1
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Steel JL, George CJ, Terhorst L, Yabes JG, Reyes V, Zandberg DP, Nilsen M, Kiefer G, Johnson J, Marsh C, Bierenbaum J, Tageja N, Krauze M, VanderWeele R, Goel G, Ramineni G, Antoni M, Vodovotz Y, Walker J, Tohme S, Billiar T, Geller DA. Patient, family caregiver, and economic outcomes of an integrated screening and novel stepped collaborative care intervention in the oncology setting in the USA (CARES): a randomised, parallel, phase 3 trial. Lancet 2024; 403:1351-1361. [PMID: 38490230 DOI: 10.1016/s0140-6736(24)00015-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/06/2023] [Accepted: 01/03/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The current standard of care of screening and referring patients for treatment for symptoms, such as depression, pain, and fatigue, is not effective. This trial aimed to test the efficacy of an integrated screening and novel stepped collaborative care intervention versus standard of care for patients with cancer and at least one of the following symptoms: depression, pain, or fatigue. METHODS This randomised, parallel, phase 3 trial was conducted in 29 oncology outpatient clinics associated with the UPMC Hillman Cancer Center in the USA. Patients (aged ≥21 years) with any cancer type and clinical levels of depression, pain, or fatigue (or all of these) were eligible. Eligible family caregivers were aged 21 years or older and providing care to a patient diagnosed with cancer who consented for this study. Patients were randomly assigned (1:1) to stepped collaborative care or standard of care using a central, permuted block design (sizes of 2, 4, and 6) stratified by sex and prognostic status. The biostatistician, oncologists, and outcome assessors were masked to treatment assignment. Stepped collaborative care was once-weekly cognitive behavioural therapy for 50-60 min from a care coordinator via telemedicine (eg, telephone or videoconferencing). Pharmacotherapy for symptoms might be initiated or changed if recommended by the treatment team or preferred by the patient. Standard of care was screening and referral to a health-care provider for treatment of symptoms. The primary outcome was health-related quality of life in patients at 6 months. Maintenance of the treatment benefits was assessed at 12 months. Participants included in the primary analysis were per intention to treat, which included patients missing one or both follow-up assessments. This trial was registered with ClinicalTrials.gov (NCT02939755). FINDINGS Between Dec 5, 2016, and April 8, 2021, 459 patients and 190 family caregivers were enrolled. 222 patients were assigned to standard of care and 237 to stepped collaborative care. Of 459 patients, 201 (44%) were male and 258 (56%) were female. Patients in the stepped collaborative care group had a greater 0-6-month improvement in health-related quality of life than patients in the standard-of-care group (p=0·013, effect size 0·09). Health-related quality of life was maintained for the stepped collaborative care group (p=0·74, effect size 0·01). Patients in the stepped collaborative care group had greater 0-6-month improvements than the standard-of-care group in emotional (p=0·012), functional (p=0·042), and physical (p=0·033) wellbeing. No adverse events were reported by patients in either group and deaths were considered unrelated to the study. INTERPRETATION An integrated screening and novel stepped collaborative care intervention, compared with the current standard of care, is recommended to improve health-related quality of life. The findings of this study will advance the implementation of guideline concordant care (screening and treatment) and has the potential to shift the practice of screening and treatment paradigm nationwide, improving outcomes for patients diagnosed with cancer. FUNDING US National Cancer Institute.
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Affiliation(s)
- Jennifer L Steel
- Department of Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychology, Dietrich School of Arts and Sciences, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Charles J George
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lauren Terhorst
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonathan G Yabes
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA; Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Dan P Zandberg
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marci Nilsen
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Jonas Johnson
- Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | | | | | | | - Gaurav Goel
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | | | - Michael Antoni
- Department of Psychology, Sylvester Cancer Center, University of Miami, FL, USA
| | - Yoram Vodovotz
- Department of Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Immunology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Computational and Systems Biology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA; Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA, USA; Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jon Walker
- School of Information Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Samer Tohme
- Department of Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Timothy Billiar
- Department of Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - David A Geller
- Department of Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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2
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New J, Cham J, Smith L, Puglisi L, Huynh T, Kurian S, Bagsic S, Fielding R, Hong L, Reddy P, Eum KS, Martin A, Barrick B, Marsh C, Quigley M, Nicholson LJ, Pandey AC. Effects of antineoplastic and immunomodulating agents on postvaccination SARS-CoV-2 breakthrough infections, antibody response, and serological cytokine profile. J Immunother Cancer 2024; 12:e008233. [PMID: 38296596 PMCID: PMC10831464 DOI: 10.1136/jitc-2023-008233] [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] [Accepted: 12/08/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Despite immunization, patients on antineoplastic and immunomodulating agents have a heightened risk of COVID-19 infection. However, accurately attributing this risk to specific medications remains challenging. METHODS An observational cohort study from December 11, 2020 to September 22, 2022, within a large healthcare system in San Diego, California, USA was designed to identify medications associated with greatest risk of postimmunization SARS-CoV-2 infection. Adults prescribed WHO Anatomical Therapeutic Chemical (ATC) classified antineoplastic and immunomodulating medications were matched (by age, sex, race, and number of immunizations) with control patients not prescribed these medications yielding a population of 26 724 patients for analysis. From this population, 218 blood samples were collected from an enrolled subset to assess serological response and cytokine profile in relation to immunization. RESULTS Prescription of WHO ATC classified antineoplastic and immunomodulatory agents was associated with elevated postimmunization SARS-CoV-2 infection risk (HR 1.50, 95% CI 1.38 to 1.63). While multiple immunization doses demonstrated a decreased association with postimmunization SARS-CoV-2 infection risk, antineoplastic and immunomodulatory treated patients with four doses remained at heightened risk (HR 1.23, 95% CI 1.06 to 1.43). Risk variation was identified among medication subclasses, with PD-1/PD-L1 inhibiting monoclonal antibodies, calcineurin inhibitors, and CD20 monoclonal antibody inhibitors identified to associate with increased risk of postimmunization SARS-CoV-2 infection. Antineoplastic and immunomodulatory treated patients also displayed a reduced IgG antibody response to SARS-CoV-2 epitopes alongside a unique serum cytokine profile. CONCLUSIONS Antineoplastic and immunomodulating medications associate with an elevated risk of postimmunization SARS-CoV-2 infection in a drug-specific manner. This comprehensive, unbiased analysis of all WHO ATC classified antineoplastic and immunomodulating medications identifies medications associated with greatest risk. These findings are crucial in guiding and refining vaccination strategies for patients prescribed these treatments, ensuring optimized protection for this susceptible population in future COVID-19 variant surges and potentially for other RNA immunization targets.
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Affiliation(s)
- Jacob New
- Medicine, Scripps Health, La Jolla, California, USA
- Scripps Research Translational Institute, La Jolla, California, USA
| | - Jason Cham
- Scripps Research Translational Institute, La Jolla, California, USA
| | - Lana Smith
- Scripps Research Translational Institute, La Jolla, California, USA
| | - Leah Puglisi
- Medicine, Scripps Health, La Jolla, California, USA
| | - Tridu Huynh
- Scripps Research Translational Institute, La Jolla, California, USA
- Division of Hematology/Oncology, University of California, La Jolla, California, USA
| | - Sunil Kurian
- Scripps Organ Transplantation Research & Biorepository, Scripps Health, La Jolla, California, USA
| | | | - Russel Fielding
- Strategy & Planning, Scripps Health, La Jolla, California, USA
| | - Lee Hong
- Medicine, Scripps Health, La Jolla, California, USA
- Scripps Research Translational Institute, La Jolla, California, USA
| | - Priya Reddy
- Medicine, Scripps Health, La Jolla, California, USA
| | - Ki Suk Eum
- Medicine, Scripps Health, La Jolla, California, USA
- Rheumatology, Veterans Administration Pacific Islands Healthcare System, Honolulu, Hawaii, USA
| | - Allison Martin
- Scripps Organ Transplantation Research & Biorepository, Scripps Health, La Jolla, California, USA
| | - Bethany Barrick
- Scripps Organ Transplantation Research & Biorepository, Scripps Health, La Jolla, California, USA
| | - Christopher Marsh
- Scripps Organ Transplantation Research & Biorepository, Scripps Health, La Jolla, California, USA
| | | | - Laura J Nicholson
- Medicine, Scripps Health, La Jolla, California, USA
- Scripps Research Translational Institute, La Jolla, California, USA
| | - Amitabh C Pandey
- Scripps Research Translational Institute, La Jolla, California, USA
- Medicine, Section of Cardiology, Tulane University, New Orleans, Louisiana, USA
- Medicine, Southeast Veterans Health Care System, New Orleans, Louisiana, USA
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Shaverdashvili K, Reyes V, Wang H, Mehta D, Marsh C, Waas JK, VanderWeele RA, Peracha SM, Liang H, Socinski MA, Gerber DE, Dowell JE, Villaruz LC. A phase II clinical trial evaluating the safety and efficacy of durvalumab as first line therapy in advanced and metastatic non-small cell lung cancer patients with Eastern Cooperative Oncology Group performance status of 2. EClinicalMedicine 2023; 66:102317. [PMID: 38192592 PMCID: PMC10772260 DOI: 10.1016/j.eclinm.2023.102317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 01/10/2024] Open
Abstract
Background Approximately 30-40% of patients with advanced and metastatic non-small cell lung cancer (NSCLC) present with an impaired performance status (PS). There are limited prospective data on the safety and efficacy of durvalumab in these patients. Methods In this single-arm phase II clinical trial (NCT02879617), patients with previously untreated Stage IIIB/IV NSCLC and ECOG PS of 2 received durvalumab 1500 mg every 28 days until progression or unacceptable toxicity. The primary endpoints were overall survival (OS) and safety determined by grade ≥3 treatment-related adverse events (TRAEs). Findings Between April 2017 and March 2021, 50 patients were enrolled, of whom 47 received durvalumab. With a median follow-up of 28 months, median OS was 6 months (95% CI 4-10). TRAEs grade 3 occurred in nine of 47 patients (19%, 95% CI 9%-33%). OS in patients with a PD-L1 TPS of 0, 1-49%, and ≥50% was six months (95% CI 3-15), 11 months (95% CI 4-16), and 11 months (95% CI 0-not reached (NR)), respectively. Health related quality of life (HQRL) assessed at baseline and during therapy demonstrated no statistically significant change over the course of treatment. Interpretation This study demonstrates that single agent durvalumab is safe and well tolerated in the 1st line treatment of patients with advanced NSCLC and ECOG PS of 2, with an encouraging OS benefit in patients with PD-L1 positive tumors. This trial is amongst the largest prospective studies evaluating durvalumab in the 1st line treatment of advanced stage NSCLC and a PS of 2. Funding AstraZeneca, NCI P30CA047904.
