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Arshad J, Rao A, Repp ML, Rao R, Wu C, Merchant JL. Myeloid-Derived Suppressor Cells: Therapeutic Target for Gastrointestinal Cancers. Int J Mol Sci 2024; 25:2985. [PMID: 38474232 PMCID: PMC10931832 DOI: 10.3390/ijms25052985] [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: 01/02/2024] [Revised: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024] Open
Abstract
Gastrointestinal cancers represent one of the more challenging cancers to treat. Current strategies to cure and control gastrointestinal (GI) cancers like surgery, radiation, chemotherapy, and immunotherapy have met with limited success, and research has turned towards further characterizing the tumor microenvironment to develop novel therapeutics. Myeloid-derived suppressor cells (MDSCs) have emerged as crucial drivers of pathogenesis and progression within the tumor microenvironment in GI malignancies. Many MDSCs clinical targets have been defined in preclinical models, that potentially play an integral role in blocking recruitment and expansion, promoting MDSC differentiation into mature myeloid cells, depleting existing MDSCs, altering MDSC metabolic pathways, and directly inhibiting MDSC function. This review article analyzes the role of MDSCs in GI cancers as viable therapeutic targets for gastrointestinal malignancies and reviews the existing clinical trial landscape of recently completed and ongoing clinical studies testing novel therapeutics in GI cancers.
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Affiliation(s)
- Junaid Arshad
- University of Arizona Cancer Center, GI Medical Oncology, Tucson, AZ 85724, USA;
| | - Amith Rao
- Banner University Medical Center—University of Arizona, Tucson, AZ 85719, USA; (A.R.)
| | - Matthew L. Repp
- College of Medicine, University of Arizona, Tucson, AZ 85719, USA;
| | - Rohit Rao
- University Hospitals Cleveland Medical Center, Case Western Reserve School of Medicine, Cleveland, OH 44106, USA;
| | - Clinton Wu
- Banner University Medical Center—University of Arizona, Tucson, AZ 85719, USA; (A.R.)
| | - Juanita L. Merchant
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine, Tucson, AZ 85724, USA
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Young S, Hannallah J, Goldberg D, Khreiss M, Shroff R, Arshad J, Scott A, Woodhead G. Liver-Directed Therapy Combined with Systemic Therapy: Current Status and Future Directions. Semin Intervent Radiol 2023; 40:515-523. [PMID: 38274222 PMCID: PMC10807971 DOI: 10.1055/s-0043-1777711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
In the past several decades, major advances in both systemic and locoregional therapies have been made for many cancer patients. This has led to modern cancer treatment algorithms frequently calling for active interventions by multiple subspecialists at the same time. One of the areas where this can be clearly seen is the concomitant use of locoregional and systemic therapies in patients with primary or secondary cancers of the liver. These combined algorithms have gained favor over the last decade and are largely focused on the allure of the combined ability to control systemic disease while at the same time addressing refractory/resistant clonal populations. While the general concept has gained favor and is likely to only increase in popularity with the continued establishment of viable immunotherapy treatments, for many patients questions remain. Lingering concerns over the increase in toxicity when combining treatment methods, patient selection, and sequencing remain for multiple cancer patient populations. While further work remains, some of these questions have been addressed in the literature. This article reviews the available data on three commonly treated primary and secondary cancers of the liver, namely, hepatocellular carcinoma, cholangiocarcinoma, and metastatic colorectal cancer. Furthermore, strengths and weaknesses are reviewed and future directions are discussed.
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Affiliation(s)
- Shamar Young
- Division of Interventional Radiology, Department of Medical Imaging, University of Arizona, Tucson, Arizona
| | - Jack Hannallah
- Division of Interventional Radiology, Department of Medical Imaging, University of Arizona, Tucson, Arizona
| | - Dan Goldberg
- Division of Interventional Radiology, Department of Medical Imaging, University of Arizona, Tucson, Arizona
| | - Mohammad Khreiss
- Division of Surgical Oncology, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Rachna Shroff
- Division of Hematology and Oncology, Department of Medicine, University of Arizona, Tucson, Arizona
| | - Junaid Arshad
- Division of Hematology and Oncology, Department of Medicine, University of Arizona, Tucson, Arizona
| | - Aaron Scott
- Division of Hematology and Oncology, Department of Medicine, University of Arizona, Tucson, Arizona
| | - Gregory Woodhead
- Division of Interventional Radiology, Department of Medical Imaging, University of Arizona, Tucson, Arizona
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Del Rivero J, Perez K, Kennedy EB, Mittra ES, Vijayvergia N, Arshad J, Basu S, Chauhan A, Dasari AN, Bellizzi AM, Gangi A, Grady E, Howe JR, Ivanidze J, Lewis M, Mailman J, Raj N, Soares HP, Soulen MC, White SB, Chan JA, Kunz PL, Singh S, Halfdanarson TR, Strosberg JR, Bergsland EK. Systemic Therapy for Tumor Control in Metastatic Well-Differentiated Gastroenteropancreatic Neuroendocrine Tumors: ASCO Guideline. J Clin Oncol 2023; 41:5049-5067. [PMID: 37774329 DOI: 10.1200/jco.23.01529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 10/01/2023] Open
Abstract
PURPOSE To develop recommendations for systemic therapy for well-differentiated grade 1 (G1) to grade 3 (G3) metastatic gastroenteropancreatic neuroendocrine tumors (GEP-NETs). METHODS ASCO convened an Expert Panel to conduct a systematic review of relevant studies and develop recommendations for clinical practice. RESULTS Eight randomized controlled trials met the inclusion criteria for the systematic review. RECOMMENDATIONS Somatostatin analogs (SSAs) are recommended as first-line systemic therapy for most patients with G1-grade 2 (G2) metastatic well-differentiated GI-NETs. Observation is an option for patients with low-volume or slow-growing disease without symptoms. After progression on SSAs, peptide receptor radionuclide therapy (PRRT) is recommended as systematic therapy for patients with somatostatin receptor (SSTR)-positive tumors. Everolimus is an alternative second-line therapy, particularly in nonfunctioning NETs and patients with SSTR-negative tumors. SSAs are standard first-line therapy for SSTR-positive pancreatic (pan)NETs. Rarely, observation may be appropriate for asymptomatic patients until progression. Second-line systemic options for panNETs include PRRT (for SSTR-positive tumors), cytotoxic chemotherapy, everolimus, or sunitinib. For SSTR-negative tumors, first-line therapy options are chemotherapy, everolimus, or sunitinib. There are insufficient data to recommend particular sequencing of therapies. Patients with G1-G2 high-volume disease, relatively high Ki-67 index, and/or symptoms related to tumor growth may benefit from early cytotoxic chemotherapy. For G3 GEP-NETs, systemic options for G1-G2 may be considered, although cytotoxic chemotherapy is likely the most effective option for patients with tumor-related symptoms, and SSAs are relatively ineffective. Qualifying statements are provided to assist with treatment choice. Multidisciplinary team management is recommended, along with shared decision making with patients, incorporating their values and preferences, potential benefits and harms, and other characteristics and circumstances, such as comorbidities, performance status, geographic location, and access to care.Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines.
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Affiliation(s)
| | | | | | | | | | | | - Sandip Basu
- Bhabha Atomic Research Centre, Tata Memorial Hospital, Mumbai, India
| | | | | | | | | | | | | | | | | | | | - Nitya Raj
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | - Simron Singh
- Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Young S, Hannallah J, Goldberg D, Sanghvi T, Arshad J, Scott A, Woodhead G. Friend or Foe? Locoregional Therapies and Immunotherapies in the Current Hepatocellular Treatment Landscape. Int J Mol Sci 2023; 24:11434. [PMID: 37511193 PMCID: PMC10380625 DOI: 10.3390/ijms241411434] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Over the last several decades, a number of new treatment options for patients with hepatocellular carcinoma (HCC) have been developed. While treatment decisions for some patients remain clear cut, a large numbers of patients have multiple treatment options, and it can be hard for multidisciplinary teams to come to unanimous decisions on which treatment strategy or sequence of treatments is best. This article reviews the available data with regard to two treatment strategies, immunotherapies and locoregional therapies, with a focus on the potential of locoregional therapies to be combined with checkpoint inhibitors to improve outcomes in patients with locally advanced HCC. In this review, the available data on the immunomodulatory effects of locoregional therapies is discussed along with available clinical data on outcomes when the two strategies are combined.
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Affiliation(s)
- Shamar Young
- Department of Medical Imaging, Division of Interventional Radiology, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724, USA
| | - Jack Hannallah
- Department of Medical Imaging, Division of Interventional Radiology, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724, USA
| | - Dan Goldberg
- Department of Medical Imaging, Division of Interventional Radiology, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724, USA
| | - Tina Sanghvi
- Department of Radiology, Southern Arizona VA, Tucson, AZ 85723, USA
| | - Junaid Arshad
- Department of Medicine, Division of Hematology and Oncology, University of Arizona, Tucson, AZ 85724, USA
| | - Aaron Scott
- Department of Medicine, Division of Hematology and Oncology, University of Arizona, Tucson, AZ 85724, USA
| | - Gregory Woodhead
- Department of Medical Imaging, Division of Interventional Radiology, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724, USA
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Nasir MH, Arshad J, Khan MM. Collaborative Device-level Botnet Detection for Internet of Things. Comput Secur 2023. [DOI: 10.1016/j.cose.2023.103172] [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: 03/08/2023]
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Saif M, Rahman FU, Liaqat J, Sajid U, Saeed F, Khan A, Khan MN, Samore NA, Siddique MB, Arshad J. Correlation of ECG changes at high altitude with findings on Coronary Angiogram. PAFMJ 2022. [DOI: 10.51253/pafmj.v72isuppl-3.9525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective: To highlight association of coronary artery disease on angiograms and high altitude-related ECG abnormalities that is thought to be ischemic in origin.
