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Pamulapati S, Conroy M, Madireddy S, Kamaraju S, Cortina C, Moore H, Hartmann J. Applications of Viscoelastic Testing in Breast Cancer Patients: A Systematic Review Focusing on Hypercoagulability and Free Flap Thrombosis. Semin Thromb Hemost 2024; 50:413-422. [PMID: 37327882 DOI: 10.1055/s-0043-1769937] [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] [Indexed: 06/18/2023]
Abstract
Viscoelastic testing is a clinically available method to assess hypercoagulability. This systematic review aims to provide a comprehensive overview of the existing literature and the potential use of such testing in patients with breast cancer. A systematic literature search for studies investigating the application of viscoelastic testing for patients with breast cancer was conducted. Studies were included as long as they were original, peer-reviewed, and in the English language. Studies were excluded if they were review articles, did not include breast cancer patients, or if the full text was unavailable. This review identified 10 articles that met the inclusion criteria. Two of the studies utilized rotational thromboelastometry, and an additional four studies used thromboelastography, to assess hypercoagulability in patients with breast cancer. Three of the identified articles discussed the use of thromboelastometry in free flap breast reconstruction for patients with breast cancer. One study was a retrospective chart review looking at thromboelastography and microsurgical breast reconstruction. Current literature regarding the application of viscoelastic testing in breast cancer and free flap breast reconstruction is limited, with no randomized trials thus far. However, some studies suggest that there may be potential utility in viscoelastic testing to assess risk for thromboembolism in breast cancer patients, and future research in this area is warranted.
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Affiliation(s)
| | | | | | - Sailaja Kamaraju
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Chandler Cortina
- Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Hunter Moore
- Division of Surgery-Transplant, University of Colorado School of Medicine, Aurora, Colorado
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Oshima K, Siddiqui N, Orfila JE, Carter D, Laing J, Han X, Zakharevich I, Iozzo RV, Ghasabyan A, Moore H, Zhang F, Linhardt RJ, Moore EE, Quillinan N, Schmidt EP, Herson PS, Hippensteel JA. A role for decorin in improving motor deficits after traumatic brain injury. Matrix Biol 2024; 125:88-99. [PMID: 38135163 PMCID: PMC10922985 DOI: 10.1016/j.matbio.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023]
Abstract
Traumatic brain injury (TBI) is the leading cause of death and disability due to injury worldwide. Extracellular matrix (ECM) remodeling is known to significantly contribute to TBI pathophysiology. Glycosaminoglycans, which are long-chain, variably sulfated polysaccharides abundant within the ECM, have previously been shown to be substantially altered after TBI. In this study, we sought to delineate the dynamics of glycosaminoglycan alterations after TBI and discover the precise biologic processes responsible for observed glycosaminoglycan changes after injury. We performed state-of-the art mass spectrometry on brain tissues isolated from mice after TBI or craniotomy-alone. We observed dynamic changes in glycosaminoglycans at Day 1 and 7 post-TBI, with heparan sulfate, chondroitin sulfate, and hyaluronan remaining significantly increased after a week vis-à-vis craniotomy-alone tissues. We did not observe appreciable changes in circulating glycosaminoglycans in mice after experimental TBI compared to craniotomy-alone nor in patients with TBI and severe polytrauma compared to control patients with mild injuries, suggesting increases in injury site glycosaminoglycans are driven by local synthesis. We subsequently performed an unbiased whole genome transcriptomics analysis on mouse brain tissues 7 days post-TBI and discovered a significant induction of hyaluronan synthase 2, glypican-3, and decorin. The functional role of decorin after injury was further examined through multimodal behavioral testing comparing wild-type and Dcn-/- mice. We discovered that genetic ablation of Dcn led to an overall negative effect of TBI on function, exacerbating motor impairments after TBI. Collectively, our results provide a spatiotemporal characterization of post-TBI glycosaminoglycan alterations in the brain ECM and support an important adaptive role for decorin upregulation after TBI.
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Affiliation(s)
- Kaori Oshima
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Noah Siddiqui
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - James E Orfila
- Department of Neurosurgery, The Ohio State University, College of Medicine, Columbus, Ohio, USA
| | - Danelle Carter
- Department of Neurology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Justin Laing
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Xiaorui Han
- Departments of Chemistry and Chemical Biology, Chemical and Biological Engineering, and Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York, USA; Curtin Medical School, Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Igor Zakharevich
- Department of Biochemistry, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Renato V Iozzo
- Department of Pathology and Genomic Medicine and the Translational Cellular Oncology Program, Sidney Kimmel Cancer Center, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Arsen Ghasabyan
- Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, Colorado, USA
| | - Hunter Moore
- Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, Colorado, USA
| | - Fuming Zhang
- Departments of Chemistry and Chemical Biology, Chemical and Biological Engineering, and Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York, USA
| | - Robert J Linhardt
- Departments of Chemistry and Chemical Biology, Chemical and Biological Engineering, and Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York, USA
| | - Ernest E Moore
- Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, Colorado, USA
| | - Nidia Quillinan
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Eric P Schmidt
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paco S Herson
- Department of Neurosurgery, The Ohio State University, College of Medicine, Columbus, Ohio, USA
| | - Joseph A Hippensteel
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
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Thivel D, Oustric P, Beaulieu K, Moore H, Bonjean L, Loglisci J, Georges M, Miyashita M, Boirie Y, Pereira B, Finlayson G. Development, sensitivity and reliability of a French version of the Leeds Food Preference Questionnaire (LFPQ-fr) for the evaluation of food preferences and reward. Physiol Behav 2023; 267:114187. [PMID: 37080481 DOI: 10.1016/j.physbeh.2023.114187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/02/2023] [Accepted: 04/09/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND . There is a growing global interest in the evaluation of food reward, necessitating the adaptation of culturally appropriate instruments for use in empirical studies. This work presents the development and validation of a culturally adapted French version of the Leeds Food Preference Questionnaire (LFPQ-fr). METHODS . The LFPQ-fr was developed and validated in healthy-weight adults using the following systematic approach: i) selection and validation of appropriate food pictures; ii) linguistic translation of liking and wanting constructs in the target population (n=430; 81% female; 42.2 ± 12.7 years); iii) validation of the sensitivity and reliability of the task performed in a fasted state and in response to a standardized test meal (n=50; 50% female; 30.0 ± 8.4 years). RESULTS . During the first and second phases, the nutritional and perceptual validation of culturally appropriate food pictures and pertinent reward constructs, respectively, was demonstrated in a healthy-weight French sample. Findings from the third phase indicated that all food reward components were sensitive to the test meal and showed moderate to high agreement in both fasted (Lin's CCC =.72-.94) and fed (Lin's CCC = .53-.80) appetitive states between visit 1 (V1) and visit (V2). Except for explicit liking fat bias, all primary outcomes were statistically consistent in fasted and fed states between V1 and V2. Changes in fat and taste biases in response to a standardized meal for all primary outcomes were also consistent between V1 and V2 except for explicit liking fat bias (Lin's CCC = .49- .72). CONCLUSION . The LFPQ-fr developed and tested in this study is a reproducible and reliable method to assess food reward in both the fasted and fed states in a healthy-weight French population.
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Affiliation(s)
- D Thivel
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Clermont Auvergne University, Clermont-Ferrand, France..
| | - P Oustric
- Appetite Control Energy Balance Group, School of Psychology, University of Leeds, Leeds LS2 9JT, UK
| | - K Beaulieu
- Appetite Control Energy Balance Group, School of Psychology, University of Leeds, Leeds LS2 9JT, UK
| | - H Moore
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Clermont Auvergne University, Clermont-Ferrand, France
| | - L Bonjean
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Clermont Auvergne University, Clermont-Ferrand, France
| | - J Loglisci
- Department of Pulmonary Medicine and Intensive Care Unit, Constitutive Reference Center for Rare Pulmonary Diseases, University Hospital, Bourgogne-Franche-Comté, Burgundy University, Dijon, France; Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS UMR6265, INRAE UMR 1324, Université de Bourgogne Franche Comté, Dijon, France
| | - M Georges
- Department of Pulmonary Medicine and Intensive Care Unit, Constitutive Reference Center for Rare Pulmonary Diseases, University Hospital, Bourgogne-Franche-Comté, Burgundy University, Dijon, France; Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS UMR6265, INRAE UMR 1324, Université de Bourgogne Franche Comté, Dijon, France
| | - M Miyashita
- Faculty of Sport Sciences, Waseda University, Saitama 359-1192, Japan
| | - Y Boirie
- CSO-CALORIS, CHU Clermont-Ferrand, Clermont-Ferrand, France; Department of Human Nutrition, CHU Clermont-Ferrand, Clermont-Ferrand, France.
| | - B Pereira
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France.
| | - G Finlayson
- Appetite Control Energy Balance Group, School of Psychology, University of Leeds, Leeds LS2 9JT, UK
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Gonzales T, Moore H, Sehgal C, Benjamin J. Disaster preparedness: gaining a wholistic understanding of caregiver’s perspectives of children and youth with special health care needs in developing future interventions. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00528-1] [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: 01/28/2023]
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Moore H, Zheng A, Cairns A, Lillaney P, Black J. Enhancement of a Machine Learning Algorithm to Alert Sleep Clinicians of Patients at Risk for Narcolepsy, Using Nocturnal Polysomnography in General Sleep Medicine Clinics. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.429] [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: 10/17/2022]
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Rodriguez IE, Yoeli D, Ferrell T, Adams MA, Nydam TL, Moore H. The Coagulation Profile of Massive Transfusion During Tissue Injury is not the Same as the Coagulation Profile of Ischemia Reperfusion. J Am Coll Surg 2022. [DOI: 10.1097/01.xcs.0000896568.31724.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Stevens J, Phillips R, Reppucci ML, Pickett K, Moore H, Bensard D. Does the mechanism matter? Comparing thrombelastography between blunt and penetrating pediatric trauma patients. J Pediatr Surg 2022; 57:1363-1369. [PMID: 34588132 DOI: 10.1016/j.jpedsurg.2021.09.010] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/25/2021] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND/PURPOSE The utility of thrombelastography (TEG) in pediatric trauma remains unknown, and differences in coagulopathy between blunt and penetrating mechanisms are not established. We aimed to compare TEG patterns in pediatric trauma patients with blunt solid organ injuries (BSOI) and penetrating injuries to determine the role of mechanism in coagulopathy. METHODS Highest-level pediatric trauma activations with BSOI or penetrating injuries and admission TEG at two pediatric trauma centers were included. TEG abnormalities were defined by each institution's normative values and compared separately by injury mechanism and evidence of shock (elevated SIPA) using Kruskal-Wallis or Fisher's exact tests. RESULTS Of 118 patients included, 64 had BSOI and 54 had penetrating injuries. There were no significant differences in TEG abnormalities between the BSOI and penetrating injury groups. Patients with shock were more likely to have decreased alpha-angles (30.9% vs. 8.0%, p = 0.01) and decreased maximum amplitude (MA) (44.1% vs. 8.0%, p < 0.001) compared to those without shock, regardless of mechanism of injury. CONCLUSIONS TEG abnormalities were not significantly different between the BSOI and penetrating groups, but there were significant differences in alpha-angle and MA in those with shock, independent of mechanism. Hemodynamic status, rather than mechanism of injury, may be more predictive of coagulopathy in pediatric trauma patients. LEVEL OF EVIDENCE/STUDY TYPE Level III, retrospective.
