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Simsek B, Zhang R, Morton C, Villanueva MS. Lemierre syndrome with pulmonary empyema caused by Prevotella intermedia. BMJ Case Rep 2024; 17:e258158. [PMID: 38490705 PMCID: PMC10946344 DOI: 10.1136/bcr-2023-258158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
Lemierre syndrome is a rare disease that is most often caused by Fusobacterium necrophorum We present a case caused by Prevotella intermedia in a young, healthy man, complicated by multiple cavitary lung lesions, loculated pleural effusions requiring chest tube placement and trapezius abscess. Our case highlights (a) P. intermedia as a rare cause of Lemierre syndrome and (b) clinical response to appropriate antimicrobial therapy may be protracted.
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Affiliation(s)
- Bahadir Simsek
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Renee Zhang
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Christopher Morton
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Merceditas S Villanueva
- Department of Internal Medicine, Section of Infectious Disease, Yale University School of Medicine, New Haven, Connecticut, USA
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Epperly R, Pinto EM, Santiago T, Sheppard H, Clay MR, Morton C, Nguyen P, Zhou Y, Woolard M, O'Reilly C, Justice J, Akers W, Johnson M, Karlstrom A, Cheng C, Zambetti G, Davidoff A, Ribeiro R, DeRenzo C. Abstract 1197: B7-H3-CAR T cells for the treatment of pediatric adrenocortical carcinoma. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-1197] [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: 04/07/2023]
Abstract
Abstract
Outcomes for pediatric patients with unresectable, metastatic, or relapsed adrenocortical carcinoma (ACC) are dismal despite aggressive management with multimodality therapies. CAR T cell therapy (CAR T) is a promising approach to improve outcomes for patients with this disease. However, progress is hindered by a lack of targetable surface antigens and limited availability of relevant preclinical models. B7-H3 is a promising immunotherapeutic target but little is known about its expression in pediatric ACC. Thus, we sought to i) evaluate B7-H3 expression in primary pediatric ACC samples and ii) assess B7-H3-CAR T activity in two novel pediatric patient-derived xenograft (PDX) models. First, we assessed B7-H3 expression in 44 pediatric adrenocortical tumors (ACTs) using a CLIA-approved immunohistochemistry (IHC) assay. ACTs had a range of B7-H3 positivity, including 24 (55%) with expression above the threshold for eligibility on our active B7-H3-CAR T clinical trial (H-score ≥ 100; NCT04897321). Univariate analyses demonstrated B7-H3 expression was correlated with the presence of germline TP53 mutations and poor prognostic factors including the inability to achieve complete resection, Cushing phenotype, and the absence of TP53 by IHC. Given a dearth of in vivo models, we next established two clinically relevant pediatric ACC PDX models. SJ-ACC4 was derived from a metastatic tumor and had somatic mutations in TP53 (p.C135Lfs*14) and CTNNB1 (p.S45F). SJACT030812_X1 (www.stjude.org/cstn) was derived from a primary tumor and had a germline TP53 mutation (p.R110Pfs*39). Both had partial ATRX deletions (exons 11-30; 3-28), uniparental disomy at chromosome 11p15, and were B7-H3-positive. Notably, SJ-ACC4 was resistant to a battery of chemotherapeutic agents. To evaluate B7-H3-CAR T anti-ACC activity in vivo, SJ-ACC4 tumor fragments were implanted subcutaneously in NOD SCID gamma (NSG) mice and treated with B7-H3-CAR or control T cells. Strikingly, B7-H3-CAR T eradicated 100% of SJ-ACC4 tumors and mice survived long term compared to controls that met endpoints within 35 days (n=8 per group, p< 0.0001). Finally, we asked if B7-H3-CAR T had antitumor activity in an orthotopic pediatric ACC PDX model. SJACT030812_X1 cells were injected into the para-adrenal region of NSG mice under ultrasound guidance and monitored by serial volumetric ultrasonography. B7-H3-CAR T again had significant antitumor activity, and mice survived long-term compared to controls that met endpoints within 42 days (n=5 per group, p< 0.01). In conclusion, B7-H3 is expressed in a majority of pediatric ACTs and B7-H3-CAR T have potent anti-ACC activity. These findings provide a strong rationale for clinically evaluating B7-H3-CAR T for pediatric patients with chemotherapy-resistant ACC. Additionally, the newly established pediatric ACC PDX models provide a valuable resource for investigating different aspects of this rare and aggressive disease.
Citation Format: Rebecca Epperly, Emilia M. Pinto, Teresa Santiago, Heather Sheppard, Michael R. Clay, Christopher Morton, Phuong Nguyen, Yinmei Zhou, Mary Woolard, Carla O'Reilly, Julie Justice, Walter Akers, Melissa Johnson, Asa Karlstrom, Cheng Cheng, Gerard Zambetti, Andrew Davidoff, Raul Ribeiro, Christopher DeRenzo. B7-H3-CAR T cells for the treatment of pediatric adrenocortical carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1197.
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Affiliation(s)
| | | | | | | | | | | | | | - Yinmei Zhou
- 1St. Jude Children's Research Hospital, Memphis, TN
| | - Mary Woolard
- 1St. Jude Children's Research Hospital, Memphis, TN
| | | | | | | | | | | | - Cheng Cheng
- 1St. Jude Children's Research Hospital, Memphis, TN
| | | | | | - Raul Ribeiro
- 1St. Jude Children's Research Hospital, Memphis, TN
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Morton C, Pisani M, Doyle M, Puchalski J. Tracheostomy Is Associated With a Decrease in Delirium and Sedation for Intubated COVID-19 Patients. J Bronchology Interv Pulmonol 2023; 30:32-36. [PMID: 35288526 DOI: 10.1097/lbr.0000000000000841] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/29/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Patients with coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome can experience prolonged periods of ventilation, high incidence of delirium, and require high amounts of sedation. Tracheostomy has been associated with earlier ventilator liberation, decreased sedation needs, and lower rates of delirium but optimal timing of tracheostomy remains unknown. Is tracheostomy associated with lower sedation requirements and lower incidence of delirium in patients with COVID-19 that are intubated? METHODS We retrospectively reviewed the first 32 patients at a large urban tertiary referral center that underwent tracheostomy for prolonged respiratory failure. We obtained Richmond Agitation Sedation-Scale scores and Confusion Assessment Method for Intensive Care Unit data along with amount(s) and type(s) of sedating medications given, in the 7 days before and after tracheostomy. Proportion of days delirious and sedating medications were compared in the 7 days before and after tracheostomy. RESULTS There was a significant decrease in the amount of opioids and benzodiazepines in the 7-day period following tracheostomy. Opioid dosing decreased by 157.5 morphine equivalents (SD=339, P =0.01) and benzodiazepine dosing decreased by 18 mg lorazepam equivalents (SD=34, P =0.01). There was no significant difference in antipsychotic or other sedative-hyponotic drug doses. There was a significant decrease in the proportion of days of coma or delirium (mean decrease in proportion=0.16, SD=0.32, P =0.008) following tracheostomy. CONCLUSION Tracheostomy was associated with a significant decrease amount of sedating medications and with a decrease in proportion of days delirious following tracheostomy.
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Affiliation(s)
- Christopher Morton
- Department of Pulmonary, Critical Care and Sleep Medicine, Yale New Haven Hospital
| | - Margaret Pisani
- Department of Pulmonary, Critical Care and Sleep Medicine, Yale New Haven Hospital
| | - Margaret Doyle
- Claude D. Pepper Older Americans Independence Center at Yale, New Haven, CT
| | - Jonathan Puchalski
- Department of Pulmonary, Critical Care and Sleep Medicine, Yale New Haven Hospital
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Ismahel H, Minhas H, Morton C, Shelley B. ADDING OBJECTIVITY TO SUBMAXIMAL EXERCISE TESTING BY ASSESSMENT OF HEART RATE RECOVERY – A HEALTHY VOLUNTEER STUDY III (SEARCH-III). J Cardiothorac Vasc Anesth 2022. [DOI: 10.1053/j.jvca.2022.09.023] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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Al-Otaibi N, Aminian J A, Anane RF, Baatsen P, Bakker SE, Bergeron J, Bharadwaj A, Bhella D, Braun T, Brescia R, Bullough P, Clare DK, Daum B, Esser TK, Farinas Lucas IDM, Frank RAW, Gold VAM, Harrison PJ, Hirst IJ, Klebl DP, Kühlbrandt W, Morton C, Muench SP, Nakasone M, Russo CJ, Saibil HR, Scheres SHW, Sehrawat V, Shah AR, Smith C, Thompson RF, Thorn A, Zanetti G. Sample preparation in single particle cryo-EM: general discussion. Faraday Discuss 2022; 240:81-100. [PMID: 36278863 DOI: 10.1039/d2fd90059a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Jones R, Pinato D, Joshua A, Forster M, Morton C, Aboud K, Liu J, Fulgenzi C, Kefas J, Edmondson S, Main N, Paull J, Fairley J, Spicer J. 1403P Efficacy and safety of dendrimer-enhanced (DEP) cabazitaxel (CTX-SPL9111) in men with metastatic castration-resistant prostate cancer (mCRPC) in a phase I/II trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Di Rollo DG, McGovern J, Morton C, Miller G, Dolan R, Horgan PG, McMillan DC, Mansouri D. Relationship between BMI, CT-derived body composition and colorectal neoplasia in a bowel screening population. Scott Med J 2022; 67:93-102. [PMID: 35603880 PMCID: PMC9358305 DOI: 10.1177/00369330221102237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction Obesity is associated with an increased risk of colorectal cancer (CRC).