Place and Duration of Study: This was a cross sectional study done in Armed Force Institute of Cardiology/National Institute of Heart Disease from Oct 2016 to Oct 2021.
Methodology: This was a cross sectional study done in AFIC/NIHD from Oct 2016–Oct 2021 (5years). A total of 103 patients at a range of 9000 to 22000 feet in altitude, with new ECG changes were selected via consecutive sampling. Data was analyzed by SPSS version-23. Descriptive statistics were run to present categorical data in frequencies and percentages. Chi-square and Fisher Exact Test was applied to find the association between study variables at 95% CI and 5% margin of error (α= 5%).
Results: The data was collected from a total of 103 respondents, mean age (years) of the respondents was 30.57±6.27, and mean duration of stay (days) at high altitude was 64.8±68.3 (Table-I). ECG changes that were recorded were: T-wave inversion in anterior leads (V1, V2, V3) were reported in n=33(32%), T- wave inversion in Inferior leads (II, III, aVF) in 21(20.3%), T-wave inversion in lateral leads (V3-V6) 10(9.7%). Normal Ejection fraction was observed in 97% of the study participants while only 3% had mild left ventricular systolic impairment. Angiographic findings were found to be normal in n=92 (89.30%), minor coronary artery disease (CAD) in n=9 (8.70%), muscle bridge in LAD in n=2 (1.90%). Our results also showed that amongst other final diagnosis, of note were vasovagal syncope (n=5; 4.8%), pulmonary embolism (n=5; 4.8%) and pulmonary arterial hypertension (n=3; 2.9%).
Conclusion: Our work leads us to the conclusion that ECG abnormalities at high altitude do not indicate coronary artery disease since they do not reflect a delay in electrical conduction or ischemia. These patients should be treated separately based on their high altitude disease symptoms (HAI).
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Sattar Y, Song D, Almas T, Zghouzi M, Talib U, Suleiman ARM, Ahmad B, Arshad J, Ullah W, Zia Khan M, Bianco CM, Bagur R, Rashid M, Mamas MA, Alraies MC. Cardiovascular outcomes and trends of Transcatheter vs. Surgical aortic valve replacement among octogenarians with heart failure: A Propensity Matched national cohort analysis. IJC Heart & Vasculature 2022; 42:101119. [PMID: 36161232 PMCID: PMC9489740 DOI: 10.1016/j.ijcha.2022.101119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/17/2022] [Accepted: 09/01/2022] [Indexed: 11/26/2022]
Abstract
Background Methods Results Conclusion
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Bialick S, Rose BE, Espejo-Freire AP, Barreto Coelho P, Costa PA, Campoverde L, Drusbosky L, Arshad J, Serrano C, George S, Bauer S, Goel N, Venkat S, Dhir A, Jonczak E, D'Amato GZ, Trent JC. KIT resistance mutations identified by circulating tumor DNA and treatment outcomes in advanced gastrointestinal stromal tumor. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.11514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11514 Background: Tyrosine kinase inhibitors (TKIs) are the cornerstone treatment for advanced GIST via pharmacologic targeting of driver oncogenes such as KIT. Detection of KIT alterations through tissue-based next-generation sequencing (NGS) is common, but circulating tumor DNA (ctDNA)-based NGS is a less invasive alternative to identify driver and resistance mutations in advanced GIST. Patients (pts) with KIT-mutant GIST benefit from first-line (1L) imatinib; however, KIT resistance mutations may confer imatinib-resistance and differential sensitivity to subsequent TKIs. We sought to analyze ctDNA from GIST pts to determine whether certain resistance mutations were associated with superior outcomes with particular TKIs in the second-line and beyond (2L+). Methods: Under an approved institutional review board protocol, a retrospective analysis was performed with available ctDNA NGS results (Guardant360; Redwood City, CA) from pts (N = 104) who progressed on 1L imatinib between 2017-21. Using R statistical programming, we identified pts with primary KIT alterations (N = 64) and known resistance mutations in KIT exons 13 (N = 25) and 17 (N = 35). We studied the median time to treatment failure (mTTF), defined as the time from treatment start to treatment end (months) due to progressive disease or toxicity, for each 2L+ drug. Using Kaplan-Meier methods, we calculated Cox proportional-hazard ratios (HR) with confidence intervals (CI) and p-values for statistical significance. Results: 49% were male (median age 66; range, 31-94). Driver oncogenes were detected in 80% (N = 83), including KIT, NF1, PDGFRA and BRAF. Of those with a KIT alteration, 12 (19%) had KIT exon 9 mutations and 52 (81%) had KIT exon 11 mutations. KIT resistance mutations were observed in KIT exons 13 (N = 25; V654), 14 (N = 2; T670), and 17 (N = 45; D816, D820, N822, Y823). Pts with KIT resistance mutations received 2L+ therapy with avapritinib, dose-escalated imatinib, nilotinib, pazopanib, ponatinib, regorafenib, ripretinib, or sunitinib. mTTF for KIT exon 13 V654 pts treated with 2L+ sunitinib, imatinib 800mg, or other was 10.8, 7.5, and 3.7 months, respectively. TTF for sunitinib vs other 2L+ drugs showed a HR of 0.51 (CI 0.33-0.8), p = 0.003. mTTF for KIT exon 17 (non-V654) pts treated with 2L+ regorafenib, imatinib 800mg, or other was 4.6, 1.2, and 6.3 months, respectively. Comparison of mTTF for regorafenib vs other 2L+ drugs was not statistically significant. Conclusions: ctDNA is a noninvasive tool for detecting driver and resistance mutations in pts with advanced GIST. GIST pts with KIT exon 13 V654 resistance mutations had superior outcomes in the 2L+ setting with sunitinib. Regorafenib was not superior to other 2L+ TKIs in pts with KIT exon 17 resistance mutations, possibly due to their own activity against exon 17 resistance alterations. ctDNA-guided therapy warrants evaluation in a prospective clinical trial.
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Affiliation(s)
- Steven Bialick
- University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL
| | - Brandon Edward Rose
- University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL
| | - Andrea P. Espejo-Freire
- University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL
| | - Priscila Barreto Coelho
- University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL
| | | | - Leticia Campoverde
- University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL
| | | | | | - Cesar Serrano
- Vall d’Hebron Institute of Oncology, Vall d’ Hebron University Hospital, Barcelona, Spain
| | | | - Sebastian Bauer
- West German Cancer Center, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Neha Goel
- University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL
| | - Shree Venkat
- University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL
| | - Aditi Dhir
- University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL
| | - Emily Jonczak
- University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL
| | - Gina Z. D'Amato
- University of Miami Sylvester Comprehensive Cancer Center, Miami, FL
| | - Jonathan C. Trent
- University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL
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Omar IA, Debe M, Jayaraman R, Salah K, Omar M, Arshad J. Blockchain-based Supply Chain Traceability for COVID-19 personal protective equipment. Comput Ind Eng 2022; 167:107995. [PMID: 35153368 PMCID: PMC8817762 DOI: 10.1016/j.cie.2022.107995] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/10/2021] [Accepted: 02/01/2022] [Indexed: 05/29/2023]
Abstract
The COVID-19 pandemic has severely impacted many industries, in particular the healthcare sector exposing systemic vulnerabilities in emergency preparedness, risk mitigation, and supply chain management. A major challenge during the pandemic was related to the increased demand for Personal Protective Equipment (PPE), resulting in critical shortages for healthcare and frontline workers. This is due to the lack of information visibility combined with the inability to precisely track product movement within the supply chain, requiring a robust traceability solution. Blockchain technology is a distributed ledger that ensures a transparent, safe, and secure exchange of data among supply chain stakeholders. The advantages of adopting blockchain technology to manage and track PPE products in the supply chain include decentralized control, security, traceability, and auditable time-stamped transactions. In this paper, we present a blockchain-based approach using smart contracts to transform PPE supply chain operations. We propose a generic framework using Ethereum smart contracts and decentralized storage systems to automate the processes and information exchange and present detailed algorithms that capture the interactions among supply chain stakeholders. The smart contract code was developed and tested in Remix environment, and the code is made publicly available on Github. We present detailed cost and security analysis incurred by the stakeholders in the supply chain. Adopting a blockchain-based solution for PPE supply chains is economically viable and provides a streamlined, secure, trusted, and transparent mode of communication among various stakeholders.
