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Kassam F, Chen H, Nosheny R, McGirr A, Williams T, Ng N, Camacho M, Mackin R, Weiner M, Ismail Z. Cognitive profile of people with mild behavioral impairment in Brain Health Registry participants. Int Psychogeriatr 2023; 35:643-652. [PMID: 35130991 PMCID: PMC10063171 DOI: 10.1017/s1041610221002878] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Dementia assessment includes cognitive and behavioral testing with informant verification. Conventional testing is resource-intensive, with uneven access. Online unsupervised assessments could reduce barriers to risk assessment. The aim of this study was to assess the relationship between informant-rated behavioral changes and participant-completed neuropsychological test performance in older adults, both measured remotely via an online unsupervised platform, the Brain Health Registry (BHR). DESIGN Observational cohort study. SETTING Community-dwelling older adults participating in the online BHR. Informant reports were obtained using the BHR Study Partner Portal. PARTICIPANTS The final sample included 499 participant-informant dyads. MEASUREMENTS Participants completed online unsupervised neuropsychological assessment including Forward Memory Span, Reverse Memory Span, Trail Making B, and Go/No-Go tests. Informants completed the Mild Behavioral Impairment Checklist (MBI-C) via the BHR Study Partner portal. Cognitive performance was evaluated in MBI+/- individuals, as was the association between cognitive scores and MBI symptom severity. RESULTS Mean age of the 499 participants was 67, of which 308/499 were females (61%). MBI + status was associated with significantly lower memory and executive function test scores, measured using Forward and Reverse Memory Span, Trail Making Errors and Trail Making Speed. Further, significant associations were found between poorer objectively measured cognitive performance, in the domains of memory and executive function, and MBI symptom severity. CONCLUSION These findings support the feasibility of remote, informant-reported behavioral assessment utilizing the MBI-C, supporting its validity by demonstrating a relationship to online unsupervised neuropsychological test performance, using a previously validated platform capable of assessing early dementia risk markers.
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Affiliation(s)
- F. Kassam
- University of Calgary, Hotchkiss Brain Institute
| | - H. Chen
- University of Calgary, Hotchkiss Brain Institute
| | - R.L. Nosheny
- University of California, San Francisco, Department of Psychiatry
| | - A. McGirr
- University of Calgary, Department of Psychiatry
| | - T. Williams
- University of California, San Francisco, Departments of Radiology and Biomedical Imaging, Medicine, Psychiatry, and Neurology
| | | | - Monica Camacho
- University of California, San Francisco, Departments of Radiology and Biomedical Imaging, Medicine, Psychiatry, and Neurology
| | - R.S. Mackin
- University of California, San Francisco, Department of Psychiatry
| | - M.W. Weiner
- University of California, San Francisco, Departments of Radiology and Biomedical Imaging, Medicine, Psychiatry, and Neurology
| | - Z. Ismail
- University of Calgary, Hotchkiss Brain Institute
- University of Calgary, Department of Psychiatry
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2
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Hill S, Kassam F, Verma S, Sidana A. Traditional and novel imaging modalities for advanced prostate cancer: A critical review. Urol Ann 2023; 15:249-255. [PMID: 37664103 PMCID: PMC10471808 DOI: 10.4103/ua.ua_170_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 04/26/2021] [Indexed: 09/05/2023] Open
Abstract
Accurate detection of metastatic prostate cancer in the setting of preoperative staging as well as posttreatment recurrence is crucial to provide patients with appropriate and timely treatment of their disease. This has traditionally been accomplished with a combination of computed tomography, magnetic resonance imaging, and bone scan. Recently, more novel imaging techniques have been developed to help improve the detection of advanced and metastatic prostate cancer. This review discusses the efficacy of the traditional imaging modalities as well as the novel imaging techniques in detecting metastatic prostate cancer. Articles discussed were gathered through a formal PubMed search.
