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Chou T, Nabavinia M, Tram NK, Rimmerman ET, Patel S, Musini KN, Eisert SN, Wolfe T, Wynveen MK, Matsuzaki Y, Kitsuka T, Iwaki R, Janse SA, Bobbey AJ, Breuer CK, Goodchild L, Malbrue R, Shinoka T, Atway SA, Go MR, Stacy MR. Quantification of Skeletal Muscle Perfusion in Peripheral Artery Disease Using 18F-Sodium Fluoride Positron Emission Tomography Imaging. J Am Heart Assoc 2024; 13:e031823. [PMID: 38353265 PMCID: PMC11010069 DOI: 10.1161/jaha.123.031823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/07/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Perfusion deficits contribute to symptom severity, morbidity, and death in peripheral artery disease (PAD); however, no standard method for quantifying absolute measures of skeletal muscle perfusion exists. This study sought to preclinically test and clinically translate a positron emission tomography (PET) imaging approach using an atherosclerosis-targeted radionuclide, fluorine-18-sodium fluoride (18F-NaF), to quantify absolute perfusion in PAD. METHODS AND RESULTS Eight Yorkshire pigs underwent unilateral femoral artery ligation and dynamic 18F-NaF PET/computed tomography imaging on the day of and 2 weeks after occlusion. Following 2-week imaging, calf muscles were harvested to quantify microvascular density. PET methodology was validated with microspheres in 4 additional pig studies and translated to patients with PAD (n=39) to quantify differences in calf perfusion across clinical symptoms/stages and perfusion responses in a case of revascularization. Associations between PET perfusion, ankle-brachial index, toe-brachial index, and toe pressure were assessed in relation to symptoms. 18F-NaF PET/computed tomography quantified significant deficits in calf perfusion in pigs following arterial occlusion and perfusion recovery 2 weeks after occlusion that coincided with increased muscle microvascular density. Additional studies confirmed that PET-derived perfusion measures agreed with microsphere-derived perfusion measures. Translation of imaging methods demonstrated significant decreases in calf perfusion with increasing severity of PAD and quantified perfusion responses to revascularization. Perfusion measures were also significantly associated with symptom severity, whereas traditional hemodynamic measures were not. CONCLUSIONS 18F-NaF PET imaging quantifies perfusion deficits that correspond to clinical stages of PAD and represents a novel perfusion imaging strategy that could be partnered with atherosclerosis-targeted 18F-NaF PET imaging using a single radioisotope injection. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03622359.
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Affiliation(s)
- Ting‐Heng Chou
- Center for Regenerative MedicineResearch Institute at Nationwide Children’s HospitalColumbusOH
| | - Mahboubeh Nabavinia
- Center for Regenerative MedicineResearch Institute at Nationwide Children’s HospitalColumbusOH
| | - Nguyen K. Tram
- Center for Regenerative MedicineResearch Institute at Nationwide Children’s HospitalColumbusOH
| | - Eleanor T. Rimmerman
- Center for Regenerative MedicineResearch Institute at Nationwide Children’s HospitalColumbusOH
- Biophysics Graduate ProgramOhio State UniversityColumbusOH
| | - Surina Patel
- Center for Regenerative MedicineResearch Institute at Nationwide Children’s HospitalColumbusOH
| | - Kumudha Narayana Musini
- Center for Regenerative MedicineResearch Institute at Nationwide Children’s HospitalColumbusOH
| | - Susan Natalie Eisert
- Center for Regenerative MedicineResearch Institute at Nationwide Children’s HospitalColumbusOH
| | - Tatiana Wolfe
- Center for Regenerative MedicineResearch Institute at Nationwide Children’s HospitalColumbusOH
| | - Molly K. Wynveen
- Center for Regenerative MedicineResearch Institute at Nationwide Children’s HospitalColumbusOH
| | - Yuichi Matsuzaki
- Center for Regenerative MedicineResearch Institute at Nationwide Children’s HospitalColumbusOH
| | - Takahiro Kitsuka
- Center for Regenerative MedicineResearch Institute at Nationwide Children’s HospitalColumbusOH
| | - Ryuma Iwaki
- Center for Regenerative MedicineResearch Institute at Nationwide Children’s HospitalColumbusOH
| | | | - Adam J. Bobbey
- Department of RadiologyNationwide Children’s HospitalColumbusOH
| | - Christopher K. Breuer
- Center for Regenerative MedicineResearch Institute at Nationwide Children’s HospitalColumbusOH
| | - Laurie Goodchild
- Animal Resources CoreResearch Institute at Nationwide Children’s HospitalColumbusOH
| | - Raphael Malbrue
- Animal Resources CoreResearch Institute at Nationwide Children’s HospitalColumbusOH
| | - Toshiharu Shinoka
- Center for Regenerative MedicineResearch Institute at Nationwide Children’s HospitalColumbusOH
| | - Said A. Atway
- Department of OrthopaedicsOhio State University College of MedicineColumbusOH
| | - Michael R. Go
- Division of Vascular Diseases & Surgery, Department of SurgeryOhio State University College of MedicineColumbusOH
| | - Mitchel R. Stacy
- Center for Regenerative MedicineResearch Institute at Nationwide Children’s HospitalColumbusOH
- Biophysics Graduate ProgramOhio State UniversityColumbusOH
- Division of Vascular Diseases & Surgery, Department of SurgeryOhio State University College of MedicineColumbusOH