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Affiliation(s)
- Ilhaam A Omar
- Department of Industrial and Systems Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Mazin Debe
- Department of Electrical Engineering and Computer Science, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Raja Jayaraman
- Department of Industrial and Systems Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Khaled Salah
- Department of Electrical Engineering and Computer Science, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Mohammad Omar
- Department of Industrial and Systems Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Junaid Arshad
- School of Computing and Engineering, Birmingham City University, Birmingham, United Kingdom
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Sattar Y, Almas T, Arshad J, Zghouzi M, Ullah W, Mir T, Mohamed MO, Elgendy IY, Aljaroudi W, Prasad A, Shlofmitz R, Mamas MA, Kereiakes DJ, Chadi Alraies M. Clinical and angiographic success and safety comparison of coronary intravascular lithotripsy: An updated meta-analysis. IJC Heart & Vasculature 2022; 39:100975. [PMID: 35242998 PMCID: PMC8881660 DOI: 10.1016/j.ijcha.2022.100975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 11/25/2022]
Abstract
Background Intravascular lithotripsy (IVL) can be used to assist stent deployment in severe coronary artery calcifications (CAC). Methods Studies employing IVL for CAC lesions were included. The primary outcomes included clinical and angiographic success. The secondary outcomes, including lumen gain, maximum calcium thickness, and calcium angle at the final angiography site, minimal lumen area site, and minimal stent area site, were analyzed by the random-effects model to calculate the pooled standardized mean difference. Tertiary outcomes included safety event ratios. Results Seven studies (760 patients) were included. The primary outcomes: pooled clinical and angiographic success event ratio parentage of IVL was 94.4% and 94.8%, respectively. On a random effect model for standard inverse variance for secondary outcomes showed: minimal lumen diameter increase with IVL was 4.68 mm (p-value < 0.0001, 95% CI 1.69–5.32); diameter decrease in the stenotic area after IVL session was −5.23 mm (95 CI –22.6–12.8). At the minimal lumen area (MLA) and final minimal stent area (MSA) sites, mean lumen area gain was 1.42 mm2 (95% CI 1.06–1.63; p < 0.00001) and 1.34 mm2 (95% CI 0.71–1.43; p < 0.00001), respectively. IVL reduced calcium thickness at the MLA site (SMD −0.22; 95% CI −0.40–0.04; P = 0.02); calcium angle was not affected at the MLA site. The tertiary outcomes: most common complication was major adverse cardiovascular events (n = 48/669), and least common complication was abrupt closure of the vessel (n = 1/669). Conclusions Evidence suggests that IVL safely and effectively facilitates stent deployment with high angiographic and clinical success rates in treating severely calcified coronary lesions.
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Syed F, Hassan M, Arif MA, Batool S, Niazi R, Laila UE, Ashraf S, Arshad J. Pre-exposure Prophylaxis With Various Doses of Hydroxychloroquine Among Healthcare Personnel With High-Risk Exposure to COVID-19: A Randomized Controlled Trial. Cureus 2021; 13:e20572. [PMID: 35103151 PMCID: PMC8776514 DOI: 10.7759/cureus.20572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 12/14/2022] Open
Abstract
Objective This trial aimed to evaluate the safety and efficacy of pre-exposure prophylaxis (PrEP) with various hydroxychloroquine (HCQ) doses against a placebo among healthcare personnel (HCP) with high-risk exposure to coronavirus disease 2019 (COVID 19). Methods A phase II, randomized, placebo-controlled trial was conducted including 200 subjects with no active or past severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (antibody testing and reverse transcription-polymerase chain reaction (RT-PCR) were taken at the time of enrollment). Subjects of experimental groups one to three received HCQ in various doses and the control group received a placebo. The study outcomes in terms of safety and efficacy were monitored. Participants exhibiting COVID-19 symptoms were tested for SARS-CoV-2 during the study and by the end of week 12 with RT-PCR or serology testing (COVID-19 IgM/IgG antibody testing). Results Out of the total participants, 146 reported exposure to a confirmed COVID-19 case in the first month, and 192 were exposed by week 12 of the study. Moreover, the precautionary use of personal protective equipment (PPE) significantly varied; initially more than 80% of the exposed HCPs were not ensuring PPE being used by the patients treated by them, which gradually developed over time. Mild treatment-related side effects were observed among the interventional and placebo arm patients. There was no significant clinical benefit of PrEP with HCQ as compared to placebo (p>0.05). Conclusion It is concluded that the PrEP HCQ does not significantly prevent COVID-19 among high-risk HCPs.
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Affiliation(s)
- Fibhaa Syed
- Internal Medicine, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, PAK
| | - Muhammad Hassan
- Neurology, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, PAK
| | - Mohammad Ali Arif
- Internal Medicine, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, PAK
| | - Sadia Batool
- Internal Medicine, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, PAK
| | - Rauf Niazi
- Internal Medicine, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, PAK
| | - Ume E Laila
- Internal Medicine, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, PAK
| | - Sadia Ashraf
- Internal Medicine, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, PAK
| | - Junaid Arshad
- Cardiology, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, PAK
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Sattar Y, Song D, Sarvepalli D, Zaidi SR, Ullah W, Arshad J, Mir T, Zghouzi M, Elgendy IY, Qureshi W, Chalfoun N, Alraies MC. Accuracy of pulsatile photoplethysmography applications or handheld devices vs. 12-lead ECG for atrial fibrillation screening: a systematic review and meta-analysis. J Interv Card Electrophysiol 2021; 65:33-44. [PMID: 34775555 DOI: 10.1007/s10840-021-01068-x] [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: 04/28/2021] [Accepted: 09/22/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The relative accuracy of pulsatile photoplethysmography applications (PPG) or handheld (HH) devices compared with the gold standard 12-lead electrocardiogram (ECG) for the diagnosis of atrial fibrillation is unknown. METHODS Digital databases were searched to identify relevant articles. Raw data were pooled using a bivariate model to calculate diagnostic accuracy measures and estimate Hierarchical Summary Receiver Operating Characteristic (HSROC). RESULTS A total of 10 articles comprising 4296 patients (mean age 68.9 years, with 56% males) were included in the analysis. Compared with EKG, the pooled sensitivity of PPG and HH devices in AF detection was 0.93 (95% CI 0.87-0.96; p < 0.05) and 0.87 (95% CI. 0.74-0.94; p < 0.05), respectively. The pooled specificity of PPG and HH devices in AF detection was 0.91 (95% CI 0.88-0.94; p < 0.05) and 0.96 (95% CI 0.90-0.98; p < 0.05), respectively. The diagnostic odds ratio was 129 and 144 for PPG and HH devices, respectively. Fagan's nomogram showed the probability of a patient having AF and normal rhythm on PPG or HH devices was 2-3%, while the post-test probability of having AF with an irregular R-R interval on PPG or HH devices was 73% and 82%, respectively. The scatter plot of positive and negative likelihood ratio showed high confirmation of AF and reliability of exclusion of absence of irregular R-R intervals (positive likelihood ratio > 10, and negative likelihood ratio < 0.1) on HH devices while PPG was used as confirmation only. CONCLUSIONS The PPG or HH devices can serve as a reliable alternative for the detection of AF.
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Affiliation(s)
- Yasar Sattar
- Cardiology, West Virginia University, Morgantown, WV, USA
| | - David Song
- Cardiology, West Virginia University, Morgantown, WV, USA
| | | | | | - Waqas Ullah
- Cardiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Junaid Arshad
- Internal Medicine, Institute of Medical Sciences, Islamabad, Pakistan
| | - Tanveer Mir
- Cardiology, Detroit Medical Center Heart Hospital, 311 Mack Ave, Detroit, MI, 48201, USA
| | - Mohamed Zghouzi
- Cardiology, Detroit Medical Center Heart Hospital, 311 Mack Ave, Detroit, MI, 48201, USA
| | | | - Waqas Qureshi
- Cardiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Nagib Chalfoun
- Cardiology, Spectrum Health Heart and Vascular, Michigan State University, Grand Rapids, MI, USA
| | - MChadi Alraies
- Cardiology, Detroit Medical Center Heart Hospital, 311 Mack Ave, Detroit, MI, 48201, USA.
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Akhter S, Awan MA, Rakha BA, Arshad J, Ansari MS, Iqbal S. Egg yolk can be partially replaced with carboxylated poly-l-lysine (cpll) in extender for nili- ravi buffalo bull sperm. Cryo Letters 2021; 42:332-340. [PMID: 35366299] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Egg yolk is inevitably associated with risks of microbial contamination and anti-cryoprotectant agents that necessitate the investigation of some synthetic alternatives. OBJECTIVE To investigate the potential of carboxylated poly-L-lysine (CPLL) as a replacement for egg yolk during the cryosurvivability of Nili-Ravi buffalo sperm. MATERIALS AND METHODS Semen collected from four Nili-Ravi buffalo bulls (two ejaculates / bull / day; total 40 ejaculates for five replicates) was cryopreserved in different experimental extenders viz: Control (CPLL 0%, egg yolk 20%); E1 (CPLL 5%, egg yolk 15%); E2 (CPLL 10%, egg yolk 10%); E3 (CPLL 15%, egg yolk 5%) and E4 (CPLL 20%, egg yolk 0%). Post-thaw quality was assessed in terms of sperm motility, plasma membrane integrity (PMI), viability, live:dead ratio, lipid peroxidation of sperm and total antioxidant capacity of seminal plasma. RESULTS Sperm motility improved (P<0.05) in extenders replacing 5%, 10% and 15% egg yolk with CPLL. Sperm PMI, viability and live:dead ratio also improved (P<0.05) in extenders replacing 10%, 15% and whole (20%) egg yolk with CPLL. In contrast, sperm DNA integrity was not different (P>0.05) when CPLL replaced egg yolk at any level. The lipid peroxidation level decreased with a concomitant increase in total antioxidant activity of seminal plasma when CPLL replaced egg yolk at 5%, 10%, 15% and 20%. CONCLUSION Replacement of 15% egg yolk in the extender with CPLL improves all sperm quality parameters: motility, PMI, viability, live:dead ratio, lipid peroxidation of sperm and total antioxidant activity of seminal plasma.
