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AlSendi M, Flynn CR, Khan MR, Selvadurai P, Crown J, McDermott RS, Walshe JM, Fennelly DW, Hanrahan EO, Doherty M, Higgins MJ. Pilot study of the implementation of G8 screening tool, Cognitive screening assessment and Chemotherapy Toxicity assessment in older adults with cancer in a Tertiary University Hospital in Ireland. Ir J Med Sci 2024; 193:45-50. [PMID: 37450258 DOI: 10.1007/s11845-023-03446-y] [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: 01/19/2023] [Accepted: 06/23/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Comprehensive geriatric assessment (CGA) is recommended by international guidelines prior to initiation of systemic anti-cancer treatment (SACT). In practice, CGA is limited by time constraints, lack of resources and expert interpretation. AIMS The primary objective of this pilot study was to establish the prevalence of frailty (assessed by G8), cognitive impairment (assessed by Mini-Cog), and risk of chemotherapy toxicity (assessed by CARG Chemo-Toxicity Calculator) among patients (pts) ≥65 years commencing SACT. We selected these three screening tools due to the ease of conducting them in a busy outpatient setting. In addition, they have been validated to predict frailty and risk of toxicity from SACT among older adults with cancer. METHODS Eligible participants were identified from medical oncology clinics. Assessments were conducted in an outpatient setting by treating physicians. Pt records were reviewed to gather demographic and cancer details. Statistical analyses were conducted using SPSS statistical software. RESULTS Sixty-three participants were enrolled. The mean age of participants was 73yrs (range=65-88). Thirty-three (52.4%) were female and 30 (47.6%) were male. The majority (n=38, 60.3%) had metastatic cancer. The mean G8 score was 11.9 (range=6-19). Eighty-three percent had a G8 score ≤14. Mini-Cog was positive in 13 pts (21%). The mean CARG score was 7.5 (range=0-16), and 80% had a risk of at least 50% grade ≥3 toxicity. Of these, 48 (76.2%) received chemotherapy and 15 (23.8%) received non-cytotoxic SACT. In multi-variate analyses, age, cancer type, treatment type, and disease stage did not impact G8, Mini-Cog, or CARG scores. CONCLUSIONS Our study has several limitations but suggests that the majority of older adults with cancer would qualify for formal CGA assessment. The risk of high-grade toxicity from SACT is substantial in this cohort. Chronological age was not found to negatively impact pts' frailty, cognition, or risk of toxicity.
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Affiliation(s)
- Maha AlSendi
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
| | - Calvin R Flynn
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Muhammad R Khan
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Paul Selvadurai
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - John Crown
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Raymond S McDermott
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Janice M Walshe
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - David W Fennelly
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Emer O Hanrahan
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Mark Doherty
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Michaela J Higgins
- Department of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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Vohra R, Singh R, Shrivastava R. A scoping review on 'Maharishi Amrit Kalash', an ayurveda formulation for cancer prevention and management. J Ayurveda Integr Med 2024; 15:100866. [PMID: 38194855 PMCID: PMC10792650 DOI: 10.1016/j.jaim.2023.100866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/27/2023] [Accepted: 11/04/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Cancer is one of the leading causes of morbidity and mortality. Current treatments include chemotherapy, radiotherapy, etc., are known to be associated with several side effects. Hence, complementary and alternative medicine is growing in acceptance around the world, particularly Ayurvedic formulations. MAK is one of the most scientifically acclaimed formulations with potential anti-neoplastic and chemoprotective properties. OBJECTIVE To study literature available on the anti-neoplastic and chemoprotective effects of MAK. MATERIAL AND METHODS A systematic literature review was conducted using multiple web-based sources: Google Scholar (185), PubMed (33), DHARA (49), AYUSH research portal (2), EBSCO (66), and CTRI (1) for all studies published before February 2021 using keywords: Maharishi Amrit Kalash, Amrit Kalash, Amrit, MAK-4, MAK-5, MAK-7, and others. A manual search was conducted on the reference list of all included articles to identify additional studies. Studies with cancer and/or chemotoxicity outcomes were selected manually. Evidence from both preclinical and clinical level studies have been included in the current review. RESULTS Out of total 79 studies on applications of MAK, 13 studies were found to state its anti-neoplastic and chemoprotective effects. The studies showed role of MAK in initiation of neoplastic transformation of cancer cells (1), carcinogenesis inhibition (4), metastases inhibition/reduction (1), cancer growth inhibition (4), induction of morphological and biochemical differentiation of cancer cells (3), and reduction in chemotoxicity (4). In studies with controlled clinical trial design (3), MAK use among patients with cancer showed a significant reduction in anorexia, vomiting, and other side effects associated with chemotherapy. A general improvement in quality-of-life scores (Karnofsky Performance Status) and well-being was also observed among patients using MAK. CONCLUSION Evidence from pre-clinical studies show promising results for use of MAK as an anti-cancer and a chemoprotective agent. More clinical studies are needed to assess the impact of MAK use for tumour regression among patients with cancer. Current scoping review provides sufficient evidence on MAK to be considered for further exploration for its anti-cancer/chemoprotective effects in bigger randomized clinical trials.