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Beverly Hery CM, Janse SA, Van Zee KJ, Naftalis EZ, Paskett ED, Naughton MJ. Factors associated with insomnia symptoms over three years among premenopausal women with breast cancer. Breast Cancer Res Treat 2023; 202:155-165. [PMID: 37542630 PMCID: PMC10504151 DOI: 10.1007/s10549-023-07058-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/16/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE We examined longitudinal trends and factors associated with insomnia over 3 years in a cohort of young breast cancer patients. METHODS Women with stage I-III breast cancer at ≤ 45 years were recruited at five institutions from New York, Texas, and North Carolina, within 8 months of diagnosis (n = 836). Participants completed questionnaires every 6 months for 3 years. Linear mixed-effects models were used to examine insomnia over time, using the Women's Health Initiative Insomnia Rating Scale (WHIIRS). We evaluated the relations of insomnia with demographic (age, race, education, income, employment, marital status), clinical (cancer stage, histologic grade, chemotherapy, radiation, hormone therapy, surgery, tumor size, body mass index, hot flashes), and social/behavioral variables (smoking status, social support, physical activity, depressive symptoms). RESULTS At baseline, 57% of participants met or exceeded the cut-off for clinical insomnia (WHIIRS score ≥ 9). Insomnia symptoms were most prevalent at baseline (p < 0.0001), but decreased significantly throughout follow-up (p < 0.001). However, 42% of participants still experienced insomnia symptoms 3 years after diagnosis. In multivariable models, older age (p = 0.02), hot flashes (p < 0.0001), and depressive symptoms (p < 0.0001) remained significantly associated with insomnia over time. CONCLUSIONS Insomnia symptoms were most frequent closer to breast cancer diagnosis and treatment, but persisted for some women who were older and those reporting higher hot flashes and depressive symptoms. Survivorship care should include assessing insomnia symptoms, particularly during and immediately after primary treatment. Implementing early interventions for sleep problems may benefit young breast cancer survivors and improve their quality of life.
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Affiliation(s)
- Chloe M Beverly Hery
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, 43210, USA.
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, 43210, USA.
| | - Sarah A Janse
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, 43210, USA
| | - Kimberly J Van Zee
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Elizabeth Z Naftalis
- Director of Breast Services, Health Texas Community Health Services Corporate, Dallas, TX, 75001, USA
| | - Electra D Paskett
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, 43210, USA
| | - Michelle J Naughton
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, 43210, USA
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Tram NK, Chou TH, Janse SA, Bobbey AJ, Audino AN, Onofrey JA, Stacy MR. Deep learning of image-derived measures of body composition in pediatric, adolescent, and young adult lymphoma: association with late treatment effects. Eur Radiol 2023; 33:6599-6607. [PMID: 36988714 DOI: 10.1007/s00330-023-09587-z] [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: 08/26/2022] [Revised: 02/07/2023] [Accepted: 02/17/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVES The objective of this study was to translate a deep learning (DL) approach for semiautomated analysis of body composition (BC) measures from standard of care CT images to investigate the prognostic value of BC in pediatric, adolescent, and young adult (AYA) patients with lymphoma. METHODS This 10-year retrospective, single-site study of 110 pediatric and AYA patients with lymphoma involved manual segmentation of fat and muscle tissue from 260 CT imaging datasets obtained as part of routine imaging at initial staging and first therapeutic follow-up. A DL model was trained to perform semiautomated image segmentation of adipose and muscle tissue. The association between BC measures and the occurrence of 3-year late effects was evaluated using Cox proportional hazards regression analyses. RESULTS DL-guided measures of BC were in close agreement with those obtained by a human rater, as demonstrated by high Dice scores (≥ 0.95) and correlations (r > 0.99) for each tissue of interest. Cox proportional hazards regression analyses revealed that patients with elevated subcutaneous adipose tissue at baseline and first follow-up, along with patients who possessed lower volumes of skeletal muscle at first follow-up, have increased risk of late effects compared to their peers. CONCLUSIONS DL provides rapid and accurate quantification of image-derived measures of BC that are associated with risk for treatment-related late effects in pediatric and AYA patients with lymphoma. Image-based monitoring of BC measures may enhance future opportunities for personalized medicine for children with lymphoma by identifying patients at the highest risk for late effects of treatment. KEY POINTS • Deep learning-guided CT image analysis of body composition measures achieved high agreement level with manual image analysis. • Pediatric patients with more fat and less muscle during the course of cancer treatment were more likely to experience a serious adverse event compared to their clinical counterparts. • Deep learning of body composition may add value to routine CT imaging by offering real-time monitoring of pediatric, adolescent, and young adults at high risk for late effects of cancer treatment.