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Affiliation(s)
- S Akhter
- Department of Zoology, Pir Mehr Ali Shah - Arid Agriculture University Rawalpindi-46300, Pakistan.
| | - M A Awan
- Department of Zoology, Pir Mehr Ali Shah - Arid Agriculture University Rawalpindi-46300, Pakistan
| | - B A Rakha
- Department of Wildlife Management, Pir Mehr Ali Shah - Arid Agriculture University Rawalpindi-46300, Pakistan
| | - J Arshad
- Department of Zoology, Pir Mehr Ali Shah - Arid Agriculture University Rawalpindi-46300, Pakistan
| | - M S Ansari
- Division of Science and Technology, University of Education, Lahore, Pakistan
| | - S Iqbal
- Semen Production Unit Qadirabad, Sahiwal, Punjab, Pakistan
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Azad MA, Arshad J, Akmal SMA, Riaz F, Abdullah S, Imran M, Ahmad F. A First Look at Privacy Analysis of COVID-19 Contact-Tracing Mobile Applications. IEEE Internet Things J 2021; 8:15796-15806. [PMID: 35782180 PMCID: PMC8768965 DOI: 10.1109/jiot.2020.3024180] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/16/2020] [Accepted: 08/28/2020] [Indexed: 05/11/2023]
Abstract
Today's smartphones are equipped with a large number of powerful value-added sensors and features, such as a low-power Bluetooth sensor, powerful embedded sensors, such as the digital compass, accelerometer, GPS sensors, Wi-Fi capabilities, microphone, humidity sensors, health tracking sensors, and a camera, etc. These value-added sensors have revolutionized the lives of the human being in many ways, such as tracking the health of the patients and the movement of doctors, tracking employees movement in large manufacturing units, monitoring the environment, etc. These embedded sensors could also be used for large-scale personal, group, and community sensing applications especially tracing the spread of certain diseases. Governments and regulators are turning to use these features to trace the people's thoughts to have symptoms of certain diseases or viruses, e.g., COVID-19. The outbreak of COVID-19 in December 2019, has seen a surge of the mobile applications for tracing, tracking, and isolating the persons showing COVID-19 symptoms to limit the spread of the disease to the larger community. The use of embedded sensors could disclose private information of the users, thus potentially bring a threat to the privacy and security of users. In this article, we analyzed a large set of smartphone applications that have been designed to contain the spread of the COVID-19 virus and bring the people back to normal life. Specifically, we have analyzed what type of permission these smartphone apps require, whether these permissions are necessary for the track and trace, how data from the user devices are transported to the analytic center, and analyzing the security measures these apps have deployed to ensure the privacy and security of users.
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Affiliation(s)
- Muhammad Ajmal Azad
- Cyber Security Research Group, College of Engineering and TechnologyUniversity of Derby Derby DE22 1GB U.K
| | - Junaid Arshad
- School of Computing and Digital TechnologyBirmingham City University Birmingham B4 7AP U.K
| | | | - Farhan Riaz
- Department of Computer and Software EngineeringNational University of Science and Technology Islamabad 44000 Pakistan
| | - Sidrah Abdullah
- Information SecurityNED University of Engineering and Technology Karachi 75300 Pakistan
| | - Muhammad Imran
- College of Computer and Information SciencesKing Saud University Riyadh11692Saudi Arabia
| | - Farhan Ahmad
- Cyber Security Research Group, College of Engineering and TechnologyUniversity of Derby Derby DE22 1GB U.K
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Sattar Y, Abdul Razzack A, Kompella R, Alhajri N, Arshad J, Ullah W, Zghouzi M, Mir T, Power D, Qureshi WT, Aljaroudi W, Elgendy IY, Mamas MA, Alraies MC. Outcomes of intravascular ultrasound versus optical coherence tomography guided percutaneous coronary angiography: A meta regression-based analysis. Catheter Cardiovasc Interv 2021; 99:E1-E11. [PMID: 34668640 DOI: 10.1002/ccd.29976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/18/2021] [Accepted: 09/29/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Studies comparing clinical outcomes with intravascular ultrasound (IVUS) versus optical coherence tomography (OCT) guidance for percutaneous coronary intervention (PCI) in patients presenting with coronary artery disease, including stable angina or acute coronary syndrome, are limited. METHODS We performed a detailed search of electronic databases (PubMed, Embase, and Cochrane) for randomized controlled trials and observational studies that compared cardiovascular outcomes of IVUS versus OCT. Data were aggregated for the primary outcome measure using the random-effects model as pooled risk ratio (RR). The primary outcome of interest was major adverse cardiac events (MACE), cardiac mortality, and all-cause mortality. Secondary outcomes included myocardial infarction (MI), stent thrombosis (ST), target lesion revascularization (TLR), and stroke. RESULTS A total of seven studies met the inclusion criteria, comprising 5917 patients (OCT n = 2075; IVUS n = 3842). OCT-PCI versus IVUS-guided PCI comparison yielded no statistically significant results for all the outcomes; MACE (RR 0.78; 95% confidence interval [CI], 0.57-1.09; p = 0.14), cardiac mortality (RR 0.97; 95% CI, 0.27-3.46; p = 0.96), all-cause mortality (RR 0.74; 95% CI, 0.39-1.39; p = 0.35), MI (RR 1.27; 95% CI, 0.52-3.07; p = 0.60), ST (RR 0.70; 95% CI, 0.13-3.61; p = 0.67), TLR (RR 1.09; 95% CI, 0.53-2.25; p = 0.81), and stroke (RR 2.32; 95% CI, 0.42-12.90; p = 0.34). Furthermore, there was no effect modification on meta-regression including demographics, comorbidities, lesion location, lesion length, and stent type. CONCLUSIONS In this meta-analysis, OCT-guided PCI was associated with no difference in clinical outcomes compared with IVUS-guided PCI.
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Affiliation(s)
- Yasar Sattar
- Cardiology, West Virginia University, Morgantown, West Virginia, USA
| | | | - Ritika Kompella
- Internal Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Noora Alhajri
- Public Health, Khalifa University College of Medicine and Health Science, Abu Dhabi, UAE
| | - Junaid Arshad
- Cardiology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Waqas Ullah
- Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Tanveer Mir
- Cardiology, Detroit Medical Center, Detroit, Michigan, USA
| | - David Power
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Waqas T Qureshi
- Cardiology, University of Massachusetts, Worcester, Massachusetts, USA
| | | | | | - Mamas A Mamas
- Cardiology, Keele University School of Medicine, Keele Cardiovascular Research Group, Stoke-on-Trent, UK
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Sattar Y, Zghouzi M, Suleiman ARM, Sheikh A, Kupferman J, Sarfraz A, Arshad J, Mir T, Ullah W, Pacha HM, Thakkar S, Elgendy IY, Alraies MC. Efficacy of remote dielectric sensing (ReDS) in the prevention of heart failure rehospitalizations: a meta-analysis. J Community Hosp Intern Med Perspect 2021; 11:646-652. [PMID: 34567456 PMCID: PMC8462919 DOI: 10.1080/20009666.2021.1955451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The clinical efficacy of remote dielectric sensing (ReDS) monitoring is not well known. Digital databases were searched to identify relevant articles. Pooled unadjusted odds ratio (OR) for dichotomous outcomes were calculated using a random-effects model. Findings were reported as a point estimate with its 95% confidence interval (CI). A total of 985 patients across seven studies were included in the meta-analysis. Patients with heart failure monitored with ReDS had significantly lower odds of hospital readmission compared with non-ReDS patients (OR = 0.40; 95% CI 0.29–0.56; z = 5.43 p = 0.000, I2 = 0%). Subgroup analysis based on the duration of follow-up showed a lower odd of readmission within 30 days (OR = 0.36; 95% CI 0.18–0.71; z = 2.93; p = 0.003; I2 5.7%), as well as between 1 and 3 months (OR = 0.42; 95% CI 0.29–0.61; z = 4.54; p = 0.000; I2 = 0.0%). ReDS effect of lower readmissions of HF was observed irrespective of the duration of follow-up (<1-month vs 1–3 months). ReDS monitoring significantly lowers the odds of HF readmission within 3 months compared to participants not using ReDS.