Unlike the indirect measures such as BMI, CT-Body composition (CT-BC) allows
for the assessment of both volume and distribution of adipose tissue.
Therefore, the aim of this study was to examine the relationship between
host characteristics, BMI, CT-BC measurements and the incidence of
colorectal neoplasia. Methods Patients undergoing CT Colonography (CTC) as part of the Scottish Bowel
Screening Programme, between July 2009 and February 2016, were eligible for
inclusion. Data were collected including demographic data,
clinicopathological variables and CT-BC measurements including skeletal
muscle index (SMI), subcutaneous fat index (SFI) and visceral fat area
(VFA). CTC, colonoscopy, and pathology reports were used to identify CRC
incidence. Associations between demographic data, clinicopathological
variables, CT-BC measurements, colorectal neoplasia and advanced colorectal
neoplasia were analysed using univariate and multivariate binary logistics
regression. Results 286 patients met the inclusion criteria. Neoplasia was detected in 105 (37%)
of the patients with advanced neoplasia being detected in 72 (69%) of
patients. On multivariate analysis sex (p < 0.05) and high VFA
(p < 0.001) remained independently associated with colorectal neoplasia.
On multivariate analysis a high SFI (p < 0.01) remained independently
associated with advanced colorectal neoplasia. BMI was not associated with
either colorectal neoplasia or advanced colorectal neoplasia. Conclusion When directly compared to BMI, CT derived fat measurements were more closely
associated with the degree of neoplasia in patients undergoing colorectal
cancer screening. In patients investigated with CT colonography, CT adipose
measures may stratify the risk and grade of neoplasia.
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Affiliation(s)
- Domenic G. Di Rollo
- Academic Unit of Surgery, University of Glasgow, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Josh McGovern
- Academic Unit of Surgery, University of Glasgow, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Christopher Morton
- Academic Unit of Surgery, University of Glasgow, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Gillian Miller
- Academic Unit of Surgery, University of Glasgow, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Ross Dolan
- Academic Unit of Surgery, University of Glasgow, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Paul G. Horgan
- Academic Unit of Surgery, University of Glasgow, Royal Infirmary, Glasgow, G31 2ER, UK
| | - Donald C. McMillan
- Academic Unit of Surgery, University of Glasgow, Royal Infirmary, Glasgow, G31 2ER, UK
| | - David Mansouri
- Academic Unit of Surgery, University of Glasgow, Royal Infirmary, Glasgow, G31 2ER, UK
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Webber M, Falconer D, AlFarih M, Joy G, Chan F, Davie C, Hamill Howes L, Wong A, Rapala A, Bhuva A, Davies RH, Morton C, Aguado-Sierra J, Vazquez M, Tao X, Krausz G, Tanackovic S, Guger C, Xue H, Kellman P, Pierce I, Schott J, Hardy R, Chaturvedi N, Rudy Y, Moon JC, Lambiase PD, Orini M, Hughes AD, Captur G. Study protocol: MyoFit46-the cardiac sub-study of the MRC National Survey of Health and Development. BMC Cardiovasc Disord 2022; 22:140. [PMID: 35365075 PMCID: PMC8972905 DOI: 10.1186/s12872-022-02582-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/23/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The life course accumulation of overt and subclinical myocardial dysfunction contributes to older age mortality, frailty, disability and loss of independence. The Medical Research Council National Survey of Health and Development (NSHD) is the world's longest running continued surveillance birth cohort providing a unique opportunity to understand life course determinants of myocardial dysfunction as part of MyoFit46-the cardiac sub-study of the NSHD. METHODS We aim to recruit 550 NSHD participants of approximately 75 years+ to undertake high-density surface electrocardiographic imaging (ECGI) and stress perfusion cardiovascular magnetic resonance (CMR). Through comprehensive myocardial tissue characterization and 4-dimensional flow we hope to better understand the burden of clinical and subclinical cardiovascular disease. Supercomputers will be used to combine the multi-scale ECGI and CMR datasets per participant. Rarely available, prospectively collected whole-of-life data on exposures, traditional risk factors and multimorbidity will be studied to identify risk trajectories, critical change periods, mediators and cumulative impacts on the myocardium. DISCUSSION By combining well curated, prospectively acquired longitudinal data of the NSHD with novel CMR-ECGI data and sharing these results and associated pipelines with the CMR community, MyoFit46 seeks to transform our understanding of how early, mid and later-life risk factor trajectories interact to determine the state of cardiovascular health in older age. TRIAL REGISTRATION Prospectively registered on ClinicalTrials.gov with trial ID: 19/LO/1774 Multimorbidity Life-Course Approach to Myocardial Health- A Cardiac Sub-Study of the MCRC National Survey of Health and Development (NSHD).
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Affiliation(s)
- Matthew Webber
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Debbie Falconer
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Mashael AlFarih
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - George Joy
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Fiona Chan
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Clare Davie
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Lee Hamill Howes
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Andrew Wong
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Alicja Rapala
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Anish Bhuva
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Institute of Health Informatics, UCL, Euston Road, London, UK
| | - Rhodri H Davies
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | | | - Jazmin Aguado-Sierra
- ELEM Biotech, S.L, Bristol, BS1 6QH, UK
- Barcelona Supercomputing Center (BSC), 08034, Barcelona, Spain
| | - Mariano Vazquez
- ELEM Biotech, S.L, Bristol, BS1 6QH, UK
- Barcelona Supercomputing Center (BSC), 08034, Barcelona, Spain
| | - Xuyuan Tao
- École Nationale Supérieure Des Arts Et Industries Textiles, 2 allée Louise et Victor Champier, 59056, Roubaix Cedex 1, France
| | - Gunther Krausz
- g.Tec Medical Engineering GmbH, Siernigtrabe 14, 4521, Schiedlberg, Austria
| | | | - Christoph Guger
- g.Tec Medical Engineering GmbH, Siernigtrabe 14, 4521, Schiedlberg, Austria
| | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Iain Pierce
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Jonathan Schott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | | | - Nishi Chaturvedi
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Yoram Rudy
- Cardiac Bioelectricity and Arrhythmia Center, Washington University, St. Louis, MO, 63130, USA
- Department of Biomedical Engineering, Washington University, St. Louis, MO, 63130, USA
| | - James C Moon
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Pier D Lambiase
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Michele Orini
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Alun D Hughes
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Gabriella Captur
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK.
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK.
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Di Rollo D, Morton C, McMillan D, Horgan P, Mansouri D. SP1.1.17The relationship between colorectal neoplasia and body composition in a bowel screening population. Br J Surg 2021. [DOI: 10.1093/bjs/znab361.012] [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: 11/14/2022]
Abstract
Abstract
Aims
Conflicting evidence exists as to the effect of elevated BMI in the development of colorectal neoplasia. Yet BMI is a crude measure of adiposity. The present study investigates the association between CT derived measures of body composition including sarcopenia, subcutaneous fat index (SFI) and visceral obesity and colorectal neoplasia.
Methods
358 consecutive patients undergoing CT virtual colonoscopy (CTC) as part of the Scottish Bowel Screening Programme were eligible for inclusion. Demographic data and the above measures body composition were calculated using previously published CT derived methods. Medical records were examined for colonoscopic findings and pathology reports.
Results
121/358 (34%) were males. Median age 65. 126/358 (35%) patients were found to have a colorectal neoplasia. 84/126 (67%) had advanced neoplasia. 26/358 (7%) had adenocarcinoma. On multivariable analysis, both male sex and visceral obesity was associated with the presence of colorectal neoplasia, OR 2.62, [95% CI 1.51-4.55, p = 0.001] and OR 2.83, {95% CI 1.25-6.41, p = 0.01] respectively. The relationship was dose dependent with an increased risk of colorectal neoplasia in the 3rd [OR 2.13 95% CI 1.09-4.14 p < 0.05] and 4th [OR 3.77 95% CI 1.96-7.26 p < 0.001] quartiles of visceral fat area. BMI, SFI and sarcopenia were not associated with colorectal neoplasia in the present study.