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Affiliation(s)
- Nguyen K Tram
- Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital, 575 Children's Crossroad, WB4133, Columbus, OH, 43215, USA
| | - Ting-Heng Chou
- Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital, 575 Children's Crossroad, WB4133, Columbus, OH, 43215, USA
| | - Sarah A Janse
- Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Adam J Bobbey
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Anthony N Audino
- Division of Hematology/Oncology/BMT, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - John A Onofrey
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Mitchel R Stacy
- Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital, 575 Children's Crossroad, WB4133, Columbus, OH, 43215, USA.
- Interdisciplinary Biophysics Graduate Program, The Ohio State University, Columbus, OH, USA.
- Division of Vascular Diseases and Surgery, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA.
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Beall M, Deep K, Tram NK, Nabavinia M, Janse SA, Chou TH, Hardisky D, Bobbey AJ, Kerlin BA, Audino AN, Stacy MR. Prognostic Value of Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Imaging for Predicting Venous Thromboembolism in Children With Lymphoma. Circ Cardiovasc Imaging 2023; 16:e014992. [PMID: 37013817 DOI: 10.1161/circimaging.122.014992] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
BACKGROUND Positron emission tomography (PET)/computed tomography (CT) imaging can detect changes in arterial inflammation, but has not been used to evaluate chemotherapy-induced venous inflammation or assess risk for venous thromboembolism (VTE) in pediatric oncology. Therefore, the purpose of this study was to evaluate the prognostic value of fluorine-18-fluorodeoxyglucose PET/CT imaging of venous inflammation for predicting VTE occurrence in the 12 months after lymphoma diagnosis in pediatric, adolescent, and young adult patients. METHODS Pediatric, adolescent, and young adult patients with lymphoma diagnoses (n=71) who underwent whole-body PET/CT imaging at initial staging of disease and first therapeutic follow-up were retrospectively evaluated for serial changes in lower extremity venous uptake of fluorine-18-fluorodeoxyglucose. PET/CT images were used to segment and quantify serial changes in fluorine-18-fluorodeoxyglucose uptake for veins of interest (ie, popliteal and femoral). Incidence of VTE was assessed for 12 months after lymphoma diagnosis. RESULTS PET/CT detected a significantly higher inflammatory response in the femoral (P=0.012) and popliteal (P=0.013) veins of patients who experienced a VTE event compared with those who remained VTE free in the 12 months after diagnosis. The area under the curve values for receiver operator characteristics analyses were 0.76 (femoral vein) and 0.77 (popliteal vein) based on incidence of VTE occurrence. Univariate analyses demonstrated that PET/CT-derived changes in femoral (P=0.008) and popliteal (P=0.002) vein inflammation were significantly associated with VTE-free survival at 12 months after diagnosis. CONCLUSIONS Fluorine-18-fluorodeoxyglucose PET/CT imaging detects treatment-induced venous toxicity that may provide insight into risk of VTE events in pediatric and adolescent and young adult patients with lymphoma.
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Affiliation(s)
- Maren Beall
- Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital, Columbus, OH (M.B., K.D., N.K.T., M.N., T.-H.C., D.H., M.R.S.)
| | - Kyra Deep
- Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital, Columbus, OH (M.B., K.D., N.K.T., M.N., T.-H.C., D.H., M.R.S.)
| | - Nguyen K Tram
- Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital, Columbus, OH (M.B., K.D., N.K.T., M.N., T.-H.C., D.H., M.R.S.)
| | - Mahboubeh Nabavinia
- Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital, Columbus, OH (M.B., K.D., N.K.T., M.N., T.-H.C., D.H., M.R.S.)
| | - Sarah A Janse
- Center for Biostatistics, The Ohio State University, Columbus. (S.A.J.)
| | - Ting-Heng Chou
- Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital, Columbus, OH (M.B., K.D., N.K.T., M.N., T.-H.C., D.H., M.R.S.)
| | - Dariya Hardisky
- Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital, Columbus, OH (M.B., K.D., N.K.T., M.N., T.-H.C., D.H., M.R.S.)
| | - Adam J Bobbey
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH. (A.J.B.)
| | - Bryce A Kerlin
- Division of Hematology/Oncology/Blood &Bone Marrow Transplant, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH. (B.A.K., A.N.A.)
- Center for Clinical and Translational Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH (B.A.K.)
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus. (B.A.K., A.N.A.)
| | - Anthony N Audino
- Division of Hematology/Oncology/Blood &Bone Marrow Transplant, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH. (B.A.K., A.N.A.)
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus. (B.A.K., A.N.A.)
| | - Mitchel R Stacy
- Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital, Columbus, OH (M.B., K.D., N.K.T., M.N., T.-H.C., D.H., M.R.S.)
- Interdisciplinary Biophysics Graduate Program, The Ohio State University, Columbus. (M.R.S.)
- Division of Vascular Diseases and Surgery, Department of Surgery, The Ohio State University College of Medicine, Columbus. (M.R.S.)