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Affiliation(s)
- Yasar Sattar
- Icahn School of Medicine, Mount Sinai Elmhurst Hospital, Queens, NY, USA
| | | | | | - Amaan Sheikh
- Icahn School of Medicine, Mount Sinai Elmhurst Hospital, Queens, NY, USA
| | - Judah Kupferman
- Icahn School of Medicine, Mount Sinai Elmhurst Hospital, Queens, NY, USA
| | | | - Junaid Arshad
- Pakistan Institute of Medical Science, Islamabad, Pakistan
| | | | - Waqas Ullah
- Abington Jefferson Health, Abington, PA, USA
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Espejo-Freire AP, Elliott A, Rosenberg A, Costa PA, Barreto-Coelho P, Jonczak E, D’Amato G, Subhawong T, Arshad J, Diaz-Perez JA, Korn WM, Oberley MJ, Magee D, Dizon D, von Mehren M, Khushman MM, Hussein AM, Leu K, Trent JC. Genomic Landscape of Angiosarcoma: A Targeted and Immunotherapy Biomarker Analysis. Cancers (Basel) 2021; 13:cancers13194816. [PMID: 34638300 PMCID: PMC8507700 DOI: 10.3390/cancers13194816] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/15/2021] [Accepted: 09/18/2021] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Angiosarcomas (AS) are rare, highly aggressive sarcomas with limited therapeutic options. Genomic sequencing techniques have identified recurrent genetic abnormalities. Nevertheless, the association of these findings with etiology, site of origin, prognosis, and therapeutic implications is not well understood. We analyzed Next Generation Sequencing (NGS) and Whole Transcriptome Sequencing (WTS) data in a cohort of 143 AS cases. We identified distinct genomic biology according to the AS primary site. Head and neck AS cases primarily have Immunotherapy (IO) response markers and mutations in TP53 and POT1. On the other hand, breast AS is enriched for cell cycle alterations, predominately MYC amplification. Additionally, a microenvironment with abundant immune cells is present in a minority of cases but distributed evenly among primary sites. Our findings can facilitate the design and optimization of therapeutic strategies for AS according to its biology at different primary sites. Abstract We performed a retrospective analysis of angiosarcoma (AS) genomic biomarkers and their associations with the site of origin in a cohort of 143 cases. Primary sites were head and neck (31%), breast (22%), extremity (11%), viscera (20%), skin at other locations (8%), and unknown (9%). All cases had Next Generation Sequencing (NGS) data with a 592 gene panel, and 53 cases had Whole Exome Sequencing (WES) data, which we used to study the microenvironment phenotype. The immunotherapy (IO) response biomarkers Tumor Mutation Burden (TMB), Microsatellite Instability (MSI), and PD-L1 status were the most frequently encountered alteration, present in 36.4% of the cohort and 65% of head and neck AS (H/N-AS) (p < 0.0001). In H/N-AS, TMB-High was seen in 63.4% of cases (p < 0.0001) and PDL-1 positivity in 33% of cases. The most common genetic alterations were TP53 (29%), MYC amplification (23%), ARID1A (17%), POT1 (16%), and ATRX (13%). H/N-AS cases had predominantly mutations in TP53 (50.0%, p = 0.0004), POT1 (40.5%, p < 0.0001), and ARID1A (33.3%, p = 0.5875). In breast AS, leading alterations were MYC amplification (63.3%, p < 0.0001), HRAS (16.1%, p = 0.0377), and PIK3CA (16.1%, p = 0.2352). At other sites, conclusions are difficult to generate due to the small number of cases. A microenvironment with a high immune signature, previously associated with IO response, was evenly distributed in 13% of the cases at different primary sites. Our findings can facilitate the design and optimization of therapeutic strategies for AS.
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Affiliation(s)
- Andrea P. Espejo-Freire
- Department of Medicine, Hematology & Oncology, Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (A.P.E.-F.); (P.A.C.); (P.B.-C.); (E.J.); (G.D.)
| | - Andrew Elliott
- Department of Clinical and Translational Research, Caris Life Sciences, Phoenix, AZ 85040, USA;
| | - Andrew Rosenberg
- Department of Pathology, Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (A.R.); (J.A.D.-P.)
| | - Philippos Apolinario Costa
- Department of Medicine, Hematology & Oncology, Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (A.P.E.-F.); (P.A.C.); (P.B.-C.); (E.J.); (G.D.)
| | - Priscila Barreto-Coelho
- Department of Medicine, Hematology & Oncology, Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (A.P.E.-F.); (P.A.C.); (P.B.-C.); (E.J.); (G.D.)
| | - Emily Jonczak
- Department of Medicine, Hematology & Oncology, Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (A.P.E.-F.); (P.A.C.); (P.B.-C.); (E.J.); (G.D.)
| | - Gina D’Amato
- Department of Medicine, Hematology & Oncology, Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (A.P.E.-F.); (P.A.C.); (P.B.-C.); (E.J.); (G.D.)
| | - Ty Subhawong
- Department of Radiology, Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
| | - Junaid Arshad
- Department of Medicine, Medical Oncology, The University of Arizona College of Medicine, University of Arizona Cancer Center, Tucson, AZ 85724, USA;
| | - Julio A. Diaz-Perez
- Department of Pathology, Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (A.R.); (J.A.D.-P.)
| | - William M. Korn
- Department of Medical Affairs, Caris Life Sciences, Phoenix, AZ 85040, USA;
| | - Matthew J. Oberley
- Department of Pathology and Genetics, Caris Life Sciences, Phoenix, AZ 85040, USA;
| | - Daniel Magee
- Department of Cognitive Computing, Caris Life Sciences, Phoenix, AZ 85040, USA;
| | - Don Dizon
- Department of Medical Oncology and Gynecologic Medical Oncology, Lifespan Cancer Institute, Rode Island Hospital, Providence, RI 02903, USA;
| | - Margaret von Mehren
- Department of Hematology & Oncology, Fox Chase Cancer Center, Temple Health, Philadelphia, PA 19111, USA;
| | - Moh’d M. Khushman
- O’Neal Comprehensive Cancer Center, Department of Medicine, Hematology & Oncology, The University of Alabama at Birmingham, Birmingham, AL 35233, USA;
| | - Atif Mahmoud Hussein
- Department of Hematology & Oncology, Memorial Health Care System, Memorial Cancer Institute, Hollywood, FL 33021, USA;
| | - Kirsten Leu
- Medical Oncology, Nebraska Cancer Specialists, Omaha, NE 68114, USA;
| | - Jonathan C. Trent
- Department of Medicine, Hematology & Oncology, Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miller School of Medicine, University of Miami, Miami, FL 33136, USA; (A.P.E.-F.); (P.A.C.); (P.B.-C.); (E.J.); (G.D.)
- Correspondence:
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Abstract
PurposeAlongside the remarkable evolution of cellular communication to 5G networks, significant security and privacy challenges have risen which can affect the widespread adoption of advanced communication technologies. In this context, the purpose of this paper is to examine research within security and privacy for 5G-based systems highlighting contributions made by the research community and identify research trends within different subdomains of 5G security where open issues still exist.Design/methodology/approachThis paper uses a bibliographic approach to review the state-of-the-art in the field of 5G security and is the pioneering effort to investigate 5G security research using this methodology. Specifically, the paper presents a quantitative description of the existing contributions in terms of authors, organizations, and countries. It then presents detailed keyword and co-citation analysis that shows the quantity and pattern of research work in different subfields. Finally, 5G security areas are identified having open challenges for future research work.FindingsThe study shows that China leads the world in terms of published research in the field of 5G security with USA and India ranked second and third respectively. Xidian University, China is ranked highest for number of publications and h-index followed by University Oulu and AALTO University Finland. IEEE Access, Sensors and IEEE Internet of Things Journal are the top publication venues in the field of 5G security. Using VOSViewer aided analysis with respect to productivity, research areas and keywords, the authors have identified research trends in 5G security among scientific community whilst highlighting specific challenges which require further efforts.Originality/valueExisting studies have focused on surveys covering state-of-the art research in secure 5G network (Zhang et al. 2019), physical layer security (Wu et al., 2018), security and privacy of 5G technologies (Khan et al., 2020) and security and privacy challenges when 5G is used in IoT (Sicari et al. 2020). However, our research has revealed no existing bibliometric studies in this area and therefore, to our best knowledge, this paper represents pioneering such effort for security within 5G.
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Arshad J, Costa PA, Barreto-Coelho P, Valdes BN, Trent JC. Immunotherapy Strategies for Gastrointestinal Stromal Tumor. Cancers (Basel) 2021; 13:3525. [PMID: 34298737 PMCID: PMC8306810 DOI: 10.3390/cancers13143525] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 01/13/2023] Open
Abstract
Gastrointestinal stromal tumors (GIST) are the most common mesenchymal soft tissue sarcoma of the gastrointestinal tract. The management of locally advanced or metastatic unresectable GIST involves detecting KIT, PDGFR, or other molecular alterations targeted by imatinib and other tyrosine kinase inhibitors. The role of immunotherapy in soft tissue sarcomas is growing fast due to multiple clinical and pre-clinical studies with no current standard of care. The potential therapies include cytokine-based therapy, immune checkpoint inhibitors, anti-KIT monoclonal antibodies, bi-specific monoclonal antibodies, and cell-based therapies. Here we provide a comprehensive review of the immunotherapeutic strategies for GIST.
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Affiliation(s)
- Junaid Arshad
- Hematology-Oncology Department, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, USA;
| | - Philippos A. Costa
- Internal Medicine Department, Jackson Memorial Hospital, University of Miami, Miami, FL 33136, USA; (P.A.C.); (P.B.-C.)
| | - Priscila Barreto-Coelho
- Internal Medicine Department, Jackson Memorial Hospital, University of Miami, Miami, FL 33136, USA; (P.A.C.); (P.B.-C.)
| | | | - Jonathan C. Trent
- Hematology-Oncology Department, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, USA;
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Razzack AA, Pothuru S, Mandava S, Hassan SA, Castellanos DMR, Reddy KT, Vicente JDDRS, Arshad J, Sattar Y. Revascularization vs. Conservative Management in Geriatric Population With Unstable Angina/Non-ST-Elevation Myocardial Infarction (UA/NSTEMI): A Systematic Review and Meta-Analysis. Cardiovascular Revascularization Medicine 2021. [DOI: 10.1016/j.carrev.2021.06.036] [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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Arshad S, Arshad J, Khan MM, Parkinson S. Analysis of security and privacy challenges for DNA-genomics applications and databases. J Biomed Inform 2021; 119:103815. [PMID: 34022422 DOI: 10.1016/j.jbi.2021.103815] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 02/06/2023]
Abstract
DNA technology is rapidly moving towards digitization. Scientists use software tools and applications for sequencing, synthesizing, analyzing and sharing of DNA and genomic data, operate lab equipment and store genetic information in shared datastores. Using cutting-edge computing methods and techniques, researchers have decoded human genome, created organisms with new capabilities, automated drug development and transformed food safety. Such software applications are typically developed to progress scientific understanding and as such cyber security is never a concern for these applications. However, with the increasing commercialisation of DNA technologies, coupled with the sensitivity of DNA data, there is a need to adopt a security-by-design approach. In this paper we investigate bio-cyber security threats to genomic-DNA data and software applications making use of such data to advance scientific research. Specifically, we adopt an empirical approach to analyse and identify vulnerabilities within genomic-DNA databases and bioinformatics software applications that can lead to cyber-attacks affecting the confidentiality, integrity and availability of such sensitive data. We present a detailed analysis of these threats and highlight potential protection mechanisms to help researchers pursue these research directions.