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Affiliation(s)
| | - Vincent Reyes
- UPMC Hillman Cancer Center, 5150 Centre Avenue, Pittsburgh, PA, 15232, USA
| | - Hong Wang
- UPMC Hillman Cancer Center, 5150 Centre Avenue, Pittsburgh, PA, 15232, USA
| | - Dhaval Mehta
- UPMC Hillman Cancer Center, 5150 Centre Avenue, Pittsburgh, PA, 15232, USA
| | - Christopher Marsh
- UPMC Hillman Cancer Center, 5150 Centre Avenue, Pittsburgh, PA, 15232, USA
| | - John K. Waas
- UPMC Hillman Cancer Center, 5150 Centre Avenue, Pittsburgh, PA, 15232, USA
| | | | - Sajid M. Peracha
- UPMC Hillman Cancer Center, 5150 Centre Avenue, Pittsburgh, PA, 15232, USA
| | - Hongmei Liang
- UPMC Hillman Cancer Center, 5150 Centre Avenue, Pittsburgh, PA, 15232, USA
| | - Mark A. Socinski
- AdventHealth Cancer Institute, 2501 N. Orange Ave, Suite 689, Orlando, FL, 32804, USA
| | - David E. Gerber
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Jonathan E. Dowell
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Liza C. Villaruz
- UPMC Hillman Cancer Center, 5150 Centre Avenue, Pittsburgh, PA, 15232, USA
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Asherson P, Johansson L, Holland R, Bedding M, Forrester A, Giannulli L, Ginsberg Y, Howitt S, Kretzschmar I, Lawrie SM, Marsh C, Kelly C, Mansfield M, McCafferty C, Khan K, Muller-Sedgwick U, Strang J, Williamson G, Wilson L, Young S, Landau S, Thomson L. Randomised controlled trial of the short-term effects of osmotic-release oral system methylphenidate on symptoms and behavioural outcomes in young male prisoners with attention deficit hyperactivity disorder: CIAO-II study. Br J Psychiatry 2023; 222:7-17. [PMID: 35657651 PMCID: PMC7613969 DOI: 10.1192/bjp.2022.77] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Research has shown that 20-30% of prisoners meet the diagnostic criteria for attention-deficit hyperactivity disorder (ADHD). Methylphenidate reduces ADHD symptoms, but effects in prisoners are uncertain because of comorbid mental health and substance use disorders. AIMS To estimate the efficacy of an osmotic-release oral system methylphenidate (OROS-methylphenidate) in reducing ADHD symptoms in young adult prisoners with ADHD. METHOD We conducted an 8-week parallel-arm, double-blind, randomised placebo-controlled trial of OROS-methylphenidate versus placebo in male prisoners (aged 16-25 years) meeting the DSM-5 criteria for ADHD. Primary outcome was ADHD symptoms at 8 weeks, using the investigator-rated Connors Adult ADHD Rating Scale (CAARS-O). Thirteen secondary outcomes were measured, including emotional dysregulation, mind wandering, violent attitudes, mental health symptoms, and prison officer and educational staff ratings of behaviour and aggression. RESULTS In the OROS-methylphenidate arm, mean CAARS-O score at 8 weeks was estimated to be reduced by 0.57 points relative to the placebo arm (95% CI -2.41 to 3.56), and non-significant. The responder rate, defined as a 20% reduction in CAARS-O score, was 48.3% for the OROS-methylphenidate arm and 47.9% for the placebo arm. No statistically significant trial arm differences were detected for any of the secondary outcomes. Mean final titrated dose was 53.8 mg in the OROS-methylphenidate arm. CONCLUSIONS ADHD symptoms did not respond to OROS-methylphenidate in young adult prisoners. The findings do not support routine treatment with OROS-methylphenidate in this population. Further research is needed to evaluate effects of higher average dosing and adherence to treatment, multi-modal treatments and preventative interventions in the community.
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5
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Chen J, Mei Q, Chen Y, Marsh C, An B, Han X, Silverwood IP, Li M, Cheng Y, He M, Chen X, Li W, Kippax-Jones M, Crawshaw D, Frogley MD, Day SJ, García-Sakai V, Manuel P, Ramirez-Cuesta AJ, Yang S, Schröder M. Highly Efficient Proton Conduction in the Metal-Organic Framework Material MFM-300(Cr)·SO 4(H 3O) 2. J Am Chem Soc 2022; 144:11969-11974. [PMID: 35775201 PMCID: PMC9348827 DOI: 10.1021/jacs.2c04900] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
![]()
The development of
materials showing rapid proton conduction with
a low activation energy and stable performance over a wide temperature
range is an important and challenging line of research. Here, we report
confinement of sulfuric acid within porous MFM-300(Cr) to give MFM-300(Cr)·SO4(H3O)2, which exhibits a record-low
activation energy of 0.04 eV, resulting in stable proton conductivity
between 25 and 80 °C of >10–2 S cm–1. In situ synchrotron X-ray powder diffraction (SXPD),
neutron powder diffraction (NPD), quasielastic neutron scattering
(QENS), and molecular dynamics (MD) simulation reveal the pathways
of proton transport and the molecular mechanism of proton diffusion
within the pores. Confined sulfuric acid species together with adsorbed
water molecules play a critical role in promoting the proton transfer
through this robust network to afford a material in which proton conductivity
is almost temperature-independent.
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Affiliation(s)
- Jin Chen
- Department of Chemistry, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Qingqing Mei
- Department of Chemistry, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Yinlin Chen
- Department of Chemistry, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Christopher Marsh
- Department of Chemistry, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Bing An
- Department of Chemistry, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Xue Han
- Department of Chemistry, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Ian P Silverwood
- ISIS Neutron and Muon Source, Rutherford Appleton Laboratory, Didcot OX11 0QX, United Kingdom
| | - Ming Li
- Faculty of Engineering, University of Nottingham, Nottingham NG7 2RD, United Kingdom
| | - Yongqiang Cheng
- Neutron Scattering Division, Neutron Sciences Directorate, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, United States
| | - Meng He
- Department of Chemistry, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Xi Chen
- Department of Chemistry, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Weiyao Li
- Department of Chemistry, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Meredydd Kippax-Jones
- Department of Chemistry, The University of Manchester, Manchester M13 9PL, United Kingdom.,Diamond Light Source, Harwell Science Campus, Oxfordshire OX11 0DE, United Kingdom
| | - Danielle Crawshaw
- Department of Chemistry, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Mark D Frogley
- Diamond Light Source, Harwell Science Campus, Oxfordshire OX11 0DE, United Kingdom
| | - Sarah J Day
- Diamond Light Source, Harwell Science Campus, Oxfordshire OX11 0DE, United Kingdom
| | - Victoria García-Sakai
- ISIS Neutron and Muon Source, Rutherford Appleton Laboratory, Didcot OX11 0QX, United Kingdom
| | - Pascal Manuel
- ISIS Neutron and Muon Source, Rutherford Appleton Laboratory, Didcot OX11 0QX, United Kingdom
| | - Anibal J Ramirez-Cuesta
- Neutron Scattering Division, Neutron Sciences Directorate, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, United States
| | - Sihai Yang
- Department of Chemistry, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Martin Schröder
- Department of Chemistry, The University of Manchester, Manchester M13 9PL, United Kingdom
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6
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Zhang H, Chen F, Giang E, Bao F, Lauer GM, Marsh C, Law M, Pockros PJ. Virus reactivation in a non-cirrhotic HBV patient requiring liver transplantation after cessation of nucleoside analogue therapy. Antivir Ther 2021; 26:3-8. [DOI: 10.1177/13596535211042205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Nucleos(t)ide analogues (NAs) are a mainstay of therapy for chronic hepatitis B (CHB) infections and have a profound effect on hepatitis B virus (HBV) suppression. We report a rare case of HBV reactivation in a CHB patient without cirrhosis following cessation of NA therapy that resulted in acute liver failure requiring liver transplantation. Investigation of the viral genetics and host immune responses suggest that viral mutations known to promote virus replication are associated with reactivation, whereas adaptive immunity to HBV remained defective in this patient. Viral sequencing may be useful for identifying mutations that are unfavorable for therapy withdrawal.