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Chou TH, Rimmerman ET, Patel S, Wynveen MK, Eisert SN, Musini KN, Janse SA, Bobbey AJ, Sarac TP, Atway SA, Go MR, Stacy MR. Vessel-by-vessel analysis of lower extremity 18F-NaF PET/CT imaging quantifies diabetes- and chronic kidney disease-induced active microcalcification in patients with peripheral arterial disease. EJNMMI Res 2023; 13:3. [PMID: 36648583 PMCID: PMC9845537 DOI: 10.1186/s13550-023-00951-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Positron emission tomography (PET)/computed tomography (CT) imaging with fluorine-18 (18F)-sodium fluoride (NaF) provides assessment of active vascular microcalcification, but its utility for evaluating diabetes mellitus (DM)- and chronic kidney disease (CKD)-induced atherosclerosis in peripheral arterial disease (PAD) has not been comprehensively evaluated. This study sought to use 18F-NaF PET/CT to quantify and compare active microcalcification on an artery-by-artery basis in healthy subjects, PAD patients with or without DM, and PAD patients with or without CKD. Additionally, we evaluated the contributions of DM, CKD, statin use and established CT-detectable calcium to 18F-NaF uptake for each lower extremity artery. METHODS PAD patients (n = 48) and healthy controls (n = 8) underwent lower extremity 18F-NaF PET/CT imaging. Fused PET/CT images guided segmentation of arteries of interest (i.e., femoral-popliteal, anterior tibial, tibioperoneal trunk, posterior tibial, and peroneal) and quantification of 18F-NaF uptake. 18F-NaF uptake was assessed for each artery and compared between subject groups. Additionally, established calcium burden was quantified for each artery using CT calcium mass score. Univariate and multivariate analyses were performed to evaluate DM, CKD, statin use, and CT calcium mass as predictors of 18F-NaF uptake in PAD. RESULTS PAD patients with DM or CKD demonstrated significantly higher active microcalcification (i.e., 18F-NaF uptake) for all arteries when compared to PAD patients without DM or CKD. Univariate and multivariate analyses revealed that concomitant DM or CKD was associated with increased microcalcification for all arteries of interest and this increased disease risk remained significant after adjusting for patient age, sex, and body mass index. Statin use was only associated with decreased microcalcification for the femoral-popliteal artery in multivariate analyses. Established CT-detectable calcium was not significantly associated with 18F-NaF uptake for 4 out of 5 arteries of interest. CONCLUSIONS 18F-NaF PET/CT imaging quantifies vessel-specific active microcalcification in PAD that is increased in multiple lower extremity arteries by DM and CKD and decreased in the femoral-popliteal artery by statin use. 18F-NaF PET imaging is complementary to and largely independent of established CT-detectable arterial calcification. 18F-NaF PET/CT imaging may provide an approach for non-invasively quantifying vessel-specific responses to emerging anti-atherogenic therapies or CKD treatment in patients with PAD.
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Affiliation(s)
- Ting-Heng Chou
- grid.240344.50000 0004 0392 3476Center for Regenerative Medicine, The Research Institute at Nationwide Children’s Hospital, 575 Children’s Crossroad, Columbus, OH WB413343215 USA
| | - Eleanor T. Rimmerman
- grid.240344.50000 0004 0392 3476Center for Regenerative Medicine, The Research Institute at Nationwide Children’s Hospital, 575 Children’s Crossroad, Columbus, OH WB413343215 USA ,grid.261331.40000 0001 2285 7943Interdisciplinary Biophysics Graduate Program, The Ohio State University, Columbus, OH USA
| | - Surina Patel
- grid.240344.50000 0004 0392 3476Center for Regenerative Medicine, The Research Institute at Nationwide Children’s Hospital, 575 Children’s Crossroad, Columbus, OH WB413343215 USA
| | - Molly K. Wynveen
- grid.240344.50000 0004 0392 3476Center for Regenerative Medicine, The Research Institute at Nationwide Children’s Hospital, 575 Children’s Crossroad, Columbus, OH WB413343215 USA
| | - Susan N. Eisert
- grid.240344.50000 0004 0392 3476Center for Regenerative Medicine, The Research Institute at Nationwide Children’s Hospital, 575 Children’s Crossroad, Columbus, OH WB413343215 USA
| | - Kumudha Narayana Musini
- grid.240344.50000 0004 0392 3476Center for Regenerative Medicine, The Research Institute at Nationwide Children’s Hospital, 575 Children’s Crossroad, Columbus, OH WB413343215 USA
| | - Sarah A. Janse
- grid.261331.40000 0001 2285 7943Center for Biostatistics, The Ohio State University, Columbus, OH USA
| | - Adam J. Bobbey
- grid.240344.50000 0004 0392 3476Department of Radiology, Nationwide Children’s Hospital, Columbus, OH USA
| | - Timur P. Sarac
- grid.261331.40000 0001 2285 7943Division of Vascular Diseases and Surgery, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH USA
| | - Said A. Atway
- grid.261331.40000 0001 2285 7943Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH USA
| | - Michael R. Go
- grid.261331.40000 0001 2285 7943Division of Vascular Diseases and Surgery, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH USA
| | - Mitchel R. Stacy
- grid.240344.50000 0004 0392 3476Center for Regenerative Medicine, The Research Institute at Nationwide Children’s Hospital, 575 Children’s Crossroad, Columbus, OH WB413343215 USA ,grid.261331.40000 0001 2285 7943Interdisciplinary Biophysics Graduate Program, The Ohio State University, Columbus, OH USA ,grid.261331.40000 0001 2285 7943Division of Vascular Diseases and Surgery, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH USA