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Affiliation(s)
- Saadia Arshad
- Department of Computer Science & IT, NED University of Engineering and Technology, Karachi, Pakistan
| | - Junaid Arshad
- School of Computing and Digital Technology, Birmingham City University, Birmingham, UK.
| | - Muhammad Mubashir Khan
- Department of Computer Science & IT, NED University of Engineering and Technology, Karachi, Pakistan
| | - Simon Parkinson
- Department of Computer Science, University of Huddersfield, Huddersfield, UK
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Abdul Razzack A, Pothuru S, Adeel Hassan S, Mandava S, Theja Reddy K, Missael Rocha Castellanos D, Rocha Castellanos D, Lilian Contreras Gallegos G, Sanchez Alfaro A, Arshad J, Sattar Y. Association of type 2 diabetes mellitus and mortality after coronary artery bypass graft surgery- a meta analysis. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.308] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background- Recent studies have demonstrated the favorable cardiovascular outcomes of coronary artery bypass graft surgery (CABG) among patients with diabetes mellitus (DM). However, little is known regarding the impact of T2DM in patients undergoing CABG. We aimed to compare the long-term mortality following CABG in patients with and without T2DM.
Methods-Electronic databases ( PubMed, Embase, Scopus, Cochrane) were searched from inception to December 15th, 2020. Unadjusted odds ratios (OR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance to be considered if the confidence interval excludes 1 and p < 0.05.The primary outcome was all-cause mortality.
Results-Sixteen studies with a total of 183,200 participants (DM = 51,474, Non-DM = 131,726) were included in our analysis. Average follow up was 3 years. Mean age was 56.7 and 54.8 in the DM and Non-DM groups respectively. A statistically significantly higher rate of mortality was observed in patients with T2DM (OR 1.54; 95%CI 1.40-1.69; p < 0.00001, I2 = 36)as opposed to patients without T2DM.
Conclusion- Although CABG is the better revascularization strategy as opposed to PCI, Type 2 DM is an independent predictor for long-term mortality after CABG surgery.
Abstract Figure.
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Affiliation(s)
- A Abdul Razzack
- Dr. N.T.R University of Health Sciences, Vijayawada, Andhra Pradesh, India
| | - S Pothuru
- Ascension Via Christi Hospital, Department of Internal Medicine, Kansas, United States of America
| | - S Adeel Hassan
- University of Louisville School of Medicine, Louisville, United States of America
| | - S Mandava
- Santa Barbara Cottage Hospital, California, United States of America
| | - K Theja Reddy
- UHS Southern California Medical Education Consortium, Temecula, California, United States of America
| | | | | | | | - A Sanchez Alfaro
- Facultad De Medicina Universidad Autónoma de Tamaulipas, Matamoros, Mexico
| | - J Arshad
- Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Y Sattar
- Icahn School of Medicine at Mount Sinai, New York, United States of America
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Abdul Razzack A, Pothuru S, Mandava S, Adeel Hassan S, Theja Reddy K, Missael Rocha Castellanos D, Arshad J, Sattar Y. Association between red blood cell transfusions and adverse effects after transcatheter aortic valve replacement- a meta analysis. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.127] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background-Transcatheter aortic valve replacement (TAVR) is associated with periprocedural bleeding , mainly driven by vascular complications leading to blood cell transfusion. Additionally, anemia is highly prevalent in this population. The decision regarding the necessity for blood transfusion in patients undergoing TAVR is challenging.
Methods-Electronic databases (Medline, Embase, Scopus, Cochrane) were searched from inception to December 16th, 2020. Unadjusted odds ratios (OR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance to be considered if the confidence interval excludes 1 and p < 0.05.The primary outcomes of interest were all-cause mortality, myocardial infarction(MI), Stroke(CVA), and acute kidney injury(AKI).
Results- A total of six studies with 6701 participants (Transfusions = 1505, Non-Transfusions = 5196) were included in our analysis. Average follow-up duration was 30 days. Mean age was 82.4 and 81.5 in the Transfusions and Non-transfusions group respectively. RBC transfusion was associated with higher 30-day mortality (OR-4.08; 95%CI 2.29-7.27; p < 0.00001; I2 = 77) as well as increased risk of acute kidney injury (AKI) (OR 2.97;95%CI 2.07-4.26; p < 0.00001; I2 = 77) and stroke (OR 2.44; 95%CI 1.78- 3.34; p < 0.00001,I2 = 0) However, there was no significant difference in the incidence of MI (OR 1.15;95%CI 0.50-2.64; p = 0.74,I2 = 0)
Conclusion- RBC transfusion is a correlate and an independent predictor of all-cause mortality, acute kidney injury and stroke in this patient population and should be used with caution
Abstract Figure.
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Affiliation(s)
- A Abdul Razzack
- Dr. N.T.R University of Health Sciences, Vijayawada, Andhra Pradesh, India
| | - S Pothuru
- Ascension Via Christi Hospital, Department of Internal Medicine, Kansas, United States of America
| | - S Mandava
- Santa Barbara Cottage Hospital, California, United States of America
| | - S Adeel Hassan
- University of Louisville School of Medicine, Louisville, United States of America
| | - K Theja Reddy
- UHS Southern California Medical Education Consortium, Temecula, California, United States of America
| | | | - J Arshad
- Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Y Sattar
- Icahn School of Medicine at Mount Sinai, New York, United States of America
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Alraies MC, Sattar Y, Sarvepalli D, Ullah W, Zaidi SR, Arshad J, Mir T, Elgendy I, Qureshi W, Zghouzi M, Suleiman AR, Hakim Z, Khan M, Chalfoun N. PHOTOPLETHYSMOGRAPHY APPLICATIONS VS. 12-LEAD EKG FOR ATRIAL FIBRILLATION SCREENING - A DIAGNOSTIC ACCURACY META-ANALYSIS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01776-9] [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: 10/21/2022]
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Sattar Y, Arshad J, Ahmad B, Suleiman AR, Ullah W, Alhatemi G, Alhajri N, Alraies MC. META ANALYSIS OF CARDIOVASCULAR OUTCOMES OF ETHYL EICOSAPENTAENOIC ACID IN DIABETES MELLITUS AND CORONARY ARTERY DISEASE. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02547-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hasan HR, Salah K, Jayaraman R, Arshad J, Yaqoob I, Omar M, Ellahham S. Blockchain-Based Solution for COVID-19 Digital Medical Passports and Immunity Certificates. IEEE Access 2020; 8:222093-222108. [PMID: 34812373 PMCID: PMC8545253 DOI: 10.1109/access.2020.3043350] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/05/2020] [Indexed: 05/18/2023]
Abstract
COVID-19 has emerged as a highly contagious disease which has caused a devastating impact across the world with a very large number of infections and deaths. Timely and accurate testing is paramount to an effective response to this pandemic as it helps identify infections and therefore mitigate (isolate/cure) them. In this paper, we investigate this challenge and contribute by presenting a blockchain-based solution that incorporates self-sovereign identity, re-encryption proxies, and decentralized storage, such as the interplanetary file systems (IPFS). Our solution implements digital medical passports (DMP) and immunity certificates for COVID-19 test-takers. We present smart contracts based on the Ethereum blockchain written and tested successfully to maintain a digital medical identity for test-takers that help in a prompt trusted response directly by the relevant medical authorities. We reduce the response time of the medical facilities, alleviate the spread of false information by using immutable trusted blockchain, and curb the spread of the disease through DMP. We present a detailed description of the system design, development, and evaluation (cost and security analysis) for the proposed solution. Since our code leverages the use of the on-chain events, the cost of our design is almost negligible. We have made our smart contract codes publicly available on Github.
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Affiliation(s)
- Haya R. Hasan
- Department of Electrical Engineering and Computer ScienceKhalifa University of Science and TechnologyAbu Dhabi127788United Arab Emirates
| | - Khaled Salah
- Department of Electrical Engineering and Computer ScienceKhalifa University of Science and TechnologyAbu Dhabi127788United Arab Emirates
| | - Raja Jayaraman
- Department of Industrial and Systems EngineeringKhalifa University of Science and TechnologyAbu Dhabi127788United Arab Emirates
| | - Junaid Arshad
- School of Computing and Digital TechnologyBirmingham City UniversityBirminghamB4 7XGU.K.