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Affiliation(s)
- Jenny Stevens
- Division of Pediatric Surgery, Department of General Surgery, Children's Hospital Colorado Anschutz Medical Campus, University of Colorado, 13123 E 16th Ave, Aurora, CO 80045, USA; Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Ryan Phillips
- Division of Pediatric Surgery, Department of General Surgery, Children's Hospital Colorado Anschutz Medical Campus, University of Colorado, 13123 E 16th Ave, Aurora, CO 80045, USA; Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Marina L Reppucci
- Division of Pediatric Surgery, Department of General Surgery, Children's Hospital Colorado Anschutz Medical Campus, University of Colorado, 13123 E 16th Ave, Aurora, CO 80045, USA; Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kaci Pickett
- The Center for Research in Outcomes for Children's Surgery, Center for Children's Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hunter Moore
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Department of Surgery, Denver Health Medical Center, Denver, CO, USA
| | - Denis Bensard
- Division of Pediatric Surgery, Department of General Surgery, Children's Hospital Colorado Anschutz Medical Campus, University of Colorado, 13123 E 16th Ave, Aurora, CO 80045, USA; Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Department of Surgery, Denver Health Medical Center, Denver, CO, USA
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Affiliation(s)
| | - Lucy Z. Kornblith
- Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA
| | - Hunter Moore
- University of Colorado Hospital, University of Colorado School of Medicine, Aurora, CO
| | | | - Martin A. Schreiber
- Oregon Health and Science University Hospital, OHSU School of Medicine, Portland, OR
| | - Bryan A. Cotton
- University of Texas Health and Science Center at Houston, McGovern Medical School, Houston, TX
| | - Matthew D. Neal
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Robert Makar
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Andrew P. Cap
- U.S. Army Institute of Surgical Research, Uniformed Services University, University of Texas Health Science Centers – San Antonio & Houston, TX
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Stevens J, Pickett K, Moore H, Reppucci ML, Phillips R, Moulton S, Bensard D. Thrombelastography and transfusion patterns in severely injured pediatric trauma patients with blunt solid organ injuries. J Trauma Acute Care Surg 2022; 92:152-158. [PMID: 34446654 DOI: 10.1097/ta.0000000000003392] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Thrombelastography (TEG) has emerged as a useful tool to diagnose coagulopathy and guide blood product usage during trauma resuscitations. This study sought to evaluate the correlation between TEG-directed blood product administration in severely injured pediatric trauma patients with blunt solid organ injuries (BSOIs). METHODS Patients (≤18 years) with severe BSOIs who presented as highest-level trauma activations at two pediatric trauma centers were included. Thrombelastography results were evaluated to determine indications for blood product administration and rates of TEG-directed resuscitation. Tetrachoric correlations and regression modeling were used to correlate TEG-directed resuscitation with clinical outcomes. RESULTS Of 64 patients who met the inclusion criteria, 32.8% (21) had elevated R times and 23.4% (15) had shortened α angles. Maximum amplitude was shortened in 29.7% (19), and percent clot lysis 30 minutes after maximum amplitude that is >3% was seen in 17.0% (9). Thrombelastography-directed resuscitation of fresh frozen plasma was followed 54.7% of the time compared with 67.2% and 81.2% for platelets and cryoprecipitate, respectively. Thrombelastography-directed resuscitation with platelets (odds ratio, 0.56; 95% confidence interval, 0.33-0.93; p = 0.03) and/or cryoprecipitate (odds ratio, 0.09; 95% confidence interval, 0.01-0.42, p = 0.003) were associated with decreased hospital length of stay and mortality, respectively. CONCLUSION Severely injured pediatric trauma patients with BSOIs were often coagulopathic upon presentation to the emergency department. Thrombelastography-directed resuscitation with platelets and/or cryoprecipitate was followed for the majority of patients and was associated with improved outcomes. LEVEL OF EVIDENCE Therapeutic/Care Management, level III.
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Affiliation(s)
- Jenny Stevens
- From the Division of Pediatric Surgery (J.S., M.L.R., R.P., S.M., D.B.), Children's Hospital Colorado, Division of Pediatric Surgery, Department of Surgery (J.S., M.L.R., R.P., S.M., D.B.), and Center for Research in Outcomes for Children's Surgery (K.P.), Center for Children's Surgery, University of Colorado School of Medicine, Aurora; and Department of Surgery (H.M., D.B.), Denver Health Medical Center, Denver, Colorado
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Cordonier GJ, Sharafati C, Mays S, Thackery L, Gemmen E, Cyphert S, Brown M, Napolillo JQ, Toney S, Moore H, Kuhlman JM, Sierros KA. Direct foam writing in microgravity. NPJ Microgravity 2021; 7:55. [PMID: 34934072 PMCID: PMC8692601 DOI: 10.1038/s41526-021-00185-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 12/06/2021] [Indexed: 11/15/2022] Open
Abstract
Herein we report 2D printing in microgravity of aqueous-based foams containing metal oxide nanoparticles. Such hierarchical foams have potential space applications, for example for in situ habitat repair work, or for UV shielding. Foam line patterns of a TiO2-containing foam have been printed onto glass substrates via Direct Foam Writing (DFW) under microgravity conditions through a parabolic aircraft flight. Initial characterization of the foam properties (printed foam line width, bubble size, etc.) are presented. It has been found that gravity plays a significant role in the process of direct foam writing. The foam spread less over the substrate when deposited in microgravity as compared to Earth gravity. This had a direct impact on the cross-sectional area and surface roughness of the printed lines. Additionally, the contact angle of deionized water on a film exposed to microgravity was higher than that of a film not exposed to microgravity, due to the increased surface roughness of films exposed to microgravity.
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Affiliation(s)
- Guy Jacob Cordonier
- Department of Mechanical and Aerospace Engineering, West Virginia University, Morgantown, WV, USA
| | - Cicely Sharafati
- Department of Mechanical and Aerospace Engineering, West Virginia University, Morgantown, WV, USA
| | - Spencer Mays
- Department of Mechanical and Aerospace Engineering, West Virginia University, Morgantown, WV, USA
| | - Lukas Thackery
- Department of Mechanical and Aerospace Engineering, West Virginia University, Morgantown, WV, USA
| | - Ellena Gemmen
- Department of Mechanical and Aerospace Engineering, West Virginia University, Morgantown, WV, USA
| | - Samuel Cyphert
- Department of Mechanical and Aerospace Engineering, West Virginia University, Morgantown, WV, USA
| | - Megan Brown
- Department of Mechanical and Aerospace Engineering, West Virginia University, Morgantown, WV, USA
| | - John Quinn Napolillo
- Department of Mechanical and Aerospace Engineering, West Virginia University, Morgantown, WV, USA
| | - Savannah Toney
- Department of Mechanical and Aerospace Engineering, West Virginia University, Morgantown, WV, USA
| | - Hunter Moore
- Department of Mechanical and Aerospace Engineering, West Virginia University, Morgantown, WV, USA
| | - John M Kuhlman
- Department of Mechanical and Aerospace Engineering, West Virginia University, Morgantown, WV, USA
| | - Konstantinos A Sierros
- Department of Mechanical and Aerospace Engineering, West Virginia University, Morgantown, WV, USA.
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Gayle S, Aiello R, Leelatian N, Beckta JM, Bechtold J, Bourassa P, Csengery J, Maguire RJ, Marshall D, Sundaram RK, Van Doorn J, Jones K, Moore H, Lopresti-Morrow L, Paradis T, Tylaska L, Zhang Q, Visca H, Reshetnyak YK, Andreev OA, Engelman DM, Glazer PM, Bindra RS, Paralkar VM. Correction to 'Tumor-selective, antigen-independent delivery of a pH sensitive peptide-topoisomerase inhibitor conjugate suppresses tumor growth without systemic toxicity'. NAR Cancer 2021; 3:zcab047. [PMID: 34888524 PMCID: PMC8651162 DOI: 10.1093/narcan/zcab047] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.1093/narcan/zcab021.].
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Affiliation(s)
| | | | - Nalin Leelatian
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Jason M Beckta
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT 06520, USA
| | | | | | | | | | | | - Ranjini K Sundaram
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Jinny Van Doorn
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Kelli Jones
- Cybrexa Therapeutics, New Haven, CT 06511, USA
| | | | | | | | | | - Qing Zhang
- Cybrexa Therapeutics, New Haven, CT 06511, USA
| | - Hannah Visca
- Physics Department, University of Rhode Island, Kingston, RI 02881, USA
| | - Yana K Reshetnyak
- Physics Department, University of Rhode Island, Kingston, RI 02881, USA
| | - Oleg A Andreev
- Physics Department, University of Rhode Island, Kingston, RI 02881, USA
| | - Donald M Engelman
- Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, CT 06511, USA
| | - Peter M Glazer
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Ranjit S Bindra
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06520, USA
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Gayle S, Aiello R, Leelatian N, Beckta JM, Bechtold J, Bourassa P, Csengery J, Maguire RJ, Marshall D, Sundaram RK, Van Doorn J, Jones K, Moore H, Lopresti-Morrow L, Paradis T, Tylaska L, Zhang Q, Visca H, Reshetnyak YK, Andreev OA, Engelman DM, Glazer PM, Bindra RS, Paralkar VM. Tumor-selective, antigen-independent delivery of a pH sensitive peptide-topoisomerase inhibitor conjugate suppresses tumor growth without systemic toxicity. NAR Cancer 2021; 3:zcab021. [PMID: 34316708 PMCID: PMC8210154 DOI: 10.1093/narcan/zcab021] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 05/03/2021] [Accepted: 05/19/2021] [Indexed: 02/04/2023] Open
Abstract
Topoisomerase inhibitors are potent DNA damaging agents which are widely used in oncology, and they demonstrate robust synergistic tumor cell killing in combination with DNA repair inhibitors, including poly(ADP)-ribose polymerase (PARP) inhibitors. However, their use has been severely limited by the inability to achieve a favorable therapeutic index due to severe systemic toxicities. Antibody-drug conjugates address this issue via antigen-dependent targeting and delivery of their payloads, but this approach requires specific antigens and yet still suffers from off-target toxicities. There is a high unmet need for a more universal tumor targeting technology to broaden the application of cytotoxic payloads. Acidification of the extracellular milieu arises from metabolic adaptions associated with the Warburg effect in cancer. Here we report the development of a pH-sensitive peptide-drug conjugate to deliver the topoisomerase inhibitor, exatecan, selectively to tumors in an antigen-independent manner. Using this approach, we demonstrate potent in vivo cytotoxicity, complete suppression of tumor growth across multiple human tumor models, and synergistic interactions with a PARP inhibitor. These data highlight the identification of a peptide-topoisomerase inhibitor conjugate for cancer therapy that provides a high therapeutic index, and is applicable to all types of human solid tumors in an antigen-independent manner.
