10.1158/1078-0432.ccr-17-2469] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 03/06/2018] [Accepted: 04/19/2018] [Indexed: 12/21/2022]
Abstract
Purpose: Matrix metalloproteinase-9 (MMP9) is implicated in protumorigenic processes. Andecaliximab (GS-5745, a monoclonal antibody targeting MMP9) was evaluated as monotherapy and in combination with mFOLFOX6.Patients and Methods: Three dosages of andecaliximab monotherapy [200, 600, and 1800 mg i.v. every 2 weeks (q2w)] were investigated in patients with advanced solid tumors (n = 13 in a 3+3 design). After determining a recommended dose, patients with advanced HER2-negative gastric/gastroesophageal junction (GEJ) adenocarcinoma (n = 40) received 800 mg andecaliximab + mFOLFOX6 q2w. Pharmacokinetics, pharmacodynamics, safety, and efficacy were assessed.Results: Andecaliximab monotherapy demonstrated no dose-limiting toxicity (DLT) in any cohort, displaying target-mediated drug disposition at the lowest dose (200 mg) and linear pharmacokinetics at higher doses. Based on target engagement, recommended doses for further study are 800 mg q2w or 1,200 mg q3w. Maximal andecaliximab target binding, defined as undetectable andecaliximab-free MMP9 in plasma, was observed in the gastric/GEJ adenocarcinoma cohort. We observed no unusual toxicity, although there were four deaths on study not attributed to andecaliximab treatment. In first-line patients (n = 36), median progression-free survival (PFS) was 9.9 months [95% confidence interval (CI), 5-13.9 months], and the overall response rate (ORR) was 50%. Among all patients (n = 40), median PFS was 7.8 (90% CI, 5.5-13.9) months, and ORR was 48%, with a median duration of response of 8.4 months.Conclusions: Andecaliximab monotherapy achieved target engagement without DLT. Andecaliximab + mFOLFOX6 showed encouraging clinical activity without additional toxicity in patients with HER2-negative gastric/GEJ adenocarcinoma. A phase III study evaluating mFOLFOX6 ± andecaliximab in this setting is ongoing. Clin Cancer Res; 24(16); 3829-37. ©2018 AACR.
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Affiliation(s)
- Manish A Shah
- Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York.
| | - Alexander Starodub
- Parkview Comprehensive Cancer Institute/Parkview Health, Fort Wayne, Indiana
| | - Sunil Sharma
- University of Utah Huntsman Cancer Institute, Salt Lake City, Utah
| | - Jordan Berlin
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Manish Patel
- Florida Cancer Specialists/Sarah Cannon Research Institute, Sarasota, Florida
| | - Zev A Wainberg
- Division of Hematology Oncology, Department of Medicine, UCLA School of Medicine, Los Angeles, California
| | - Jorge Chaves
- Northwest Medical Specialties PLLC, Tacoma, Washington
| | | | | | | | - Xi Huang
- Gilead Sciences, Inc., Foster City, California
| | | | | | | | | | | | - Johanna C Bendell
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, Tennessee
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Lohiya V, Lohiya S, Windsor K. A large thigh mass: a blood clot or a rare skeletal muscle metastasis from renal cell carcinoma. Springerplus 2013; 2:399. [PMID: 24024088 PMCID: PMC3765606 DOI: 10.1186/2193-1801-2-399] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 08/13/2013] [Indexed: 11/24/2022]
Abstract
Background Renal cell carcinoma (RCC) is a tumor known for its unusual presentations and high rate of metastasis. Metastasis to lung, liver, bone and brain are common, but to skeletal muscle(SM) is very rare. Because only 11% of the RCC metastases to SM present after 10 years of initial presentation, there is no general consensus for its annual surveillance. Methods We report a case of a 58 year old male with a history of RCC, initially diagnosed 11 years ago, who presented with a large SM mass. A large mass measuring more than 25 cm was located in left posterior thigh and was present for more than a year. It initially was diagnosed as a large blood clot and was treated with warfarin for more than 6 months. Clinical work up including FDG-PET/CT and MRI raised the possibility of a tumor, but a negative biopsy made the diagnosis uncertain. Because of high suspicion for a tumor, patient underwent a complete resection of the mass. Results The resected mass measuring 28 × 18 × 7 cm was detailed as the largest skeletal muscle metastasis from RCC ever reported. Conclusion This case emphasizes the importance of maintaining a high suspicion for metastasis even in less common metastatic sites mainly in patients with a history of RCC. It also highlights the importance of annual surveillance for metastasis in patients with RCC even after 10 years of initial presentation using FDG-PET/CT.
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Affiliation(s)
- Vipin Lohiya
- Internal medicine, Baptist Health System, 800, Montclair Rd, Birmingham, 35203 Alabama USA
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Beveridge RA, Miller JA, Kales AN, Binder RA, Robert NJ, Harvey JH, Windsor K, Gore I, Cantrell J, Thompson KA, Taylor WR, Barnes HM, Schiff SA, Shields JA, Cambareri RJ, Butler TP, Meister RJ, Feigert JM, Norgard MJ, Moraes MA, Helvie WW, Patton GA, Mundy LJ, Henry D, Sheridan MJ. A comparison of efficacy of sargramostim (yeast-derived RhuGM-CSF) and filgrastim (bacteria-derived RhuG-CSF) in the therapeutic setting of chemotherapy-induced myelosuppression. Cancer Invest 2000; 16:366-73. [PMID: 9679526 DOI: 10.3109/07357909809115775] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A randomized, double-blind, multicenter study in 181 afebrile cancer patients with ANC levels < 500/microL receiving myelosuppressive chemotherapy was undertaken to compare sargramostim (yeast-derived recombinant human granulocyte-macrophage colony-stimulating factor, RhuGM-CSF) and filgrastim (bacteria-derived recombinant human granulocyte colony-stimulating factor, RhuG-CSF) in the treatment of chemotherapy-induced myelosuppression. Patients received daily subcutaneous (SC) injections of either agent until ANC levels reached at least 1500/microL. There was no statistical difference between treatment groups in the mean number of days to reach an ANC of 500/microL, but the mean number of days to reach ANC levels of 1000/microL and 1500/microL was approximately one day less in patients receiving filgrastim. Fewer patients in the sargramostim arm were hospitalized, and they had a shorter mean length of hospitalization, mean duration of fever, and mean duration of i.v. antibiotic therapy compared with patients who received filgrastim. Both growth factors were well tolerated. No patient was readmitted to the hospital after growth factor was discontinued. Sargramostim and filgrastim have comparable efficacy and tolerability in the treatment of standard-dose chemotherapy-induced myelosuppression in community practice.
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Affiliation(s)
- R A Beveridge
- Fairfax Hematology-Oncology Associates, Inc., Annandale, Virginia, USA
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Trott MC, Windsor K. Leadership effectiveness: how do you measure up? Nurs Econ 1999; 17:127-30. [PMID: 10711151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
The purpose of this article is to provide leaders with a tool to collect accurate data of subordinate's perceptions. Leaders in the nursing profession must feel comfortable and be encouraged to seek the opinion of the staff they serve. Without actively seeking the feedback of subordinates there is no opportunity for personal growth and insight. So, while asking for staff feedback can be a "daring adventure" for any leader, leading staff who do not want to follow will result in an organization of "nothing" in today's health care arena.
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Affiliation(s)
- M C Trott
- IV Therapy Service, Saint Vincent Health Center, Erie, PA, USA
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