| | - Ibrar Yaqoob
- Department of Electrical Engineering and Computer ScienceKhalifa University of Science and TechnologyAbu Dhabi127788United Arab Emirates
| | - Mohammed Omar
- Department of Industrial and Systems EngineeringKhalifa University of Science and TechnologyAbu Dhabi127788United Arab Emirates
| | - Samer Ellahham
- Heart and Vascular Institute, Cleveland Clinic Abu DhabiAbu DhabiUnited Arab Emirates
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Arshad J, Roberts A, Ahmed J, Cotta J, Pico BA, Kwon D, Trent JC. Utility of Circulating Tumor DNA in the Management of Patients With GI Stromal Tumor: Analysis of 243 Patients. JCO Precis Oncol 2020; 4:66-73. [DOI: 10.1200/po.19.00253] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE GI stromal tumor (GIST) is the most common sarcoma of the GI tract. Management of patients with GIST is determined by KIT, PDGFRA, or other genomic alterations. Tissue-based next-generation sequencing (NGS) analysis is the standard approach for diagnosis, prognosis, and treatment selection. However, circulating tumor DNA (ctDNA)–based NGS is a novel and noninvasive alternative. METHODS ctDNA sequencing results were evaluated in blood samples from 243 de-identified patients within the Guardant360 database. Under an approved institutional review board protocol, a retrospective analysis was performed on 45 single-institution patients. RESULTS Of 243 patients, 114 (47%) were women, and the median age was 59 years (range, 17-90 years). Patients with no alterations and variations of uncertain significance were excluded. Of the 162 patients with known pathogenic mutations, KIT was the most common (56%), followed by NF (7%), PDGFRA (6%), PI3KCA (6%), KRAS (5%), and others (6%). Most tumors harbored an actionable KIT or PDGFRA mutation. Our institutional cohort (n = 45) had 16 (35%) KIT exon 11 mutations, 3 (6%) KIT exon 9 mutations, and 1 (2%) PDGFRA mutation detected on ctDNA. Resistance mutations were observed in KIT exon 17 (8 patients), exon 13 (3 patients), and in both (3 patients). Our comparison of ctDNA with tissue NGS revealed a positive predictive value (PPV) of 100%. Failure of concordance was observed in patients with localized or low disease burden. From the time of ctDNA testing, the median overall survival was not reached, whereas the median progression-free survival was 7 months. CONCLUSION ctDNA provides a rapid, noninvasive analysis of current mutations with a high PPV for patients with metastatic GIST. ctDNA-based testing may help to define the optimal choice of therapy on the basis of resistance mutations and should be studied prospectively.
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Affiliation(s)
- Junaid Arshad
- University of Miami, Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL
| | | | | | - Jared Cotta
- University of Miami, Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL
| | - Brian A. Pico
- University of Miami, Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL
| | - Deukoo Kwon
- University of Miami, Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL
| | - Jonathan C. Trent
- University of Miami, Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL
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Arshad J, Barreto-Coelho P, Jonczak E, Espejo A, D'Amato G, Trent JC. Identification of Genetic Alterations by Circulating Tumor DNA in Leiomyosarcoma: A Molecular Analysis of 73 Patients. J Immunother Precis Oncol 2020; 3:64-68. [PMID: 36751526 PMCID: PMC9179395 DOI: 10.36401/jipo-20-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/31/2020] [Indexed: 01/20/2023]
Abstract
Background Leiomyosarcoma is a malignant mesenchymal tumor of cells of smooth muscle lineage arising commonly in retroperitoneum, uterus, large veins, and the limbs. The genetics of leiomyosarcomas are complex and there is very limited understanding of common driver mutations. Circulating tumor DNA (ctDNA) offers a rapid and noninvasive method of next-generation sequencing (NGS) that could be used for diagnosis, therapy, and detection of recurrence. Methods ctDNA testing was performed using Guardant360, which detects single nucleotide variants, amplifications, fusions, and specific insertion/deletion mutations in 73 genes using NGS. Results Of 73 patients, 59 were found to have one or more cancer-associated genomic alteration. Forty-five (76%) were female with a median age of 63 (range, 38-87) years. All samples were designated metastatic. The most common alterations were detected in Tp53 (65%), BRAF (13%), CCNE (13%), EGFR (12%), PIK3CA (12%), FGFR1 (10%), RB1(10%), KIT (8%), and PDGFRA (8%). Some of the other alterations included RAF1, ERBB2, MET, PTEN TERT, APC, and NOTCH1. Potentially targetable mutations, by Food and Drug Administration-approved or clinical trials, were found in 24 (40%) of the 73 patients. Four patients (5%) were found to have incidental germline TP53 mutations. Conclusion NGS of ctDNA allows identification of genomic alterations in plasma from patients with leiomyosarcoma. Unfortunately, there is limited activity of current targeted agents in leiomyosarcomas. These results suggest opportunities to develop therapy against TP53, cell cycle, and kinase signaling pathways. Further validation and prospective evaluation is warranted to investigate the clinical utility of ctDNA for patients with leiomyosarcoma.
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Affiliation(s)
- Junaid Arshad
- Department of Medicine, Division of Medical Oncology, Miller School of Medicine, Jackson Memorial Hospital/University of Miami, Miami, FL, USA
| | - Priscila Barreto-Coelho
- Department of Medicine, Division of Internal Medicine, Miller School of Medicine, Jackson Memorial Hospital/University of Miami, Miami, FL, USA
| | - Emily Jonczak
- Department of Medicine, Division of Medical Oncology, Miller School of Medicine, Jackson Memorial Hospital/University of Miami, Miami, FL, USA
| | - Andrea Espejo
- Department of Medicine, Division of Medical Oncology, Miller School of Medicine, Jackson Memorial Hospital/University of Miami, Miami, FL, USA
| | - Gina D'Amato
- Department of Medicine, Division of Medical Oncology, Miller School of Medicine, Jackson Memorial Hospital/University of Miami, Miami, FL, USA
,Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Jonathan C. Trent
- Department of Medicine, Division of Medical Oncology, Miller School of Medicine, Jackson Memorial Hospital/University of Miami, Miami, FL, USA
,Sylvester Comprehensive Cancer Center, Miami, FL, USA
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Espejo Freire AP, Elliott A, Akgun Y, Costa P, Alasfour M, Rosenberg A, Diaz-Perez J, Subhawong T, Arshad J, Korn WM, Dizon DS, von Mehren M, Khushman MM, Hussein AM, Leu K, Trent JC. Genomic landscape of angiosarcoma: A targeted and immunotherapy biomarker analysis of 143 patients. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.11545] [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: 11/20/2022] Open
Abstract
11545 Background: Targeted therapies for angiosarcoma (AS) patients have limited efficacy. Although significant responses to immunotherapy (IO-therapy) have been observed in cutaneous AS, its efficacy across all types of AS is not known. Herein, we describe genetic and molecular biomarkers of AS in order to propose potential therapeutic options. Methods: We retrospectively reviewed 143 AS tumors profiled by Next-Generation Sequencing (NGS) 592-gene panel (Caris Life Sciences,Irving, TX, USA). Whole transcriptome sequencing (WTS) was performed on 53 tumors. Mutations and copy number amplifications (CNAs) were analyzed and grouped by pathway. Biomarkers potentially associated with response to IO-therapy (TMB-High [≥10/Mb], MSI-High, and PD-L1 [IHC ≥ 2+ and 5%]) were also analyzed. AS subtypes based on primary tumor site were compared. P-values were corrected using a Benjamini & Hochberg method. Results: Sample median age was 67 (range 22-89), 61% were female, and 29% were classified as metastatic/recurrent. The most commonly mutated genes were TP53 (29%), ARID1A (17%), POT1 (16%), and ATRX (13%); MYC CNA was found in 23% of cases. IO-therapy markers were present in 36.4% of cases (TMB-High in 26%, PD-L1+ 21.8%, MSI-High 0.7%). Pathway alterations were detected in 86% of AS cases. By pathway, TP53 was altered in 31%, cell cycle 30%, DNA damage repair (DDR) 21%, RAS 18%, PI3K 15% and chromatin remodeling 14%. By site, head/neck (HN) AS had the highest rate of IO-therapy markers (65%, p < 0.05) [TMB-High (63%, p < 0.0001)], TP53 mutation (51%, p = 0.07), and POT1A mutation (41%, p < 0.01). MYC CNA was highest in breast (63%) and extremity (40%) AS (p < 0.0001). DDR alterations were present in 56% (p = 0.09) of cutaneous AS and ranged from 12-27% in other subtypes (not significant, NS). RAS and PI3K alterations ranged from 6-27% across all subtypes (NS). Conclusions: Our findings suggest differential angiosarcoma biology across primary sites. HN AS had more frequent markers of potential IO-therapy response, as well as DDR alterations. Next in frequency, we found ARID1A which is possibly associated with overactive EZH2, a target of tazemetostat. MYC amplification suggests a role targeting cell cycle via cyclin-dependent kinase or bromodomain inhibitors in breast and extremity ASs. Finally, RAS and PI3K are mutated in a low percentage of cases, explaining the limited benefit of tyrosine kinase inhibitors in AS. Future AS clinical trials should be designed with consideration of primary site, IO-therapy response biomarkers, and activated pathway.