Conclusions
Male sex and in particular, visceral obesity is associated with increased risk of colorectal neoplasia. In addition to the known cardiovascular and metabolic dangers of visceral obesity, the present work suggests that visceral obesity may also play a role in colorectal neoplasia formation.
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Morton C, Matin RN. Embracing artificial intelligence- how can we make it inclusive and relevant for real world dermatological practice? Br J Dermatol 2021; 186:180-182. [PMID: 34375440 DOI: 10.1111/bjd.20699] [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] [Received: 05/24/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 11/30/2022]
Abstract
Artificial intelligence (AI) developments are rapidly advancing with algorithms capable of out-performing dermatologists in specific contrived challenges, but where prospective evaluation in real-world settings remain limited. Professional bodies have a role to encourage AI approaches to address clinical unmet needs, improve quality of care, and enhance patient experience without compromising safety. In 2019, the American Academy of Dermatology advocated principles of human-centred design for augmented intelligence innovations (1) emphasising the importance of synergy between dermatologist and the computer. More recently, the British Association of Dermatologists highlighted the weak current evidence-base supporting effectiveness of AI interventions in routine clinical practice and encouraged clinicians to independently evaluate the evidence prior to adoption (2).
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Affiliation(s)
- C Morton
- Stirling Community Hospital, NHS Forth Valley, Livilands Stirling, FK8 2AU, UK
| | - R N Matin
- Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Old Road, Headington, Oxford, UK
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Forbes H, Bhaskaran K, Grint D, Hu V, Langan S, McDonald H, Morton C, Smeeth L, Walker J, Warren‐Gash C. Incidence of acute complications of herpes zoster among immunocompetent adults in England: a matched cohort study using routine health data. Br J Dermatol 2021; 184:1077-1084. [PMID: 33216946 PMCID: PMC8607468 DOI: 10.1111/bjd.19687] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Herpes zoster can cause rare but serious complications; the frequency of these complications has not been well described. OBJECTIVES To quantify the risks of acute non-postherpetic neuralgia (PHN) zoster complications, to inform vaccination policy. METHODS We conducted a cohort study among unvaccinated immunocompetent adults with incident zoster, and age-, sex- and practice-matched control adults without zoster, using routinely collected health data from the UK Clinical Practice Research Datalink (years 2001 to 2018). Crude attributable risks of complications were estimated as the difference between Kaplan-Meier-estimated 3-month cumulative incidences in patients with zoster vs. controls. We used Cox models to obtain hazard ratios for our primary outcomes in patients with and without zoster. Primary outcomes were ocular, neurological, cutaneous, visceral and zoster-specific complications. We also assessed whether antivirals during acute zoster protected against the complications. RESULTS In total 178 964 incident cases of zoster and 1 799 380 controls were included. The absolute risks of zoster-specific complications within 3 months of zoster diagnosis were 0·37% [95% confidence interval (CI) 0·34-0·39] for Ramsay Hunt syndrome, 0·01% (95% CI 0·0-0·01) for disseminated zoster, 0·04% (95% CI 0·03-0·05) for zoster death and 0·97% (95% CI 0·92-1·00) for zoster hospitalization. For other complications, attributable risks were 0·48% (95% CI 0·44-0·51) for neurological complications, 1·33% (95% CI 1·28-1·39) for ocular complications, 0·29% (95% CI 0·26-0·32) for cutaneous complications and 0·78% (95% CI 0·73-0·84) for visceral complications. Attributable risks were higher among patients > 50 years old. Patients with zoster had raised risks of all primary outcomes relative to controls. Antiviral prescription was associated with reduced risk of neurological complications (hazard ratio 0·61, 95% CI 0·53-0·70). CONCLUSIONS Non-PHN complications of zoster were relatively common, which may affect cost-effectiveness calculations for zoster vaccination. Clinicians should be aware that zoster can lead to various complications, besides PHN.
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Affiliation(s)
- H.J. Forbes
- London School of Hygiene & Tropical MedicineLondonUK
| | - K. Bhaskaran
- London School of Hygiene & Tropical MedicineLondonUK
| | - D. Grint
- London School of Hygiene & Tropical MedicineLondonUK
- NIHR Health Protection Research Unit in ImmunisationLondonUK
| | - V.H. Hu
- London School of Hygiene & Tropical MedicineLondonUK
| | - S.M. Langan
- London School of Hygiene & Tropical MedicineLondonUK
| | - H.I. McDonald
- London School of Hygiene & Tropical MedicineLondonUK
- NIHR Health Protection Research Unit in ImmunisationLondonUK
| | - C. Morton
- London School of Hygiene & Tropical MedicineLondonUK
| | - L. Smeeth
- London School of Hygiene & Tropical MedicineLondonUK
| | - J.L. Walker
- London School of Hygiene & Tropical MedicineLondonUK
- NIHR Health Protection Research Unit in ImmunisationLondonUK
- Statistics, Modelling and Economics DepartmentPublic Health EnglandLondonUK
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Minhas H, Morton C, Shelley B. Adding objectivity to submaximal exercise testing by assessment of heart rate recovery—a healthy volunteer study – II (SEARCH-II). J Cardiothorac Vasc Anesth 2020. [DOI: 10.1053/j.jvca.2020.09.021] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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O'Brien CR, Li M, Morton C. An 80-Year-Old Man With a 24-Hour History of Epigastric Pain. Chest 2020; 156:e127-e131. [PMID: 31812211 DOI: 10.1016/j.chest.2019.05.039] [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] [Received: 12/10/2018] [Revised: 04/29/2019] [Accepted: 05/16/2019] [Indexed: 11/24/2022] Open
Abstract
CASE PRESENTATION An 80-year-old man was admitted to our hospital with 24 hours of epigastric pain. The pain was described as sharp, episodic, nonradiating, and without an identifiable provoking factor. Associated symptoms included nausea and nonbloody vomiting. He denied dyspnea, angina, fevers, chills, dysphagia, diarrhea, melena, or hematochezia. He had taken less than 2 g of acetaminophen earlier in the day without symptomatic relief. He had a 30-pack-year smoking history but quit over 25 years ago. He did not drink alcohol or use illicit drugs. He had a medical history of end-stage renal disease, for which he had undergone hemodialysis; hypertension; metastatic prostate cancer, for which he had received androgen deprivation therapy; and abdominal aortic aneurysm. His surgical history included a remote endovascular repair of the abdominal aortic aneurysm. His medications included amlodipine, losartan, carvedilol, sevelamer, and leuprolide.
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Affiliation(s)
- Corey R O'Brien
- Department of Internal Medicine, Yale-New Haven Hospital, New Haven, CT; West Haven Veterans Affairs Medical Center, West Haven, CT.
| | - Muyi Li
- Department of Internal Medicine, Yale-New Haven Hospital, New Haven, CT; West Haven Veterans Affairs Medical Center, West Haven, CT
| | - Christopher Morton
- Department of Critical Care, Pulmonary and Sleep Medicine, Yale-New Haven Hospital, New Haven, CT; West Haven Veterans Affairs Medical Center, West Haven, CT
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Morton C, Gabr A, Riaz A, Mouli S, Thornburg B, Desai K, Sato K, Salem R, Lewandowski R. Abstract No. 716 Long-term outcomes of Yttrium-90 radioembolization for hepatocellular carcinoma due to underlying non-alcoholic steatohepatitis. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Abstract
Bronchoscopy is an important tool for the diagnosis of pulmonary disorders in immunocompromised patients. The addition of biopsies to bronchoalveolar lavage improves the diagnostic yield of non-infectious etiologies, although the underlying etiology of the immunocompromised state must be considered and may be influential. Certain unknowns remain, including timing of bronchoscopy and its impact on medical management and mortality. The ongoing role of non-invasive testing for infectious complications prior to bronchoscopy also remains to be defined. This review addresses the role of bronchoscopy in immunocompromised states related to underlying hematologic malignancies, prescription drug use or chemotherapy, and other disorders that predispose patients to infectious or non-infectious pulmonary diseases.