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Affiliation(s)
- Rini Vohra
- Maharishi Ayurveda Products Private Limited, Noida, U.P, 201306, India; Maharishi University of Information Technology, Noida, Uttar Pradesh, India.
| | - Radha Singh
- Maharishi Ayurveda Products Private Limited, Noida, U.P, 201306, India
| | - Richa Shrivastava
- Maharishi Ayurveda Europe B.V, Looskade 20, 6041 LE Roermond, The Netherlands
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Beukers K, Bessems SAM, van de Wouw AJ, van den Berkmortel FWPJ, Belgers HJ, Konsten JLM, Sipers WMWH, Janssen-Heijnen MLG. Associations between the Geriatric-8 and 4-meter gait speed test and subsequent delivery of adjuvant chemotherapy in older patients with colon cancer. J Geriatr Oncol 2021; 12:1166-1172. [PMID: 34006492 DOI: 10.1016/j.jgo.2021.05.004] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 02/27/2021] [Accepted: 05/04/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Feasible screening methods are important to identify older patients who might benefit from adjuvant chemotherapy. The aim of this study was to investigate the associations between the outcomes of screening for frailty with the Geriatric-8 questionnaire (G8) and the 4-meter gait speed test (4MGST) and subsequent delivery of adjuvant chemotherapy and treatment tolerance in older patients with colon cancer. MATERIAL AND METHODS This retrospective multicentre study included all patients aged ≥70 with primary colon carcinoma who underwent elective surgery between May 2016 and December 2018 and for whom adjuvant chemotherapy was indicated. Data were analysed using multivariate regression models. RESULTS 97 (73.5%) of 132 eligible patients were screened by the G8 and 85 (64.4%) by the 4MGST. In univariate analyses, patients who scored indicative for frailty on both the G8 (≤14) and the 4MGST (>4 s) significantly more often did not proceed with adjuvant chemotherapy than patients who scored fit on both instruments (OR = 5.10, p = 0.01). After adjustment for gender, stage, and postoperative complications, the OR decreased to 4.22 (p = 0.04). Tolerance of treatment was very high (93%) and did not differ between screening groups. CONCLUSION Although patients who scored indicative for frailty on both the G8 and the 4MGST significantly more often did not proceed with adjuvant chemotherapy, it is still unknown whether the G8 and the 4MGST are reliable tools for identifying patients who are at high risk for severe chemotoxicity. Nonetheless, this study shows that current selection for adjuvant chemotherapy among older patients with colon cancer is safe with low rates of severe chemotoxicity.
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Affiliation(s)
- K Beukers
- Department of Medical Oncology, VieCuri Medical Centre, Venlo, the Netherlands; Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands.
| | - S A M Bessems
- Department of Surgery, VieCuri Medical Centre, Venlo, the Netherlands
| | - A J van de Wouw
- Department of Medical Oncology, VieCuri Medical Centre, Venlo, the Netherlands
| | | | - H J Belgers
- Department of Surgery, Zuyderland Medical Centre, Sittard-Heerlen, the Netherlands
| | - J L M Konsten
- Department of Surgery, VieCuri Medical Centre, Venlo, the Netherlands
| | - W M W H Sipers
- Department of Geriatric Medicine, Zuyderland Medical Centre, Sittard-Heerlen, the Netherlands
| | - M L G Janssen-Heijnen
- Department of Geriatric Medicine, Zuyderland Medical Centre, Sittard-Heerlen, the Netherlands; Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands
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Burger A, Weidinger M, Baumann N, Vesely A, Lichtscheidl I. The response of the accumulator plants Noccaea caerulescens, Noccaea goesingense and Plantago major towards the uranium. J Environ Radioact 2021; 229-230:106544. [PMID: 33556790 DOI: 10.1016/j.jenvrad.2021.106544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 01/21/2021] [Accepted: 01/23/2021] [Indexed: 06/12/2023]
Abstract
Uranium (U) is a naturally occurring metal; its environmental levels can be increased due to processes in the nuclear industry and fertilizer production. The transfer of U in the food chain from plants is associated with deleterious chemical and radiation effects. To date, limited information is available about U toxicity on plant physiology. This study investigates the responses of metal-accumulating plants to different concentrations of U. The plants Noccaea caerulescens and Noccaea goesingense are known as metal hyperaccumulators and therefore could serve as candidates for the phytoremediation of radioactive hotspots; Plantago major is a widely used pharmaceutical plant that pioneers polluted grounds and therefore should not contain high concentrations of toxic elements. The experimental plants were grown hydroponically at U concentrations between 1 μM and 10 mM. The content of U and essential elements was analyzed in roots and leaves by ICP-MS. The amount of accumulated U was influenced by its concentration in the hydroponics. Roots contained most of the metal, whereas less was transported up to the leaves, with the exception of N. goesingense in a medium concentration of U. U also influenced the nutrient profile of the plants. We localized the U in plant tissues using EDX in the SEM. U was evenly distributed in roots and leaves of Noccaea species, with one exception in the roots of N. goesingense, where the central cylinder contained more U than the cortex. The toxicity of U was assessed by measuring growth and photosynthetic parameters. While root biomass of N. caerulescens was not affected by U, root biomass of N. goesingense decreased significantly at high U concentrations of 0.1 and 10 mM and root biomass of P. major decreased at 10 mM U. Dry weight of leaves was decreased at different U concentrations in the three plant species; a promotive effect was observed in N. caerulescens at lowest concentration offered. Chlorophyll a fluorescence was not affected or negatively affected by U in both Noccaea species, whereas in Plantago also positive effects were observed. Our results show that the impact of U on Plantago and Noccaea relates to its external concentration and to the plant species. When growing in contaminated areas, P. major should not be used for medicinal purpose. Noccaea species and P. major could immobilize U in their rhizosphere in hotspots contaminated by U, and they could extract limited amounts of U into their leaves.