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Affiliation(s)
- Han Zhang
- Division of Gastroenterology/Hepatology, Scripps Clinic, La Jolla, CA, USA
| | - Fang Chen
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Erick Giang
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Fei Bao
- Department of Pathology, Scripps Clinic, La Jolla, CA, USA
| | - Georg M Lauer
- Gastrointestinal Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Christopher Marsh
- Scripps Center for Organ Transplantation, Scripps Clinic, La Jolla, CA, USA
| | - Mansun Law
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | - Paul J Pockros
- Division of Gastroenterology/Hepatology, Scripps Clinic, La Jolla, CA, USA
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
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Marsh C, Shearer GC, Knight BT, Paul-Taylor J, Burrows AD. Supramolecular aspects of biomolecule interactions in metal–organic frameworks. Coord Chem Rev 2021. [DOI: 10.1016/j.ccr.2021.213928] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Marsh C, Han X, Li J, Lu Z, Argent SP, da Silva I, Cheng Y, Daemen LL, Ramirez-Cuesta AJ, Thompson SP, Blake AJ, Yang S, Schröder M. Exceptional Packing Density of Ammonia in a Dual-Functionalized Metal-Organic Framework. J Am Chem Soc 2021; 143:6586-6592. [PMID: 33885294 PMCID: PMC8154541 DOI: 10.1021/jacs.1c01749] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report the reversible adsorption of ammonia (NH3) up to 9.9 mmol g-1 in a robust Al-based metal-organic framework, MFM-303(Al), which is functionalized with free carboxylic acid and hydroxyl groups. The unique pore environment decorated with these acidic sites results in an exceptional packing density of NH3 at 293 K (0.801 g cm-3) comparable to that of solid NH3 at 193 K (0.817 g cm-3). In situ synchrotron X-ray diffraction and inelastic neutron scattering reveal the critical role of free -COOH and -OH groups in immobilizing NH3 molecules. Breakthrough experiments confirm the excellent performance of MFM-303(Al) for the capture of NH3 at low concentrations under both dry and wet conditions.
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Affiliation(s)
- Christopher Marsh
- Department of Chemistry, University of Manchester, Manchester, M13 9PL, U.K
| | - Xue Han
- Department of Chemistry, University of Manchester, Manchester, M13 9PL, U.K
| | - Jiangnan Li
- Department of Chemistry, University of Manchester, Manchester, M13 9PL, U.K
| | - Zhenzhong Lu
- Department of Chemistry, University of Manchester, Manchester, M13 9PL, U.K
| | - Stephen P Argent
- School of Chemistry, University of Nottingham, Nottingham, NG7 2RD, U.K
| | - Ivan da Silva
- ISIS Neutron and Muon Source, Rutherford Appleton Laboratory, Oxford, OX11 0QX, U.K
| | - Yongqiang Cheng
- Neutron Scattering Division, Neutron Sciences Directorate, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, United States
| | - Luke L Daemen
- Neutron Scattering Division, Neutron Sciences Directorate, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, United States
| | - Anibal J Ramirez-Cuesta
- Neutron Scattering Division, Neutron Sciences Directorate, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, United States
| | - Stephen P Thompson
- Diamond Light Source, Harwell Science Campus, Oxfordshire, OX11 0DE, U.K
| | - Alexander J Blake
- School of Chemistry, University of Nottingham, Nottingham, NG7 2RD, U.K
| | - Sihai Yang
- Department of Chemistry, University of Manchester, Manchester, M13 9PL, U.K
| | - Martin Schröder
- Department of Chemistry, University of Manchester, Manchester, M13 9PL, U.K
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Nicholson L, McLawhon RW, Kurian S, Fitzgerald RL, Case J, Marsh C, Quigley M. Healthcare worker seroconversion for SARS-CoV-2 at two large health systems in San Diego. Am J Infect Control 2021; 49:506-507. [PMID: 33388312 PMCID: PMC7836216 DOI: 10.1016/j.ajic.2020.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 11/27/2022]
Abstract
Coronavirus Disease 2019 infections among healthcare workers were widely reported in China and Europe as the pandemic expanded to the United States. In order to examine the infection rate among these essential workers, we combined results of SARS-CoV-2 serology testing offered free to healthcare workers at two large San Diego health systems when the antibody assays first became available.
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10
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Struss W, Garrett A, Hamer K, Marsh C, Chedgy E, Dudderidge T, Somani B, Dyer J. Patient triggered follow up (PTFU) for prostate cancer patients post radiotherapy and radical prostatectomy. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32713-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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11
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Harper A, Gerth A, Marsh C, Park C. Atrial fibrillation and non-ischaemic cardiomyopathy in the peripartum period. Anaesth Rep 2020; 8:152-155. [PMID: 33305289 DOI: 10.1002/anr3.12078] [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] [Accepted: 09/22/2020] [Indexed: 11/07/2022] Open
Abstract
A 31-year-old primiparous woman with a history of bigeminy as a teenager developed atrial fibrillation with rapid ventricular response during elective caesarean section. Initial postoperative medical management was undertaken on the maternal high dependency unit and involved the administration of beta-blockers and digoxin. On postoperative day 1 the patient was transferred to the coronary care unit where she subsequently required synchronised direct current cardioversion to restore sinus rhythm. The patient remained on the coronary care unit for 5 days before discharge. Magnetic resonance imaging undertaken 6 weeks postpartum showed non-ischaemic cardiomyopathy. In this report, we discuss tachycardia-induced and peripartum cardiomyopathies, along with their potential underlying pathologies, incidence and associated morbidity. We describe potential pharmacological therapies including beta-blockers and angiotensin-converting enzyme inhibitors, as well as the implications of such medications for breastfeeding mothers. Patients presenting with palpitations in the antenatal period should receive prompt investigation including electrocardiography with ambulatory monitoring considered for those with persistent symptoms. Anyone with a proven cardiac arrhythmia should undergo echocardiography. This report illustrates the importance of the investigation of the symptoms of arrhythmia during pregnancy and emphasises the role of multidisciplinary working in the management of obstetric patients with complex medical comorbidity.
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Affiliation(s)
- A Harper
- Department of Paediatric Intensive Care Bristol Royal Hospital for Children Bristol UK
| | - A Gerth
- Addenbrookes Hospital Cambridge UK
| | - C Marsh
- Department of Anaesthesia Royal United Hospital Bath UK
| | - C Park
- Department of Obstetrics Royal United Hospital Bath UK
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Abernethy G, Otter D, Arnold K, Austad J, Christiansen S, Ferreira I, Irvine F, Marsh C, Massom LR, Otter D, Pearce K, Stevens J, Szpylka J, Vyas P, Woollard D, Wu C. Determination of Immunoglobulin G in Bovine Colostrum and Milk Powders, and in Dietary Supplements of Bovine Origin by Protein G Affinity Liquid Chromatography: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/93.2.622] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
An AOAC collaborative study was conducted to evaluate an affinity LC procedure for measuring immunoglobulin G (IgG) in selected dairy powders. The powders were extracted with 0.15 M sodium chloride solution and the pH was adjusted to 4.6 to precipitate caseins, which would otherwise lead to an overestimation of IgG. The analyte was then bound to a commercially available Protein G affinity cartridge and selectively eluted with a glycine buffer at pH 2.5. Detection was at 280 nm and quantification was made against a calibration curve prepared from bovine serum IgG. The samples analyzed included the likely matrixes for which this assay will find commercial use, namely, high- and low-protein-content colostrum powders, tablets containing colostrum powder, and some IgG-containing dairy powders; milk protein isolate, whey protein concentrate, and skim milk powder. Eleven laboratories provided data for the study and assayed blind duplicates of six materials. The repeatability RSD values ranged from 2.1 to 4.2 and the reproducibility RSD values ranged from 6.4 to 18.5. The Protein G method with casein removal has adequate reproducibility for measuring IgG in colostrum-derived powders that are traded on the basis of IgG content as a colostral marker.
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Affiliation(s)
- Grant Abernethy
- Fonterra Co-operative Group Ltd, Private Bag 11029, Palmerston North 4442, New Zealand
| | - Don Otter
- AgResearch Ltd, Grasslands Research Centre, Tennent Dr, Private Bag 11008, Palmerston North 4442, New Zealand
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13
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Soo E, Welch A, Marsh C, McKay DB. Molecular strategies used by hibernators: Potential therapeutic directions for ischemia reperfusion injury and preservation of human donor organs. Transplant Rev (Orlando) 2019; 34:100512. [PMID: 31648853 DOI: 10.1016/j.trre.2019.100512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 12/12/2022]
Affiliation(s)
- E Soo
- Scripps Research, Department of Immunology and Molecular Biology, 10550 North Torrey Pines Rd, La Jolla, CA, United States of America; Scripps Clinic and Green Hospital, Department of Medicine and Surgery, 10660 North Torrey Pines Rd, La Jolla, CA, United States of America
| | - A Welch
- Scripps Research, Department of Immunology and Molecular Biology, 10550 North Torrey Pines Rd, La Jolla, CA, United States of America
| | - C Marsh
- Scripps Clinic and Green Hospital, Department of Medicine and Surgery, 10660 North Torrey Pines Rd, La Jolla, CA, United States of America
| | - D B McKay
- Scripps Research, Department of Immunology and Molecular Biology, 10550 North Torrey Pines Rd, La Jolla, CA, United States of America; Scripps Clinic and Green Hospital, Department of Medicine and Surgery, 10660 North Torrey Pines Rd, La Jolla, CA, United States of America.