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Affiliation(s)
| | | | - Nalin Leelatian
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Jason M Beckta
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT 06520, USA
| | | | | | | | | | | | - Ranjini K Sundaram
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Jinny Van Doorn
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Kelli Jones
- Cybrexa Therapeutics, New Haven, CT 06511, USA
| | | | | | | | | | - Qing Zhang
- Cybrexa Therapeutics, New Haven, CT 06511, USA
| | - Hannah Visca
- Physics Department, University of Rhode Island, Kingston, RI 02881, USA
| | - Yana K Reshetnyak
- Physics Department, University of Rhode Island, Kingston, RI 02881, USA
| | - Oleg A Andreev
- Physics Department, University of Rhode Island, Kingston, RI 02881, USA
| | - Donald M Engelman
- Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, CT 06511, USA
| | - Peter M Glazer
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Ranjit S Bindra
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06520, USA
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Stillson JE, Bunch CM, Gillespie L, Khan R, Wierman M, Pulvirenti J, Phyu H, Anderson S, Al-Fadhl M, Thomas AV, Kwaan HC, Moore E, Moore H, Walsh MM. Thromboelastography-Guided Management of Anticoagulated COVID-19 Patients to Prevent Hemorrhage. Semin Thromb Hemost 2021; 47:442-446. [PMID: 33607668 DOI: 10.1055/s-0041-1723754] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- John E Stillson
- South Bend Campus, Indiana University School of Medicine, South Bend, Indiana
| | - Connor M Bunch
- South Bend Campus, Indiana University School of Medicine, South Bend, Indiana
| | - Laura Gillespie
- Department of Quality and Performance Improvement, Saint Joseph Regional Medical Center, Mishawaka, Indiana
| | - Rashid Khan
- Department of Hematology, Michiana Hematology Oncology, Mishawaka, Indiana
| | - Meredith Wierman
- Department of Infectious Disease, Saint Joseph Regional Medical Center, Mishawaka, Indiana
| | - Joseph Pulvirenti
- Department of Infectious Disease, Saint Joseph Regional Medical Center, Mishawaka, Indiana
| | - Htay Phyu
- Department of Infectious Disease, Saint Joseph Regional Medical Center, Mishawaka, Indiana
| | - Stephen Anderson
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana.,Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana
| | - Mahmoud Al-Fadhl
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana
| | - Anthony V Thomas
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana
| | - Hau C Kwaan
- Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ernest Moore
- Department of Surgery, Denver Health Medical Center and University of Colorado Health Sciences Center, Denver, Colorado
| | - Hunter Moore
- Department of Surgery, Denver Health Medical Center and University of Colorado Health Sciences Center, Denver, Colorado
| | - Mark M Walsh
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana.,Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana
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Affiliation(s)
- Hunter Moore
- Department of Surgery, University of Colorado, Denver, Colo
| | - Alden Harken
- Department of Surgery, University of California, San Francisco-East Bay, Oakland, Calif.
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Aiello RJ, Gayle S, Bechtold J, Bourassa P, Csengery J, Deshpande K, Jones K, Lopresti-Morrow L, Maguire R, Marshall D, Moore H, Paradis T, Tylaska L, Zhang Q, Volkmann R, Bindra RS, Glazer PM, Paralkar V. Abstract 6249: CBX-12: A low pH targeting alphalex™-exatecan conjugate for the treatment of solid tumors. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-6249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Topoisomerase inhibitors are potent DNA damaging agents with great potential as anti-cancer drugs for a wide range of solid tumors. However, dose-limiting toxicities such as myelosuppression and gastric toxicity have prevented them from reaching their full clinical potential. Targeting topoisomerase inhibitors with antibodies (i.e. antibody-drug conjugates; ADCs) may enhance the therapeutic window of these agents, but this approach typically limits applicability to a small subset of patients with tumors expressing the target antigen.
We recently developed the alphalexTM tumor-targeting platform to overcome the limitations of ADC-based therapeutic strategies. Rather than targeting a specific antigen, alphalexTM consists of a unique variant of pH-Low Insertion Peptide, (pHLIP®; references 1-3) which targets the low pH environment of the tumor, a universal feature characteristic of all tumors due to the Warburg effect. These alphalexTM conjugates form an alpha helix only in low pH conditions, allowing for insertion of the peptide within the cancer cell membrane, delivery of C-terminal warheads across the membrane, and subsequent intracellular release of the agent via glutathione reduction of the linker, thereby allowing for tumor-specific intracellular delivery in an antigen-independent manner.
We report the discovery and development of CBX-12, an alphalexTM conjugate of the potent topoisomerase inhibitor, exatecan. CBX-12 provides additional proof of mechanism to the alphalexTM platform by displaying remarkable tumor-targeting properties in preclinical models. CBX-12 displays enhanced stability in plasma in vivo, undergoing only 0.003% warhead release over 30 hours in circulation and demonstrating exquisite selectivity for tumor over normal tissues in mouse tumor models. Notably, CBX-12 allows for efficient delivery of exatecan into tumors due to a highly optimized cleavable linker, allowing CBX-12 to display extraordinary efficacy in a HER2-negative tumor model in an antigen-independent manner. At 10 mg/kg, CBX-12 treatment almost completely suppressed growth of human colorectal tumors in mice, with complete sparing of bone marrow. In contrast, in animals dosed with the equimolar free exatecan (1.15 mg/kg) there was substantial tumor growth accompanied by neutropenia and weight loss.
This superior profile of CBX-12 allow us to greatly enhance efficacy relative to dosing equimolar amounts of unconjugated exatecan, which causes significant, dose-limiting bone marrow toxicity. We have demonstrated that CBX-12 is both safe and has potent anti-tumor activity in preclinical models, and we plan to rapidly move forward with the clinical development of CBX-12 as our lead candidate.
References
1. Rather than targeting a specific antigen, alphalexTM includes a pHLIP® peptide. pHLIP® peptides are a family of pH-Low Insertion Peptides that target acidic cell surfaces. pHLIP® was developed at Yale University and the University of Rhode Island and is exclusively licensed to pHLIP, Inc.
2. Wyatt LC et al. Applications of pHLIP Technology for Cancer Imaging and Therapy. Trends Biotechnol. 2017;35(7):653-664.
3. Wyatt LC et al. Peptides of pHLIP family for targeted intracellular and extracellular delivery of cargo molecules to tumors. PNAS. 2018;115(12):E2811-E2818.
Citation Format: Robert J. Aiello, Sophia Gayle, Jane Bechtold, Patricia Bourassa, Johanna Csengery, Ketaki Deshpande, Kelli Jones, Lori Lopresti-Morrow, Robert Maguire, Dan Marshall, Hunter Moore, Timothy Paradis, Laurie Tylaska, Qing Zhang, Robert Volkmann, Ranjit S. Bindra, Peter M. Glazer, Vishwas Paralkar. CBX-12: A low pH targeting alphalex™-exatecan conjugate for the treatment of solid tumors [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 6249.
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16
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Gayle S, Aiello R, Bechtold J, Bourassa P, Csengery J, Deshpande K, Jones K, Lopresti-Morrow L, Maguire R, Marshall D, Moore H, Paradis T, Tylaska L, Zhang Q, Volkmann R, Bindra RS, Glazer PM, Paralkar V. Abstract 6242: Development of alphalex™-toxin low pH targeting conjugates for the treatment of solid tumors. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-6242] [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
Maytansines and their derived maytansinoid DMx compounds are high potency microtubule targeting compounds that have an extremely narrow therapeutic window. Unacceptable dose limiting systemic toxicity has limited the therapeutic potential of these potent anti-oncogenic compounds. Targeting maytansinoids to the tumor is the only feasible method of unlocking the clinical potential of such toxic molecules. To date Trastuzumab-DM1 (Kadcyla®) remains the only approved antibody-maytansinoid conjugate on the market. Most preclinical maytansinoid conjugates to date face the same issues encountered by Kadcyla® - tumor restriction by target antigen and the potential for off target release of payload.
alphalexTM is a tumor targeting technology consisting of a unique variant of pH-Low Insertion Peptide (pHLIP®; references 1-3), cleavable small molecule linker and anti-cancer agent warhead. alphalexTM thereby allows for antigen independent targeting of the tumor and enables intracellular delivery of the warhead by leveraging the low pH microenvironment of the tumor, a universal feature common to all tumors due to the Warburg effect. Here we demonstrate the ability to conjugate the maytansinoids DM1 and DM4 to alphalexTM via both direct and linker-mediated conjugation. We have demonstrated the ability of our alphalexTM-DM4 conjugate candidates (CBX-13) to have single digit nanomolar potency in vitro as well as exquisitely potent and long-lasting anti-tumor activity in a HER2-negative xenograft model that is un-targetable by competing therapies. In particular we have demonstrated that CBX-13 safely delivers amounts of maytansinoid in vivo that otherwise result in systemic toxicity and death when dosed as free warhead. Based on the SAR of this first generation of maytansinoid conjugates we are further optimizing our alphalexTM - maytansinoid conjugation strategy with the goal of moving forward with IND-enabling studies in the near future.
References
1. Rather than targeting a specific antigen, alphalexTM includes a pHLIP® peptide. pHLIP® peptides are a family of pH-Low Insertion Peptides that target acidic cell surfaces. pHLIP® was developed at Yale University and the University of Rhode Island, and is exclusively licensed to pHLIP, Inc.
2. Wyatt LC, Lewis JS, Andreev OA, Reshetnyak YK, Engelman DM. Applications of pHLIP Technology for Cancer Imaging and Therapy. Trends Biotechnol. 2017 Jul;35(7):653-664.
3. Wyatt LC, Moshnikova A, Crawford T, Engelman DM, Andreev OA, Reshetnyak YK. Peptides of pHLIP family for targeted intracellular and extracellular delivery of cargo molecules to tumors. Proc Natl Acad Sci USA. 2018 Mar 20;115(12):E2811-E2818.
Citation Format: Sophia Gayle, Robert Aiello, Jane Bechtold, Patricia Bourassa, Johanna Csengery, Ketaki Deshpande, Kelli Jones, Lori Lopresti-Morrow, Robert Maguire, Dan Marshall, Hunter Moore, Timothy Paradis, Laurie Tylaska, Qing Zhang, Robert Volkmann, Ranjit S. Bindra, Peter M. Glazer, Vishwas Paralkar. Development of alphalex™-toxin low pH targeting conjugates for the treatment of solid tumors [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 6242.
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17
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Liu Y, Dash A, Krez A, Kim HJ, Cunningham M, Schwab F, Hughes A, Carlson B, Samuel A, Marty E, Moore H, McMahon DJ, Carrino JA, Bockman RS, Stein EM. Low volumetric bone density is a risk factor for early complications after spine fusion surgery. Osteoporos Int 2020; 31:647-654. [PMID: 31919536 DOI: 10.1007/s00198-019-05245-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/20/2019] [Indexed: 12/17/2022]
Abstract
UNLABELLED This study aims to investigate lumbar spine (LS) volumetric bone density (vBMD) as a risk factor for complications (pseudoarthrosis, instrumentation failure, adjacent fractures), re-operation, and time to complication after fusion. INTRODUCTION Lumbar spine (LS) fusion surgery is increasingly performed worldwide. Complications after fusion result in significant morbidity and healthcare costs. Multiple factors, including osteoporosis, have been suggested to contribute to risk of complications and re-operation. However, most studies have used DXA, which is subject to artifact in patients with spine pathology, and none have investigated the relationship between BMD and timing of post-operative complications. This study aims to investigate LS volumetric bone density (vBMD) as a risk factor for complications (pseudoarthrosis, instrumentation failure, adjacent fractures), re-operation, and time to complication after fusion. METHODS We evaluated a cohort of 359 patients who had initial LS fusion surgery at our institution, had pre-operative LS CTs and post-operative imaging available for review. Demographic factors, smoking status, vBMD, and details of surgical procedure were related to likelihood and timing of post-operative complications. RESULTS Mean age was 60 ± 14 years, vBMD 122 ± 37 g/cm3. Median follow-up was 11 months. Skeletal complications occurred in 47 patients (13%); 34 patients (10%) required re-operation. Low vBMD (directly measured and estimated using HU) and smoking were associated with increased risk of skeletal complications. Each increase in baseline vBMD of 10 g/cm3 decreased the complication hazard and increased the complication-free duration in time-to-event analysis (hazard ratio 0.91, 95% CI 0.83-0.98, p < 0.02). CONCLUSIONS Low vBMD was a significant risk factor for early post-operative complications in patients undergoing LS fusion. Prospective studies are needed to confirm these findings and to elucidate the optimal timing for follow-up and strategies for prevention of post-operative complications in this population.