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Affiliation(s)
- Anna Burger
- Cell Imaging and Ultrastructure Research, University of Vienna, Althanstraße 14, 1090, Vienna, Austria.
| | - Marieluise Weidinger
- Cell Imaging and Ultrastructure Research, University of Vienna, Althanstraße 14, 1090, Vienna, Austria
| | - Nils Baumann
- Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstraße 400, 01328, Dresden, Germany
| | - Andreas Vesely
- Nuclear Engineering Seibersdorf GmbH, 2444, Seibersdorf, Austria
| | - Irene Lichtscheidl
- Cell Imaging and Ultrastructure Research, University of Vienna, Althanstraße 14, 1090, Vienna, Austria
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Mashiach J, Zohni K, Lopez L, Filice M, Garcia M, Wyse B, Glass K, Dviri M, Baram S, Gauthier-Fisher A, Librach CL. Human umbilical cord perivascular cells prevent chemotherapeutic drug-induced male infertility in a mouse model. F S Sci 2021; 2:24-32. [PMID: 35559762 DOI: 10.1016/j.xfss.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/13/2020] [Accepted: 12/03/2020] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To study whether intratesticular (IT) administration of 2 sources of human umbilical cord perivascular cells (HUCPVC), rich and potent sources of mesenchymal stromal cells (MSC), before chemotherapy can prevent infertility in a mouse model. DESIGN Two control groups of CD1 male mice without busulfan (BUS) administration (untreated and IT media injection groups) were included. Experimental groups included IT administration of media, first trimester (FTM) HUCPVCs or term HUCPVCs (n = 5 each) injected 3 days before BUS treatment (20 mg/kg). All groups were included in a mating time course study over 6 months. SETTING Preclinical study in a fertility center research laboratory. PATIENTS Not applicable. INTERVENTION IT delivery of FTM or term HUCPVC before BUS treatment. MAIN OUTCOME MEASURES Pregnancies, litter sizes, and gross morphology of offspring were monitored. Caudal epididymal sperm concentration, motility, and progressive motility were assessed by computer-assisted sperm analysis. Spermatogenesis was also assessed histologically in testicular tissue sections. RESULTS FTM and term HUCPVC displayed an MSC-associated immunophenotype and expressed transcripts encoding paracrine factors known to regulate the testicular cell niche. IT administration of FTM and term HUCPVC before chemotherapy promoted the recovery of spermatogenesis and fertility compared with BUS-treated animals that received a media injection. Although the total number of pups sired over 6 months by males treated with FTM or term HUCPVC was reduced compared with untreated or media-injected controls, litter size and sperm parameters in fertile animals did not differ between control and cell-treated groups. CONCLUSION HUCPVC represent a promising source of MSC-based therapy to prevent gonadotoxic chemotherapeutic drug-induced infertility.
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Affiliation(s)
| | - Khaled Zohni
- CReATe Fertility Centre, Toronto, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada; Department of Obstetrics and Gynecology, University of Manitoba, Winnipeg, Manitoba, Canada; Heartland Fertility and Gynecology clinic, Winnipeg, Manitoba, Canada
| | | | | | | | | | - Karen Glass
- CReATe Fertility Centre, Toronto, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - Michal Dviri
- CReATe Fertility Centre, Toronto, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada
| | - Shira Baram
- CReATe Fertility Centre, Toronto, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada; Emek Medical Center, Afula, Israel
| | | | - Clifford L Librach
- CReATe Fertility Centre, Toronto, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada; Department of Physiology University of Toronto, Toronto, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Canada; Department of Gynecology, Women's College Hospital, Toronto, Canada
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Zohni K, Lopez L, Mander P, Szaraz P, Filice M, Wyse BA, Garcia M, Gat I, Glass K, Gauthier-Fisher A, Librach CL. Human umbilical cord perivascular cells maintain regenerative traits following exposure to cyclophosphamide. Cancer Lett 2020; 501:133-146. [PMID: 33387641 DOI: 10.1016/j.canlet.2020.12.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 10/13/2020] [Revised: 12/15/2020] [Accepted: 12/21/2020] [Indexed: 11/19/2022]
Abstract
Chemotherapies can cause germ cell depletion and gonadal failure. When injected post-chemotherapy, mesenchymal stromal cells (MSCs) from various sources have been shown to have regenerative effects in rodent models of chemotherapy-induced gonadal injury. Here, we evaluated two properties of a novel source of MSC, first trimester (FTM) human umbilical cord perivascular cells (HUCPVCs) (with increased regenerative potential compared to older sources), that may render them a promising candidate for chemotherapeutic gonadal injury prevention. Firstly, their ability to resist the cytotoxic effects of cyclophosphamide (CTX) in vitro, as compared to term HUCPVCs and bone marrow cells (BMSCs); and secondly, whether they prevent gonadal dysfunction if delivered prior to gonadotoxic therapy in vivo. BMSC, FTM HUCPVC, term HUCPVC, and control NTERA2 cells were treated with moderate (150 μmol/L) and high (300 μmol/L) doses of CTX in vitro. Viability, proliferative capacity, mesenchymal cell lineage markers and differentiation capacity, immunogenicity, and paracrine gene expression were assessed. CTX was administered to Wistar rats 2 days following an intra-ovarian injection of FTM HUCPVC. HUCPVC survival and ovarian follicle numbers were assessed using histological methods. We conclude that FTM HUCPVC maintain key regenerative properties following chemotherapy exposure and that pre-treatment with these cells may prevent CTX-induced ovarian damage in vivo. Therefore, HUCPVCs are promising candidates for fertility preservation.