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14
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Rought P, Marsh C, Pili S, Silverwood IP, Sakai VG, Li M, Brown MS, Argent SP, Vitorica-Yrezabal I, Whitehead G, Warren MR, Yang S, Schröder M. Modulating proton diffusion and conductivity in metal-organic frameworks by incorporation of accessible free carboxylic acid groups. Chem Sci 2019; 10:1492-1499. [PMID: 30809366 PMCID: PMC6354967 DOI: 10.1039/c8sc03022g] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 11/02/2018] [Indexed: 11/23/2022] Open
Abstract
Three multi-carboxylic acid functionalised ligands have been designed, synthesised and utilised to prepare the new barium-based MOFs, MFM-510, -511, and -512, which show excellent stability to water-vapour. MFM-510 and MFM-511 show moderate proton conductivities (2.1 × 10-5 and 5.1 × 10-5 S cm-1, respectively) at 99% RH and 298 K, attributed to the lack of free protons or hindered proton diffusion within the framework structures. In contrast, MFM-512, which incorporates a pendant carboxylic acid group directed into the pore of the framework, shows a two orders of magnitude enhancement in proton conductivity (2.9 × 10-3 S cm-1). Quasi-elastic neutron scattering (QENS) suggests that the proton dynamics of MFM-512 are mediated by "free diffusion inside a sphere" confirming that incorporation of free carboxylic acid groups within the pores of MOFs is an efficient albeit synthetically challenging strategy to improve proton conductivity.
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Affiliation(s)
- Peter Rought
- School of Chemistry , University of Manchester , Manchester M13 9PL , UK . ;
| | - Christopher Marsh
- School of Chemistry , University of Manchester , Manchester M13 9PL , UK . ;
| | - Simona Pili
- School of Chemistry , University of Manchester , Manchester M13 9PL , UK . ;
| | - Ian P Silverwood
- ISIS Pulsed Neutron and Muon Source , Rutherford Appleton Laboratory , Oxfordshire OX11 0QX , UK
| | - Victoria García Sakai
- ISIS Pulsed Neutron and Muon Source , Rutherford Appleton Laboratory , Oxfordshire OX11 0QX , UK
| | - Ming Li
- School of Engineering , University of Nottingham , Nottingham NG7 2RD , UK
| | - Martyn S Brown
- School of Chemistry , University of Manchester , Manchester M13 9PL , UK . ;
| | - Stephen P Argent
- School of Chemistry , University of Warwick , Coventry CV4 7AL , UK
| | | | - George Whitehead
- School of Chemistry , University of Manchester , Manchester M13 9PL , UK . ;
| | - Mark R Warren
- Diamond Light Source , Harwell Science and Innovation Campus , Oxfordshire OX11 0DE , UK
| | - Sihai Yang
- School of Chemistry , University of Manchester , Manchester M13 9PL , UK . ;
| | - Martin Schröder
- School of Chemistry , University of Manchester , Manchester M13 9PL , UK . ;
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Friedewald JJ, Kurian SM, Heilman RL, Whisenant TC, Poggio ED, Marsh C, Baliga P, Odim J, Brown MM, Ikle DN, Armstrong BD, charette JI, Brietigam SS, Sustento-Reodica N, Zhao L, Kandpal M, Salomon DR, Abecassis MM. Development and clinical validity of a novel blood-based molecular biomarker for subclinical acute rejection following kidney transplant. Am J Transplant 2019; 19:98-109. [PMID: 29985559 PMCID: PMC6387870 DOI: 10.1111/ajt.15011] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [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: 04/25/2018] [Revised: 06/12/2018] [Accepted: 07/03/2018] [Indexed: 01/25/2023]
Abstract
Noninvasive biomarkers are needed to monitor stable patients after kidney transplant (KT), because subclinical acute rejection (subAR), currently detectable only with surveillance biopsies, can lead to chronic rejection and graft loss. We conducted a multicenter study to develop a blood-based molecular biomarker for subAR using peripheral blood paired with surveillance biopsies and strict clinical phenotyping algorithms for discovery and validation. At a predefined threshold, 72% to 75% of KT recipients achieved a negative biomarker test correlating with the absence of subAR (negative predictive value: 78%-88%), while a positive test was obtained in 25% to 28% correlating with the presence of subAR (positive predictive value: 47%-61%). The clinical phenotype and biomarker independently and statistically correlated with a composite clinical endpoint (renal function, biopsy-proved acute rejection, ≥grade 2 interstitial fibrosis, and tubular atrophy), as well as with de novo donor-specific antibodies. We also found that <50% showed histologic improvement of subAR on follow-up biopsies despite treatment and that the biomarker could predict this outcome. Our data suggest that a blood-based biomarker that reduces the need for the indiscriminate use of invasive surveillance biopsies and that correlates with transplant outcomes could be used to monitor KT recipients with stable renal function, including after treatment for subAR, potentially improving KT outcomes.
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Affiliation(s)
| | | | | | - Thomas C. Whisenant
- UC San Diego Center for Computational Biology & Bioinformatics, San Diego, CA, USA
| | | | | | | | - Jonah Odim
- National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Merideth M. Brown
- National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | | | | | - jane I. charette
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Lihui Zhao
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Manoj Kandpal
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Grandhe S, Lee JA, Chandra A, Marsh C, Frenette CT. Trapped vessel of abdominal pain with hepatomegaly: A case report. World J Hepatol 2018; 10:887-891. [PMID: 30533189 PMCID: PMC6280163 DOI: 10.4254/wjh.v10.i11.887] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/17/2018] [Accepted: 10/10/2018] [Indexed: 02/06/2023] Open
Abstract
Abdominal pain with elevated transaminases from inferior vena cava (IVC) obstruction is a relatively common reason for referral and further workup by a hepatologist. The differential for the cause of IVC obstruction is extensive, and the most common etiologies include clotting disorders or recent trauma. In some situations the common etiologies have been ruled out, and the underlying process for the patient’s symptoms is still not explained. We present one unique case of abdominal pain and hepatomegaly secondary to IVC constriction from extrinsic compression of the diaphragm. Based on this patient’s presentation, we urge that physicians be cognizant of the IVC diameter and consider extrinsic compression as a contributor to the patient’s symptoms. If IVC compression from the diaphragm is confirmed, early referral to vascular surgery is strongly advised for further surgical intervention.
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Affiliation(s)
- Sirisha Grandhe
- Department of Gastroenterology and Hepatology, University of California Davis Medical Center, Sacramento, CA 95817, United States
| | - Joy A Lee
- Department of Internal Medicine, Scripps Green Hospital, La Jolla, CA 92037, United States
| | - Ankur Chandra
- Department of Vascular Surgery, Scripps Green Hospital, La Jolla, CA 92037, United States
| | - Christopher Marsh
- Scripps Center for Organ Transplant, Scripps Green Hospital, La Jolla, CA 92037, United States
| | - Catherine T Frenette
- Scripps Center for Organ Transplant, Scripps Green Hospital, La Jolla, CA 92037, United States
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Affiliation(s)
- M E Vaglio
- Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas
| | - C Marsh
- Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas
| | - E Carey
- Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas
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Marsh C, Link A, King-Bailey G, Donati G. Effects of Fragment and Vegetation Structure on the Population Abundance of Ateles hybridus, Alouatta seniculus and Cebus albifrons in Magdalena Valley, Colombia. Folia Primatol (Basel) 2016; 87:17-30. [DOI: 10.1159/000443929] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 01/04/2016] [Indexed: 11/19/2022]
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Abstract
OBJECTIVE Epidermolysis bullosa (EB) describes a number of genetically inherited conditions which cause skin fragility and minor trauma leading to skin damage, skin loss and wounding. Owing to the fragility of the skin and requirement for frequent dressing changes, at present, the optimal dressing(s) is not clear. Our objective was to assess the use of a keratin gel in the management of wounds in patients with different forms of EB. METHOD We treated patients with different types of EB and a range of wounds with a novel keratin gel. In a convenience sample of consecutive patients, we introduced the keratin gel into their treatment regimen maintaining other aspects of their care. RESULTS Patients reported faster healing and more resilient healed skin. Of the ten patients treated in this pilot study, six found the gel effective; two found it ineffective; and in two patients, it caused itching leading to discontinuation of the treatment. CONCLUSION The results of this case study series suggest that keratin gel can be useful in the management of EB and are consistent with previous published experiences.
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Affiliation(s)
- J Denyer
- EB Clinical Nurse Specialist, Great Ormond Street Hospital, London, UK
| | - C Marsh
- Wound Care Business Manager, Keraplast Research, Christchurch, New Zealand
| | - R S Kirsner
- Professor and Interim Chair, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, USA
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Everett TC, Ng E, Power D, Marsh C, Tolchard S, Shadrina A, Bould MD. The Managing Emergencies in Paediatric Anaesthesia global rating scale is a reliable tool for simulation-based assessment in pediatric anesthesia crisis management. Paediatr Anaesth 2013; 23:1117-23. [PMID: 23800112 DOI: 10.1111/pan.12212] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The use of simulation-based assessments for high-stakes physician examinations remains controversial. The Managing Emergencies in Paediatric Anaesthesia course uses simulation to teach evidence-based management of anesthesia crises to trainee anesthetists in the United Kingdom (UK) and Canada. In this study, we investigated the feasibility and reliability of custom-designed scenario-specific performance checklists and a global rating scale (GRS) assessing readiness for independent practice. METHODS After research ethics board approval, subjects were videoed managing simulated pediatric anesthesia crises in a single Canadian teaching hospital. Each subject was randomized to two of six different scenarios. All 60 scenarios were subsequently rated by four blinded raters (two in the UK, two in Canada) using the checklists and GRS. The actual and predicted reliability of the tools was calculated for different numbers of raters using the intraclass correlation coefficient (ICC) and the Spearman-Brown prophecy formula. RESULTS Average measures ICCs ranged from 'substantial' to 'near perfect' (P ≤ 0.001). The reliability of the checklists and the GRS was similar. Single measures ICCs showed more variability than average measures ICC. At least two raters would be required to achieve acceptable reliability. CONCLUSIONS We have established the reliability of a GRS to assess the management of simulated crisis scenarios in pediatric anesthesia, and this tool is feasible within the setting of a research study. The global rating scale allows raters to make a judgement regarding a participant's readiness for independent practice. These tools may be used in the future research examining simulation-based assessment.