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Affiliation(s)
- Y Liu
- Division of Endocrinology and Metabolic Bone Disease, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
- Department of Medicine, Lahey Clinic, Burlington, MA, USA
| | - A Dash
- Division of Endocrinology and Metabolic Bone Disease, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
| | - A Krez
- Division of Endocrinology and Metabolic Bone Disease, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
| | - H J Kim
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - M Cunningham
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - F Schwab
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - A Hughes
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - B Carlson
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopedics, University of Kansas Medical Center, Kansas City, KS, USA
| | - A Samuel
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - E Marty
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - H Moore
- Weill Cornell Medical College, New York, NY, USA
| | - D J McMahon
- Division of Endocrinology and Metabolic Bone Disease, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
| | - J A Carrino
- Department of Radiology, Hospital for Special Surgery, New York, NY, USA
| | - R S Bockman
- Division of Endocrinology and Metabolic Bone Disease, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
| | - E M Stein
- Division of Endocrinology and Metabolic Bone Disease, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA.
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18
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Walsh M, Fries D, Moore E, Moore H, Thomas S, Kwaan HC, Marsee MK, Grisoli A, McCauley R, Vande Lune S, Chitta S, Vyakaranam S, Waxman D, McCurdy MT, Zimmer D, Patel B, Thachil J. Whole Blood for Civilian Urban Trauma Resuscitation: Historical, Present, and Future Considerations. Semin Thromb Hemost 2020; 46:221-234. [PMID: 32160645 DOI: 10.1055/s-0040-1702174] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Whole blood (WB) has been used for more than a century for far-forward combat resuscitation. Following the Iraq/Afghanistan combat, maritime, and austere environment use of WB for the resuscitation of severely hemorrhaging patients, there has been an increasing use of WB for the civilian urban resuscitation environment population. The impetus for this was not just improved outcomes in far-forward hospitals, which had different populations and different needs than the civilian urban population, but also an application of the lessons suggested by recent 1:1:1 plasma:platelets:packed red cells fixed-ratio studies for patients with massive transfusion needs. Mechanistic, logistic, and standardization concerns have been addressed and are evolving as the WB project advances. A small number of studies have been published on WB in the civilian urban trauma population. In addition, European experience with viscoelastic testing and resuscitation with fibrinogen and prothrombin complex concentrate has provided another viewpoint regarding the choice of resuscitation strategies for severely bleeding trauma patients in urban civilian environments. There are randomized controlled trials in process, which are testing the hypothesis that WB may be beneficial for the civilian urban population. Whether WB will improve mortality significantly is now a matter of intense study, and this commentary reviews the history, mechanistic foundations, and logistical aspects for the use of WB in the civilian trauma population.
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Affiliation(s)
- Mark Walsh
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana.,Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana.,Beacon Medical Group Trauma & Surgical Services, South Bend, Indiana
| | - Dietmar Fries
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Ernest Moore
- Ernest E. Moore Trauma Center, Denver General Hospital, University of Colorado School of Medicine, Denver, Colorado
| | - Hunter Moore
- Ernest E. Moore Trauma Center, Denver General Hospital, University of Colorado School of Medicine, Denver, Colorado
| | - Scott Thomas
- Beacon Medical Group Trauma & Surgical Services, South Bend, Indiana
| | - Hau C Kwaan
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Anne Grisoli
- Indiana University School of Medicine, South Bend, Indiana
| | - Ross McCauley
- Indiana University School of Medicine, South Bend, Indiana
| | | | - Swetha Chitta
- Beacon Medical Group Trauma & Surgical Services, South Bend, Indiana
| | - Sudhir Vyakaranam
- Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana.,Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana
| | - Dan Waxman
- Versiti Blood Center of Indiana, Indianapolis, Indiana
| | - Michael T McCurdy
- Department of Critical Care and Emergency Medicine, University of Maryland, Baltimore, Maryland
| | - Donald Zimmer
- Beacon Medical Group Trauma & Surgical Services, South Bend, Indiana
| | - Bhavesh Patel
- Department of Critical Care Medicine, Mayo Clinic Phoenix, Arizona
| | - Jecko Thachil
- Department of Haematology, Manchester Royal Infirmary, Manchester, United Kingdom
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Choudhury RA, Moore H, Nydam TL. Serial Transverse Enteroplasty Increases Rates of Enteral Autonomy and Improves Long-Term Survival for Pediatric Small Bowel Syndrome Patients: A Markov Decision Analysis. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Walsh M, Moore EE, Moore H, Thomas S, Lune SV, Zimmer D, Dynako J, Hake D, Crowell Z, McCauley R, Larson EE, Miller M, Pohlman T, Achneck HE, Martin P, Nielsen N, Shariff F, Ploplis VA, Castellino FJ. Use of Viscoelastography in Malignancy-Associated Coagulopathy and Thrombosis: A Review. Semin Thromb Hemost 2019; 45:354-372. [PMID: 31108555 PMCID: PMC7707018 DOI: 10.1055/s-0039-1688497] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The relationship between malignancy and coagulopathy is one that is well documented yet incompletely understood. Clinicians have attempted to quantify the hypercoagulable state produced in various malignancies using common coagulation tests such as prothrombin time, activated partial thromboplastin time, and platelet count; however, due to these tests' focus on individual aspects of coagulation during one specific time point, they have failed to provide clinicians the complete picture of malignancy-associated coagulopathy (MAC). Viscoelastic tests (VETs), such as thromboelastography (TEG) and rotational thromboelastometry (ROTEM), are whole blood analyses that have the advantage of providing information related to the cumulative effects of plasma clotting factors, platelets, leukocytes, and red cells during all stages of the coagulation and fibrinolytic processes. VETs have gained popularity in the care of trauma patients to objectively measure trauma-induced coagulopathy (TIC), but the utility of VETs remains yet unrealized in many other medical specialties. The authors discuss the similarities and differences between TIC and MAC, and propose a mechanism for the hypercoagulable state of MAC that revolves around the thrombomodulin-thrombin complex as it switches between activating the protein C anticoagulation pathway or the thrombin activatable fibrinolysis inhibitor coagulation pathway. Additionally, they review the current literature on the use of TEG and ROTEM in patients with various malignancies. Although limited research is currently available, early results demonstrate the utility of both TEG and ROTEM in the prediction of hypercoagulable states and thromboembolic complications in oncologic patients.
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Affiliation(s)
- Mark Walsh
- Saint Joseph Regional Medical Center, Mishawaka, Indiana
- Beacon Medical Group Trauma & Surgical Research Services, South Bend, Indiana
- Indiana University School of Medicine, South Bend Campus, South Bend, Indiana
| | - Ernest E. Moore
- Ernest E. Moore Trauma Center Denver General Hospital, University of Colorado School of Medicine, Denver, Colorado
| | - Hunter Moore
- Ernest E. Moore Trauma Center Denver General Hospital, University of Colorado School of Medicine, Denver, Colorado
| | - Scott Thomas
- Beacon Medical Group Trauma & Surgical Research Services, South Bend, Indiana
| | - Stefani Vande Lune
- Indiana University School of Medicine, South Bend Campus, South Bend, Indiana
| | - David Zimmer
- Indiana University School of Medicine, South Bend Campus, South Bend, Indiana
| | - Joseph Dynako
- Indiana University School of Medicine, South Bend Campus, South Bend, Indiana
| | - Daniel Hake
- Chicago College of Osteopathic Medicine at Midwestern University, Downers Grove, Illinois
| | - Zachary Crowell
- Chicago College of Osteopathic Medicine at Midwestern University, Downers Grove, Illinois
| | - Ross McCauley
- Indiana University School of Medicine, South Bend Campus, South Bend, Indiana
| | - Emilee E. Larson
- Indiana University School of Medicine, South Bend Campus, South Bend, Indiana
| | - Michael Miller
- Beacon Medical Group Trauma & Surgical Research Services, South Bend, Indiana
| | - Tim Pohlman
- Beacon Medical Group Trauma & Surgical Research Services, South Bend, Indiana
| | | | - Peter Martin
- Department of Emergency Medicine, Tulane School of Medicine, New Orleans, Louisiana
| | - Nathan Nielsen
- Division of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane School of Medicine, New Orleans, Louisiana
| | - Faisal Shariff
- Indiana University School of Medicine, South Bend Campus, South Bend, Indiana
| | - Victoria A. Ploplis
- W.M. Keck Center for Transgene Research, The University of Notre Dame, Notre Dame, Indiana
- Department of Chemistry and Biochemistry, The University of Notre Dame, Notre Dame, Indiana
| | - Francis J. Castellino
- W.M. Keck Center for Transgene Research, The University of Notre Dame, Notre Dame, Indiana
- Department of Chemistry and Biochemistry, The University of Notre Dame, Notre Dame, Indiana
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21
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Kim J, Miller J, Kotecha R, Chao S, Ahluwalia M, Peereboom D, Mohammadi A, Barnett G, Murphy E, Vogelbaum M, Angelov L, Abraham J, Moore H, Budd G, Suh J. Stereotactic Radiosurgery with Concurrent HER2-directed Therapy is Associated with Improved Objective Response for Breast Cancer Brain Metastasis. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Lieberman JA, Girgis RR, Brucato G, Moore H, Provenzano F, Kegeles L, Javitt D, Kantrowitz J, Wall MM, Corcoran CM, Schobel SA, Small SA. Hippocampal dysfunction in the pathophysiology of schizophrenia: a selective review and hypothesis for early detection and intervention. Mol Psychiatry 2018; 23:1764-1772. [PMID: 29311665 PMCID: PMC6037569 DOI: 10.1038/mp.2017.249] [Citation(s) in RCA: 217] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/18/2017] [Accepted: 09/27/2017] [Indexed: 02/07/2023]
Abstract
Scientists have long sought to characterize the pathophysiologic basis of schizophrenia and develop biomarkers that could identify the illness. Extensive postmortem and in vivo neuroimaging research has described the early involvement of the hippocampus in the pathophysiology of schizophrenia. In this context, we have developed a hypothesis that describes the evolution of schizophrenia-from the premorbid through the prodromal stages to syndromal psychosis-and posits dysregulation of glutamate neurotransmission beginning in the CA1 region of the hippocampus as inducing attenuated psychotic symptoms and initiating the transition to syndromal psychosis. As the illness progresses, this pathological process expands to other regions of the hippocampal circuit and projection fields in other anatomic areas including the frontal cortex, and induces an atrophic process in which hippocampal neuropil is reduced and interneurons are lost. This paper will describe the studies of our group and other investigators supporting this pathophysiological hypothesis, as well as its implications for early detection and therapeutic intervention.