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Affiliation(s)
- Spencer Hill
- Department of Urology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Farzaan Kassam
- Department of Urology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sadhna Verma
- Department of Urology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Abhinav Sidana
- Department of Urology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Clearwater W, Kassam F, Aalami Harandi A, Tenggardjaja CF, Abraham N. Combination and Novel Pharmacologic Agents for OAB. Curr Urol Rep 2022; 23:129-141. [PMID: 35567657 DOI: 10.1007/s11934-022-01097-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW To evaluate recent literature on combination and novel pharmacologic therapies for overactive bladder (OAB). RECENT FINDINGS Combination therapies demonstrating greater efficacy than monotherapy include combination anticholinergics, anticholinergic plus β-3 agonist, and anticholinergic with behavioral modification, percutaneous tibial nerve stimulation, or sacral neuromodulation. Promising novel therapies include new bladder selective anticholinergics, new β-3 agonists, and gabapentin. OAB is a symptom complex caused by dysfunction in the interconnected neural, muscular, and urothelial systems that control micturition. Although several therapeutic targets and treatment options exist, complete resolution is not always achieved, discontinuation rate for medical therapy is high, and few patients subsequently progress to third-line treatment options. Recent literature suggests combination therapy diversifying therapeutic targets is more effective than targeting a single pathway and novel treatments targeting additional pathways have promising results.
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Affiliation(s)
- Whitney Clearwater
- Department of Obstetrics & Gynecology and Women's Health, Division of Female Pelvic Medicine and Reconstructive Surgery, Montefiore Medical Center / Albert Einstein College of Medicine, 1250 Waters Place, Tower Two, 9th floor, Bronx, NY, 10461, USA
| | - Farzaan Kassam
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Place, Tower 1 PH, Bronx, NY, 10461, USA
| | | | - Christopher F Tenggardjaja
- Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, Kaiser Permanente Los Angeles Medical Center, Sunset Blvd, Los Angeles, CA, USA
| | - Nitya Abraham
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Place, Tower 1 PH, Bronx, NY, 10461, USA.
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Daulton R, Kassam F, Milligan K, Berry A. Making Lemonade Together -- How Program Directors, Applicants, and Medical Schools Can Thrive During the Upcoming Interview Season. MedEdPublish (2016) 2020; 9:198. [PMID: 38073826 PMCID: PMC10699402 DOI: 10.15694/mep.2020.000198.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
This article was migrated. The article was marked as recommended. The virtual residency interview process ushers in a new era of medical education. Many stakeholders are increasingly concerned as validated recommendations regarding Match success appear less reliable, fossilized rules have become increasingly fluid, and traditional streams of communication have become inadequate. Program directors will look to sell their program using unvalidated methods. Applicants will make life-altering decisions using fewer data points than historically available. Medical schools will endeavor to advise their students as they gear up for breaking new ground. In this piece, we introduce considerations and recommendations for the main players involved in the virtual interview process. If each party prioritizes teamwork and communication, we can collectively tackle the challenges of the upcoming cycle and turn lemons into lemonade.
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Kuo JC, Graham DM, Salvarrey A, Kassam F, Le LW, Shepherd FA, Burkes R, Hollen PJ, Gralla RJ, Leighl NB. A randomized trial of the electronic Lung Cancer Symptom Scale for quality-of-life assessment in patients with advanced non-small-cell lung cancer. ACTA ACUST UNITED AC 2020; 27:e156-e162. [PMID: 32489264 DOI: 10.3747/co.27.5651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction Improving health-related quality of life (hrqol) is a key goal of systemic therapy in advanced lung cancer, although routine assessment remains challenging. We analyzed the impact of a real-time electronic hrqol tool, the electronic Lung Cancer Symptom Scale (elcss-ql), on palliative care (pc) referral rates, patterns of chemotherapy treatment, and use of other supportive interventions in patients with advanced non-small-cell lung cancer (nsclc) receiving first-line chemotherapy. Methods Patients with advanced nsclc starting first-line chemotherapy were randomized to their oncologist receiving or not receiving their elcss-ql data before each clinic visit. Patients completed the elcss-ql at baseline, before each chemotherapy cycle, and at subsequent follow-up visits until disease progression. Prospective data about the pc referral rate, hrqol, and use of other supportive interventions were collected. Results For the 95 patients with advanced nsclc who participated, oncologists received real-time elcss-ql data for 44 (elcss-ql arm) and standard clinical assessment alone for 51 (standard arm). The primary endpoint, the pc referral rate, was numerically higher, but statistically similar, for patients in the elcss-ql and standard arms. The hrqol scores over time were not significantly different between the two study arms. Conclusions The elcss-ql is feasible as a tool for use in routine clinical practice, although no statistically significant effect of its use was demonstrated in our study. Improving access to supportive care through the collection of patient-reported outcomes and hrqol should be an important component of care for patients with advanced lung cancer.