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Affiliation(s)
- Tobias C Everett
- Department of Anesthesiology and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Homa L, Marsh C, Will M, Fisseha S, Skorupski J. Use of high cost monitoring during letrozole ovulation induction and effect on pregnancy rates - a randomized controlled pilot study. Fertil Steril 2013. [DOI: 10.1016/j.fertnstert.2013.07.1134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Teperman L, Moonka D, Sebastian A, Sher L, Marotta P, Marsh C, Koneru B, Goss J, Preston D, Roberts JP. Calcineurin inhibitor-free mycophenolate mofetil/sirolimus maintenance in liver transplantation: the randomized spare-the-nephron trial. Liver Transpl 2013; 19:675-89. [PMID: 23775875 DOI: 10.1002/lt.23658] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Accepted: 04/08/2013] [Indexed: 12/12/2022]
Abstract
Mycophenolate mofetil (MMF) and sirolimus (SRL) have been used for calcineurin inhibitor (CNI) minimization to reduce nephrotoxicity following liver transplantation. In this prospective, open-label, multicenter study, patients undergoing transplantation from July 2005 to June 2007 who were maintained on MMF/CNI were randomized 4 to 12 weeks after transplantation to receive MMF/SRL (n = 148) or continue MMF/CNI (n = 145) and included in the intent-to-treat population. The primary efficacy endpoints were the mean percentage change in the calculated glomerular filtration rate (GFR) and a composite of biopsy-proven acute rejection (BPAR), graft lost, death, and lost to follow-up 12 months after transplantation. Patients were followed for a median of 519 days after randomization. MMF/SRL was associated with a significantly greater renal function improvement from baseline with a mean percentage change in GFR of 19.7 ± 40.6 (versus 1.2 ± 39.9 for MMF/CNI, P = 0.0012). The composite endpoint demonstrated the noninferiority of MMF/SRL versus MMF/CNI (16.4% versus 15.4%, 90% confidence interval = -7.1% to 9.0%). The incidence of BPAR was significantly greater with MMF/SRL (12.2%) versus MMF/CNI (4.1%, P = 0.02). Graft loss (including death) occurred in 3.4% of the MMF/SRL-treated patients and in 8.3% of the MMF/CNI-treated patients (P = 0.04). Malignancy-related deaths were less frequent with MMF/SRL. Adverse events caused withdrawal for 34.2% of the MMF/SRL-treated patients and for 24.1% of the MMF/CNI-treated patients (P = 0.06). The use of MMF/SRL is an option for liver transplant recipients who can benefit from improved renal function but is associated with an increased risk of rejection (but not graft loss).
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Affiliation(s)
- Lewis Teperman
- Mary Lea Johnson Richards Organ Transplant Center, New York University School of Medicine, New York, NY 10016, USA.
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Turnbull A, Marsh C. Peri-operative anisocoria - the importance of pupil assessment before general anaesthesia. Anaesthesia 2012; 67:1053-4. [DOI: 10.1111/j.1365-2044.2012.07282.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shirley LA, Marsh C, Walker J, Coyle W, Tahiri S, Manzanera AG, Aguilar LK, Aguilar-Cordova E, Chung VM, Bloomston M. Phase I trial of gene-mediated cytotoxic immunotherapy combined with resection for pancreatic adenocarcinoma. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.241] [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
241 Background: While surgical resection of pancreatic adenocarcinoma provides the only chance of cure, long-term survival is still poor. Immunotherapy approaches may improve outcomes. Gene Mediated Cytotoxic Immunotherapy (GMCI) generates a systemic anti-tumor vaccine effect through intra-tumoral delivery of an adenoviral vector expressing the HSV-thymidine kinase gene (AdV-tk) followed by anti-herpetic prodrug administration. This is the first application of GMCI in pancreatic cancer. Methods: This study evaluated 4 dose levels of AdV-tk (3x1010 to 1x1012 vector particles) injected into pancreatic tumors via EUS 2 weeks before resection. Patients then underwent attempt at resection. If resection was undertaken, AdV-tk was injected into the resection bed. If resection was not possible, AdV-tk was injected into the primary tumor. The prodrug, Valacyclovir, was given for 14 days after each injection. Postoperative therapy was not protocol-driven. Results: The study accrued 14 patients with 12 completing therapy: 3 at each of the 4 planned dose levels. One patient died of an unrelated myocardial infarction 2 days after initial injection and one patient dropped out mid-treatment after metastases were found at surgery. Median age was 67 years (range 40-81). Of 12 patients explored, 4 were not resected due to distant metastases (N=3) or locally advanced disease (N=1). Three patients had Grade 3 possibly-related adverse events: 2 abdominal pain and one dehydration with renal insufficiency. There were no dose limiting toxicities and no grade 4 clinical adverse events. Grade 3-4 laboratory abnormalities were AST/ALT, bilirubin, alkaline phosphatase and lipase, all in patients with obstructive jaundice. Post-operative complications included 2 patients who developed abscesses requiring drainage. Six of 12 patients are alive 5-34 months after start of treatment including 5 resected patients and one unresected. Conclusions: AdV-tk can be safely injected into potentially resectable pancreatic tumors prior to planned resection. Early results are encouraging and justify further evaluation in a Phase 2 study.
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Affiliation(s)
- Lawrence Andrew Shirley
- The Ohio State University Medical Center, Columbus, OH; Scripps Green Hospital, La Jolla, CA; The Ohio State University, Columbus, OH; Advantagene, Inc., Auburndale, MA; City of Hope, Duarte, CA; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Christopher Marsh
- The Ohio State University Medical Center, Columbus, OH; Scripps Green Hospital, La Jolla, CA; The Ohio State University, Columbus, OH; Advantagene, Inc., Auburndale, MA; City of Hope, Duarte, CA; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Jon Walker
- The Ohio State University Medical Center, Columbus, OH; Scripps Green Hospital, La Jolla, CA; The Ohio State University, Columbus, OH; Advantagene, Inc., Auburndale, MA; City of Hope, Duarte, CA; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Walter Coyle
- The Ohio State University Medical Center, Columbus, OH; Scripps Green Hospital, La Jolla, CA; The Ohio State University, Columbus, OH; Advantagene, Inc., Auburndale, MA; City of Hope, Duarte, CA; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Sanaa Tahiri
- The Ohio State University Medical Center, Columbus, OH; Scripps Green Hospital, La Jolla, CA; The Ohio State University, Columbus, OH; Advantagene, Inc., Auburndale, MA; City of Hope, Duarte, CA; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Andrea G Manzanera
- The Ohio State University Medical Center, Columbus, OH; Scripps Green Hospital, La Jolla, CA; The Ohio State University, Columbus, OH; Advantagene, Inc., Auburndale, MA; City of Hope, Duarte, CA; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Laura K. Aguilar
- The Ohio State University Medical Center, Columbus, OH; Scripps Green Hospital, La Jolla, CA; The Ohio State University, Columbus, OH; Advantagene, Inc., Auburndale, MA; City of Hope, Duarte, CA; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Estuardo Aguilar-Cordova
- The Ohio State University Medical Center, Columbus, OH; Scripps Green Hospital, La Jolla, CA; The Ohio State University, Columbus, OH; Advantagene, Inc., Auburndale, MA; City of Hope, Duarte, CA; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Vincent M. Chung
- The Ohio State University Medical Center, Columbus, OH; Scripps Green Hospital, La Jolla, CA; The Ohio State University, Columbus, OH; Advantagene, Inc., Auburndale, MA; City of Hope, Duarte, CA; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Mark Bloomston
- The Ohio State University Medical Center, Columbus, OH; Scripps Green Hospital, La Jolla, CA; The Ohio State University, Columbus, OH; Advantagene, Inc., Auburndale, MA; City of Hope, Duarte, CA; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH
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Platter E, Lawson M, Marsh C, Sazinsky MH. Characterization of a non-ribosomal peptide synthetase-associated diiron arylamine N-oxygenase from Pseudomonas syringae pv. phaseolicola. Arch Biochem Biophys 2011; 508:39-45. [DOI: 10.1016/j.abb.2011.01.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 01/10/2011] [Accepted: 01/12/2011] [Indexed: 11/16/2022]
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Bloomston M, Marsh C, Walker J, Coyle W, Marx H, Tahiri S, Moran Cruz C, Aguilar LK, Aguilar-Cordova E, Chung VM. Phase I trial of gene-mediated cytotoxic immunotherapy in combination with chemoradiation for locally advanced pancreatic cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.195] [Citation(s) in RCA: 2] [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