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Affiliation(s)
- Christopher Morton
- Division of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jonathan Puchalski
- Division of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
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Rokita JL, Rathi KS, Cardenas MF, Upton KA, Jayaseelan J, Cross KL, Pfeil J, Egolf LE, Way GP, Farrel A, Kendsersky NM, Patel K, Gaonkar KS, Modi A, Berko ER, Lopez G, Vaksman Z, Mayoh C, Nance J, McCoy K, Haber M, Evans K, McCalmont H, Bendak K, Böhm JW, Marshall GM, Tyrrell V, Kalletla K, Braun FK, Qi L, Du Y, Zhang H, Lindsay HB, Zhao S, Shu J, Baxter P, Morton C, Kurmashev D, Zheng S, Chen Y, Bowen J, Bryan AC, Leraas KM, Coppens SE, Doddapaneni H, Momin Z, Zhang W, Sacks GI, Hart LS, Krytska K, Mosse YP, Gatto GJ, Sanchez Y, Greene CS, Diskin SJ, Vaske OM, Haussler D, Gastier-Foster JM, Kolb EA, Gorlick R, Li XN, Reynolds CP, Kurmasheva RT, Houghton PJ, Smith MA, Lock RB, Raman P, Wheeler DA, Maris JM. Genomic Profiling of Childhood Tumor Patient-Derived Xenograft Models to Enable Rational Clinical Trial Design. Cell Rep 2019; 29:1675-1689.e9. [PMID: 31693904 PMCID: PMC6880934 DOI: 10.1016/j.celrep.2019.09.071] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/10/2019] [Accepted: 09/24/2019] [Indexed: 02/08/2023] Open
Abstract
Accelerating cures for children with cancer remains an immediate challenge as a result of extensive oncogenic heterogeneity between and within histologies, distinct molecular mechanisms evolving between diagnosis and relapsed disease, and limited therapeutic options. To systematically prioritize and rationally test novel agents in preclinical murine models, researchers within the Pediatric Preclinical Testing Consortium are continuously developing patient-derived xenografts (PDXs)-many of which are refractory to current standard-of-care treatments-from high-risk childhood cancers. Here, we genomically characterize 261 PDX models from 37 unique pediatric cancers; demonstrate faithful recapitulation of histologies and subtypes; and refine our understanding of relapsed disease. In addition, we use expression signatures to classify tumors for TP53 and NF1 pathway inactivation. We anticipate that these data will serve as a resource for pediatric oncology drug development and will guide rational clinical trial design for children with cancer.
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Affiliation(s)
- Jo Lynne Rokita
- Division of Oncology, Children's Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104-4318, USA; Department of Bioinformatics and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Center for Data-Driven Discovery in Biomedicine, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Komal S Rathi
- Department of Bioinformatics and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Center for Data-Driven Discovery in Biomedicine, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Maria F Cardenas
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Kristen A Upton
- Division of Oncology, Children's Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104-4318, USA
| | - Joy Jayaseelan
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | | | - Jacob Pfeil
- UC Santa Cruz Genomics Institute, University of California, Santa Cruz, Santa Cruz, CA 95064, USA
| | - Laura E Egolf
- Division of Oncology, Children's Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104-4318, USA; Cell and Molecular Biology Graduate Group, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Gregory P Way
- Genomics and Computational Biology Graduate Group, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Alvin Farrel
- Department of Bioinformatics and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Nathan M Kendsersky
- Division of Oncology, Children's Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104-4318, USA; Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Khushbu Patel
- Department of Bioinformatics and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Krutika S Gaonkar
- Department of Bioinformatics and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Center for Data-Driven Discovery in Biomedicine, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Apexa Modi
- Division of Oncology, Children's Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104-4318, USA; Genomics and Computational Biology Graduate Group, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Esther R Berko
- Division of Oncology, Children's Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104-4318, USA
| | - Gonzalo Lopez
- Division of Oncology, Children's Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104-4318, USA; Department of Bioinformatics and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Zalman Vaksman
- Department of Bioinformatics and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Chelsea Mayoh
- Children's Cancer Institute, School of Women's and Children's Health, UNSW Sydney, Sydney, NSW, Australia
| | - Jonas Nance
- Cancer Center, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX 79430, USA
| | - Kristyn McCoy
- Cancer Center, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX 79430, USA
| | - Michelle Haber
- Children's Cancer Institute, School of Women's and Children's Health, UNSW Sydney, Sydney, NSW, Australia
| | - Kathryn Evans
- Children's Cancer Institute, School of Women's and Children's Health, UNSW Sydney, Sydney, NSW, Australia
| | - Hannah McCalmont
- Children's Cancer Institute, School of Women's and Children's Health, UNSW Sydney, Sydney, NSW, Australia
| | - Katerina Bendak
- Children's Cancer Institute, School of Women's and Children's Health, UNSW Sydney, Sydney, NSW, Australia
| | - Julia W Böhm
- Children's Cancer Institute, School of Women's and Children's Health, UNSW Sydney, Sydney, NSW, Australia
| | - Glenn M Marshall
- Children's Cancer Institute, School of Women's and Children's Health, UNSW Sydney, Sydney, NSW, Australia; Sydney Children's Hospital, Sydney, NSW, Australia
| | | | - Karthik Kalletla
- Department of Bioinformatics and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Center for Data-Driven Discovery in Biomedicine, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Frank K Braun
- Texas Children's Cancer and Hematology Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Lin Qi
- Preclinical Neurooncology Research Program, Texas Children's Cancer Research Center, Texas Children's Hospital, Houston, TX 77030, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Yunchen Du
- Preclinical Neurooncology Research Program, Texas Children's Cancer Research Center, Texas Children's Hospital, Houston, TX 77030, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Huiyuan Zhang
- Preclinical Neurooncology Research Program, Texas Children's Cancer Research Center, Texas Children's Hospital, Houston, TX 77030, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Holly B Lindsay
- Preclinical Neurooncology Research Program, Texas Children's Cancer Research Center, Texas Children's Hospital, Houston, TX 77030, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Sibo Zhao
- Preclinical Neurooncology Research Program, Texas Children's Cancer Research Center, Texas Children's Hospital, Houston, TX 77030, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jack Shu
- Preclinical Neurooncology Research Program, Texas Children's Cancer Research Center, Texas Children's Hospital, Houston, TX 77030, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Patricia Baxter
- Preclinical Neurooncology Research Program, Texas Children's Cancer Research Center, Texas Children's Hospital, Houston, TX 77030, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Christopher Morton
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Dias Kurmashev
- Greehey Children's Cancer Research Institute, University of Texas Health Science Center, San Antonio, TX 78229, USA
| | - Siyuan Zheng
- Greehey Children's Cancer Research Institute, University of Texas Health Science Center, San Antonio, TX 78229, USA
| | - Yidong Chen
- Greehey Children's Cancer Research Institute, University of Texas Health Science Center, San Antonio, TX 78229, USA
| | - Jay Bowen
- The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Anthony C Bryan
- The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Kristen M Leraas
- The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Sara E Coppens
- The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | | | - Zeineen Momin
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Wendong Zhang
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Gregory I Sacks
- Division of Oncology, Children's Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104-4318, USA
| | - Lori S Hart
- Division of Oncology, Children's Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104-4318, USA
| | - Kateryna Krytska
- Division of Oncology, Children's Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104-4318, USA
| | - Yael P Mosse
- Division of Oncology, Children's Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104-4318, USA
| | - Gregory J Gatto
- Department of Global Health Technologies, RTI International, Research Triangle Park, NC 27709, USA
| | - Yolanda Sanchez
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA; Norris Cotton Cancer Center, Lebanon, NH 03766, USA
| | - Casey S Greene
- Childhood Cancer Data Lab, Alex's Lemonade Stand Foundation, Philadelphia, PA 19102, USA; Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sharon J Diskin
- Division of Oncology, Children's Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104-4318, USA; Department of Bioinformatics and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Olena Morozova Vaske
- Department of Molecular, Cell and Developmental Biology, University of California, Santa Cruz, Santa Cruz, CA 95064, USA; UC Santa Cruz Genomics Institute, University of California, Santa Cruz, Santa Cruz, CA 95064, USA
| | - David Haussler
- UC Santa Cruz Genomics Institute, University of California, Santa Cruz, Santa Cruz, CA 95064, USA; Howard Hughes Medical Institute, University of California, Santa Cruz, Santa Cruz, CA 95064, USA
| | - Julie M Gastier-Foster
- The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA; The Ohio State University College of Medicine, Departments of Pathology and Pediatrics, Columbus, OH 43210, USA
| | - E Anders Kolb
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA 19107, USA; Nemours Center for Cancer and Blood Disorders, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA
| | - Richard Gorlick
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Xiao-Nan Li
- Preclinical Neurooncology Research Program, Texas Children's Cancer Research Center, Texas Children's Hospital, Houston, TX 77030, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; Division of Hematology, Oncology, Neuro-oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - C Patrick Reynolds
- Cancer Center, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX 79430, USA
| | - Raushan T Kurmasheva
- Greehey Children's Cancer Research Institute, University of Texas Health Science Center, San Antonio, TX 78229, USA
| | - Peter J Houghton
- Greehey Children's Cancer Research Institute, University of Texas Health Science Center, San Antonio, TX 78229, USA
| | | | | | - Pichai Raman
- Department of Bioinformatics and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Center for Data-Driven Discovery in Biomedicine, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - David A Wheeler
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - John M Maris
- Division of Oncology, Children's Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104-4318, USA.