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Affiliation(s)
- J C Kuo
- Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON.,University of New South Wales, Sydney, Australia
| | - D M Graham
- Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON.,Queen's University Belfast, Belfast, U.K
| | - A Salvarrey
- Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - F Kassam
- Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON.,Division of Medical Oncology, Southlake Regional Cancer Centre, Newmarket, ON
| | - L W Le
- Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - F A Shepherd
- Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - R Burkes
- Division of Medical Oncology, Mount Sinai Hospital, Toronto, ON
| | - P J Hollen
- School of Nursing, University of Virginia, Charlottesville, VA, U.S.A
| | - R J Gralla
- Albert Einstein College of Medicine, New York, NY, U.S.A
| | - N B Leighl
- Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON
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Matar RN, Gardner TJ, Kassam F, Grawe BM. When do patients truly reach maximal medical improvement after undergoing reverse shoulder arthroplasty? The incidence and clinical significance of pain and patient-reported outcome measure improvement. JSES Int 2020; 4:675-679. [PMID: 32939505 PMCID: PMC7479027 DOI: 10.1016/j.jseint.2020.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hypothesis Patients receiving reverse total shoulder arthroplasty (RTSA) may reach MMI prior to 12 months postoperatively. Background With the growth of RTSA indications, there is a paucity of information regarding maximum medical improvement (MMI) after these procedures. Systems of evaluating recovery, such as patient-reported outcome measures and minimal clinically important differences (MCIDs) will allow for measurement of when patients reach maximum medical improvement (MMI) after these procedures. Purpose To evaluate when patients have reached MMI after RTSA. Methods Patients were prospectively enrolled in the institution's RTSA registry. All patients undergoing RTSA who agreed to be enrolled were included. Patient-specific factors, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, and pain data were collected preoperatively and at 6 and 12 months postoperatively. Subgroup analysis was performed on preoperative diagnosis before analyzing MCID and MMI. MMI was calculated by using the last time point interval that an MCID did not occur. Results Of 182 patients, 92 had complete 12-month postoperative data, including visual analog scale (VAS) pain and ASES scores. Subgroup analysis showed preoperative diagnosis of rotator cuff arthropathy, revision surgery, glenohumeral arthritis, proximal humerus fracture, and chronic dislocation. All 5 groups had improvement that exceeded MCID thresholds at 6 months and variable improvement from 6-12 months. Analysis of variance compared the different groups, showing that VAS pain scores and ASES scores were different at all time points except for preoperative VAS pain scores. Conclusions Patients undergoing RTSA may reach MMI at 6 months instead of the previously reported 1-year time point. Data from this study can allow providers to deliver value care and potentially limit visits after 6 months postoperatively.
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Affiliation(s)
- Robert N. Matar
- Corresponding author: Robert N. Matar, MD, Department of Orthopaedics and Sports Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267-0212, USA.
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Morris MC, Kassam F, Bercz A, Beckmann N, Schumacher F, Gulbins E, Makley AT, Goodman MD. The Role of Chemoprophylactic Agents in Modulating Platelet Aggregability After Traumatic Brain Injury. J Surg Res 2019; 244:1-8. [PMID: 31279258 DOI: 10.1016/j.jss.2019.06.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/22/2019] [Accepted: 06/06/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND The pathophysiology behind the subacute but persistent hypercoagulable state after traumatic brain injury (TBI) is poorly understood but contributes to morbidity induced by venous thromboembolism. Because platelets and their microvesicles have been hypothesized to play a role in post-traumatic hypercoagulability, administration of commonly used agents may ameliorate this coagulability. We hypothesized that utilization of aspirin, ketorolac, amitriptyline, unfractionated heparin, or enoxaparin would modulate the platelet aggregation response after TBI. METHODS Concussive TBI was induced by weight drop. Mice were then randomized to receive aspirin, ketorolac, amitriptyline, heparin, enoxaparin, or saline control at 2 and 8 h after TBI. Mice were sacrificed at 6 or 24 h after injury to determine coagulability by rotational thromboelastometry (ROTEM), platelet function testing with impedance aggregometry, and microvesicle enumeration. Platelet sphingolipid metabolites were analyzed by mass spectrometry. RESULTS ROTEM demonstrated increased platelet contribution to maximum clot firmness at 6 h after TBI in mice that received aspirin or amitriptyline, but this did not persist at 24 h. By contrast, adenosine diphosphate- and arachidonic acid-induced platelet aggregation at 6 h was significantly lower in mice receiving ketorolac, aspirin, and amitriptyline compared with mice receiving saline at 6 h after injury and only arachidonic acid-initiated platelet aggregation was decreased by aspirin at 24 h. There were no differences in microvesicle production at either time point. Platelet sphingosine-1-phosphate levels were decreased at 6 h in the group receiving amitriptyline and increased at 24 h along with platelet ceramide levels at 24 h in the amitriptyline group. CONCLUSION After TBI, amitriptyline decreased platelet aggregability and increased contribution to clot in a manner similar to aspirin. The amitriptyline effects on platelet function and sphingolipid metabolites may represent a possible role of the acid sphingomyelinase in the hypercoagulability observed after injury. In addition, inhibition of platelet reactivity may be an underappreciated benefit of low molecular weight heparins, such as enoxaparin.