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Affiliation(s)
- Khaled Zohni
- CReATe Fertility Centre, Toronto, Ontario, Canada; Department of Obstetrics & Gynecology, University of Toronto, Toronto, Canada; Department of Obstetrics and Gynecology, University of Manitoba, Winnipeg, Canada; Heartland Fertility and Gynecology Clinic, Winnipeg, Manitoba, Canada
| | - Lianet Lopez
- CReATe Fertility Centre, Toronto, Ontario, Canada
| | | | - Peter Szaraz
- CReATe Fertility Centre, Toronto, Ontario, Canada
| | | | | | | | - Itai Gat
- CReATe Fertility Centre, Toronto, Ontario, Canada; Pinchas Borenstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel HaShomer, Ramat Gan, Affiliated to Sackler Medical School, University of Tel Aviv, Israel
| | - Karen Glass
- CReATe Fertility Centre, Toronto, Ontario, Canada; Department of Obstetrics & Gynecology, University of Toronto, Toronto, Canada
| | | | - Clifford L Librach
- CReATe Fertility Centre, Toronto, Ontario, Canada; Department of Obstetrics & Gynecology, University of Toronto, Toronto, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Canada; Department of Physiology, University of Toronto, Toronto, Canada; Department of Gynecology, Women's College Hospital, Toronto, ON, Canada.
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Caan BJ, Meyerhardt JA, Brown JC, Campbell KL, Cespedes Feliciano EM, Lee C, Ross MC, Quinney S, Quesenberry C, Sternfeld B, Schmitz KH. Recruitment strategies and design considerations in a trial of resistance training to prevent dose-limiting toxicities in colon cancer patients undergoing chemotherapy. Contemp Clin Trials 2020; 101:106242. [PMID: 33301991 DOI: 10.1016/j.cct.2020.106242] [Citation(s) in RCA: 12] [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: 08/27/2020] [Revised: 11/25/2020] [Accepted: 12/04/2020] [Indexed: 12/29/2022]
Abstract
Low muscle is associated with an increased risk of chemotherapy-related dose limiting toxicities (DLT) in cancer patients. Resistance training (RT) improves muscle mass; however, the effects of RT on preventing DLTs and dose reductions in colon cancer patients has not been investigated. FOcus on Reducing dose-limiting toxicities in Colon cancer with resistance Exercise (FORCE) is a multicenter, randomized clinical trial examining the effects of RT on relative dose intensity (RDI; primary outcome) and moderate and severe chemotoxicities (primary outcome) in non-metastatic colon cancer patients receiving adjuvant chemotherapy. Patients (N = 180) will be recruited from Kaiser Permanente Northern California, Dana-Farber Cancer Institute, and Penn State Cancer Institute. This paper describes recruitment strategies and design considerations. Patients will be randomized in equal numbers to RT intervention or control. Patients have baseline and post completion of chemotherapy visits where information on anthropometry, physical function, body composition, quality of life, physical activity and dietary behaviors, and inflammatory blood markers will be collected. Patient-reported outcomes of chemotherapy side effects will be collected around the time of chemotherapy throughout the duration of the trial. Intervention participants will be prescribed a progressive RT program consisting of 4-6 visits with a certified exercise trainer, delivered either in-person or remotely by video conference, and will be asked to engage twice weekly in-home training sessions. Control patients at the end of the study receive a consult with a FORCE exercise trainer, an online exercise RT training program and a set of resistance bands. Results of this trial will provide information on the benefit of resistance exercise as a treatment to increase RDI.
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Affiliation(s)
- Bette J Caan
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | - Jeffrey A Meyerhardt
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston, MA 02215, USA.
| | - Justin C Brown
- Cancer Metabolism Research Program, Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Road, Baton Rouge, Louisiana 70808, USA.
| | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, 212 Friedman Building, 2177 Westbrook Mall, Vancouver, British Columbia V6T 1Z3, Canada.
| | | | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | - Michelle C Ross
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | - Sara Quinney
- Disease and Therapeutic Response Modeling Program, Indiana University School of Medicine, 950 W Walnut Street, Indianapolis, Indiana 46202, USA.
| | - Charles Quesenberry
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | - Barbara Sternfeld
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Kathryn H Schmitz
- Penn State Cancer Institute, The Pennsylvania State University, 500 University Drive, Hershey, PA 17033, USA.
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Ma M, Wang R, Xu L, Xu M, Liu S. Emerging health risks and underlying toxicological mechanisms of uranium contamination: Lessons from the past two decades. Environ Int 2020; 145:106107. [PMID: 32932066 DOI: 10.1016/j.envint.2020.106107] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/28/2020] [Accepted: 08/30/2020] [Indexed: 06/11/2023]
Abstract
Uranium contamination is a global health concern. Regarding natural or anthropogenic uranium contamination, the major sources of concern are groundwater, mining, phosphate fertilizers, nuclear facilities, and military activities. Many epidemiological and laboratory studies have demonstrated that environmental and occupational uranium exposure can induce multifarious health problems. Uranium exposure may cause health risks because of its chemotoxicity and radiotoxicity in natural or anthropogenic scenarios: the former is generally thought to play a more significant role with regard to the natural uranium exposure, and the latter is more relevant to enriched uranium exposure. The understanding of the health risks and underlying toxicological mechanisms of uranium remains at a preliminary stage, and many controversial findings require further research. In order to present state-of-the-art status in this field, this review will primarily focus on the chemotoxicity of uranium, rather than its radiotoxicity, as well as the involved toxicological mechanisms. First, the natural or anthropogenic uranium contamination scenarios will be briefly summarized. Second, the health risks upon natural uranium exposure, for example, nephrotoxicity, bone toxicity, reproductive toxicity, hepatotoxicity, neurotoxicity, and pulmonary toxicity, will be discussed based on the reported epidemiological cases and laboratory studies. Third, the recent advances regarding the toxicological mechanisms of uranium-induced chemotoxicity will be highlighted, including oxidative stress, genetic damage, protein impairment, inflammation, and metabolic disorder. Finally, the gaps and challenges in the knowledge of uranium-induced chemotoxicity and underlying mechanisms will be discussed.