195 Background: More than 80% of patients with pancreatic cancer present with locally advanced or metastatic disease and have a median survival of only 6 months. Immunotherapy approaches may improve outcomes. Gene Mediated Cytotoxic Immunotherapy (GMCI) is an approach that generates a systemic anti-tumor vaccine effect through intra-tumoral delivery of an adenoviral vector expressing the HSV-thymidine kinase gene (AdV-tk) followed by anti-herpetic prodrug and synergy with chemoradiation. The mechanisms of action involve tumor cytotoxicity, activation of antigen presenting cells and stimulation of systemic anti-tumor T-cell immunity. Safety with potential efficacy has been demonstrated in multiple clinical studies. This is the first application of GMCI in pancreatic cancer. Methods: This study evaluated 4 dose levels of AdV-tk (3x1010 to 1x1012 vector particles) injected into locally advanced tumors via EUS or CT-guidance before and during week 3 of standard 5-FU-chemoradiation. Valacyclovir (Valtrex, GSK) prodrug was given for 14 days after each of 2 AdV-tk injections. Results: The study completed accrual with 13 patients enrolled and 12 completing therapy with 3 at each of the 4 dose levels. One patient refused further participation during course 1 after recovering from azotemia. Median age was 64 years (range 55-81) and median baseline CA19-9 was 1634 U/ml. No dose limiting toxicities and no injection related complications occurred. Possibly related grade 3-4 toxicities, all of which were transient, included dehydration, azotemia and worsening elevation of bilirubin and AST. Kaplan-Meier estimated median survival is 12.2 months with 6 patients still alive at 8-20 months. Two patients achieved a partial response by RECIST criteria. One occurred in week 6 despite discontinuing 5-FU/radiation during week 1. The other had gradual decrease of a 7 cm tumor over 11 months. Serum CA19-9 levels decreased in 8/8 evaluable patients by 32-91% at 3 months after treatment initiation. Conclusions: AdV-tk can be safely injected into pancreatic tumors and combined with standard chemoradiation. Early results are highly encouraging and justify further evaluation in a phase II study. [Table: see text]
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Affiliation(s)
- M. Bloomston
- The Ohio State University Medical Center, Columbus, OH; Scripps Green Hospital, La Jolla, CA; City of Hope National Medical Center, Duarte, CA; The Ohio State University, Columbus, OH; Advantagene, Inc., Auburndale, MA; City of Hope, Duarte, CA
| | - C. Marsh
- The Ohio State University Medical Center, Columbus, OH; Scripps Green Hospital, La Jolla, CA; City of Hope National Medical Center, Duarte, CA; The Ohio State University, Columbus, OH; Advantagene, Inc., Auburndale, MA; City of Hope, Duarte, CA
| | - J. Walker
- The Ohio State University Medical Center, Columbus, OH; Scripps Green Hospital, La Jolla, CA; City of Hope National Medical Center, Duarte, CA; The Ohio State University, Columbus, OH; Advantagene, Inc., Auburndale, MA; City of Hope, Duarte, CA
| | - W. Coyle
- The Ohio State University Medical Center, Columbus, OH; Scripps Green Hospital, La Jolla, CA; City of Hope National Medical Center, Duarte, CA; The Ohio State University, Columbus, OH; Advantagene, Inc., Auburndale, MA; City of Hope, Duarte, CA
| | - H. Marx
- The Ohio State University Medical Center, Columbus, OH; Scripps Green Hospital, La Jolla, CA; City of Hope National Medical Center, Duarte, CA; The Ohio State University, Columbus, OH; Advantagene, Inc., Auburndale, MA; City of Hope, Duarte, CA
| | - S. Tahiri
- The Ohio State University Medical Center, Columbus, OH; Scripps Green Hospital, La Jolla, CA; City of Hope National Medical Center, Duarte, CA; The Ohio State University, Columbus, OH; Advantagene, Inc., Auburndale, MA; City of Hope, Duarte, CA
| | - C. Moran Cruz
- The Ohio State University Medical Center, Columbus, OH; Scripps Green Hospital, La Jolla, CA; City of Hope National Medical Center, Duarte, CA; The Ohio State University, Columbus, OH; Advantagene, Inc., Auburndale, MA; City of Hope, Duarte, CA
| | - L. K. Aguilar
- The Ohio State University Medical Center, Columbus, OH; Scripps Green Hospital, La Jolla, CA; City of Hope National Medical Center, Duarte, CA; The Ohio State University, Columbus, OH; Advantagene, Inc., Auburndale, MA; City of Hope, Duarte, CA
| | - E. Aguilar-Cordova
- The Ohio State University Medical Center, Columbus, OH; Scripps Green Hospital, La Jolla, CA; City of Hope National Medical Center, Duarte, CA; The Ohio State University, Columbus, OH; Advantagene, Inc., Auburndale, MA; City of Hope, Duarte, CA
| | - V. M. Chung
- The Ohio State University Medical Center, Columbus, OH; Scripps Green Hospital, La Jolla, CA; City of Hope National Medical Center, Duarte, CA; The Ohio State University, Columbus, OH; Advantagene, Inc., Auburndale, MA; City of Hope, Duarte, CA
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Kurian S, Williams A, Campbell D, Mondala T, Head S, Horvath S, Gaber L, Lin W, Robison E, Schaffer R, Fisher J, Flechner SM, Chan L, Wiseman A, Shidban H, Mendez R, Heilman R, Marsh C, Salomon D. DISCOVERY AND VALIDATION OF PERIPHERAL BLOOD DIAGNOSTIC BIOMARKERS FOR ACUTE KIDNEY REJECTION: REPORT OF THE TGCG STUDY. Transplantation 2010. [DOI: 10.1097/00007890-201007272-00459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Azithromycin enhances the response to root planing and produces anti-inflammatory effects in treating chronic lung disease. This led us to hypothesize that azithromycin inhibits inflammatory mediator production in gingiva, leading to decreased gingival crevicular fluid (GCF) volume. To test this hypothesis, ten periodontally healthy volunteers received azithromycin every 24 hours for 48 hours. GCF samples were collected from 12 maxillary interproximal sites prior to azithromycin (baseline) and 2, 4, 7, and 14 days later. Samples were assayed for IL-1beta, IL-8, TNF-alpha, VEGF, IL-6, and IL-10. With azithromycin treatment, GCF volume decreased significantly on days 2 through 7 (P < 0.05), but increased toward baseline levels on day 14. This was accompanied by a transient decrease in the content of IL-1beta, IL-8, TNF-alpha, and VEGF (P < 0.05). IL-6 and IL-10 were not detected. Since plaque was absent throughout the study, the findings suggest that azithromycin produces anti-inflammatory effects in gingiva.
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Affiliation(s)
- W Ho
- Division of Periodontology, College of Dentistry, 305 West 12th Avenue
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Abernethy G, Otter D, Arnold K, Austad J, Christiansen S, Ferreira I, Irvine F, Marsh C, Massom LR, Otter D, Pearce K, Stevens J, Szpylka J, Vyas P, Woollard D, Wu C. Determination of immunoglobulin G in bovine colostrum and milk powders, and in dietary supplements of bovine origin by protein G affinity liquid chromatography: collaborative study. J AOAC Int 2010; 93:622-627. [PMID: 20480910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
An AOAC collaborative study was conducted to evaluate an affinity LC procedure for measuring immunoglobulin G (IgG) in selected dairy powders. The powders were extracted with 0.15 M sodium chloride solution and the pH was adjusted to 4.6 to precipitate caseins, which would otherwise lead to an overestimation of IgG. The analyte was then bound to a commercially available Protein G affinity cartridge and selectively eluted with a glycine buffer at pH 2.5. Detection was at 280 nm and quantification was made against a calibration curve prepared from bovine serum IgG. The samples analyzed included the likely matrixes for which this assay will find commercial use, namely, high- and low-protein-content colostrum powders, tablets containing colostrum powder, and some IgG-containing dairy powders; milk protein isolate, whey protein concentrate, and skim milk powder. Eleven laboratories provided data for the study and assayed blind duplicates of six materials. The repeatability RSD values ranged from 2.1 to 4.2% and the reproducibility RSD values ranged from 6.4 to 18.5%. The Protein G method with casein removal has adequate reproducibility for measuring IgG in colostrum-derived powders that are traded on the basis of IgG content as a colostral marker.
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Affiliation(s)
- Grant Abernethy
- Fonterra Co-operative Group Ltd, Private Bag 11029, Palmerston North 4442, New Zealand.
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Perrine TM, Smith RG, Marsh C, Dunietz BD. Gating of single molecule transistors: Combining field-effect and chemical control. J Chem Phys 2008; 128:154706. [DOI: 10.1063/1.2897425] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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31
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Rivera L, Giap H, Miller W, Fisher J, Hillebrand DJ, Marsh C, Schaffer RL. Hepatic intra-arterial infusion of yttrium-90 microspheres in the treatment of recurrent hepatocellular carcinoma after liver transplantation: A case report. World J Gastroenterol 2006; 12:5729-32. [PMID: 17007031 PMCID: PMC4088179 DOI: 10.3748/wjg.v12.i35.5729] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) recurs with a reported frequency of 12%-18% after liver transplantation. Recurrence is associated with a mortality rate exceeding 75%. Approximately one-third of recurrences develop in the transplanted liver and are therefore amenable to local therapy. A variety of treatment modalities have been reported including resection, transarterial chemo-embolization (TACE), radiofrequency ablation (RFA), ethanol ablation, cryoablation, and external beam irradiation. Goals of treatment are tumor control and the minimization of toxic effect to functional parenchyma. Efficacy of treatment is mitigated by the need for ongoing immunosuppression. Yttrium-90 microspheres have been used as a treatment modality both for primary HCC and for pre-transplant management of HCC with promising results.
Twenty-two months after liver transplantation for hepatitis C cirrhosis complicated by HCC, a 42-year old man developed recurrence of HCC in his transplant allograft. Treatment of multiple right lobe lesions with anatomic resection and adjuvant chemotherapy was unsuccessful. Multifocal recurrence in the remaining liver allograft was treated with hepatic intra-arterial infusion of yttrium-90 microspheres (SIR-Spheres, Sirtex Medical Inc., Lake Forest, IL, USA). Efficacy was demonstrated by tumor necrosis on imaging and a decrease in alpha-fetoprotein (AFP) level. There were no adverse consequences of initial treatment.