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Affiliation(s)
| | - Farzaan Kassam
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Aron Bercz
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Nadine Beckmann
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Fabian Schumacher
- Department of Molecular Biology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
| | - Erich Gulbins
- Department of Molecular Biology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Amy T Makley
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
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Morris MC, Bercz A, Niziolek GM, Kassam F, Veile R, Friend LA, Pritts TA, Makley AT, Goodman MD. UCH-L1 is a Poor Serum Biomarker of Murine Traumatic Brain Injury After Polytrauma. J Surg Res 2019; 244:63-68. [PMID: 31279265 DOI: 10.1016/j.jss.2019.06.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/23/2019] [Accepted: 06/06/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Several serum biomarkers have been studied to diagnose incidence and severity of traumatic brain injury (TBI), but a reliable biomarker in TBI has yet to be identified. Ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) has been proposed as a biomarker in clinical and preclinical studies, largely in the setting of isolated TBI or concussion. The aim of this study was to evaluate the performance of UCH-L1 as a serum biomarker in the setting of polytrauma and TBI. METHODS Multiple variations of murine TBI and polytrauma models were used to evaluate serum biomarkers. The different models included TBI with and without hemorrhagic shock and resuscitation, isolated extremity vascular ligation, extremity ischemia/reperfusion, and blunt tail injury. Blood was drawn at intervals after injury, and serum levels of neuron-specific enolase, UCH-L1, creatine kinase, and syndecan-1 were evaluated by enzyme-linked immunosorbent assay. RESULTS UCH-L1 levels were not significantly different between TBI, tail injury, and sham TBI. By contrast, neuron-specific enolase levels were increased in TBI mice compared with tail injury and sham TBI mice. UCH-L1 levels increased regardless of TBI status at 30 min and 4 h after hemorrhagic shock and resuscitation. In mice that underwent femoral artery cannulation followed by hemorrhagic shock/resuscitation, UCH-L1 levels were significantly elevated compared with shock sham mice at 4 h (3158 ± 2168 pg/mL, 4 h shock versus 0 ± 0 pg/mL, 4 h shock sham; P < 0.01) and at 24 h (3253 ± 2954 pg/mL, 24 h shock versus 324 ± 482 pg/mL, 24 h shock sham; P = 0.03). No differences were observed in UCH-L1 levels between the sham shock and the arterial ligation, vein ligation, or extremity ischemia/reperfusion groups at any time point. Similar to UCH-L1, creatine kinase was elevated only after shock compared with sham mice at 4, 24, and 72 h after injury. CONCLUSIONS Our study demonstrates that UCH-L1 is not a specific marker for TBI but is elevated in models that induce central and peripheral nerve ischemia. Given the increase in UCH-L1 levels observed after hemorrhagic shock, we propose that UCH-L1 may be a useful adjunct in quantifying severity of shock or global ischemia rather than as a specific marker of TBI.