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Morton C, Shelley B. Adding objectivity to submaximal exercise testing by assessment of heart rate recovery – A healthy volunteer study (search). J Cardiothorac Vasc Anesth 2019. [DOI: 10.1053/j.jvca.2019.07.042] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Morton C, Shelley B, Shaw M. Adding objectivity to submaximal exercise testing by non-linear modelling of heart rate recovery profile (search-modelling). J Cardiothorac Vasc Anesth 2019. [DOI: 10.1053/j.jvca.2019.07.041] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Armond RD, Morton C, Patel SI, Combs D, Parthasarathy S. 0285 Sex As A Biological Variable On The Inflammatory Effects Of Intermittent Hypoxia. Sleep 2019. [DOI: 10.1093/sleep/zsz067.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Richard De Armond
- UAHS Center for Sleep & Circadian Sciences; Division of Pulmonary, Allergy, Critical Care & Sleep Medicine; University of Arizona, Tucson, AZ, USA
| | - Christopher Morton
- UAHS Center for Sleep & Circadian Sciences; Division of Pulmonary, Allergy, Critical Care & Sleep Medicine; University of Arizona, Tucson, AZ, USA
| | - Salma I Patel
- UAHS Center for Sleep & Circadian Sciences; Division of Pulmonary, Allergy, Critical Care & Sleep Medicine; University of Arizona, Tucson, AZ, USA
| | - Daniel Combs
- UAHS Center for Sleep & Circadian Sciences; Division of Pulmonary, Allergy, Critical Care & Sleep Medicine; University of Arizona, Tucson, AZ, USA
| | - Sairam Parthasarathy
- UAHS Center for Sleep & Circadian Sciences; Division of Pulmonary, Allergy, Critical Care & Sleep Medicine; University of Arizona, Tucson, AZ, USA
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Morton C, Shelley B. Adding objectivity to Submaximal Exercise testing by Assessment of heart Rate ReCovery—a Healthy volunteer study (SEARCH). Br J Anaesth 2019. [DOI: 10.1016/j.bja.2018.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Simons G, Belcher J, Morton C, Kumar K, Falahee M, Mallen C, Stack R, Raza K. FRI0078 Symptom Recognition and Its Effect on Help-Seeking in Rheumatoid Arthritis, Bowel Cancer and Angina: A Mixed Methods Approach. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2340] [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: 11/04/2022]
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Brimble MA, Zhou J, Morton C, Meagher M, Nathwani AC, Gray JT, Davidoff AM. 547. AAV Preparations Contain Contamination from DNA Sequences in Production Plasmids Directly Outside of the ITRs. Mol Ther 2016. [DOI: 10.1016/s1525-0016(16)33355-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Bruce J, Parker A, Donald M, Esposito M, Curatolo L, Kennedy A, Simpson K, Morton C, Cormack J, Austin M. Impact of a dedicated trauma desk in ambulance control on the identification of major trauma in Scotland. Crit Care 2014. [PMCID: PMC4068883 DOI: 10.1186/cc13256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Pinto EM, Morton C, Rodriguez-Galindo C, McGregor L, Davidoff AM, Mercer K, Debelenko LV, Billups C, Ribeiro RC, Zambetti GP. Establishment and characterization of the first pediatric adrenocortical carcinoma xenograft model identifies topotecan as a potential chemotherapeutic agent. Clin Cancer Res 2013; 19:1740-7. [PMID: 23406775 DOI: 10.1158/1078-0432.ccr-12-3354] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE Pediatric adrenocortical carcinoma (ACC) is a rare and highly aggressive malignancy. Conventional chemotherapeutic agents have shown limited utility and are largely ineffective in treating children with advanced ACC. The lack of cell lines and animal models of pediatric ACC has hampered the development of new therapies. Here we report the establishment of the first pediatric ACC xenograft model and the characterization of its sensitivity to selected chemotherapeutic agents. EXPERIMENTAL DESIGN A tumor from an 11-year-old boy with previously untreated ACC was established as a subcutaneous xenograft in immunocompromised CB17 scid(-/-) mice. The patient harbored a germline TP53 G245C mutation, and the primary tumor showed loss of heterozygosity with retention of the mutated TP53 allele. Histopathology, DNA fingerprinting, gene expression profiling, and biochemical analyses of the xenograft were conducted and compared with the primary tumor and normal adrenal cortex. The second endpoint was to assess the preliminary antitumor activity of selected chemotherapeutic agents. RESULTS The xenograft maintained the histopathologic and molecular features of the primary tumor. Screening the xenograft for drug responsiveness showed that cisplatin had a potent antitumor effect. However, etoposide, doxorubicin, and a panel of other common cancer drugs had little or no antitumor activity, with the exception of topotecan, which was found to significantly inhibit tumor growth. Consistent with these preclinical findings, topotecan as a single agent in a child with relapsed ACC resulted in disease stabilization. CONCLUSION Our study established a novel TP53-associated pediatric ACC xenograft and identified topotecan as a potentially effective agent for treating children with this disease.
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Affiliation(s)
- Emilia M Pinto
- International Outreach Program, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
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Hartwich J, Orr WS, Ng CY, Spence Y, Morton C, Davidoff AM. HIF-1α activation mediates resistance to anti-angiogenic therapy in neuroblastoma xenografts. J Pediatr Surg 2013; 48:39-46. [PMID: 23331791 PMCID: PMC3601778 DOI: 10.1016/j.jpedsurg.2012.10.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 10/13/2012] [Indexed: 01/26/2023]
Abstract
INTRODUCTION The anti-tumor activity of angiogenesis inhibitors is often limited by the development of resistance to these drugs. Here we establish HIF-1α as a major factor in the development of this resistance in neuroblastoma xenografts. METHODS Neuroblastoma xenografts were established by injecting unmodified SKNAS or NB-1691 cells (2 × 10(6) cells), or cells in which HIF-1α expression had been knocked down with shRNA, into the retroperitoneal space of SCID mice. Treatment of established tumors included bevacizumab (5mg/kg q2wk), sunitinib (40 mg/kg qd), or topotecan (0.5mg/kg qd) alone or in combination for a total of two weeks. RESULTS NB-1691 xenografts showed no difference in relative growth in HIF-1α knockdowns compared to control tumors (73.33 ± 7.90 vs 79.94 ± 6.15, p=0.528). However, HIF-1α knockdowns demonstrated relative final volumes that were significantly lower than unmodified tumors when both were treated with bevacizumab (35.88 ± 4.24 vs 53.57 ± 6.61, p=0.0544) or sunitinib (12.46 ± 2.59 vs 36.36 ± 4.82, p=0.0024). Monotherapy of unmodified xenografts with bevacizumab, sunitinib, or topotecan was largely ineffective. Relative final volumes of NB-1691 xenografts were significantly less in cohorts treated with sunitinib+topotecan (4.78 ± 0.77 vs 39.17 ± 2.44 [sunitinib alone], p=0.011) and bevacizumab+topotecan (13.63 ± 1.55 vs 48.16 ± 9.94 [bevacizumab alone], p=0.014). CONCLUSION Upregulation of HIF-1α appears to be a significant mechanism of resistance to antiangiogenic therapies in neuroblastoma. Suppressing HIF-1α with low-dose topotecan potentiates the effects of the antiangiogenic drugs in a mouse model.