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Tang J, Janse SA, Carbone DP, Shields PG, Wong ML, Arrato NA, Andersen BL, Presley CJ. Characteristics associated with functional resilience versus functional decline among adult patients with advanced non–small cell lung cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.1538] [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: 11/20/2022] Open
Abstract
1538 Background: As more treatment options become available for advanced non-small cell lung cancer (NSCLC), oncologists still have difficulty predicting functional resiliency versus functional disability throughout treatment. Functional resiliency refers to the ability to recover baseline functional status in the face of an intervening health care event. This study aims to identify characteristics associated with resilience among adults with advanced NSCLC. Methods: In a prospective cohort of participants with newly diagnosed stage IV NSCLC, resilience was evaluated based on three functional disability items in the EQ-5D-5L (modified: mEQ-5D-5L) through 12 months of follow-up compared to baseline scores. This included patients treated with chemotherapy, immunotherapy, targeted agents and no treatment. Participants were classified into four groups: functional decline, maintenance, resilient, or variable. Resilience was determined based on improvement in disability scores, with a 1-point increase in functional status score representing a 0.5 standard deviation change on the mEQ-5D-5L. Patient characteristics included demographics, comorbidities, ECOG performance status, presence of brain or bone metastases, mood (GAD-7, PHQ-9), and lung cancer-specific symptoms (QLQ-LC13). Treatment toxicity and toxicity grades were also recorded. Differences between groups were determined through Fisher’s exact test or ANOVA. Results: Among 207 participants, 87 (42.0%) maintained functional status, 78 (37.7%) experienced functional decline, 22 (10.6%) were classified as resilient and 20 (9.7%) were variable. Characteristics associated with higher resilience (p < 0.1) included being employed (p = 0.02) and living in a metro setting (p = 0.10). Characteristics not associated with resilience included age, education level, smoking status, presence of brain metastases, ECOG performance status, or psychological symptoms. Approximately half the participants (n = 105, 50.7%) who received treatment experienced toxicities. One third (33.8%) experienced ≥ grade 3 toxicities. There was no significant association between toxicity grade and resilience grouping. Conclusions: Characteristics associated with functional resilience included employment status and living setting. At least half of adults with advanced NSCLC experience treatment-related toxicities. It is important to determine characteristics of resilience to better understand which patients will tolerate cancer treatments.
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Affiliation(s)
- Joy Tang
- Ohio State University, Columbus, OH
| | - Sarah A. Janse
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH
| | | | - Peter G. Shields
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Melisa L. Wong
- UCSF Helen Diller Comprehensive Cancer Center, San Francisco, CA
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Boe BA, Armstrong AK, Janse SA, Loccoh EC, Stockmaster K, Holzer RJ, Cheatham SL, Cheatham JP, Berman DP. Percutaneous Implantation of Adult Sized Stents for Coarctation of the Aorta in Children ≤20 kg: A 12-Year Experience. Circ Cardiovasc Interv 2021; 14:e009399. [PMID: 33544625 DOI: 10.1161/circinterventions.120.009399] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Stent implantation (SI) is more effective than balloon angioplasty for the treatment of coarctation of the aorta (CoA). Due to technical factors, balloon angioplasty is more commonly performed in small patients. We sought to evaluate outcomes of percutaneous adult sized SI for the treatment of CoA in small patients. METHODS A single-center retrospective review of all patients ≤20 kg who underwent percutaneous adult sized SI for native or recurrent CoA from 2004 to 2015 was performed. RESULTS Thirty-nine patients (20 patients ≤10 kg) were identified, with 28 (71.8%) having recurrent CoA and 22 (56.4%) previously failed balloon angioplasty. At the time of SI, the median (range) patient age and weight were 1.1 (0.3-7.9) years and 10 (5.5-20.4) kg, respectively. SI resulted in significant improvements in the median gradient (26 mm Hg [interquartile range (IQR), 18-42] to 0 mm Hg [IQR, 0-2]; P< 0.05) and median minimum diameter (3.6 mm [IQR, 2.4-4.8] to 7.7 mm [IQR, 6.5-9.4]; P<0.05). Seven patients (18%) had procedural adverse events. Twenty-seven (69%) patients underwent elective reintervention at a median time of 49.3 (IQR, 26.5-63.2) months from SI, with 8 (21%) stents requiring repeat SI for stent fracture. Over a median follow-up of 67.2 (IQR, 33.8-116.1) months, 25 patients (69%) were without hypertension or blood pressure gradient. Three (11%) patients developed femoral arterial occlusion. CONCLUSIONS Adult sized SI is an alternative to surgical intervention for small patients with CoA. SI carries a risk of access-related complications, which may improve with the development of lower profile stents with adult sized maximum diameters.