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Affiliation(s)
- JA Lieberman
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - RR Girgis
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - G Brucato
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - H Moore
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - F Provenzano
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - L Kegeles
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - D Javitt
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - J Kantrowitz
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - MM Wall
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - CM Corcoran
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - SA Schobel
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - SA Small
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA,Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA,Department of Radiology, College of Physicians & Surgeons, Columbia University, New York, NY, USA
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23
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Wenzel S, Rhoades H, Moore H, Lahey J, Henwood B, La Motte-Kerr W, Bird M. Life Goals Over Time Among Homeless Adults in Permanent Supportive Housing. Am J Community Psychol 2018; 61:421-432. [PMID: 29537648 PMCID: PMC6217826 DOI: 10.1002/ajcp.12237] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Permanent supportive housing (PSH) is a widely-accepted solution to the challenge of chronic homelessness. While housing support and retention, physical health, and healthcare continue to be important for formerly homeless persons in PSH, "higher-order" and humanistic needs such as thriving have received less attention and as a result are less well understood in this population. One important indicator of thriving is the ability to establish and articulate life goals. This study utilizes longitudinal data from 421 formerly homeless adults prior to their move into PSH, and at 3-, 6- and 12-months after move-in (369 respondents completed all four interviews), to examine what life goals are articulated by this population and how those goals change over time. Prior to housing, most respondents articulated housing attainment as their primary life goal, whereas at follow-up interviews health goals, housing relocation, and financial goals became more prevalent. Aspirational goals (e.g., independence, self-improvement, artistic pursuits) were also common, but demonstrated a decrease over time in housing. Relationship goals remained common and consistent over time. Findings indicate that housing is a necessary, but perhaps not sufficient, step for improving thriving among formerly homeless adults. Implications for practice and future research are discussed.
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Affiliation(s)
- S.L. Wenzel
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 1149 S. Hill St., Suite 360, Los Angeles, CA 90015
| | - H. Rhoades
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 1149 S. Hill St., Suite 360, Los Angeles, CA 90015
| | - H. Moore
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 1149 S. Hill St., Suite 360, Los Angeles, CA 90015
| | - J. Lahey
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 1149 S. Hill St., Suite 360, Los Angeles, CA 90015
| | - B. Henwood
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 1149 S. Hill St., Suite 360, Los Angeles, CA 90015
| | - W. La Motte-Kerr
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 1149 S. Hill St., Suite 360, Los Angeles, CA 90015
| | - M. Bird
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 1149 S. Hill St., Suite 360, Los Angeles, CA 90015
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Carvelli L, Neergard Olesen A, Leary EB, Moore H, Schneider LD, Peppard PE, Jennum PJ, Sørensen HB, Mignot E. 0323 Design of a Deep Learning Based Algorithm forAutomatic Detection of Leg Movements During Sleep. Sleep 2018. [DOI: 10.1093/sleep/zsy061.322] [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)
- L Carvelli
- Stanford University Center for Sleep Sciences and Medicine, Palo Alto, CA
| | - A Neergard Olesen
- Stanford University Center for Sleep Sciences and Medicine, Palo Alto, CA
| | - E B Leary
- Stanford University Center for Sleep Sciences and Medicine, Palo Alto, CA
| | - H Moore
- Stanford University Center for Sleep Sciences and Medicine, Palo Alto, CA
| | - L D Schneider
- Stanford University Center for Sleep Sciences and Medicine, Palo Alto, CA
| | - P E Peppard
- University of Wisconsin-Madison, Madison, WI
| | - P J Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Glostrup, DENMARK
| | - H B Sørensen
- Department of Electrical Engineering, Technical University of Denmark, Kgs. Lyngby, DENMARK
| | - E Mignot
- Stanford University Center for Sleep Sciences and Medicine, Palo Alto, CA
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Chapman M, Moore E, Moore H, Rochon P, Johnson D. Abstract No. 458 Defining the hemostatic disorders of end-stage renal disease: platelet dysfunction is just the tip of the iceberg. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.503] [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: 10/17/2022] Open
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Leyrer C, Balagamwala E, Reddy C, Berriochoa C, Shah C, Cherian S, Donaldson A, Calhoun B, Stewart R, Moore H, Tendulkar R. The Importance of Treatment and Timing in Metaplastic Breast Cancer. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.660] [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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Kheirbek R, Fokar A, Llorente M, Fletcher R, Moore H. INCIDENCE OF HEART FAILURE IN PREDOMINANTLY MALE U.S VETERAN CENTENARIANS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.887] [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)
- R. Kheirbek
- Washington DC VA Medical Center, Washington, District of Columbia,
- George Washington School of Medicine and Health Sciences, Washington, District of Columbia,
- Georgetown University Medical School, Washington, District of Columbia
| | - A. Fokar
- Washington DC VA Medical Center, Washington, District of Columbia,
- Georgetown University Medical School, Washington, District of Columbia
| | - M. Llorente
- Washington DC VA Medical Center, Washington, District of Columbia,
- Georgetown University Medical School, Washington, District of Columbia
| | - R. Fletcher
- Washington DC VA Medical Center, Washington, District of Columbia,
- Georgetown University Medical School, Washington, District of Columbia
| | - H. Moore
- Washington DC VA Medical Center, Washington, District of Columbia,
- Uniformed Services University, Bethesda, MD, Washington, District of Columbia,
- Georgetown University Medical School, Washington, District of Columbia
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Frank M, Khodadoust M, Chu M, Kohrt H, Advani R, Alizadeh A, Reddy S, Maeda L, Gupta N, Laport G, Meyer E, Miklos D, Negrin R, Rezvani A, Weng W, Sheehan K, Czerwinski D, Faham M, Okada A, Moore H, Phillips D, Wapnir I, Brody J, Levy R. PHASE I/II CLINICAL TRIAL OF AN ACTIVATED WHOLE TUMOR CELL VACCINE FOLLOWED BY TRANSFER OF IMMUNE T CELLS IN PATIENTS WITH MANTLE CELL LYMPHOMA. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M. Frank
- Division of Oncology; Stanford University; Stanford USA
| | - M. Khodadoust
- Division of Oncology; Stanford University; Stanford USA
| | - M. Chu
- Department of Oncology; University of Alberta; Edmonton Canada
| | - H. Kohrt
- Division of Oncology; Stanford University; Stanford USA
| | - R. Advani
- Division of Oncology; Stanford University; Stanford USA
| | - A. Alizadeh
- Division of Oncology; Stanford University; Stanford USA
| | - S. Reddy
- Division of Oncology; Stanford University; Stanford USA
| | - L. Maeda
- Division of Oncology; Stanford University; Stanford USA
| | - N. Gupta
- Division of Oncology; Stanford University; Stanford USA
| | - G. Laport
- Division of Blood and Marrow Transplantation; Stanford University; Stanford USA
| | - E. Meyer
- Division of Blood and Marrow Transplantation; Stanford University; Stanford USA
| | - D. Miklos
- Division of Blood and Marrow Transplantation; Stanford University; Stanford USA
| | - R. Negrin
- Division of Blood and Marrow Transplantation; Stanford University; Stanford USA
| | - A. Rezvani
- Division of Blood and Marrow Transplantation; Stanford University; Stanford USA
| | - W. Weng
- Division of Blood and Marrow Transplantation; Stanford University; Stanford USA
| | - K. Sheehan
- Division of Blood and Marrow Transplantation; Stanford University; Stanford USA
| | - D. Czerwinski
- Division of Oncology; Stanford University; Stanford USA
| | - M. Faham
- Adaptive Biotechnologies, Adaptive Biotechnologies; Seattle USA
| | - A. Okada
- Division of Oncology; Stanford University; Stanford USA
| | - H. Moore
- Division of Oncology; Stanford University; Stanford USA
| | - D. Phillips
- Division of Oncology; Stanford University; Stanford USA
| | - I. Wapnir
- Department of Sugery; Stanford University; Stanford USA
| | - J. Brody
- Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai; New York USA
| | - R. Levy
- Division of Oncology; Stanford University; Stanford USA
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Walsh M, Shreve J, Thomas S, Moore E, Moore H, Hake D, Pohlman T, Davis P, Ploplis V, Piscoya A, Wegner J, Bryant J, Crepinsek A, Lantry J, Sheppard F, Castellino F. Fibrinolysis in Trauma: "Myth," "Reality," or "Something in Between". Semin Thromb Hemost 2017; 43:200-212. [PMID: 28219085 DOI: 10.1055/s-0036-1597900] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The emphasis on fibrinolysis as an important contributor to trauma-induced coagulopathy (TIC) has led to a debate regarding the relative clinical significance of fibrinolysis in the setting of trauma. The debate has centered on two camps. The one camp defines fibrinolysis in trauma by standard coagulation tests as well as fibrin split products, D-dimers, and plasmin/antiplasmin levels. This camp favors a more liberal use of tranexamic acid and attributes more significance to hyperfibrinolysis in TIC. The other camp favors a definition of fibrinolysis based on the viscoelastic tests (VET), rotational thromboelastometry (ROTEM), and thromboelastography (TEG). These whole blood assays define hyperfibrinolysis at a higher threshold than plasma-based tests. Therefore, this VET camp reserves antifibrinolytic treatment for patients who demonstrate severe coagulopathy associated with hyperfibrinolysis. This bimodal attribution of the clinical relevance of fibrinolysis in trauma suggests that there may be an underlying "Myth" of the concept of TIC that was historically defined by plasma-based tests and a future "Reality" of the concept of TIC that is grounded on an understanding of TIC based on a VET-defined "fibrinolytic spectrum" of TIC. This narrative review explores this "Myth" and "Reality" of fibrinolysis in TIC and proposes a direction that will allow a "Future" interpretation of TIC that incorporates both the past "Myth" and present "Reality" of fibrinolysis TIC.