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Affiliation(s)
| | - Aron Bercz
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Grace M Niziolek
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Farzaan Kassam
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Rose Veile
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Lou Ann Friend
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Timothy A Pritts
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Amy T Makley
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
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Zibdawi L, Simos D, Kassam S, Rana A, Kassam F, Rahim Y. Clinical practice patterns on the use of adjuvant bisphosphonate for early breast cancer: a Canadian perspective. Breast 2019. [DOI: 10.1016/s0960-9776(19)30116-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: 11/28/2022] Open
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Stewart SE, Mayerfeld C, Arnold PD, Crane JR, O'Dushlaine C, Fagerness JA, Yu D, Scharf JM, Chan E, Kassam F, Moya PR, Wendland JR, Delorme R, Richter MA, Kennedy JL, Veenstra-VanderWeele J, Samuels J, Greenberg BD, McCracken JT, Knowles JA, Fyer AJ, Rauch SL, Riddle MA, Grados MA, Bienvenu OJ, Cullen B, Wang Y, Shugart YY, Piacentini J, Rasmussen S, Nestadt G, Murphy DL, Jenike MA, Cook EH, Pauls DL, Hanna GL, Mathews CA. Meta-analysis of association between obsessive-compulsive disorder and the 3' region of neuronal glutamate transporter gene SLC1A1. Am J Med Genet B Neuropsychiatr Genet 2013; 162B:367-79. [PMID: 23606572 DOI: 10.1002/ajmg.b.32137] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [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] [Received: 10/22/2012] [Accepted: 01/15/2013] [Indexed: 12/12/2022]
Abstract
The neuronal glutamate transporter gene SLC1A1 is a candidate gene for obsessive-compulsive disorder (OCD) based on linkage studies and convergent evidence implicating glutamate in OCD etiology. The 3' end of SLC1A1 is the only genomic region with consistently demonstrated OCD association, especially when analyzing male-only probands. However, specific allele associations have not been consistently replicated, and recent OCD genome-wide association and meta-analysis studies have not incorporated all previously associated SLC1A1 SNPs. To clarify the nature of association between SLC1A1 and OCD, pooled analysis was performed on all available relevant raw study data, comprising a final sample of 815 trios, 306 cases and 634 controls. This revealed weak association between OCD and one of nine tested SLC1A1 polymorphisms (rs301443; uncorrected P = 0.046; non-significant corrected P). Secondary analyses of male-affecteds only (N = 358 trios and 133 cases) demonstrated modest association between OCD and a different SNP (rs12682807; uncorrected P = 0.012; non-significant corrected P). Findings of this meta-analysis are consistent with the trend of previous candidate gene studies in psychiatry and do not clarify the putative role of SLC1A1 in OCD pathophysiology. Nonetheless, it may be important to further examine the potential associations demonstrated in this amalgamated sample, especially since the SNPs with modest associations were not included in the more highly powered recent GWAS or in a past meta-analysis including five SLC1A1 polymorphisms. This study underscores the need for much larger sample sizes in future genetic association studies and suggests that next-generation sequencing may be beneficial in examining the potential role of rare variants in OCD.
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Affiliation(s)
- S E Stewart
- McLean Hospital, Belmont, Massachusetts, USA.
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Villarreal-Garza C, Bouganim N, Khalaf D, Clemons M, Kassam F, Enright K, Verma S, Myers J, Dent R. P5-19-14: Platinum-Based Chemotherapy in Triple-Negative Breast Cancer. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p5-19-14] [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: 11/16/2022]
Abstract
Abstract
Background: There is increasing evidence that DNA repair defects characteristic of BRCA1-related cancers and triple negative breast cancer (TNBC) confer sensitivity to certain chemotherapeutic agents, such as platinums. However, prospective and retrospective studies comparing the efficacy of these agents versus conventional treatment in TNBC are lacking. The aim of this study was to evaluate the efficacy of platinum-based chemotherapy (PBC) in metastatic TNBC in terms of median duration of treatment and overall-survival (OS) and compare it to patients treated with conventional chemotherapy. Methods: We performed a retrospective chart review of patients with metastatic TNBC who received PBC from January 2007 to June 2010 treated at the Sunnybrook Odette Cancer Center and the Ottawa Hospital Cancer Centre. This cohort was compared to a control group that included metastatic TNBC treated with conventional agents that included anthracyclines, taxanes, capecitabine, and vinorelbine.