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Affiliation(s)
- Minghao Ma
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Ruixia Wang
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Lining Xu
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Ming Xu
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; School of Environment, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou 310024, China; University of Chinese Academy of Sciences, Beijing 100049, China.
| | - Sijin Liu
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; University of Chinese Academy of Sciences, Beijing 100049, China
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Abstract
Injection of contrast media is the foundation of invasive and interventional cardiovascular practice. Iodine-based contrast was first used in the 1920s for urologic procedures and examinations. The initially used agents had high ionic and osmolar concentrations, which led to significant side effects, namely nausea, vomiting, and hypotension. Newer contrast agents had lower ionic concentrations and lower osmolarity. Modifications to the ionic structure and iodine content led to the development of ionic low-osmolar, nonionic low-osmolar, and nonionic iso-osmolar contrast media. Contemporary contrast agents are better tolerated and produce fewer major side effects.
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Retornaz F, Guillem O, Rousseau F, Morvan F, Rinaldi Y, Nahon S, Castagna C, Boulahssass R, Grino M, Gholam D. Predicting Chemotherapy Toxicity and Death in Older Adults with Colon Cancer: Results of MOST Study. Oncologist 2020; 25:e85-e93. [PMID: 31387952 PMCID: PMC6964155 DOI: 10.1634/theoncologist.2019-0241] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 03/29/2019] [Accepted: 07/08/2019] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Older patients with colon cancer (CC) are vulnerable to chemotherapy toxicity and death. Establishing simple scores specific for patients with CC to predict severe chemotoxicity or early death is needed to select the best treatment strategy. SUBJECTS, MATERIALS, AND METHODS This prospective multicenter study included patients aged ≥70 years with CC receiving adjuvant or first-line metastatic chemotherapy. Frailty markers (nutrition, physical activity, energy, mobility, strength), comprehensive geriatric assessment (functional status, comorbidities, falls, nutrition, cognition, and depression), and usual laboratory parameters were collected. Logistic or Cox regression was used to examine at 500 days the association between frailty markers, comprehensive geriatric assessment, laboratory parameters, and grade 3-4 toxicity or death. RESULTS A total of 97 patients (median age, 79.0 years) received adjuvant (37.1%) or metastatic (62.9%) chemotherapy. During the first 500 days, grade 3-4 toxicity occurred in 49.5%, and 30% died. The predictive model for grade 3-4 toxicity combined (polychemotherapy × 3) + (hypoalbuminemia <32 g/L × 2) + (abnormal grip strength × 1.5) + C-reactive protein >11 mg/L + Eastern Cooperative Oncology Group performance status (ECOG-PS), cutoff score >3. The predictive model for death combined (metastasis × 5) + (age × 2) + alkaline phosphatase >100 IU/mL + sex (female) + abnormal grip strength + ECOG-PS, cutoff score >6. For chemotoxicity prediction, sensitivity was 81.6% and specificity 71.4%. For death prediction, sensitivity was 89.7% and specificity was 83.6%. CONCLUSION These simple and efficient "ColonPrediscores" will help to better identify older patients with CC with increased risk of chemotherapy-related toxicity and/or death. IMPLICATIONS FOR PRACTICE The two scores assessed in this study, called "ColonPrediscores", offer a major advantage in that they do not need a previous complete geriatric assessment, which makes them an easy-to-use tool in oncologic settings.