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Affiliation(s)
- Louis Rivera
- Scripps Center for Organ and Cell Transplantation, 10666 N. Torrey Pines Rd, MD 200N, La Jolla, CA 92037, USA
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32
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Dai Y, Hebert MF, Isoherranen N, Davis CL, Marsh C, Shen DD, Thummel KE. EFFECT OFCYP3A5POLYMORPHISM ON TACROLIMUS METABOLIC CLEARANCE IN VITRO. Drug Metab Dispos 2006; 34:836-47. [PMID: 16501005 DOI: 10.1124/dmd.105.008680] [Citation(s) in RCA: 211] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Previous investigations of solid organ transplant patients treated with tacrolimus showed that individuals carrying a CYP3A5*1 allele have lower dose-adjusted trough blood concentrations compared with homozygous CYP3A5*3 individuals. The objective of this investigation was to quantify the contribution of CYP3A5 to the hepatic and renal metabolic clearance of tacrolimus. Four primary tacrolimus metabolites, 13-O-desmethyl tacrolimus (13-DMT) (major), 15-O-desmethyl tacrolimus, 31-O-desmethyl tacrolimus (31-DMT), and 12-hydroxy tacrolimus (12-HT), were generated by human liver microsomes and heterologously expressed CYP3A4 and CYP3A5. The unbound tacrolimus concentration was low (4-15%) under all incubation conditions. For CYP3A4 and CYP3A5, V(max) was 8.0 and 17.0 nmol/min/nmol enzyme and K(m,u) was 0.21 and 0.21 muM, respectively. The intrinsic clearance of CYP3A5 was twice that of CYP3A4. The formation rates of 13-DMT, 31-DMT, and 12-HT were >or=1.7-fold higher, on average, in human liver microsomes with a CYP3A5*1/*3 genotype compared with those with a homozygous CYP3A5*3/*3 genotype. Tacrolimus disappearance clearances were 15.9 +/- 9.8 ml/min/mg protein and 6.1 +/- 3.6 ml/min/mg protein, respectively, for the two genotypes. In vitro to in vivo scaling using both liver microsomes and recombinant enzymes yielded higher predicted in vivo tacrolimus clearances for patients with a CYP3A5*1/*3 genotype compared with those with a CYP3A5*3/*3 genotype. In addition, formation of 13-DMT was 13.5-fold higher in human kidney microsomes with a CYP3A5*1/*3 genotype compared with those with a CYP3A5*3/*3 genotype. These data suggest that CYP3A5 contributes significantly to the metabolic clearance of tacrolimus in the liver and kidney.
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Affiliation(s)
- Yang Dai
- Department of Pharmaceutics, University of Washington, Seattle, 98195-7610, USA
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33
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Affiliation(s)
- Christopher Marsh
- Transplant Surgery, Scripps Center for Organ and Cell Transplantation, Scripps Clinic & Green Hospital, Department of Molecular and Experimental Medicine, The Scripps Reseach Institute, La Jolla, California
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35
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Abstract
A 42-yr-old male presented with a family history of pancreatic carcinoma inherited an autosomal dominant pattern. The development of endocrine and exocrine pancreatic insufficiency served as early markers for neoplastic transformation. Screening endoscopic ultrasound and ERCP showed abnormalities suggestive of pancreatic dysplasia. Total pancreatectomy was performed and pathology confirmed carcinoma in situ, also known as high-grade pancreatic ductal dysplasia or Pan IN-3. The patient's post-operative course was complicated by life threatening, brittle diabetes. Pancreas transplantation was successfully performed. One year following transplantation, the patient has excellent pancreas graft function. He remains insulin free and has no signs of malignancy. Total pancreatectomy followed by pancreas transplantation is a viable therapeutic option for patients in the dysplastic but still pre-malignant phase of familial pancreatic adenocarcinoma who develop hypoglycemic unawareness following total pancreatectomy.
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Affiliation(s)
- Kevin P Charpentier
- Department of Surgery, Division of General Surgery, University of Washington Medical Center, Washington, DC, USA
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36
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Abstract
Overexpression of fibroblast growth factor 8 (FGF8) mRNA has been previously described in prostate cancer. Of its four isoforms, FGF8b is thought to be the most important in carcinogenesis. We hypothesised that immunodetection of FGF8b in archival prostate cancer specimens is of potential prognostic value. Using a selected cohort of prostate tumours from transurethral (n=30) and radical prostatectomies (n=59), an optimised protocol for FGF8b immunoreactivity was used to corroborate expression with clinical parameters. No expression was observed in benign prostates (n=10). In prostate cancer, immunoreactivity was localised to the malignant epithelium with weak signals in the adjacent stroma. Expression of FGF8b in stage T1 and T2 cancers were 40 and 67%, respectively. In contrast, FGF8b expression was present in 94% of T3 and 100% of T4 cancers. By histological grade, FGF8b was found in 41% of low-grade cancers (Gleason score 4-6), 60% of intermediate-grade cancers (Gleason score 7 and 92% of high-grade cancers (Gleason score 8-10). The intensity of expression was significantly associated with stage (P=0.0004) and grade (P<0.0001) of disease. We further hypothesised that FGF8b overexpression resulted from enhanced transcription and translation rather than from abnormalities involving the FGF8 gene locus. This was tested by means of fluorescent in situ hybridisation in 20 cancer specimens to map the FGF8 gene locus. FGF8 gene copy number in benign and malignant nuclei was found to be similar (2.33+/-0.57 and 2.0+/-0.81, respectively P=0.51). Based on these findings, we propose a multicentre study on cohorts of patients to further evaluate FGF8b as a potential prognostic marker in prostate cancer.
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Affiliation(s)
- V J Gnanapragasam
- Prostate Research Group, School of Surgical Sciences, University of Newcastle upon Tyne, Framlington Place, Newcastle upon Tyne NE2 4HH, UK.
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37
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Gallagher M, Pei J, Youngs D, Hamilton K, Yadock W, Dieterich S, Lagasca R, Mickelson E, Marsh C, Hansen J, Nelson K. Donor-specific hyporesponsiveness measured by CTLP and CFSE dye dilution. Hum Immunol 2002. [DOI: 10.1016/s0198-8859(02)00509-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
AIMS The histopathological diagnosis of chromophobe renal cell carcinoma can present a diagnostic challenge, as these tumours can resemble either conventional renal cell carcinoma or oncocytoma. The aim of this study was to determine whether cytokeratin 7 expression is of practical use in the distinction of these three entities. METHODS AND RESULTS A total of 40 cases previously diagnosed as either chromophobe renal cell carcinoma, conventional renal cell carcinoma or oncocytoma were identified. A representative section of each was stained with H&E and cytokeratin 7. Following independent review of the cases by three pathologists, a consensus diagnosis for each case was reached and the pattern of cytokeratin 7 staining was assessed. There were 12 cases of chromophobe renal cell carcinoma in the study, all of which showed a characteristic peripheral membrane pattern of staining for cytokeratin 7. Seventeen of the 18 cases of conventional renal cell carcinoma studied were negative for cytokeratin 7, while one case showed weak focal staining of <5% of the cells. The 10 cases of oncocytoma showed patchy weak to moderate cytoplasmic expression of cytokeratin 7, without the characteristic peripheral membrane accentuation seen in the chromophobe carcinomas. CONCLUSIONS Immunohistochemical staining for cytokeratin 7 appears to be a useful adjunct in the diagnosis of chromophobe renal cell carcinoma, and in distinguishing this tumour from both oncocytoma and conventional renal cell carcinoma.
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Affiliation(s)
- Marie E Mathers
- Department of Histopathology, Freeman Hospital, Newcastle upon Tyne, UK.
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39
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Abstract
Hock damage is one of the most common traumatic injuries suffered by dairy cows, but most hock injuries should be avoidable. This study investigated the effect of housing system on the development of hock damage in first lactation Holstein heifers. After calving, 60 heifers were randomly allocated to either straw yards, cubicles with butyl rubber mats or cubicles with mattresses filled with chopped tyres. The hocks of these heifers were examined in the first week after calving (week 1) and in weeks 6, 12 and 26 of lactation. Hock damage was scored as either 1 (hair loss only) or 2 (all other damage). Heifers housed in cubicles with mats had significantly worse lesions at week 26 than at week 1, while there was no change in heifers housed in cubicles with matresses, and heifers housed on straw had significantly lower lesion scores. Additionally, heifers with no lesions at calving were significantly more likely to develop lesions when kept on mats than heifers kept on straw or mattresses. These data suggest that replacing mats with mattresses in cubicles can result in a significant reduction in traumatic hock injury.
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Affiliation(s)
- C T Livesey
- Veterinary Laboratories Agency, New Haw, Addlestone, Surrey
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40
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Qureshi KN, Griffiths TR, Robinson MC, Marsh C, Roberts JT, Lunec J, Neal DE, Mellon JK. Combined p21WAF1/CIP1 and p53 overexpression predict improved survival in muscle-invasive bladder cancer treated by radical radiotherapy. Int J Radiat Oncol Biol Phys 2001; 51:1234-40. [PMID: 11728682 DOI: 10.1016/s0360-3016(01)01801-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The prognostic value of p21 and p53 expression was evaluated for patients with muscle-invasive bladder cancer treated by radical radiotherapy. METHODS AND MATERIALS Sixty-eight paraffin-embedded sections from surgically resected tumors taken prior to irradiation were immunostained for p21 and p53. RESULTS Nuclear staining for p21 and p53 was demonstrated in 32/68 (47%) and 46/68 (68%) tumors, respectively. There was no correlation between p21 and p53 immunopositivity in this group (r = 0.067, p = 0.56). Patients were stratified into four distinct groups depending on staining for p21 and p53: p21+p53+, p21+p53-, p21-p53+, and p21-p53-. Patients with p21+p53+ tumors had the best prognosis with a 3-year survival of 82% compared to 12% for p21-p53+ tumors (p = 0.0031), 29% for p21+p53- tumors (p = 0.0108); and 45% for p21-p53- tumors (p = 0.0375). The p21+p53+ group also demonstrated significantly improved survival when a combined analysis was performed of p21-p53+, p21-p53-, and p21+p53- tumors (3-year survival = 30%, p = 0.0062). In a multivariate model, p21+p53+ tumors (p = 0.0108, relative risk [RR] = 5.18) and complete/partial response (p = 0.0019, RR = 3.76) were the only independent predictors of improved survival. CONCLUSIONS With muscle-invasive bladder tumors treated by radical radiotherapy, stratification for p21 and p53 identifies distinct prognostic groups, with p21+p53+ tumors being associated with the best survival and p21-p53+ the worst.