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Affiliation(s)
- Joseph Hartwich
- Department of Surgery, St Jude Children's Research Hospital, Memphis TN 38105
- Department of Surgery, Virginia Commonwealth University, Richmond VA 23284
| | - W. Shannon Orr
- Department of Surgery, St Jude Children's Research Hospital, Memphis TN 38105
- Department of Surgery, University of Tennessee Health Science Center, Memphis TN 38105
| | - Catherine Y. Ng
- Department of Surgery, St Jude Children's Research Hospital, Memphis TN 38105
| | - Yunyu Spence
- Department of Surgery, St Jude Children's Research Hospital, Memphis TN 38105
| | - Christopher Morton
- Department of Surgery, St Jude Children's Research Hospital, Memphis TN 38105
| | - Andrew M. Davidoff
- Department of Surgery, St Jude Children's Research Hospital, Memphis TN 38105
- Department of Surgery, University of Tennessee Health Science Center, Memphis TN 38105
- Corresponding author. Tel.: +1 901 595 4060; fax: +1 901 595 6621. (A.M. Davidoff)
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Tran H, Li Y, Baer D, Morton C, Armstrong M, Udaltsova N, Friedman G, Klatsky A. Risk of Gastrointestinal Malignancies in Asian Americans. Ann Epidemiol 2012. [DOI: 10.1016/j.annepidem.2012.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Allen J, Tyrrell J, Morton C, Campbell S, Curnow A. Comparison of protoporphyrin IX accumulation and photobleaching during methyl-aminolevulinate photodynamic therapy of skin tumours located at acral and non-acral sites. Photodiagnosis Photodyn Ther 2011. [DOI: 10.1016/j.pdpdt.2011.03.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Tyrrell JS, Morton C, Campbell SM, Curnow A. Comparison of protoporphyrin IX accumulation and destruction during methylaminolevulinate photodynamic therapy of skin tumours located at acral and nonacral sites. Br J Dermatol 2011; 164:1362-8. [PMID: 21564050 DOI: 10.1111/j.1365-2133.2011.10265.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Topical photodynamic therapy (PDT) is successful in the treatment of nonmelanoma skin cancers and associated precancers, but efficacy is significantly reduced in actinic keratosis lesions not located on the face or scalp. OBJECTIVES To compare the changes in protoporphyrin IX (PpIX) fluorescence in lesions undergoing routine methylaminolevulinate (MAL) PDT and the clinical outcome observed 3 months after treatment in lesions located at acral and nonacral sites. METHODS This study was a noninterventional, nonrandomized, observational study, which monitored changes in PpIX fluorescence in 200 lesions during standard dermatological MAL-PDT. These data were subsequently analysed in terms of lesions located at acral and nonacral sites. RESULTS Clinical clearance was significantly reduced (P < 0·01) in acral skin lesions when compared with lesions located at nonacral sites. The accumulation and destruction of PpIX fluorescence was significantly reduced in these acral lesions (P < 0·05 and P < 0·001, respectively). Specifically, lesion location at acral sites significantly reduced changes in PpIX fluorescence in actinic keratosis lesions during MAL-PDT (P < 0·01 and P < 0·05). CONCLUSIONS These data suggest that reduced PpIX accumulation and the subsequent reduction in PpIX photobleaching within acral lesions result in the reduced responsiveness of these lesions to MAL-PDT. Future work should therefore aim to improve photosensitizer accumulation/photobleaching within lesions located at acral sites.
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Affiliation(s)
- J S Tyrrell
- Clinical Photobiology, European Centre of Environment and Human Health, Peninsula Medical School, University of Exeter, Royal Cornwall Hospital, Treliske, Truro, Cornwall, UK
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Fraser CG, McDonald PJ, Colford L, Irvine A, Kenicer M, Morton C, Birrell J, Steele RJC. Experience with a wipe guaiac-based faecal occult blood test as an alternative test in a bowel screening programme. J Med Screen 2011; 17:211-3. [PMID: 21258132 DOI: 10.1258/jms.2010.010048] [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: 11/18/2022]
Abstract
The format of the traditional guaiac faecal occult blood test (gFOBT), particularly the collection technique, might cause difficulties for some. A multistage evaluation of alternative tests was performed. Firstly, four tests with different faecal collection approaches were assessed: a focus group recommended further investigation of a wipe gFOBT. Secondly, 100 faecal samples were analysed using two wipe tests and the routine gFOBT: no differences were found. Thirdly, a wipe gFOBT was introduced. Over 21 months, 400 requests were made and 311 wipe kit sets were submitted for analysis: 153 (49.2%) were negative, 21 (6.8%) positive (all 3 kits positive), 96 (30.9%) weak positive (1 or 2 positive) and 41 (13.2%) un-testable. Forty-three participants were referred for colonoscopy. Outcome data were provided on 39 participants: nine declined colonoscopy, two were judged unsuitable, two did not attend, two were already in follow-up, 13 had normal colonoscopy and two normal barium enema, two had diverticular disease, two had a metaplastic polyp, four had a low-risk adenoma and one had a high-risk adenoma. No participant had cancer. Detection of significant neoplasia was small. The use of the wipe gFOBT was ceased: it cannot be recommended as a screening test for bowel cancer.
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Affiliation(s)
- C G Fraser
- Scottish Bowel Screening Centre Laboratory, Kings Cross, Dundee DD3 8EA, Scotland, UK.
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Abu-Ain M, Aazem S, Morton C, Kumwenda M, Griffiths D, Jacob A. A rare potentially treatable cause of bilateral optic disc swelling. BMJ Case Rep 2010; 2010:2010/oct12_2/bcr0320102835. [PMID: 22789833 DOI: 10.1136/bcr.03.2010.2835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Rapid onset bilateral optic disc swelling generally indicates an intracranial problem-that is, papilloedema. However, when there is also visual loss, disease affecting the optic nerves themselves must be considered. We present the diagnostic problem of a patient with optic disc swelling and progressive visual loss. Investigations finally revealed hypocalcaemia secondary to primary hypoparathyroidism. With treatment a marked improvement in vision occurred. This reversible rare cause of optic disc swelling should not be forgotten.
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Affiliation(s)
- M Abu-Ain
- Department of Ophthalmology, Royal Gwent Hospital, Newport, UK
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Hartwich JE, Ng C, Morton C, Davidoff AM. Rapamycin upregulates osteoprotegerin and increases time to pathologic fracture in a mouse neuroblastoma bone metastasis model. J Am Coll Surg 2010. [DOI: 10.1016/j.jamcollsurg.2010.06.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Iqbal A, Morton C, Kong KL. Fibrinolysis during anaphylaxis, and its spontaneous resolution, as demonstrated by thromboelastography. Br J Anaesth 2010; 105:168-71. [PMID: 20584738 DOI: 10.1093/bja/aeq138] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A large and ever-growing number of agents used in anaesthesia can precipitate acute anaphylactic reactions after their administration. Anaphylaxis is a sudden onset (or rapidly progressive), severe systemic allergic reaction, affecting multiple organ systems. The number of people who suffer severe systemic allergic reactions is increasing. The incidence is about 1-3 reactions per 10 000 population per annum, although anaphylaxis is not always recognized; therefore, certain UK studies may underestimate the incidence. In this case report, we present an episode of acute fibrinolysis associated with life-threatening anaphylaxis, demonstrated by thromboelastography (TEG) and resolving spontaneously. This is despite an added fibrinolytic insult in the form of cardiopulmonary bypass. There is a paucity of literature detailing fibrinolysis occurring during anaphylaxis, most likely due to the limited availability of TEG in the acute setting and the primary clinical focus of delivering life-saving interventions.
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Affiliation(s)
- A Iqbal
- Featherstone Department of Anaesthesia and Intensive Care, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
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Wei JS, Johansson P, Chen QR, Song YK, Durinck S, Wen X, Cheuk ATC, Smith MA, Houghton P, Morton C, Khan J. microRNA profiling identifies cancer-specific and prognostic signatures in pediatric malignancies. Clin Cancer Res 2009; 15:5560-8. [PMID: 19706822 DOI: 10.1158/1078-0432.ccr-08-3287] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [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: 01/07/2023]
Abstract
PURPOSE microRNAs have been shown to be involved in different human cancers. We therefore have performed expression profiles on a panel of pediatric tumors to identify cancer-specific microRNAs. We also investigated if microRNAs are coregulated with their host gene. EXPERIMENTAL DESIGN We performed parallel microRNAs and mRNA expression profiling on 57 tumor xenografts and cell lines representing 10 different pediatric solid tumors using microarrays. For those microRNAs that map to their host mRNA, we calculated correlations between them. RESULTS We found that the majority of cancer types clustered together based on their global microRNA expression profiles by unsupervised hierarchical clustering. Fourteen microRNAs were significantly differentially expressed between rhabdomyosarcoma and neuroblastoma, and 8 of them were validated in independent patient tumor samples. Exploration of the expression of microRNAs in relationship with their host genes showed that the expression for 43 of 68 (63%) microRNAs located inside known coding genes was significantly correlated with that of their host genes. Among these 43 microRNAs, 5 of 7 microRNAs in the OncomiR-1 cluster correlated significantly with their host gene MIRHG1 (P < 0.01). In addition, high expression of MIRHG1 was significantly associated with high stage and MYCN amplification in neuroblastoma tumors, and the expression level of MIRHG1 could predict the outcome of neuroblastoma patients independently from the current neuroblastoma risk-stratification in two independent patient cohorts. CONCLUSION Pediatric cancers express cancer-specific microRNAs. The high expression of the OncomiR-1 host gene MIRHG1 correlates with poor outcome for patients with neuroblastoma, indicating important oncogenic functions of this microRNA cluster in neuroblastoma biology.
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Affiliation(s)
- Jun S Wei
- Oncogenomics Section, Pediatric Oncology Branch, Advanced Technology Center, National Cancer Institute, Gaithersburg, Maryland 20877, USA.
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Abstract
A 46-year-old woman with Graves' disease developed infiltrative dermopathy of the thenar eminences. We believe this to be the first reported case of infiltrative dermopathy affecting the thenar eminences, and question whether repetitive occupational injury may have been a contributing factor. There is little published evidence to guide the treatment of infiltrative dermopathy.