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Affiliation(s)
- Frédérique Retornaz
- Internal Medicine Research and Care Unit, European HospitalMarseilleFrance
- Geriatric Day Hospital Unit, State Geriatric CenterMarseilleFrance
| | - Olivier Guillem
- Geriatric Medicine Unit, Inter‐communal Hospital Center from Southern AlpsGapFrance
| | - Frédérique Rousseau
- Geriatric Coordination Unit for Geriatric Oncology PACA Ouest, Paoli Calmettes InstituteMarseilleFrance
| | | | | | - Sophie Nahon
- Hematology/Oncology Day Hospital, Hospital Center du Pays d'AixAix en ProvenceFrance
| | - Chantal Castagna
- Geriatric Mobile Unit, Hospital Center Toulon La SeyneToulonFrance
| | - Rabia Boulahssass
- Geriatric Coordination Unit for Geriatric Oncology PACA Est FHU ONCOAGE, Hospital University CenterNiceFrance
| | - Michel Grino
- Department of Clinical Research, State Geriatric CenterMarseilleFrance
- Aix‐Marseille University, INSERM, INRA, C2VNMarseilleFrance
| | - Dany Gholam
- Hemato‐Oncology Unit, Saint George Hospital University Medical Center SGHUMC, BeirutLebanon
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Rump A, Eder S, Lamkowski A, Hermann C, Abend M, Port M. A quantitative comparison of the chemo- and radiotoxicity of uranium at different enrichment grades. Toxicol Lett 2019; 313:159-168. [PMID: 31276769 DOI: 10.1016/j.toxlet.2019.07.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/24/2019] [Accepted: 07/01/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The radiotoxic effects of uranium are often in the focus of the public fears but the chemical toxic effects of uranium are reported to surpass radiation effects. As there is no uranium isotope that is not radioactive, it is not possible to study chemical effects fully independently from radiation effects. In order to quantitate and compare radio- and chemotoxicity, we determined the median lethal doses of uranium due to its chemical toxicity and calculated the absorbed radiological doses resulting from the ingestion or inhalation of corresponding amounts depending on the isotopic enrichment grade. Committed effective doses over 50 years are related to the stochastic health effects like cancer occurrence and can be converted to a loss of statistical life time (mean loss 0.4 day / mSv). The equivalent doses absorbed within a short time frame permits conclusion on the induction of deterministic effects (e.g. acute radiation sickness). METHOD Simulations were based on the biokinetic models of the International Commission for Radioprotection and performed using Integrated Modules for Bioassay Analysis software. Results were compared with the doses given by the calculator of the WISE uranium project. The fractions of the total doses absorbed within different time periods were derived from the respective areas under the activity-time curves in the whole body. RESULTS The distribution of the total dose on the organs and tissues depends on the invasion pathway and the solubility of the compound. In the case of inhalation, the absorption of the total dose is more protracted than after ingestion. The incorporation of depleted or natural uranium in lethal amounts due to nephrotoxicity does not lead to deterministic radiation effects and is associated with committed effective doses reaching at most about 200 mSv (proposed possible threshold for therapeutic interventions after accidental radionuclide incorporation). The inhalation of low enriched uranium leads to higher effective doses up to 690 mSv, but they are still insufficient to cause acute deterministic effects. Even highly enriched uranium seems not to induce radiation nephropathy, but deterministic effects on the hematopoetic system cannot be excluded in particularly sensitive patients. But the equivalent doses to the lungs associated with the inhalation of poorly soluble compounds of highly enriched uranium are in a range that may induce radiation pneumonitis. CONCLUSION Our findings give clear evidence that for depleted and natural uranium chemical toxicity is much more marked than radiotoxicity. However, this conclusion must not be drawn for enriched and in particular highly enriched compounds that besides stochastic effects may even cause deterministic radiation effects.
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Affiliation(s)
- A Rump
- Bundeswehr Institute of Radiobiology, Munich, Germany.
| | - S Eder
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - A Lamkowski
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - C Hermann
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - M Abend
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - M Port
- Bundeswehr Institute of Radiobiology, Munich, Germany
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12
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Beaugelin-Seiller K, Gilbin R, Reygrobellet S, Garnier-Laplace J. A single indicator of noxiousness for people and ecosystems exposed to stable and radioactive substances. Environ Pollut 2019; 249:560-565. [PMID: 30933752 DOI: 10.1016/j.envpol.2019.03.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/21/2019] [Accepted: 03/15/2019] [Indexed: 06/09/2023]
Abstract
Inspired by methods used for life cycle impact assessment (LCIA), we constructed a series of indicators to appreciate the noxiousness of radioactive materials and wastes for human and ecosystem health. According to known potential human health and ecological effects of such materials, six main impact categories were considered to initiate the development of the method: human cancer and non-cancer effects vs. ecotoxicity, considering both chemotoxicity and radiotoxicity. For ecosystems, the noxiousness indicator is based on the concept of Potentially Affected Fraction (PAF), used as a damage indicator at the ecosystem level. The PAF express the toxic pressure on the environment due to one substance. It has been enlarged to mixtures of substances as multi-substances PAF (ms-PAF), and applied to a mix of stable and radioactive substances. Combining ecotoxicity data and a simplified model of exposure of fauna and flora, we proposed a chemotoxicity indicator and a radiotoxicity indicator, ultimately aggregated into a single indicator simply by addition. According to acknowledged practices in LCIA and corresponding available data, we suggested implementing to human health an approach similar to that applied to ecosystems. We produced eigth basic indicators combining effects categories (cancer and non cancer), exposure pathways (ingestion and inhlation) and substances (chemicals and radionuclides). The principle of additivity supporting the whole proposed approach allows their complete aggregation into a single indicator also for human health. Different source terms may be then easily directly compared in terms of human and ecological noxiousness. Applied to the time evolution of a High Level radioactive Waste (HLW), the method confirmed over 1 million years the dominance of the radiotoxicity in the noxiousness of the material for both humans and environment. However there is a change with time in the ranking of the most noxious substances, with stable metals contribution going progressively up. Finally, the HLW global noxiousness, integrating human health and ecological aspects, was assessed through time at three stages and showed a temporal decrease as expected from the dominance of the radiotoxicity.