Results: A total of 166 metastatic TNBC patients were analyzed: 60 treated with PBC and 106 managed with conventional treatment. Median age at diagnosis was 48 years and distant disease-free interval was 26 months (m) for both groups. Patients on both groups had multiple sites of metastases at diagnosis of recurrence than a single site of metastasis (69% for both groups). Of the 60 patients treated with PBC, 90% received a combination regimen, most commonly weekly cisplatin plus gemcitabine in 37% of patients and cisplatin plus vinorelbine in 17% of patients. The median number of cycles delivered was 4 (1-24). 33% received the PBC as first-line treatment, 38% as second-line, 18% as third-line, 7% as fourth line, and 3% as fifth-line. Only 8 patients (5%) discontinued PBC secondary to toxicity. The median time on treatment in first, second and third-line therapy was longer for the PBC group compared to the conventional group (5 vs. 2 m, p=0.108; 5 vs. 2 m, p=0.01; and 4 vs. 1 m, p=0.026). Patients treated with PBC had a longer OS compared to those managed conventionally (16 vs. 10 m, p=0.039).
Conclusions: PBC appears to improve clinical outcomes in patients with metastatic TNBC compared to those treated with conventional chemotherapy regimens. Although this is a retrospective study with its obvious limitations, it adds to the growing body of literature, suggesting the benefit of PBC in TNBC. Prospective trials are needed to confirm its benefit in order to integrate it as part of the routine management of these patients.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-19-14.
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Affiliation(s)
- C Villarreal-Garza
- 1Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Credit Valley Hospital, Mississauga, ON, Canada
| | - N Bouganim
- 1Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Credit Valley Hospital, Mississauga, ON, Canada
| | - D Khalaf
- 1Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Credit Valley Hospital, Mississauga, ON, Canada
| | - M Clemons
- 1Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Credit Valley Hospital, Mississauga, ON, Canada
| | - F Kassam
- 1Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Credit Valley Hospital, Mississauga, ON, Canada
| | - K Enright
- 1Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Credit Valley Hospital, Mississauga, ON, Canada
| | - S Verma
- 1Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Credit Valley Hospital, Mississauga, ON, Canada
| | - J Myers
- 1Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Credit Valley Hospital, Mississauga, ON, Canada
| | - R Dent
- 1Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Credit Valley Hospital, Mississauga, ON, Canada
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Villarreal-Garza CM, Clemons M, Kassam F, Enright K, Verma S, Myers JA, Dent RA. Platinum-based chemotherapy in triple-negative breast cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1090] [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: 11/20/2022] Open
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Amir E, Miller N, Geddie W, Maung H, Freedman OC, Oldfield M, Napolskikh J, Kassam F, Simmons C, Clemons M. Abstract PD10-05: Do the Results of Metastatic Breast Tumour Biopsies Affect Patient Survival Outcomes? Results from a Large Prospective Trial. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-pd10-05] [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: 11/16/2022]
Abstract
Abstract
Background: Differences in receptor status between primary and metastatic breast cancer are well recognized. We have previous demonstrated substantial receptor discordance rates resulting in a change in management in 14% of patients. However, while retrospective studies suggest that discordance can be associated with a worse patient prognosis, there are currently no prospective data assessing the impact of such discordance on survival outcomes.
Methods: A single-center prospective biopsy study was performed. Patients with either recurrent or progressive disease underwent biopsy of their metastases. Subsequent treatment choices were modified according to the results and patients were followed up for progression or death. To account for the differing times at which patients entered the study, progression-free survival (PFS) was calculated as the duration between biopsy and either progression or death. Overall survival (OS) was defined as the duration from diagnosis of metastatic disease to death. A Cox propotional hazards model accounting for duration of metastatic disease and visceral versus non-visceral metastatic disease was utilized.
Results: 121 biopsies were completed and 38% of cases showed discordance between the primary and the recurrence. Survival data were available from 96 patients. After a median follow-up of 11 months, 76 patients (79%) had progressed and 38 (40%) had died. There was no difference in median PFS between concordant and discordance cases (5.9 vs. 6.5 months, HR 0.89, p=0.61). There was a non-significant trend towards worse OS in discordant cases (50.6 vs. 57.8 months, HR 0.77, p=0.47). When compared with the primary tumour a gain of HER2 was associated with a poor survival, while loss of HER2 was associated with improved outcome. Metastatic biopsies showed a trend towards better prediction of response to endocrine therapy with tumors losing progesterone receptor expression between primary and metastatic disease having worse DFS on endocrine therapy. Conclusion: We have previously shown that performing metastatic biopsies is associated with a substantial rate of receptor discordance between primary and metastatic disease. The current analysis demonstrates that this discordance is associated with a trend towards worse OS, but not PFS. Knowledge of the receptor status of metastatic disease allows better prognostication between HER2-postive and HER2-negative disease and also allows for improved prediction of response to endocrine therapy. Metastatic biopsies should therefore be considered in patients with recurrent breast cancer.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr PD10-05.