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Affiliation(s)
- Brian A Boe
- Pediatrics, The Heart Center, The Ohio State University School of Medicine, Nationwide Children's Hospital, Columbus, OH (B.A.B., A.K.A., K.S., S.L.C., J.P.C., D.P.B.)
| | - Aimee K Armstrong
- Pediatrics, The Heart Center, The Ohio State University School of Medicine, Nationwide Children's Hospital, Columbus, OH (B.A.B., A.K.A., K.S., S.L.C., J.P.C., D.P.B.)
| | - Sarah A Janse
- Center for Biostatistics Department of Biomedical Informatics, The Ohio State University, Columbus (S.A.J.)
| | - Eméfah C Loccoh
- The Ohio State University College of Medicine, Columbus (E.C.L.)
| | - Katie Stockmaster
- Pediatrics, The Heart Center, The Ohio State University School of Medicine, Nationwide Children's Hospital, Columbus, OH (B.A.B., A.K.A., K.S., S.L.C., J.P.C., D.P.B.)
| | - Ralf J Holzer
- Department of Pediatrics, Weill Cornell Medical College, New York, NY (R.J.H.)
| | - Sharon L Cheatham
- Pediatrics, The Heart Center, The Ohio State University School of Medicine, Nationwide Children's Hospital, Columbus, OH (B.A.B., A.K.A., K.S., S.L.C., J.P.C., D.P.B.)
| | - John P Cheatham
- Pediatrics, The Heart Center, The Ohio State University School of Medicine, Nationwide Children's Hospital, Columbus, OH (B.A.B., A.K.A., K.S., S.L.C., J.P.C., D.P.B.)
| | - Darren P Berman
- Pediatrics, The Heart Center, The Ohio State University School of Medicine, Nationwide Children's Hospital, Columbus, OH (B.A.B., A.K.A., K.S., S.L.C., J.P.C., D.P.B.)
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Sigmund AM, Rosko AE, Janse SA, Pisegna J, Krok-Schoen JL, Presley CJ. Patterns of physical and mental health well-being in older female cancer survivors. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.29_suppl.173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
173 Background: The majority of cancer survivors are older adults (≥65 years), but their lifestyle behaviors are understudied. Factors associated with improved physical and mental well-being in older female cancer survivors are not well understood. The objective of this study was to evaluate the factors associated with physical and mental well-being in older female cancer survivors, including the role of malnutrition, physical activity, and level of emotional support. Methods: Older female cancer survivors (n=171) completed surveys to assess health related quality of life (HRQoL) using SF-36, malnutrition screening tool (MST), and physical activity. Demographics were also collected. The data was analyzed using descriptive analyses, correlations, and ANCOVAs. Survivors were divided into four phenotypes for analysis using the SF-36 physical and mental composite scores (PCS; MCS) stratified based on the sample’s mean scores (table). Factors associated with the four groups were assessed including demographic characteristics, cancer type, level of emotional support, risk for malnutrition, and physical activity. Results: The majority of the cohort (mean age=74.5 years) were white and highly educated. 68.4% were breast cancer survivors, with 10.5% hematologic malignancy survivors, 5.3% gynecologic malignancy survivors, and 15.8% other. Mean PCS and MCS were 41.94 and 48.47, respectively, comparable to general older adult population means. When divided into four groups based on PCS/MCS, there were no significant differences by demographic characteristics or cancer type. Survivors with higher emotional support scores had significantly higher PCS/MCS scores (p<0.001). There was also a significant difference in risk for malnutrition, as those with high PCS/MCS were at lower risk for malnutrition (p≤0.001). Survivors with low PCS/MCS engaged in less moderate exercise as compared to those with high PCS/MCS (p=0.028). Conclusions: This study suggests that lower risk for malnutrition as well as higher levels of emotional support are associated with higher physical and mental well-being in older female cancer survivors. These are two potential modifiable targets for interventional studies to optimize physical and mental well-being among older cancer survivors. [Table: see text]
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Affiliation(s)
- Audrey M Sigmund
- Divisions of Hematology and Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center/The James Cancer Hospital & Solove Research Institute, Columbus, OH
| | - Ashley Elizabeth Rosko
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center/The James Cancer Hospital & Solove Research Institute, Columbus, OH
| | - Sarah A Janse
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH
| | - Janell Pisegna
- Division of Medical Dietetics and Health Sciences, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH
| | - Jessica L. Krok-Schoen
- Division of Medical Dietetics and Health Sciences, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH
| | - Carolyn J Presley
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center/The James Cancer Hospital & Solove Research Institute, Columbus, OH
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9