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Affiliation(s)
- Karine Beaugelin-Seiller
- Institut de Radioprotection et de Sûreté Nucléaire, PSE-ENV/SRTE/LECO, St Paul les Durance, 13115, France.
| | - Rodolphe Gilbin
- Institut de Radioprotection et de Sûreté Nucléaire, PSE-ENV/SRTE, St Paul les Durance, 13115, France
| | - Sophie Reygrobellet
- Institut de Radioprotection et de Sûreté Nucléaire, PSE-ENV/SEREN/LEREN, St Paul les Durance, 13115, France
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Couderc AL, Boulahssass R, Nouguerède E, Gobin N, Guérin O, Villani P, Barlesi F, Paillaud E. Functional status in a geriatric oncology setting: A review. J Geriatr Oncol 2019; 10:884-894. [PMID: 30824222 DOI: 10.1016/j.jgo.2019.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 01/07/2019] [Accepted: 02/11/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Comprehensive Geriatric Assessment (CGA), is used in older patients with cancer to identify frailties, which can interfere with specialized treatment, and to help with therapeutic care. Functional Status (FS) is a domain of CGA in which Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) are evaluation tools. OBJECTIVE Our study reviewed the data available on the most frequently used tools to assess ADL and IADL in a geriatric oncology setting and their predictive values on overall survival (OS), toxicity, treatment feasibility or decision and postoperative complications. DESIGN This review was based on a systematic search of the MEDLINE® database for articles published in English and French between January 1, 2010, and December 31, 2017. In the final analysis, 40 out of 4061 studies were included. RESULTS The most common ADL and IADL scales used are the Katz ADL (KL-ADL) in 25 studies and the Lawton IADL (IADL8) in 22 studies. FS is predictive of OS in 11 out of 24 studies, chemotoxicity in 2 out of 7 studies, treatment feasibility in 2 out of 5 studies, treatment decisions in 2 out of 3 studies, and postoperative complications in 4 out of 6 studies. CONCLUSION FS is of prognostic value in a geriatric oncology setting despite heterogeneous methodology and inclusion criteria, in the studies included. Additional research is needed to explore more precisely the prognostic value of FS in overall survival, toxicity, treatment feasibility or decision and postoperative complications, in older cancer patients.
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Affiliation(s)
- Anne-Laure Couderc
- Division of Internal Medicine, Geriatry and Therapeutic, Sainte Marguerite Hospital, AP-HM, Marseille, France; Coordination Unit for Geriatric Oncology (UCOG), PACA West, France.
| | - Rabia Boulahssass
- Geriatric Department, Coordination Unit for Geriatric Oncology (UCOG) PACA East, Cimiez Hospital, Nice, France
| | - Emilie Nouguerède
- Division of Internal Medicine, Geriatry and Therapeutic, Sainte Marguerite Hospital, AP-HM, Marseille, France
| | - Nirvina Gobin
- Division of Internal Medicine, Geriatry and Therapeutic, Sainte Marguerite Hospital, AP-HM, Marseille, France
| | - Olivier Guérin
- Geriatric Department, Coordination Unit for Geriatric Oncology (UCOG) PACA East, Cimiez Hospital, Nice, France; Nice Sophia-Antipolis University, Nice, France
| | - Patrick Villani
- Division of Internal Medicine, Geriatry and Therapeutic, Sainte Marguerite Hospital, AP-HM, Marseille, France; Aix-Marseille University, Marseille, France
| | - Fabrice Barlesi
- Aix-Marseille University, Marseille, France; Division of Multidisciplinary Oncology and Therapeutic Innovations, North Hospital, AP-HM, Marseille, France
| | - Elena Paillaud
- Department of Geriatrics, Geriatric Oncology Unit, APHP, Hospital European Georges Pompidou, Paris, France; Clinical Epidemiology and Ageing Unit, EA, 7376, Universite' Paris-Est, Creteil, France
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Wang TQ, Samuel JN, Brown MC, Vennettilli A, Solomon H, Eng L, Liang M, Gill G, Merali Z, Tian C, Cheng NYH, Campbell M, Patel D, Liu AX, Liu G, Howell D. Routine Surveillance of Chemotherapy Toxicities in Cancer Patients Using the Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). Oncol Ther 2018; 6:189-201. [PMID: 32700029 PMCID: PMC7360011 DOI: 10.1007/s40487-018-0065-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction Systematic documentation of chemotoxicities in outpatient clinics is challenging. Incorporating patient-reported outcome (PRO) measures in clinical workflows can be an efficient strategy to strengthen the assessment of symptomatic treatment toxicities in oncology clinical practice. We compared the adequateness, feasibility, and acceptability of toxicity documentation using systematic, prospective, application of the PRO Common Toxicity Criteria for Adverse Events (PRO-CTCAE) tool. Methods At a comprehensive cancer center, data abstraction of electronic health record reviews elucidated current methods and degree of chemotoxicity documentation. Web-based 32-item PRO-CTCAE questionnaires, administered in ambulatory clinics of patients receiving chemotherapy, captured chemotoxicities and respective severities. Patient telephone surveys assessed whether healthcare providers had addressed chemotoxicities to the patients’ satisfaction. Results Over a broad demographic of 497 patients receiving chemotherapy, 90% (95% CI 84–96%) with significant chemotoxicities (n = 107) reported that their providers had discussed toxicities with them; of these, 70% received a therapy management change, while among the rest, 17% desired a change in management. Of patients surveyed, 91% (95% CI 82–99%) were satisfied with their current chemotoxicity management. Clinician chart documentation varied greatly; descriptors rather than numerical grading scales were typically used. Although 93% of patients were willing to complete the PRO survey, only 50% thought that it would be acceptable to complete this survey at routine clinic visits. Conclusion Use of PRO-CTCAE in routine clinical practice promotes systematic evaluation of symptomatic toxicities and improves the clarity, consistency, and efficiency of clinician documentation; however, methods to improve patient willingness to complete this tool routinely are needed.