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Affiliation(s)
- K N Qureshi
- Department of Surgery, The Medical School, University of Newcastle, Newcastle-upon-Tyne, United Kingdom.
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41
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Abstract
A total of 1,729 children (2nd-9th grades) in South Africa, Iceland, Poland, Australia, the U.K., and the U.S.A. rated 20 events in terms of how upsetting they are. Save in Poland, the ratings were in close agreement (r, .85-.97), placing the loss of parent at the top and a new baby sibling at the bottom. In Poland, the baby's arrival led the list. Even so, what was seen as quite upsetting fell everywhere in the same two categories--experiences that threaten one's sense of security and those that occasion personal denigration and embarrassment.
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Affiliation(s)
- K Yamamoto
- University of Colorado at Denver 80217, USA
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43
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Marsh C, Manners R, Platt M. Ptosis repair in a patient with oculopharyngeal dystrophy: brow suspension using autogenous fascia lata by spinal anaesthesia. Eye (Lond) 2000; 14 ( Pt 3A):389-90. [PMID: 11027008 DOI: 10.1038/eye.2000.96] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Paramalingam S, Winchester J, Marsh C. On the Fouling of Falling Film Evaporators Due to Film Break-Up. Food and Bioproducts Processing 2000. [DOI: 10.1205/096030800532770] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Fibroblast growth factors (FGFs) have been implicated in the development of numerous malignancies including prostate cancer. In a pilot study it has been shown that FGF8 mRNA is up-regulated in prostate cancer. The aim of the present study was to determine whether aFGF and bFGF were co-expressed with FGF8 in human prostate cancer. Twenty-nine cases of prostate cancer of different histological grades were examined. Immunohistochemical analysis was employed to study aFGF and bFGF expression. In the light of the results, aFGF immunoreactivity was studied in a further 43 cases. aFGF and bFGF immunoreactivity was identified in the cytoplasm of the malignant prostatic epithelium. aFGF was overexpressed in 62/72 (86.1 per cent) cases and bFGF in 19/29 (65.5 per cent). High levels of aFGF immunoreactivity were noted in areas of high-grade prostatic intraepithelial neoplasia (PIN). In this series, aFGF immunoreactivity was most commonly observed and correlated closely with Gleason score and tumour stage ( p=0.007 and 0.007, respectively). Co-localization of aFGF, bFGF, and FGF8 was detected in 9/29 (31.0 per cent) cases. There was a significant correlation between aFGF and FGF8 expression. In conclusion, aFGF, bFGF, and FGF8 are co-localized in human prostate cancer; they may have a synergistic effect in prostate cancer growth and progression.
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Affiliation(s)
- T J Dorkin
- School of Surgical Sciences, University of Newcastle upon Tyne, U.K
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46
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Qureshi KN, Griffiths TR, Robinson MC, Marsh C, Roberts JT, Hall RR, Lunec J, Neal DE. TP53 accumulation predicts improved survival in patients resistant to systemic cisplatin-based chemotherapy for muscle-invasive bladder cancer. Clin Cancer Res 1999; 5:3500-7. [PMID: 10589764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
To examine retrospectively the prognostic significance of TP53 immunoreactivity for both tumor response and patient survival in 83 patients with nonmetastatic muscle-invasive bladder cancer treated with a single transurethral resection (TUR) of tumor and combined cisplatin-based systemic chemotherapy followed by repeat TUR, paraffin-embedded sections of a bladder tumor obtained at TUR before chemotherapy (1 T2, 52 T3, and 30 T4) were immunostained for TP53 using monoclonal PAb1801 and DO-7 antibodies. For the entire cohort, TP53 immunopositivity (PAb1801 or DO-7) did not predict complete response (CR), complete or partial response (PR), progressive disease, or time to death from bladder cancer. There was a highly significant correlation between PAb1801 and DO-7 nuclear immunoreactivity (r = 0.8242; P<0.0001). In 76 patients in which complete clinical data were available, tumor stage (T2/T3; P = 0.0499), CR and PR (P = 0.0016) and CR (P<0.0001) were associated with patient survival. In a multivariate model, CR (P<0.0001) was the only independent predictor of improved survival. In complete responders, neither TP53 immunostaining nor clinicopathological factors stratified patients into prognostic groups. However, in the subset of patients (n = 38) who were chemoresistant (PR or progressive disease), improved survival was associated with > or =20% TP53 immunoreactivity (PAb1801; P = 0.0191) and tumor stage (T2/T3; P = 0.0358). TP53 immunopositivity (PAb1801 or DO-7) did not predict overall survival or response to systemic chemotherapy in patients with nonmetastatic but predominantly clinical stage > or =T3 bladder cancer, but it had prognostic significance within the chemoresistant subgroup.
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Affiliation(s)
- K N Qureshi
- Department of Urology, Royal Hallamshire Hospital, The Central Sheffield University Hospitals, Sheffield, United Kingdom.
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48
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Dorkin TJ, Robinson MC, Marsh C, Bjartell A, Neal DE, Leung HY. FGF8 over-expression in prostate cancer is associated with decreased patient survival and persists in androgen independent disease. Oncogene 1999; 18:2755-61. [PMID: 10348350 DOI: 10.1038/sj.onc.1202624] [Citation(s) in RCA: 114] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Identification of prostate cancers at high risk of progression is difficult and a better understanding of how peptide growth factors influence cellular function might be useful. Fibroblast growth factors (FGFs) have been implicated in prostate cancer development. FGF8 was identified in the Shionogi mouse mammary carcinoma SC-3 cell line as an androgen-induced mitogen. We tested if FGF8 was over-expressed in human prostate cancer and if its expression correlated with clinical data and outcome. One hundred and six cases of prostate cancer and ten cases of BPH were examined. In situ hybridization was employed to detect FGF8 mRNA expression, which was identified within the malignant prostatic epithelium in 85/106 (80.2%) cases. Increased expression of FGF8 correlated significantly with higher Gleason scores (P=0.0004) and advanced tumour stage (P=0.0016). Using immunohistochemistry, we confirmed over-expression of the FGF8b isoform. Men with tumours which expressed high levels of FGF8 had worse survival (P=0.034), although FGF8 mRNA was not able to provide additional prognostic information in a multivariate analysis. Additionally, FGF8 expression was shown to persist in androgen independent prostate cancer. Using a range of normal adult tissues, FGF8 expression was restricted to neurones and the germinal epithelium in addition to the prostate. In vitro studies demonstrated that in the presence of neutralizing antibody to FGF8b there was significant inhibition of prostate cancer cell growth, confirming the biological significance of FGF8 in prostate carcinogenesis.
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Affiliation(s)
- T J Dorkin
- School of Surgical Sciences, The Medical School, University of Newcastle upon Tyne, UK
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Marsh C. Can drowning in swimming pools be prevented? Pediatrics 1999; 103:856. [PMID: 10206860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
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Johnson MI, Robinson MC, Marsh C, Robson CN, Neal DE, Hamdy FC. Expression of Bcl-2, Bax, and p53 in high-grade prostatic intraepithelial neoplasia and localized prostate cancer: relationship with apoptosis and proliferation. Prostate 1998; 37:223-9. [PMID: 9831218 DOI: 10.1002/(sici)1097-0045(19981201)37:4<223::aid-pros3>3.0.co;2-o] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Apoptosis-regulating genes have been shown to be important in the biology of prostate cancer. The aim of this study was to examine and correlate the expression of the apoptosis-regulating genes bcl-2, bax, and p53 with the frequency of apoptosis and rate of proliferation in benign prostatic epithelium (BP), prostate cancer, and high-grade prostatic intraepithelial neoplasia (HGPIN), which is currently considered the most likely precursor of prostate cancer. METHODS Forty-four patients with histologically proven prostate cancer were investigated. All the men underwent radical prostatectomy. Immunohistochemistry was performed to assess expression of bcl-2, bax, and p53, and proliferation rate, as measured by the Ki-67 index. The frequency of apoptotic bodies was assessed by morphological criteria. RESULTS The apoptotic index (AI) was highest in prostate cancer, and was significantly greater in HGPIN compared to benign prostate. The Ki-67 index was greatest in cancer, intermediate in HGPIN, and lowest in BP. The AI was increased in areas of BP in patients treated with neoadjuvant androgen ablation. No change in AI was seen in treated cases of HGPIN or cancer. Accumulation of p53 protein was infrequent in prostate cancer (2/43: 4.6%), and was absent in HGPIN. Bcl-2 overexpression was present in 2.3% of cancers (1/43) and in 34.9% of cases of HGPIN (15/43). Bax expression was seen in all cases of cancer and HGPIN. There was no correlation between bcl-2 expression and the apoptotic and Ki-67 indices in HGPIN. CONCLUSIONS p53 and bcl-2 expression is infrequent in clinically organ confined prostate cancer. Bcl-2 expression is significantly higher in HGPIN than in both the associated prostate cancer and BP. The AI and Ki-67 index appeared intermediate in the putative precursor lesion HGPIN compared to prostate cancer and BP.
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Affiliation(s)
- M I Johnson
- Department of Surgery, School of Surgical Sciences, University of Newcastle, Newcastle upon Tyne, United Kingdom
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