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Straub JM, Calamari KA, Shin TJ, Janse SA, Forrest LA, deSilva BW, Matrka LA. The safety of in-office laryngologic procedures during active antithrombotic therapy. Laryngoscope Investig Otolaryngol 2020; 5:890-894. [PMID: 33134536 PMCID: PMC7585240 DOI: 10.1002/lio2.451] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/08/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To determine whether patients undergoing in-office laryngologic procedures on antithrombotic therapy are at increased risk for treatment-related complications. METHODS Patients were those who underwent at least one in-office laryngologic procedure with any of three fellowship-trained laryngologists. Procedures were identified by current procedural terminology (CPT) code and included biopsies, excisions, laser ablations, and injections (therapeutic and augmentative). Patients were divided into two groups based on the use of antithrombotic therapy at the time of their procedure. Retrospective chart review was performed to identify any complications, with an average follow-up of 186 days. RESULTS Five hundred-sixty-four unique individuals were identified with ages ranging from 18 to 93 years old and with a relatively even distribution between females (45%) and males (55%). They underwent 647 procedures in total, 310 of which were performed while on some form of antithrombotic therapy. Sixteen procedures were associated with complications either during or after the procedure. In comparing overall complication rates, there was no significant difference between non-antithrombotic (2.4%) and antithrombotic (3.3%) cohorts (OR 1.09, 95% CI [0.46-2.60], P = .8454). CONCLUSIONS In spite of known risks in other settings, antithrombotic agents do not appear to confer increased risk of treatment-related complications during in-office laryngologic procedures, obviating the need for cessation of therapy prior to these interventions. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Jeffrey M. Straub
- Department of Otolaryngology—Head and Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| | - Kevin A. Calamari
- Department of Otolaryngology—Head and Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| | - Timothy J. Shin
- Department of Otolaryngology—Head and Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| | - Sarah A. Janse
- Department of Biomedical InformaticsThe Ohio State UniversityColumbusOhioUSA
| | - Lowell A. Forrest
- Department of Otolaryngology—Head and Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| | - Brad W. deSilva
- Department of Otolaryngology—Head and Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
| | - Laura A. Matrka
- Department of Otolaryngology—Head and Neck SurgeryThe Ohio State UniversityColumbusOhioUSA
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10
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Naughton MJ, Beverly Hery CM, Janse SA, Naftalis EZ, Paskett ED, Van Zee KJ. Prevalence and correlates of job and insurance problems among young breast cancer survivors within 18 months of diagnosis. BMC Cancer 2020; 20:432. [PMID: 32423486 PMCID: PMC7236509 DOI: 10.1186/s12885-020-06846-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 04/07/2020] [Indexed: 11/25/2022] Open
Abstract
Background The prevalence and correlates of job and insurance problems were examined among a cohort of young U.S. breast cancer survivors during the first 18-months following diagnosis. Methods Participants were 708 women diagnosed at ≤45 years with stage I-III breast cancer. 90% were non-Hispanic white, 76% were married/partnered and 67% had ≥4-year college degree. Univariable and multivariable logistic regression examined the associations between demographic, lifestyle and clinical factors with job and insurance problems. Results 18-months after diagnosis, 56% of participants worked full-time, 16% part-time, 18% were homemakers and/or students, 4.5% were unemployed, and 2.4% were disabled. The majority (86%) had private insurance. Job-related problems were reported by 40% of women, and included believing they could not change jobs for fear of losing health insurance (35.0%), being fired (2.3%), and being demoted, denied promotion or denied wage increases (7.8%). Greater job-related problems were associated with being overweight vs. under/normal weight (p = 0.006), income <$50,000/per year (p = 0.01), and working full-time vs. part-time (p = 0.003). Insurance problems were reported by 27% of women, and included being denied health insurance (2.6%), health insurance increases (4.3%), being denied health benefit payments (14.8%) or denied life insurance (11.4%). Insurance problems were associated with being under/normal weight vs. obese (p = 0.01), not being on hormone therapy (p < 0.001), and a tumor size > 5 cm vs. < 2 cm (p = 0.01). Conclusions Young survivors experienced significant job- and insurance-related issues following diagnosis. To the extent possible, work and insurance concerns should be addressed prior to treatment to inform work expectations and avoid unnecessary insurance difficulties.
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Affiliation(s)
- Michelle J Naughton
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, 43210, USA.