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Affiliation(s)
- S A Rice
- Department of Dermatology, Stirling Royal Infirmary, Stirling, UK
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Steele RJC, McClements PL, Libby G, Black R, Morton C, Birrell J, Mowat NAG, Wilson JA, Kenicer M, Carey FA, Fraser CG. Results from the first three rounds of the Scottish demonstration pilot of FOBT screening for colorectal cancer. Gut 2009; 58:530-5. [PMID: 19036949 DOI: 10.1136/gut.2008.162883] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.7] [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] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To assess the effects of the first three rounds of a pilot colorectal screening programme based on guaiac faecal occult blood testing (gFOBT) and their implications for a national population-based programme. METHODS A demonstration pilot programme was conducted in three Scottish NHS Boards. Residents aged between 50 and 69 years registered on the Community Health Index were included in the study. RESULTS In the first round, the uptake was 55.0%, the positivity rate was 2.07% and the cancer detection rate was 2.1/1000 screened. In the second round, these were 53.0%, 1.90% and 1.2/1000, respectively, and in the third round, 55.3%, 1.16% and 0.7/1000, respectively. In the first round, the positive predictive value of the gFOBT was 12.0% for cancer and 36.5% for adenoma; these fell to 7.0% and 30.3% in the second round and were maintained at 7.5% and 29.1% in the third round. The percentage of screen-detected cancers diagnosed at Dukes' stage A was 49.2% in the first round, 40.1% in the second round and 36.3% in the third round. CONCLUSIONS These results are compatible with those of previous randomised trials done in research settings, demonstrating that population-based colorectal cancer screening is feasible in Scotland and should lead to a comparable reduction in disease-specific mortality.
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Affiliation(s)
- R J C Steele
- Department of Surgery, University of Dundee, Dundee, UK.
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Lock R, Carol H, Houghton P, Morton C, Phelps D, Tucker C, Payne-Turner D, Zuany-Amorim C, Smith M. 192 POSTER Pediatric Preclinical Testing Program (PPTP) evaluation of the anti-CD19-DM4 conjugated antibody SAR3419. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)72124-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Kolb E, Morton C, Houghton P, Maris J, Friedman H, Kier S, Gorlick R, Kang M, Reynolds C, Smith M. 558 POSTER Pediatric Preclinical Testing Program (PPTP) evaluation of the fully human anti-IGF-1R antibody IMC-A12. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)72492-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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40
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Smith MA, Maris JM, Keir ST, Lock RB, Carol H, Gorlick R, Kolb EA, Keshelava N, Reynolds CP, Morton C, Houghton PJ. Pediatric preclinical testing program (PPTP) efficacy and pharmacodynamic evaluation of the Hsp90 inhibitor 17-DMAG. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.3575] [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
3575 Background: 17-DMAG is a small-molecule inhibitor of the protein chaperone HSP90 that is being developed as an anticancer agent because of the multiple HSP90 client proteins involved in cancer cell growth and survival. Methods: The PPTP includes an in vitro panel (n=27) as well as panels of xenografts (n=61) representing most of the common types of childhood solid tumors and childhood ALL. 17-DMAG was tested against the in vitro panel at concentrations from 1 nM to 10 microM and was tested against the in vivo tumor panels by IP administration using a 50 mg/kg BID twice weekly x 6 weeks dose and schedule. The PPTP’s 3 measures of antitumor activity were used (Houghton et al. Ped Blood Cancer 2006): 1) an objective response measure; 2) treated to control (T/C) tumor volume at day 21; and 3) a time to event (EFS T/C) measure. HSP70 induction was was used as a pharmacodynamic measure of HSP90 inhibition and was determined in tumor and liver tissue at 8 and 24 hours following the second of two doses of 17-DMAG (50 mg/kg IP) administered at 12 hour intervals. Results: 17-DMAG had an EC50 of 62 nM against the PPTP’s in vitro panel, with a trend for lower EC50 values for the rhabdomyosarcoma panel (median EC50 31 nM) compared to the remaining PPTP in vitro cell lines (p=0.06) and for higher EC50 values for the neuroblastoma lines (median EC50 396 nM, p=0.01). 17-DMAG induced significant differences in EFS distribution in 15 of 30 of the solid tumor xenografts, and in 4 of 6 of the evaluable ALL xenografts. Using the time to event activity measure, 17-DMAG had intermediate or high activity against 4 of 28 evaluable solid tumor xenografts (1 of 2 rhabdoid tumor and 3 of 4 alveolar rhabdomyosarcoma). The only objective response (a PR) observed was for an alveolar rhabdomyosarcoma xenograft. HSP70 induction was observed in both liver and tumor tissue, with robust induction (up to 450% increase versus control) occurring in both responding and non-responding tumors. Conclusions: 17-DMAG produced its greatest antitumor activity against alveolar rhabdomyosarcoma xenografts. Robust HSP70 induction was observed in both responding and non-responding xenografts, suggesting that tumor-specific downstream effects of HSP90 inhibition are primary determinants of response. (Supported by NCI NO1CM42216) No significant financial relationships to disclose.
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Affiliation(s)
- M. A. Smith
- Cancer Therapy Evaluation Program, Bethesda, MD; Children’s Hospital of Philadelphia, Philadelphia, PA; Duke University, Durham, NC; Children’s Cancer Institute Australia, Randwick, Australia; Albert Einstein College of Medicine, New York City, NY; Children’s Hospital of Los Angeles, Los Angeles, CA; St. Jude Children’s Research Hospital, Memphis, TN
| | - J. M. Maris
- Cancer Therapy Evaluation Program, Bethesda, MD; Children’s Hospital of Philadelphia, Philadelphia, PA; Duke University, Durham, NC; Children’s Cancer Institute Australia, Randwick, Australia; Albert Einstein College of Medicine, New York City, NY; Children’s Hospital of Los Angeles, Los Angeles, CA; St. Jude Children’s Research Hospital, Memphis, TN
| | - S. T. Keir
- Cancer Therapy Evaluation Program, Bethesda, MD; Children’s Hospital of Philadelphia, Philadelphia, PA; Duke University, Durham, NC; Children’s Cancer Institute Australia, Randwick, Australia; Albert Einstein College of Medicine, New York City, NY; Children’s Hospital of Los Angeles, Los Angeles, CA; St. Jude Children’s Research Hospital, Memphis, TN
| | - R. B. Lock
- Cancer Therapy Evaluation Program, Bethesda, MD; Children’s Hospital of Philadelphia, Philadelphia, PA; Duke University, Durham, NC; Children’s Cancer Institute Australia, Randwick, Australia; Albert Einstein College of Medicine, New York City, NY; Children’s Hospital of Los Angeles, Los Angeles, CA; St. Jude Children’s Research Hospital, Memphis, TN
| | - H. Carol
- Cancer Therapy Evaluation Program, Bethesda, MD; Children’s Hospital of Philadelphia, Philadelphia, PA; Duke University, Durham, NC; Children’s Cancer Institute Australia, Randwick, Australia; Albert Einstein College of Medicine, New York City, NY; Children’s Hospital of Los Angeles, Los Angeles, CA; St. Jude Children’s Research Hospital, Memphis, TN
| | - R. Gorlick
- Cancer Therapy Evaluation Program, Bethesda, MD; Children’s Hospital of Philadelphia, Philadelphia, PA; Duke University, Durham, NC; Children’s Cancer Institute Australia, Randwick, Australia; Albert Einstein College of Medicine, New York City, NY; Children’s Hospital of Los Angeles, Los Angeles, CA; St. Jude Children’s Research Hospital, Memphis, TN
| | - E. A. Kolb
- Cancer Therapy Evaluation Program, Bethesda, MD; Children’s Hospital of Philadelphia, Philadelphia, PA; Duke University, Durham, NC; Children’s Cancer Institute Australia, Randwick, Australia; Albert Einstein College of Medicine, New York City, NY; Children’s Hospital of Los Angeles, Los Angeles, CA; St. Jude Children’s Research Hospital, Memphis, TN
| | - N. Keshelava
- Cancer Therapy Evaluation Program, Bethesda, MD; Children’s Hospital of Philadelphia, Philadelphia, PA; Duke University, Durham, NC; Children’s Cancer Institute Australia, Randwick, Australia; Albert Einstein College of Medicine, New York City, NY; Children’s Hospital of Los Angeles, Los Angeles, CA; St. Jude Children’s Research Hospital, Memphis, TN
| | - C. P. Reynolds
- Cancer Therapy Evaluation Program, Bethesda, MD; Children’s Hospital of Philadelphia, Philadelphia, PA; Duke University, Durham, NC; Children’s Cancer Institute Australia, Randwick, Australia; Albert Einstein College of Medicine, New York City, NY; Children’s Hospital of Los Angeles, Los Angeles, CA; St. Jude Children’s Research Hospital, Memphis, TN
| | - C. Morton
- Cancer Therapy Evaluation Program, Bethesda, MD; Children’s Hospital of Philadelphia, Philadelphia, PA; Duke University, Durham, NC; Children’s Cancer Institute Australia, Randwick, Australia; Albert Einstein College of Medicine, New York City, NY; Children’s Hospital of Los Angeles, Los Angeles, CA; St. Jude Children’s Research Hospital, Memphis, TN
| | - P. J. Houghton
- Cancer Therapy Evaluation Program, Bethesda, MD; Children’s Hospital of Philadelphia, Philadelphia, PA; Duke University, Durham, NC; Children’s Cancer Institute Australia, Randwick, Australia; Albert Einstein College of Medicine, New York City, NY; Children’s Hospital of Los Angeles, Los Angeles, CA; St. Jude Children’s Research Hospital, Memphis, TN
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Whiteford CC, Bilke S, Greer BT, Chen Q, Braunschweig TA, Cenacchi N, Wei JS, Smith MA, Houghton P, Morton C, Reynolds CP, Lock R, Gorlick R, Khanna C, Thiele CJ, Takikita M, Catchpoole D, Hewitt SM, Khan J. Credentialing preclinical pediatric xenograft models using gene expression and tissue microarray analysis. Cancer Res 2007; 67:32-40. [PMID: 17210681 DOI: 10.1158/0008-5472.can-06-0610] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [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: 12/29/2022]
Abstract
Human tumor xenografts have been used extensively for rapid screening of the efficacy of anticancer drugs for the past 35 years. The selection of appropriate xenograft models for drug testing has been largely empirical and has not incorporated a similarity to the tumor type of origin at the molecular level. This study is the first comprehensive analysis of the transcriptome of a large set of pediatric xenografts, which are currently used for preclinical drug testing. Suitable models representing the tumor type of origin were identified. It was found that the characteristic expression patterns of the primary tumors were maintained in the corresponding xenografts for the majority of samples. Because a prerequisite for developing rationally designed drugs is that the target is expressed at the protein level, we developed tissue arrays from these xenografts and corroborated that high mRNA levels yielded high protein levels for two tested genes. The web database and availability of tissue arrays will allow for the rapid confirmation of the expression of potential targets at both the mRNA and the protein level for molecularly targeted agents. The database will facilitate the identification of tumor markers predictive of response to tested agents as well as the discovery of new molecular targets.