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Affiliation(s)
- Mark Walsh
- Departments of Surgery and Emergency Medicine, Memorial Hospital Trauma Center, South Bend, Indiana
| | - Jacob Shreve
- Departments of Surgery and Emergency Medicine, Memorial Hospital Trauma Center, South Bend, Indiana
| | - Scott Thomas
- Departments of Surgery and Emergency Medicine, Memorial Hospital Trauma Center, South Bend, Indiana
| | - Ernest Moore
- Department of Surgery, Denver General Hospital, Denver, Colorado
| | - Hunter Moore
- Department of Surgery, Denver General Hospital, Denver, Colorado
| | - Daniel Hake
- Departments of Surgery and Emergency Medicine, Memorial Hospital Trauma Center, South Bend, Indiana
| | - Tim Pohlman
- Departments of Surgery and Emergency Medicine, Memorial Hospital Trauma Center, South Bend, Indiana
| | - Patrick Davis
- Departments of Surgery and Emergency Medicine, Memorial Hospital Trauma Center, South Bend, Indiana
| | - Victoria Ploplis
- W. M. Keck Center for Transgene Research, University of Notre Dame, Notre Dame, Indiana
| | - Andres Piscoya
- Departments of Surgery and Emergency Medicine, Memorial Hospital Trauma Center, South Bend, Indiana
| | - Julie Wegner
- Department of Surgery, Midwestern University Clinic, University of Arizona, Glendale, Arizona
| | - John Bryant
- Departments of Surgery and Emergency Medicine, Memorial Hospital Trauma Center, South Bend, Indiana
| | - Anton Crepinsek
- Departments of Surgery and Emergency Medicine, Memorial Hospital Trauma Center, South Bend, Indiana
| | - James Lantry
- Department of Defense, ECMO Inpatient and Transport Programs, San Antonio Military Medicine Center/SAUSHEC, San Antonia, Texas
| | - Forest Sheppard
- Department Head, Expeditionary and Trauma Medicine, Naval Medical Research Unit, San Antonio, Texas
| | - Francis Castellino
- W. M. Keck Center for Transgene Research, University of Notre Dame, Notre Dame, Indiana
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Kruse ML, Raska P, Abraham J, Budd GT, Montero A, Grobmyer S, Moore H. Abstract P2-12-04: Impact of institution of young women's breast cancer clinic on time to treatment and utilization of fertility, genetics and social work consultations in women under age 50 with new diagnosis of early stage breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-12-04] [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: Genetic counseling and fertility resources are often underutilized in young women with early stage breast cancer (ESBC) due, in part, to concerns about treatment delays. At our institution, women newly diagnosed with ESBC typically see a breast surgeon, medical oncologist and radiation oncologist in a multidisciplinary clinic with additional cancer related subspecialist referrals occurring at those providers' discretion. We hypothesized that time to treatment (TTT) and utilization of fertility, genetics and social work consultations would improve after implementing a Young Women's Breast Cancer Clinic. As of January 1, 2015, all patients under age 50 seen at Cleveland Clinic for new diagnosis of ESBC were automatically offered scheduling of appointments with medical genetics, reproductive endocrinology and social work in addition to the usual multidisciplinary team.
Methods: Women under age 50 diagnosed with ESBC seen at Cleveland Clinic from 1/2014-12/2015 were identified using our tumor registry. Demographics, tumor pathology, clinical and treatment histories were obtained through medical chart review as per IRB approved protocol. Time from initial visit in our system to date of treatment initiation was calculated for all patients and compared between the 2014 (pre-intervention) and 2015 (post-intervention) cohorts as was time from diagnosis (biopsy date) to treatment initiation. Completed reproductive endocrinology, genetic counseling and social work consultations were documented. Welch two sample t-test was used to compare time to treatment between groups. Chi squared test was used to compare frequency of subspecialty consultations between groups.
Results: 207 young women with ESBC were identified over the 2 year period, 99 in 2014 and 108 in 2015. Median age was 45 in 2014 and 44 in 2015. Most were diagnosed outside of our hospital system, 58% in 2014 and 76% in 2015. The most common initial treatment was surgery with reconstruction (S+R) (54% and 50% for 2014 and 2015 respectively) followed by chemotherapy (23% and 27%) then surgery without reconstruction (S) (20% and 24%). Median TTT from first encounter was 30 days in 2014 and 28 days in 2015 (p=0.33) and was 36 days versus 33.5 days (p=0.23) when calculated from biopsy date. TTT in the S and S+R groups was 37 vs 28 days (p=0.84) and 36.5 vs 32 days, (p=0.21), respectively. Genetics, reproductive endocrinology and social work consults in 2014 vs 2015 were documented as 89% vs 94%, 4% vs 9% and 58 vs% 55% (p=0.22, 0.32, 0.77). For patients under age 40, 27% in 2014 and 30% in 2015 completed reproductive endocrinology consultations.
Conclusions: Offering upfront scheduling of breast cancer related subspecialty appointments for young women with newly diagnosed ESBC did not significantly improve overall TTT. There was a trend towards improved TTT in those receiving surgery with or without reconstruction as first treatment and no suggestion of delay in TTT. A modest numeric increase in completed genetic counseling and reproductive endocrinology consultations was not statistically significant, but may have been clinically meaningful for affected individuals.
Citation Format: Kruse ML, Raska P, Abraham J, Budd GT, Montero A, Grobmyer S, Moore H. Impact of institution of young women's breast cancer clinic on time to treatment and utilization of fertility, genetics and social work consultations in women under age 50 with new diagnosis of early stage breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-12-04.
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Affiliation(s)
| | - P Raska
- Cleveland Clinic, Cleveland, OH
| | | | - GT Budd
- Cleveland Clinic, Cleveland, OH
| | | | | | - H Moore
- Cleveland Clinic, Cleveland, OH
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Baar J, Abraham J, Silverman P, Budd GT, Vinayak S, Varadan V, Moore H, Montero A, Fu P. Abstract OT2-01-10: Pilot study of carboplatin, nab-paclitaxel and pembrolizumab for metastatic triple-negative breast cancer (ongoing clinical trial). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-ot2-01-10] [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. Triple-negative breast cancer (TNBC) is associated with an aggressive phenotype and decreased survival. TNBC is characterized by tumor-infiltrating lymphocytes (TIL) which predict for a better prognosis and likely reflect immune recognition of tumor-associated antigens by TIL. However, potent immune suppressive signals exist in the tumor microenvironment such as those mediated by PD-1 with its ligand, PD-L1. Therefore, to test the validity of decreasing PD-1/PD-L1-mediated immune suppression, a Phase Ib study of single-agent pembrolizumab in 32 patients with advanced TNBC showed a partial response of 16.1% and stable disease of 9.7%, thereby attesting to the effectiveness of single-agent pembrolizumab in these patients. Other studies have demonstrated that cytotoxic chemotherapy favorably modulates immunity against cancer and there is therefore a strong rationale to combine chemotherapy with an immune modulator such as pembrolizumab for the treatment of mTNBC.
TRIAL DESIGN. This is an investigator-initiated, industry-sponsored (Merck) pilot study of carboplatin (C), nab-paclitaxel (N) and pembrolizumab (P) in 30 patients with metastatic (m) TNBC. Eligible patients will receive 3 cycles of CNP, with each cycle consisting of C (AUC 6 on days 1 of a 21-day cycle), N (100 mg/m2 IV on days 1, 8 and 15 of a 21-day cycle), and P (200 mg IV on day 15 of each cycle). After completion of 3 cycles CNP, patients with responding or stable disease by RECIST 1.1 criteria will be eligible for additional cycle(s) of CNP.
ELIGIBILITY CRITERIA. Patients must have radiologically measurable mTNBC, an ECOG performance status of 0-1, must not have received more than 2 prior therapies for this disease, and must be willing to undergo a preliminary biopsy of a metastatic focus for research purposes. A second post-treatment biopsy will be encouraged but will not be mandated.
SPECIFIC AIMS. The primary objective is to determine overall response rate (ORR) in patients treated with CNP. The secondary objectives are to determine progression-free survival (PFS) and safety/tolerability of CNP. Correlative objectives include the identification of pathologic and genomic correlates of response to CNP.
STATISTICAL METHODS. Clinical response will be scored using RECIST 1.1 criteria. Under the proposed treatment, the expected clinical response is about 35%. With the precision of the 2-sided 95% confidence interval for the response rate set to 0.17 (the distance to the expected response rate of 35%), the sample size required for the study is 30 patients. The true response rate of therapy will be estimated based on the number of responses using a binomial distribution and its confidence intervals will be estimated using Wilson's method. The Kaplan-Meier method will be used to estimate PFS. Factors including pathologic and genomic correlates that predict survival outcomes will be identified by Cox model or extensions of the Cox model.
TARGET ACCRUAL. We plan to enroll 30 patients over 2 years, with the first patient expected to be enrolled in September 2016.
CONTACT INFORMATION. Joseph Baar, MD, PhD. Seidman Cancer Center of University Hospitals Case Medical Center. E-mail: joseph.baar@uhhospitals.org.
Citation Format: Baar J, Abraham J, Silverman P, Budd GT, Vinayak S, Varadan V, Moore H, Montero A, Fu P. Pilot study of carboplatin, nab-paclitaxel and pembrolizumab for metastatic triple-negative breast cancer (ongoing clinical trial) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT2-01-10.
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Affiliation(s)
- J Baar
- Seidman Cancer Center, Cleveland, OH; Taussig Cancer Center, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH
| | - J Abraham
- Seidman Cancer Center, Cleveland, OH; Taussig Cancer Center, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH
| | - P Silverman
- Seidman Cancer Center, Cleveland, OH; Taussig Cancer Center, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH
| | - GT Budd
- Seidman Cancer Center, Cleveland, OH; Taussig Cancer Center, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH
| | - S Vinayak
- Seidman Cancer Center, Cleveland, OH; Taussig Cancer Center, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH
| | - V Varadan
- Seidman Cancer Center, Cleveland, OH; Taussig Cancer Center, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH
| | - H Moore
- Seidman Cancer Center, Cleveland, OH; Taussig Cancer Center, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH
| | - A Montero
- Seidman Cancer Center, Cleveland, OH; Taussig Cancer Center, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH
| | - P Fu
- Seidman Cancer Center, Cleveland, OH; Taussig Cancer Center, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH
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Walsh M, Thomas S, Moore E, Moore H, Piscoya A, Hake D, Son M, Pohlman T, Wegner J, Bryant J, Grassetto A, Davis P, Nielsen N, Crepinsek A, Shreve JT, Castellino F. Tranexamic Acid for Trauma Resuscitation in the United States of America. Semin Thromb Hemost 2016; 43:213-223. [PMID: 27907937 DOI: 10.1055/s-0036-1586226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The utilization of tranexamic acid (TXA) for the management of bleeding trauma patients has been a subject of much debate on both sides of the Atlantic and in Australia. As a result of the large randomized controlled study called the Clinical Randomization of an Antifibrinolytic in Severe Hemorrhage (CRASH-2), there was an initial enthusiasm for the use of TXA to treat bleeding patients. However, the adoption of TXA in the United States was delayed by concerns of "knowledge and evidence gaps" of the CRASH-2 study and because of a lack of mechanistic rationale that would explain the survival benefit noted in the study. Subsequent nonrandomized controlled trials questioned the liberal use of TXA in trauma patients. This narrative review explores the historical as well as clinical and theoretical grounds for the more measured use of TXA in the United States and proposes a clinical and point-of-care guided utilization of TXA, blood components, and adjunctive hemostatic agents in bleeding trauma patients.
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Affiliation(s)
- Mark Walsh
- Department of Emergency Medicine, Memorial Hospital of South Bend, South Bend, Indiana
| | - Scott Thomas
- Department of Emergency Medicine, Memorial Hospital of South Bend, South Bend, Indiana
| | - Ernest Moore
- Department of Surgery, Denver General Hospital, Denver, Colorado
| | - Hunter Moore
- Department of Surgery, Denver General Hospital, Denver, Colorado
| | - Andres Piscoya
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Daniel Hake
- Department of Emergency Medicine, Memorial Hospital of South Bend, South Bend, Indiana
| | - Michael Son
- Department of Emergency Medicine, Memorial Hospital of South Bend, South Bend, Indiana
| | - Tim Pohlman
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | - John Bryant
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Alberto Grassetto
- Departments of Anesthesia, Emergency, and Critical Care Medicine, Ospedale dell'Angelo di Mestre, Venice, Italy
| | - Patrick Davis
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Nathan Nielsen
- Division of Pulmonary Diseases, Critical Care and Environmental Medicine Tulane School of Medicine, New Orleans, Louisiana
| | - Anton Crepinsek
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Jacob T Shreve
- Department of Emergency Medicine, Memorial Hospital of South Bend, South Bend, Indiana
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Warner AW, Moore H, Reinhard D, Ball LA, Knoppers BM. Harmonizing Global Biospecimen Consent Practices to Advance Translational Research: A Call to Action. Clin Pharmacol Ther 2016; 101:317-319. [PMID: 27558027 DOI: 10.1002/cpt.461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 07/27/2016] [Accepted: 08/22/2016] [Indexed: 01/14/2023]
Abstract
One of the many challenges of translational medicine is working with research participants to donate biospecimens through an ethical informed consent framework. The increasingly complex ethical and regulatory differences across jurisdictions translates into limitations on use and potential value of biological specimens and their associated data in clinical research. We introduce a call to action for more uniform global standards for collection of biological specimen informed consent data to enable greater advancements in medical research.