| | - Chloe M Beverly Hery
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, 43210, USA
| | - Sarah A Janse
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, 43210, USA
| | - Elizabeth Z Naftalis
- Health Texas Community Health Services Corporate Director of Breast Services, Dallas, TX, 75001, USA
| | - Electra D Paskett
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, 43210, USA
| | - Kimberly J Van Zee
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
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Bustamante Alvarez JG, Dittmar K, Janse SA, Kiourtsis S, Owen DH, Bertino EM, He K, Carbone DP, Otterson GA. Initiation of targeted therapy based on ctDNA only in metastatic NSCLC. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e20687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20687 Background: Next generation sequencing (NGS) of circulating tumor DNA (ctDNA) can identify sensitizing and resistance mutations in Non-Small Cell Lung Cancer (NSCLC). ctDNA is helpful when tissue is insufficient for genomic testing, or repeat biopsy is undesirable. Here we report a single institution experience of ctDNA testing on diagnosis (DX) and progression (PD), and how this intervention can help avoid further invasive interventions and warrant change in management. Methods: This is a single institution retrospective study of advanced NSCLC patients (pts) who had ctDNA from plasma tested using Guardant360, which identifies somatic genomic alterations by massively parallel sequencing of target genes. An institutional CLIA tissue panel using FISH (for MET, RET, ROS1 and ALK) and NGS for selected genes was used for tissue analysis. Actionable mutations are those with FDA approved (EGFR, ALK, ROS, BRAF) or NCCN recommended targeted therapies (RET fusions and MET amplifications or MET Exon 14 skipping mutation). All the included patients had cancer confirmed by pathology analysis. IRB approval was obtained prior to data collection. Results: A total of 163 ctDNA samples from 143 pts were evaluated (82 at DX and 81 on PD) . 17 out of 82 (20.7%) ctDNA samples sent at DX had actionable mutations identified (4 EGFR exon 19 deletion, 2 EGFR Exon 21 L858R, 1 EGFR L861R, 4 EML4-ALK Fusion, 2 CD74-ROS1 Fusion, 2 MET exon 14 skipping mutation, 2 KIF5B-RET fusion). 7 out of 82 (8.5%) pts initiated targeted therapy based on ctDNA results only (5 with no or insufficient tissue available, 2 with negative tissue analysis). Among them, 1 CR, 5 PR, and 1 SD were achieved. For the 2 pts with negative tissue analysis , one had initial PR for 4 months with crizotinib and on progression tissue rebiopsy was positive for ALK rearrangement on FISH, for L1152R on NGS and on ctDNA for EML4-ALK Fusion, ALK G1202R and L1152P. On second line this patient achieved a near CR with Carboplatin/Pemetrexed/Pembrolizumab. The second patient with negative tissue had CD74-ROS1 fusion on ctDNA and achieved a CR with crizotinib for 8 months. The Response Rate for patients started on targeted therapies based on ctDNA only was 85%. Conclusions: A substantial number of NSCLC pts benefited from targeted ctDNA NGS by identifying actionable mutations that led to appropriate targeted treatments. Initiation of targeted therapy for advanced NSCLC was possible based on ctDNA testing only .
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Affiliation(s)
| | | | | | | | - Dwight Hall Owen
- Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus, OH
| | | | - Kai He
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Gregory Alan Otterson
- Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus, OH
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12
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Nelson PT, Wang WX, Janse SA, Thompson KL. MicroRNA expression patterns in human anterior cingulate and motor cortex: A study of dementia with Lewy bodies cases and controls. Brain Res 2017; 1678:374-383. [PMID: 29146111 DOI: 10.1016/j.brainres.2017.11.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/08/2017] [Accepted: 11/10/2017] [Indexed: 02/07/2023]
Abstract
OVERVIEW MicroRNAs (miRNAs) have been implicated in neurodegenerative diseases including Parkinson's disease and Alzheimer's disease (AD). Here, we evaluated the expression of miRNAs in anterior cingulate (AC; Brodmann area [BA] 24) and primary motor (MO; BA 4) cortical tissue from aged human brains in the University of Kentucky AD Center autopsy cohort, with a focus on dementia with Lewy bodies (DLB). METHODS RNA was isolated from gray matter of brain samples with pathology-defined DLB, AD, AD + DLB, and low-pathology controls, with n = 52 cases initially included (n = 23 with DLB), all with low (<4 h) postmortem intervals. RNA was profiled using Exiqon miRNA microarrays. Quantitative PCR for post hoc replication was performed on separate cases (n = 6 controls) and included RNA isolated from gray matter of MO, AC, primary somatosensory (BA 3), and dorsolateral prefrontal (BA 9) cortical regions. RESULTS The miRNA expression patterns differed substantially according to anatomic location: of the relatively highly-expressed miRNAs, 150/481 (31%) showed expression that was different between AC versus MO (at p < .05 following correction for multiple comparisons), most (79%) with higher expression in MO. A subset of these results were confirmed in qPCR validation focusing on miR-7, miR-153, miR-133b, miR-137, and miR-34a. No significant variation in miRNA expression was detected in association with either neuropathology or sex after correction for multiple comparisons. CONCLUSION A subset of miRNAs (some previously associated with α-synucleinopathy and/or directly targeting α-synuclein mRNA) were differentially expressed in AC and MO, which may help explain why these brain regions show differences in vulnerability to Lewy body pathology.
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Affiliation(s)
- Peter T Nelson
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40536, USA; Department of Pathology, University of Kentucky, Lexington, KY 40536, USA.
| | - Wang-Xia Wang
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40536, USA
| | - Sarah A Janse
- Department of Statistics, University of Kentucky, Lexington, KY 40536, USA
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