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Affiliation(s)
- Craig C Whiteford
- Oncogenomics Section, Comparative Oncology Program, and Cell and Molecular Biology Section, Pediatric Oncology Branch
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Houghton P, Maris J, Friedman H, Keir S, Lock R, Gorlick R, Kolb E, Reynolds C, Morton C, Smith M. 313 POSTER Pediatric preclinical testing program (PPTP) evaluation of the KSP inhibitor Ispinesib (SB-715992). EJC Suppl 2006. [DOI: 10.1016/s1359-6349(06)70318-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Smith M, Maris J, Keir S, Friedman H, Lock R, Kolb E, Keshelava N, Reynolds C, Morton C, Houghton P. 322 POSTER Pediatric Preclinical Testing Program (PPTP) evaluation of the Src-Abl inhibitor dasatinib (BMS-354825). EJC Suppl 2006. [DOI: 10.1016/s1359-6349(06)70327-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Morton C, Campbell S, Gupta G, Keohane S, Lear J, Zaki I, Walton S, Kerrouche N, Thomas G, Soto P. Intraindividual, right-left comparison of topical methyl aminolaevulinate-photodynamic therapy and cryotherapy in subjects with actinic keratoses: a multicentre, randomized controlled study. Br J Dermatol 2006; 155:1029-36. [PMID: 17034536 DOI: 10.1111/j.1365-2133.2006.07470.x] [Citation(s) in RCA: 166] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Actinic keratosis (AK), the most common premalignant skin condition, can represent a management challenge. Treatment should not only be effective, but also well tolerated and allow for good cosmesis on typical sun-exposed highly visible body sites. OBJECTIVES The primary objective was to compare the lesion response and subject preference for topical methyl aminolaevulinate (MAL)-photodynamic therapy (PDT) vs. cryotherapy for the treatment of AK. METHODS In this 24-week, multicentre, randomized, intraindividual (right-left) study, subjects received both one treatment session of MAL-PDT and a double freeze-thaw cryotherapy; the treatments were randomly allocated to either side of the face/scalp. Lesions with a noncomplete response were retreated after 12 weeks. The primary assessments were the subject's overall preference and lesion response at week 24. Secondary assessments included lesion response at week 12, cosmetic outcome, subject and investigator cosmetic outcome preference at week 24, and investigator overall preference at week 24. Skin discomfort and adverse events were also evaluated. RESULTS In total, 119 subjects with 1,501 lesions were included in the study. At week 12, treatment with MAL-PDT resulted in a significantly larger rate of cured lesions relative to cryotherapy (percentage lesion reduction from baseline: 86.9% vs. 76.2%; P < 0.001). At week 24, both treatment groups showed a high rate of cured lesions (89.1% for MAL-PDT vs. 86.1% for cryotherapy; P = 0.20; 95% confidence interval: -1.62 to 7.67). Results for subject and investigator preferences as well as cosmetic outcome favoured MAL-PDT. Both treatment regimens were safe and well tolerated. CONCLUSIONS The present study shows that, when treated with both MAL-PDT and cryotherapy, subjects significantly prefer MAL-PDT treatment for AK. MAL-PDT is an attractive treatment option for AK, with comparable efficacy and superior cosmetic outcomes compared with double freeze-thaw cryotherapy.
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Affiliation(s)
- C Morton
- Royal Cornwall Hospital, Truro TR1 3LJ, UK.
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Kurmasheva R, Morton C, Houghton PJ. Developing new agents for the treatment of childhood cancer. Curr Opin Investig Drugs 2005; 6:1215-27. [PMID: 16372407] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The development of new drugs for the treatment of childhood cancer presents novel challenges, and pediatric clinical trials of a new agent are often initiated many years after testing in adults. It is estimated that there are over 400 new entities being developed as cancer treatments, although few of these have been developed specifically for the treatment of childhood malignancies. This raises the question of how agents can be prioritized for pediatric clinical testing. In this review, the molecular characteristics of childhood cancers that may be valuable in steering choices for rational or molecularly targeted treatments are described, and the Pediatric Preclinical Testing Program, a National Cancer Institute initiative to identify agents that should be prioritized for clinical evaluation against childhood cancer, is presented.
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Affiliation(s)
- Raushan Kurmasheva
- St Jude Children's Research Hospital, Molecular Pharmacology, 332 North Lauderdale Street, Memphis, TN 38105-2794, USA
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Abstract
The neural systems sustaining object naming were examined using the activation likelihood estimation (ALE) meta-analysis approach on the results of 16 previously published studies. The activation task in each study required subjects to name pictures of objects or animals, but the baseline tasks varied. Separate meta-analyses were carried out on studies that used: (1) high-level baselines to control for speech processing and visual input; and (2) low-level baselines that did not control for speech or complex visual processing. The results of the two meta-analyses were then compared directly, revealing a double dissociation in the activation pattern for studies using high and low baselines. To interpret the differential activations, we report two new functional imaging experiments. The aim of the first was to characterize activation differences associated with visual stimuli that are typically used in baseline conditions (complex visual features, simple structures, or fixation). The aim of the second was to classify object-naming regions in terms of whether they were engaged preferentially by semantic or phonological processes. The results reveal a remarkably precise correspondence between the areas identified by the meta-analyses as affected differentially by baseline and the areas that are affected differentially by non-object structure, semantics or phonology. As expected, high-level baselines reduced object-naming activation in areas associated with the processing of complex visual features and speech production. In addition, high-level baselines increased sensitivity to activation in areas associated with semantic processing, visual-speech integration and response selection. For example, activation in the anterior temporal areas that neuropsychological studies have associated with semantic processing was more strongly activated in the context of high-level baselines. These results therefore have implications for understanding the convergence of functional imaging and neuropsychological findings.
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Affiliation(s)
- Cathy J Price
- Wellcome Department of Imaging Neuroscience, Institute of Neurology, London, United Kingdom.
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Hay IC, Dick D, Morton C. Quality of life assessment of alopecia areata − a comparison of two geographic areas in Scotland. Clin Exp Dermatol 2002. [DOI: 10.1046/j.1365-2230.2002.104154.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: 11/20/2022]
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Morton C. Quality must be enshrined. Aust Nurs J 2001; 9:3. [PMID: 11908008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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