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Affiliation(s)
- A W Warner
- Global Specimen Solutions, Inc, Raleigh, North Carolina, USA
| | - H Moore
- NIH, NCI Biorepositories and Biospecimen Research Branc, Rockville, Maryland, USA
| | - D Reinhard
- Bristol-Myers Squibb, Clinical Sample Strategy & Operation, Pennington, New Jersey, USA
| | - L A Ball
- BioStorage Technologies, Inc, Indianapolis, Indiana, USA
| | - B M Knoppers
- Center of Genomics and Policy, McGill Universit, Montreal, Quebec, Canada
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Williams L, McGovern E, Kimmich O, Molloy A, Beiser I, Butler JS, Molloy F, Logan P, Healy DG, Lynch T, Walsh R, Cassidy L, Moriarty P, Moore H, McSwiney T, Walsh C, O'Riordan S, Hutchinson M. Epidemiological, clinical and genetic aspects of adult onset isolated focal dystonia in Ireland. Eur J Neurol 2016; 24:73-81. [DOI: 10.1111/ene.13133] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 08/09/2016] [Indexed: 02/06/2023]
Affiliation(s)
- L. Williams
- Department of Neurology; St Vincent's University Hospital; Dublin Ireland
- School of Medicine and Medical Sciences; University College Dublin; Dublin Ireland
| | - E. McGovern
- Department of Neurology; St Vincent's University Hospital; Dublin Ireland
- School of Medicine and Medical Sciences; University College Dublin; Dublin Ireland
| | - O. Kimmich
- Department of Neurology; St Vincent's University Hospital; Dublin Ireland
- School of Medicine and Medical Sciences; University College Dublin; Dublin Ireland
| | - A. Molloy
- Department of Neurology; St Vincent's University Hospital; Dublin Ireland
- School of Medicine and Medical Sciences; University College Dublin; Dublin Ireland
| | - I. Beiser
- Department of Neurology; St Vincent's University Hospital; Dublin Ireland
- School of Medicine and Medical Sciences; University College Dublin; Dublin Ireland
| | - J. S. Butler
- Trinity Centre for Bioengineering; Dublin and School of Mathematical Sciences; Dublin Institute of Technology; Dublin Ireland
| | | | - P. Logan
- Beaumont Hospital; Dublin Ireland
| | | | - T. Lynch
- Mater Misericordiae University Hospital; Dublin Ireland
| | - R. Walsh
- Adelaide and Meath Hospital; Dublin Ireland
| | - L. Cassidy
- Royal Victoria Eye and Ear Hospital; Dublin Ireland
| | - P. Moriarty
- Royal Victoria Eye and Ear Hospital; Dublin Ireland
| | - H. Moore
- Cork University Hospital; Cork Ireland
| | | | - C. Walsh
- Departments of Statistics; Trinity College Dublin; University of Limerick; Limerick Ireland
| | - S. O'Riordan
- Department of Neurology; St Vincent's University Hospital; Dublin Ireland
- School of Medicine and Medical Sciences; University College Dublin; Dublin Ireland
| | - M. Hutchinson
- Department of Neurology; St Vincent's University Hospital; Dublin Ireland
- School of Medicine and Medical Sciences; University College Dublin; Dublin Ireland
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Abstract
OBJECTIVE This prospective longitudinal study aims to determine the risk factors of wandering-related adverse consequences in community-dwelling persons with mild dementia. These adverse consequences include negative outcomes of wandering (falls, fractures, and injuries) and eloping behavior. METHODS We recruited 143 dyads of persons with mild dementia and their caregivers from a veteran's hospital and memory clinic in Florida. Wandering-related adverse consequences were measured using the Revised Algase Wandering Scale - Community Version. Variables such as personality (Big Five Inventory), behavioral response to stress, gait, and balance (Tinetti Gait and Balance), wayfinding ability (Wayfinding Effectiveness Scale), and neurocognitive abilities (attention, cognition, memory, language/verbal skills, and executive functioning) were also measured. Bivariate and logistic regression analyses were performed to assess the predictors of these wandering-related adverse consequences. RESULTS A total of 49% of the study participants had falls, fractures, and injuries due to wandering behavior, and 43.7% demonstrated eloping behaviors. Persistent walking (OR = 2.6) and poor gait (OR = 0.9) were significant predictors of negative outcomes of wandering, while persistent walking (OR = 13.2) and passivity (OR = 2.55) predicted eloping behavior. However, there were no correlations between wandering-related adverse consequences and participants' characteristics (age, gender, race, ethnicity, and education), health status (Charlson comorbidity index), or neurocognitive abilities. CONCLUSION Our results highlight the importance of identifying at-risk individuals so that effective interventions can be developed to reduce or prevent the adverse consequences of wandering.
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Affiliation(s)
- N Ali
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore.,School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - S L Luther
- VISN 8 Center of Innovation, James A. Haley VA Hospital, Tampa, FL, USA
| | - L Volicer
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - D Algase
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - E Beattie
- School of Nursing, Queensland University of Technology, Brisbane, Australia
| | - L M Brown
- VISN 8 Center of Innovation, James A. Haley VA Hospital, Tampa, FL, USA.,School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - V Molinari
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - H Moore
- VISN 8 Center of Innovation, James A. Haley VA Hospital, Tampa, FL, USA
| | - I Joseph
- James A. Haley VA Hospital, Tampa, FL
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Kruse ML, Santa-Maria CA, Raska P, Swoboda A, Jain S, Sohal D, Moore H, Budd GT, Abraham J, Montero AJ. Abstract P4-13-24: Impact of genomic medicine on clinical decision making in patients with advanced breast cancer at two academic medical centers. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p4-13-24] [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: A deeper molecular understanding of cancer biology has led to the development of therapies targeting driver mutations. Genomic profiling of tumors is commercially available and has become integrated into many clinical practices as part of a paradigm shift towards personalized care of cancer patients. The current impact of genomic profiling on clinical decision making for patients with advanced breast cancer is not well described.
Methods: Patients with metastatic breast cancer (mBC) who had tumors submitted for commercial genomic analysis from 2013-2015 were identified consecutively at two large academic cancer centers with genomic basket trials open for the majority of the collection period. Demographics, tumor pathology, clinical, and treatment histories were extracted through medical chart review as per an IRB approved protocol. Data from genomic analysis reports was extracted including number and type of mutations, FDA approved therapies and clinical trials available. Genomic analysis was determined to have impacted clinical decision making if the next line of therapy was influenced either by accrual to clinical trial, or a decision to prescribe an FDA-approved therapy. The most frequent somatic mutations and their relative frequencies were determined.
Results: A total of 82 patients with mBC who had undergone commercially available genomic testing were identified. The median age was 49 (range: 29-70). 42 patients (51%) had ER-positive HER2-negative disease, 33 (40%) had ER-negative HER2-negative disease, 4 (5%) had ER-negative HER2-positive disease and 3 (4%) had ER-positive HER2-positive disease. The median number of lines of therapy received prior to genomic profiling was 2 (range 0-15). Genomic analysis reports suggested that 61 (74%) of these patients had at least one FDA approved medication available for at least one somatic mutation, and 79 (96%) had at least one clinical trial available (39 (46%) in the same state, 11 (13%) in the same institution). Genomic testing influenced management in 8 patients (10%), with 6 patients (7%) experiencing a change in next line of therapy attributable to genomic information. In 74 patients (90%), genomic testing results did not affect clinical decision-making. The most frequently observed somatic mutations included: TP53, PI3KCA, MYC, CCDN1, FGF, ZNF703, GATA3, ARID1A, MCL1, PTEN, MYST3, and BRCA1.
Conclusions: Genomic testing did not affect management in the vast majority of mBC patients treated at two major academic cancer centers. Furthermore, the most identified mutated genes found were not targetable. The real world clinical utility of genomic analysis remains limited in breast cancer but may influence clinical decision making in a minority of patients.
Citation Format: Kruse ML, Santa-Maria CA, Raska P, Swoboda A, Jain S, Sohal D, Moore H, Budd GT, Abraham J, Montero AJ. Impact of genomic medicine on clinical decision making in patients with advanced breast cancer at two academic medical centers. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-13-24.
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Affiliation(s)
- ML Kruse
- Cleveland Clinic, Cleveland, OH; Northwestern University, Chicago, IL
| | - CA Santa-Maria
- Cleveland Clinic, Cleveland, OH; Northwestern University, Chicago, IL
| | - P Raska
- Cleveland Clinic, Cleveland, OH; Northwestern University, Chicago, IL
| | - A Swoboda
- Cleveland Clinic, Cleveland, OH; Northwestern University, Chicago, IL
| | - S Jain
- Cleveland Clinic, Cleveland, OH; Northwestern University, Chicago, IL
| | - D Sohal
- Cleveland Clinic, Cleveland, OH; Northwestern University, Chicago, IL
| | - H Moore
- Cleveland Clinic, Cleveland, OH; Northwestern University, Chicago, IL
| | - GT Budd
- Cleveland Clinic, Cleveland, OH; Northwestern University, Chicago, IL
| | - J Abraham
- Cleveland Clinic, Cleveland, OH; Northwestern University, Chicago, IL
| | - AJ Montero
- Cleveland Clinic, Cleveland, OH; Northwestern University, Chicago, IL
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Winter A, Raska P, Ornstein M, Moore H, Montero A, Budd GT, Tullio K, Bailey J, Abraham J. Abstract P1-09-03: Socioeconomic characteristics of African American women with breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-09-03] [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: Breast cancer is the most common cancer among African American (AA) women. Despite having a lower incidence of breast cancer compared to white women (124.4 compared to 127.9 per 100,000), AAs have a higher death rate (30.2 compared to 21.3 per 100,000). One explanation for this discrepancy is that breast cancer in AAs is often detected at a later stage compared to white women. We conducted this retrospective study to examine socioeconomic characteristics among AA women with breast cancer to see if there were factors associated with stage of diagnosis which may contribute to the known disparities. Methods: We identified all AA women diagnosed with any stage breast cancer from 2006-2014 within the Cleveland Clinic Cancer Data Warehouse and classified them into either early or late stage disease at time of diagnosis. Stages 0-II were classified as early and stages III-IV as late. We examined several variables at diagnosis including age, marital status, tobacco use, alcohol use, Medicaid insurance status, and breast cancer subtype which included HER-2 positive (HER+), hormone receptor positive/HER2 negative (HR+/HER-), and triple negative(TN). AA median income was obtained from US census data according to the zip code at diagnosis. We conducted univariate logistic regression for individual estimates and confidence intervals and multiple logistic regression and model selection to determine significant predictors of stage of diagnosis. Results: Of the 771 AA women identified, 108 (14%) were diagnosed at a late stage of disease with a median age of 59 years. Receptor status distribution was 12.4%, 31%, and 16.6% for HER+, HR+/HER-, and TN respectively for early stage, and 15.7%, 27%, and 25% for late stage. Among early stage 50% were current or previous smokers and 2.6% had Medicaid insurance compared to late stage patients where 63% were current or previous smokers and 9.2% had Medicaid insurance. Multiplicative effect estimates and 95% confidence intervals from univariate logistic regressions identified the following significant factors: tobacco use 1.48 [1.11-1.96] and Medicaid 3.73 [1.56-8.51] (p-values<0.01), and TNBC 1.67 [1.02-2.68] (p-value<0.05). In a stepwise model selection, only tobacco use and Medicaid were retained in the model, as well as age at diagnosis. Conclusions: There are socioeconomic differences among AA women with breast cancer. Only tobacco use, Medicaid insurance, and age at diagnosis were predictive of late stage in this study.