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Affiliation(s)
- Tian Qi Wang
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | | | | | | | | | - Lawson Eng
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Mindy Liang
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | | | - Zahra Merali
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Chenchen Tian
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | | | - Matthew Campbell
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Ai Xin Liu
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Geoffrey Liu
- Princess Margaret Cancer Center, Toronto, ON, Canada.
| | - Doris Howell
- Princess Margaret Cancer Center, Toronto, ON, Canada
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Brayboy LM, Oulhen N, Long S, Voigt N, Raker C, Wessel GM. Multidrug resistance transporter-1 and breast cancer resistance protein protect against ovarian toxicity, and are essential in ovarian physiology. Reprod Toxicol 2017; 69:121-31. [PMID: 28216407 DOI: 10.1016/j.reprotox.2017.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 02/03/2017] [Accepted: 02/03/2017] [Indexed: 12/14/2022]
Abstract
Ovarian protection from chemotoxicity is essential for reproductive health. Our objective is to determine the role of ATP-dependent, Multidrug Resistance Transporters (MDRs) in this protection. Previously we identified MDR-dependent cytoprotection from cyclophosphamide in mouse and human oocytes by use of MDR inhibitors. Here we use genetic deletions in MDR1a/b/BCRP of mice to test MDR function in ovarian somatic cells and find that mdr1a/b/bcrp-/- mice had significantly increased sensitivity to cyclophosphamide. Further, estrus cyclicity and follicle distribution in mdr1a/b/bcrp-/- mice also differed from age-matched wildtype ovaries. We found that MDR gene activity cycles through estrus and that MDR-1b cyclicity correlated with 17β-estradiol surges. We also examined the metabolite composition of the ovary and learned that the mdr1a/b/bcrp-/- mice have increased accumulation of metabolites indicative of oxidative stress and inflammation. We conclude that MDRs are essential to ovarian protection from chemotoxicity and may have an important physiological role in the ovary.
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Knott K, Starling N, Rasheed S, Foran J, Cafferkey C, Rosen S, Nicholson A, Baksi J, Lyon A. A case of Takotsubo syndrome following 5-fluorouracil chemotherapy. Int J Cardiol 2014; 177:e65-7. [PMID: 25449494 DOI: 10.1016/j.ijcard.2014.09.154] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 09/27/2014] [Indexed: 10/24/2022]
Affiliation(s)
| | | | | | - John Foran
- Royal Brompton and Harefield NHS Foundation Trust, United Kingdom
| | | | - Stuart Rosen
- Royal Brompton and Harefield NHS Foundation Trust, United Kingdom
| | - Andrew Nicholson
- Royal Brompton and Harefield NHS Foundation Trust, United Kingdom
| | - John Baksi
- Royal Brompton and Harefield NHS Foundation Trust, United Kingdom
| | - Alexander Lyon
- Royal Brompton and Harefield NHS Foundation Trust, United Kingdom
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Abstract
Nonrenal complications of contrast media are caused by chemotoxic or anaphylactoid reactions related to the contrast agent used. Chemotoxicity is mainly attributed to ionic concentration and osmolality. Anaphylactoid reactions are typically caused by direct activation of basophils, mast cells, and complement rather than an observable antigen-antibody interaction, and may be acute or delayed. History of an adverse reaction following prior exposure is the strongest predictor of a subsequent adverse reaction to contrast. Premedication regimens of corticosteroids or antihistamines can lower the risk of repeat adverse reactions. Treatment of anaphylactoid reactions depends on the severity of symptoms.
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Affiliation(s)
- Damien Marycz
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, 900 South Limestone Street, 326 Wethington Building, Lexington, KY 40536-0200, USA
| | - Khaled M Ziada
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, 900 South Limestone Street, 326 Wethington Building, Lexington, KY 40536-0200, USA.
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Popa MA, Wallace KJ, Brunello A, Extermann M, Balducci L. Potential drug interactions and chemotoxicity in older patients with cancer receiving chemotherapy. J Geriatr Oncol 2014; 5:307-14. [PMID: 24821377 DOI: 10.1016/j.jgo.2014.04.002] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 01/28/2014] [Accepted: 04/21/2014] [Indexed: 11/22/2022]
Abstract
PURPOSE Increased risk of drug interactions due to polypharmacy and aging-related changes in physiology among older patients with cancer is further augmented during chemotherapy. No previous studies examined potential drug interactions (PDIs) from polypharmacy and their association with chemotherapy tolerance in older patients with cancer. METHODS This study is a retrospective medical chart review of 244 patients aged 70+ years who received chemotherapy for solid or hematological malignancies. PDI among all drugs, supplements, and herbals taken with the first chemotherapy cycle were screened for using the Drug Interaction Facts software, which classifies PDIs into five levels of clinical significance with level 1 being the highest. Descriptive and correlative statistics were used to describe rates of PDI. The association between PDI and severe chemotoxicity was tested with logistic regressions adjusted for baseline covariates. RESULTS A total of 769 PDIs were identified in 75.4% patients. Of the 82 level 1 PDIs identified among these, 32 PDIs involved chemotherapeutics. A large proportion of the identified PDIs were of minor clinical significance. The risk of severe non-hematological toxicity almost doubled with each level 1 PDI (OR=1.94, 95% CI: 1.22-3.09), and tripled with each level 1 PDI involving chemotherapeutics (OR=3.08, 95% CI: 1.33-7.12). No association between PDI and hematological toxicity was found. CONCLUSIONS In this convenience sample of older patients with cancer receiving chemotherapy we found notable rates of PDI and a substantial adjusted impact of PDI on risk of non-hematological toxicity. These findings warrant further research to optimize chemotherapy outcomes.
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