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Affiliation(s)
- E Amir
- Princess Margaret Hospital, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada; The Ottawa Hospital Cancer Centre, ON, Canada
| | - N Miller
- Princess Margaret Hospital, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada; The Ottawa Hospital Cancer Centre, ON, Canada
| | - W Geddie
- Princess Margaret Hospital, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada; The Ottawa Hospital Cancer Centre, ON, Canada
| | - H Maung
- Princess Margaret Hospital, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada; The Ottawa Hospital Cancer Centre, ON, Canada
| | - OC Freedman
- Princess Margaret Hospital, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada; The Ottawa Hospital Cancer Centre, ON, Canada
| | - M Oldfield
- Princess Margaret Hospital, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada; The Ottawa Hospital Cancer Centre, ON, Canada
| | - J Napolskikh
- Princess Margaret Hospital, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada; The Ottawa Hospital Cancer Centre, ON, Canada
| | - F Kassam
- Princess Margaret Hospital, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada; The Ottawa Hospital Cancer Centre, ON, Canada
| | - C Simmons
- Princess Margaret Hospital, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada; The Ottawa Hospital Cancer Centre, ON, Canada
| | - M. Clemons
- Princess Margaret Hospital, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada; The Ottawa Hospital Cancer Centre, ON, Canada
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Kassam F, Enright K, Dent R, Flynn C, Myers J, Fralick M, Kumar R, Clemons M. Outcomes for metastatic triple-negative (TN) breast cancer: Impact for clinical practice and trial design. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.1121] [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] Open
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Visbal A, Kassam F, Johnston M, Feld R, Shepherd F, Darling G, Keshavjee S, Pierre A, Waddell L, Leighl N. PD-101 Review of practice patterns for adjuvant chemotherapy inpatients with completely resected non-small cell lung cancer (NSCLC). Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)80434-9] [Citation(s) in RCA: 2] [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: 11/26/2022]
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Kassam F, Salvarrey A, Shepherd F, Feld R, Gralla R, Leighl N. P-507 Randomized trial to investigate the impact of a computer-generated quality of Life assessment program on treatment patterns for advanced non-small cell lung cancer patients. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)81000-1] [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]
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Kassam F, Johnston MR, Feld R, Shepherd F, Darling G, Keshavjee S, Pierre AF, Waddell TK, Hornby JK, Leighl N. Referral patterns for adjuvant therapy in non-small cell lung cancer. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.7217] [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: 11/20/2022] Open
Affiliation(s)
- F. Kassam
- Univ of Toronto, Toronto, ON, Canada; Princess Margaret Hosp, Toronto, ON, Canada
| | - M. R. Johnston
- Univ of Toronto, Toronto, ON, Canada; Princess Margaret Hosp, Toronto, ON, Canada
| | - R. Feld
- Univ of Toronto, Toronto, ON, Canada; Princess Margaret Hosp, Toronto, ON, Canada
| | - F. Shepherd
- Univ of Toronto, Toronto, ON, Canada; Princess Margaret Hosp, Toronto, ON, Canada
| | - G. Darling
- Univ of Toronto, Toronto, ON, Canada; Princess Margaret Hosp, Toronto, ON, Canada
| | - S. Keshavjee
- Univ of Toronto, Toronto, ON, Canada; Princess Margaret Hosp, Toronto, ON, Canada
| | - A. F. Pierre
- Univ of Toronto, Toronto, ON, Canada; Princess Margaret Hosp, Toronto, ON, Canada
| | - T. K. Waddell
- Univ of Toronto, Toronto, ON, Canada; Princess Margaret Hosp, Toronto, ON, Canada
| | - J. K. Hornby
- Univ of Toronto, Toronto, ON, Canada; Princess Margaret Hosp, Toronto, ON, Canada
| | - N. Leighl
- Univ of Toronto, Toronto, ON, Canada; Princess Margaret Hosp, Toronto, ON, Canada
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