Citation Format: Winter A, Raska P, Ornstein M, Moore H, Montero A, Budd GT, Tullio K, Bailey J, Abraham J. Socioeconomic characteristics of African American women with breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-09-03.
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Affiliation(s)
| | - P Raska
- Cleveland Clinic, Cleveland, OH
| | | | - H Moore
- Cleveland Clinic, Cleveland, OH
| | | | - GT Budd
- Cleveland Clinic, Cleveland, OH
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Berriochoa C, Leyrer C, Agrawal S, Donaldson A, Stewart R, Moore H, Tendulkar R, Calhoun B. Metaplastic Breast Cancer: A Clinicopathologic Correlation of Histologic Subtype on Disease Control. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mazarello Paes V, Hesketh K, O'Malley C, Moore H, Summerbell C, Griffin S, van Sluijs EMF, Ong KK, Lakshman R. Determinants of sugar-sweetened beverage consumption in young children: a systematic review. Obes Rev 2015; 16:903-13. [PMID: 26252417 PMCID: PMC4737242 DOI: 10.1111/obr.12310] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/17/2015] [Accepted: 06/30/2015] [Indexed: 01/05/2023]
Abstract
Sugar-sweetened beverage (SSB) consumption is associated with adverse health outcomes. Improved understanding of the determinants will inform effective interventions to reduce SSB consumption. A total of 46,876 papers were identified through searching eight electronic databases. Evidence from intervention (n = 13), prospective (n = 6) and cross-sectional (n = 25) studies on correlates/determinants of SSB consumption was quality assessed and synthesized. Twelve correlates/determinants were associated with higher SSB consumption (child's preference for SSBs, TV viewing/screen time and snack consumption; parents' lower socioeconomic status, lower age, SSB consumption, formula milk feeding, early introduction of solids, using food as rewards, parental-perceived barriers, attending out-of-home care and living near a fast food/convenience store). Five correlates/determinants were associated with lower SSB consumption (parental positive modelling, parents' married/co-habiting, school nutrition policy, staff skills and supermarket nearby). There was equivocal evidence for child's age and knowledge, parental knowledge, skills, rules/restrictions and home SSB availability. Eight intervention studies targeted multi-level (child, parents, childcare/preschool setting) determinants; four were effective. Four intervention studies targeted parental determinants; two were effective. One (effective) intervention targeted the preschool environment. There is consistent evidence to support potentially modifiable correlates/determinants of SSB consumption in young children acting at parental (modelling), child (TV viewing) and environmental (school policy) levels.
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Affiliation(s)
- V Mazarello Paes
- Institute of Public Health, University of Cambridge, Cambridge, UK.,Institute of Child Health, University College London, London, UK
| | - K Hesketh
- Institute of Child Health, University College London, London, UK.,MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
| | - C O'Malley
- School of Medicine, Pharmacy and Health, Durham University Queens Campus, Stockton-On-Tees, UK
| | - H Moore
- School of Medicine, Pharmacy and Health, Durham University Queens Campus, Stockton-On-Tees, UK
| | - C Summerbell
- School of Medicine, Pharmacy and Health, Durham University Queens Campus, Stockton-On-Tees, UK
| | - S Griffin
- Institute of Public Health, University of Cambridge, Cambridge, UK.,MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
| | - E M F van Sluijs
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
| | - K K Ong
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
| | - R Lakshman
- Institute of Public Health, University of Cambridge, Cambridge, UK.,MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, UK
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Milekic MH, Xin Y, O'Donnell A, Kumar KK, Bradley-Moore M, Malaspina D, Moore H, Brunner D, Ge Y, Edwards J, Paul S, Haghighi FG, Gingrich JA. Age-related sperm DNA methylation changes are transmitted to offspring and associated with abnormal behavior and dysregulated gene expression. Mol Psychiatry 2015; 20:995-1001. [PMID: 25092244 DOI: 10.1038/mp.2014.84] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [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: 01/16/2014] [Revised: 05/14/2014] [Accepted: 06/17/2014] [Indexed: 12/15/2022]
Abstract
Advanced paternal age (APA) has been shown to be a significant risk factor in the offspring for neurodevelopmental psychiatric disorders, such as schizophrenia and autism spectrum disorders. During aging, de novo mutations accumulate in the male germline and are frequently transmitted to the offspring with deleterious effects. In addition, DNA methylation during spermatogenesis is an active process, which is susceptible to errors that can be propagated to subsequent generations. Here we test the hypothesis that the integrity of germline DNA methylation is compromised during the aging process. A genome-wide DNA methylation screen comparing sperm from young and old mice revealed a significant loss of methylation in the older mice in regions associated with transcriptional regulation. The offspring of older fathers had reduced exploratory and startle behaviors and exhibited similar brain DNA methylation abnormalities as observed in the paternal sperm. Offspring from old fathers also had transcriptional dysregulation of developmental genes implicated in autism and schizophrenia. Our findings demonstrate that DNA methylation abnormalities arising in the sperm of old fathers are a plausible mechanism to explain some of the risks that APA poses to resulting offspring.
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Affiliation(s)
- M H Milekic
- Department of Psychiatry, Columbia University and The New York State Psychiatric Institute, New York, NY, USA
| | - Y Xin
- Department of Psychiatry, Columbia University and The New York State Psychiatric Institute, New York, NY, USA
| | - A O'Donnell
- Department of Genetics and Development, Columbia University, New York, NY, USA
| | - K K Kumar
- Department of Psychiatry, Columbia University and The New York State Psychiatric Institute, New York, NY, USA
| | - M Bradley-Moore
- Department of Psychiatry, Columbia University and The New York State Psychiatric Institute, New York, NY, USA
| | - D Malaspina
- 1] Department of Psychiatry, New York University, New York, NY, USA [2] Department of Psychiatry, New York University, and The NY OMH Creedmoor Psychiatric Center, New York, NY, USA
| | - H Moore
- Department of Psychiatry, Columbia University and The New York State Psychiatric Institute, New York, NY, USA
| | - D Brunner
- 1] Department of Psychiatry, Columbia University and The New York State Psychiatric Institute, New York, NY, USA [2] PsychoGenics, New York, NY, USA
| | - Y Ge
- Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA
| | - J Edwards
- Center for Pharmacogenomics, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - S Paul
- Helen & Robert Appel Institute for Alzheimer's Research, Mind and Brain Institute, Weill Cornell Medical School, New York, NY, USA
| | - F G Haghighi
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J A Gingrich
- Department of Psychiatry, Columbia University and The New York State Psychiatric Institute, New York, NY, USA
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Redpath S, Lemyre B, Moore H, Ponnuthurai J, Chan J, Barrowman N. 88: Effectiveness of Therapeutic Hypothermia on Transport within a Large Geographical Area. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e66] [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: 11/12/2022] Open
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Whisson S, Smith S, Moore H, Summerbell C. Exploring service providers' and commissioners' views on a community pharmacy led weight management service. A qualitative study. Appetite 2015. [DOI: 10.1016/j.appet.2014.12.182] [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: 11/17/2022]
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Smith S, Summerbell C, Moore H, O'malley C. Tees Consumption and Activity in Kids Experience (TeesCAKE). Qualitative results. Appetite 2015. [DOI: 10.1016/j.appet.2014.12.181] [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: 10/24/2022]
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Moore H. Finding my friend's heart in the difficult patient. Bull Am Coll Surg 2014; 99:12. [PMID: 24956905] [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: 06/03/2023]
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Agrawal L, Moore H, Vaught J. MC13-0047 Serum and tissue biomarkers for cancer biospecimen integrity. Eur J Cancer 2013. [DOI: 10.1016/s0959-8049(13)70159-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: 10/26/2022]
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Moore H, Engel K. SP035 NCI biospecimen evidence-based practices. Eur J Cancer 2013. [DOI: 10.1016/s0959-8049(13)70113-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Wohlauer M, Robinson T, Moore H, Bacon A, Marshall G, Arcomano T. Massive colomegaly due to recurrent sigmoid volvulus. J Gastrointestin Liver Dis 2012; 21:127. [PMID: 22720297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Max Wohlauer
- University of Colorado School of Medicine, Aurora, CO, USA
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Thapar A, Moore H, Golden D, Davies A. Peri-operative antithrombotic therapy: bridging the gap. Ann R Coll Surg Engl 2012; 94:142-5. [PMID: 22507714 DOI: 10.1308/003588412x13171221590854] [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: 11/22/2022] Open
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Gibson EL, Kreichauf S, Wildgruber A, Vögele C, Summerbell CD, Nixon C, Moore H, Douthwaite W, Manios Y. A narrative review of psychological and educational strategies applied to young children's eating behaviours aimed at reducing obesity risk. Obes Rev 2012; 13 Suppl 1:85-95. [PMID: 22309067 DOI: 10.1111/j.1467-789x.2011.00939.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [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: 12/13/2022]
Abstract
Strategies to reduce risk of obesity by influencing preschool children's eating behaviour are reviewed. The studies are placed in the context of relevant psychological processes, including inherited and acquired preferences, and behavioural traits, such as food neophobia, 'enjoyment of food' and 'satiety responsiveness'. These are important influences on how children respond to feeding practices, as well as predictors of obesity risk. Nevertheless, in young children, food environment and experience are especially important for establishing eating habits and food preferences. Providing information to parents, or to children, on healthy feeding is insufficient. Acceptance of healthy foods can be encouraged by five to ten repeated tastes. Recent evidence suggests rewarding healthy eating can be successful, even for verbal praise alone, but that palatable foods should not be used as rewards for eating. Intake of healthier foods can be promoted by increasing portion size, especially in the beginning of the meal. Parental strategies of pressuring to eat and restriction do not appear to be causally linked to obesity, but are instead primarily responses to children's eating tendencies and weight. Moderate rather than frequent restriction may improve healthy eating in children. Actively positive social modelling by adults and peers can be effective in encouraging healthier eating.
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Affiliation(s)
- E L Gibson
- Department of Psychology, University of Roehampton, London, UK.
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Melis M, Marcon F, Masi A, Sarpel U, Miller G, Cohen S, Moore H, Berman R, Pachter H, Newman E. Is the Addition of Grade to the AJCC Staging for Patients Undergoing Pancreaticoduodenectomy Beneficial? J Surg Res 2012. [DOI: 10.1016/j.jss.2011.11.751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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