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Affiliation(s)
- Andrea P. Espejo Freire
- University of Miami-Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miami, FL
| | | | - Yamac Akgun
- University of Miami-Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miami, FL
| | - Philippos Costa
- University of Miami-Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miami, FL
| | - Maryam Alasfour
- University of Miami-Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miami, FL
| | - Andrew Rosenberg
- University of Miami-Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miami, FL
| | - Julio Diaz-Perez
- University of Miami-Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miami, FL
| | - Ty Subhawong
- Department of Radiology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Junaid Arshad
- University of Miami-Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miami, FL
| | | | | | | | - Moh'd M. Khushman
- Medical Oncology, The University of South Alabama, Mitchell Cancer Institute, Mobile, AL
| | | | | | - Jonathan C. Trent
- University of Miami-Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miami, FL
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Espejo Freire AP, Costa P, Alasfour M, Akgun Y, Rosenberg A, Diaz-Perez J, Kwon D, Subhawong T, Arshad J, Trent JC. Clinical behavior and treatment outcomes in angiosarcoma: A 10-year retrospective review. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e23555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e23555 Background: Angiosarcoma (AS) is a highly aggressive sarcoma. Five-year overall survival (OS) with local disease is only about 60% despite multimodality treatment. In advanced disease, responses to cytotoxic chemotherapy are common; however, median OS is only 3-12 mos. Targeted therapies (TT) have not been consistently effective. Early results for immune checkpoint inhibitors (ICI) are promising but their efficacy has not been compared to chemotherapy. Here we present the outcome of AS patients by systemic regimen and multimodality approach. Methods: We identified 39 patients with pathologically confirmed AS treated at Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital from 2009 to 2019. Clinical characteristics, treatment, responses and survival were analized. We calculated OS using Kaplan-Meier method and statistical significance with Log-Rank Test and Cox regression to estimate hazard ratio (HR) and 95% confidence interval. Progression-free survival (PFS) was analyzed for different regimens in the palliative setting using same approach as for OS. Results: In our cohort, median follow-up is 2.3 years (95% CI = 2 to 3.3), 48% were women and median age at diagnosis was 63 (range 13-89). At presentation, 16 pts (41%) had local disease and 23 advanced or metastatic (59%). By location, 13 pts (33%) had primary cutaneous AS, 12 pts (31%) visceral AS, 5 pts (13%) primary breast AS, 2 (5%) extremity AS and 7 (18%) radiation associated AS. Multimodality treatment was used in 29 pts (74%). OS in the entire cohort at 3 years was 49% (95% CI = 28 to 67%). OS between local disease was (N = 16) and in advanced disease (N = 23) was not statistically significant (p = 0.485; HR = 1.1 [95% CI = 0.4 to 3.3]). In the neoadjuvant setting, objective response rates trended to favor doxorubicin-based regimen (DBR) over taxane-based regimens (TBR) (80% vs. 40%) but were not statistically different (p = 0.519). In the advanced setting, PFS for DBR was 3.9 mo (95% CI 1.1 to 4.9 mo), 5.9 mo for TBR (95% CI 2.3 to 10.9 mo), 6.1 mo for ICI (95% CI not estimable), and 2.4 mo for targeted therapy (TT) (95% CI 0.8 to 8.8 mo), most common TT agent was pazopanib (71% of TT agents). Conclusions: AS is highly aggressive and most patients with local presentation will relapse translating in similar OS to the advanced cohort. No significant activity was seen for TT. In the advanced setting, chemotherapy with TBR appears slightly superior to DBR. ICIs resulted in similar if not superior PFS despite its use in a later line setting. Studies incorporating ICIs into earlier lines of therapy are warranted.
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Affiliation(s)
- Andrea P. Espejo Freire
- University of Miami-Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miami, FL
| | - Philippos Costa
- University of Miami-Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miami, FL
| | - Maryam Alasfour
- University of Miami-Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miami, FL
| | - Yamac Akgun
- University of Miami-Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miami, FL
| | - Andrew Rosenberg
- University of Miami-Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miami, FL
| | - Julio Diaz-Perez
- University of Miami-Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miami, FL
| | - Deukwoo Kwon
- University of Miami Sylvester Comprehensive Cancer Center, Miami, FL
| | - Ty Subhawong
- Department of Radiology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Junaid Arshad
- University of Miami-Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miami, FL
| | - Jonathan C. Trent
- University of Miami-Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miami, FL
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Husnain M, Komanduri K, Ramdial J, Lekakis LJ, Wang TP, Goodman M, Pereira DL, Beitinjaneh A, Carollo D, Ali R, Mohammed YN, Arshad J, Byrnes D, Saul EE, Aguirre LE, Jimenez AM. Pre-transplant molecular minimal residual disease (MMRD) is associated with inferior outcomes in patients with acute myeloid leukemia undergoing allogeneic stem cell transplantation. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.7547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7547 Background: Allogeneic Stem Cell Transplant (alloSCT) continues to be the optimal consolidation strategy for many patients with AML; cytogenetic and molecular abnormalities are known predictors of post-transplant outcomes. There is increasing evidence that Molecular Minimal Residual Disease (MMRD) following induction has important prognostic implications and its value in the prediction of post-transplant relapse continues to be elucidated. We aim to evaluate the impact of genetics and pre-transplant MMRD on clinical outcomes following alloSCT. Methods: We retrospectively evaluated eighty-nine patients, ≥18 years with a diagnosis of AML in complete morphologic remission (i.e. < 5% BM blasts by morphologic assessment) who received alloSCT between 01/2012-05/2018 at the University of Miami and for whom cytogenetic and comprehensive molecular data was available prior to transplantation. Patients were stratified into favorable, intermediate and poor-risk categories based on 2017 ELN criteria. MMRD was defined as persistent leukemia-specific mutations prior to transplantation (i.e. NPM1, FLT3, CEBPA, IDH1-2, RUNX1 and TP53). Persistence of DTA mutations (DNMT3A, TET2 and ASXL1) was not considered MMRD, patients with unavailable cytogenetic/molecular data at diagnosis were excluded. Results: Seventy-four (83%) patients were transplanted in CR1, myeloablative conditioning was used in 72% of patients. Two-year OS and LFS were 69.4% and 78.2%, respectively. Stratification by ELN criteria resulted in prognostic separation for patients transplanted in CR1: 2-year OS for favorable (87%), intermediate (68%) and adverse risk (51%) patients (p = 0.0417). The presence of MMRD was the strongest predictor of post-transplant outcomes for the whole cohort with 2-year OS and LFS of 29.4% and 37.1% (HR 5.45 [95%CI 2.43-12.3] p = 0.0001; HR 12.4 [95%CI: 3.76 to 39.8] p = 0.0001); respectively. Subgroup analysis confirmed that MMRD was associated with significantly inferior LFS for IM/favorable and adverse risk patients (HR: 6.76 [95% CI 1.12 to 40.9], p = 0.038). Conclusions: Pre-transplant MMRD was the most important prognostic factor for relapse and survival in our cohort of AML patients undergoing alloSCT. Correlation of MMRD with other transplant variables such as conditioning intensity, MRD status by MFC and the impact of pre-emptive/therapeutic strategies in high-risk patients continues to be explored.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Douglas Carollo
- Division of Transplantation and Cell Therapy, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL
| | | | | | - Junaid Arshad
- University of Miami-Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miami, FL
| | | | - Eduardo Edelman Saul
- Department of Internal Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL
| | | | - Antonio Martin Jimenez
- Division of Transplantation and Cell Therapy, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL
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Abstract
Introduction: Gastrointestinal stromal tumor (GIST) is the most common malignant mesenchymal tumor of the gastrointestinal system. Multiple advances in the management of GIST from the discovery of KIT/PDGRA and other genetic alterations have led to the development of multiple tyrosine kinase inhibitors. Response assessment in GIST is determined with iRECIST (Response Evaluation Criteria in Solid Tumors), PERCIST (PET response criteria in solid tumors), or Choi criteria. Molecular genotyping of the tissue samples is the recent standard for diagnosis, treatment, and response to treatment.Areas covered: In this study, we provide a brief overview of the history of the GIST, molecular sequencing, available treatment options and clinical trials, radiologic response assessment, and the role of ctDNA in response evaluation.Expert opinion: Future GIST management is related to the development of sensitive assays to detect genetic alterations for initial diagnosis, treatment selection, monitoring the response to treatment, resistant mutations, and predicting survival.
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Affiliation(s)
- Junaid Arshad
- Miller School of Medicine/Sylvester Comprehensive Cancer Centre, University of Miami, Miami, FL, USA
| | - Jibran Ahmed
- Department of Hematology and Medical Oncology, Westchester Medical Center, Valhalla, NY, USA
| | - Ty Subhawong
- Miller School of Medicine/Sylvester Comprehensive Cancer Centre, University of Miami, Miami, FL, USA
| | - Jonathan C Trent
- Miller School of Medicine/Sylvester Comprehensive Cancer Centre, University of Miami, Miami, FL, USA
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Arshad J, Roberts A, Cotta JA, Trent JC. Identification of genomic alterations by circulating tumor DNA in leiomyosarcoma: A molecular analysis of 73 patients. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11044 Background: Leiomyosarcoma is a malignant mesenchymal tumor of cells of smooth muscle lineage arising commonly in retroperitoneum, uterus, large veins, and the limbs. In contrast to many sarcomas, the genetics of leiomyosarcomas are complex and there is very limited understanding of common driver mutations. Circulating Tumor DNA (ctDNA) offers a rapid and non-invasive method of next-generation sequencing (NGS) that could be utilized for diagnosis, therapy and detection of recurrence. Methods: ctDNA testing was performed using Guardant360, which detects single nucleotide variants, amplifications, fusions, and specific insertion/deletion mutations in 73 genes utilizing NGS. Blood samples from patients with leiomyosarcoma were analyzed, and results from December 2014-December 2018 were reviewed. Results: Of the 90 samples collected and analyzed, alterations were detected in 73 ctDNA samples. After exclusion of variants of uncertain significance (VUS), 63 ctDNA samples harbored cancer-associated genomic alterations. Of 73 patients, 59 were found to have one or more cancer-associated genomic alteration. 76% (45) were female with a median age of 63 (range, 38-87) years. All samples were designated metastatic. The following table shows common alterations and types of mutations. The other alterations included RAF1, ERBB2, MET, PTEN, TERT, APC and NOTCH1. In 24 of the 73 patients (33%) the genomic alterations detected by ctDNA are potentially targetable by an FDA-approved or clinical trial therapy. There were 4 (5%) patients who were found to have incidental germline TP53 mutations. Conclusions: NGS of ctDNA allows identification of genomic alterations in plasma from patients with leiomyosarcoma. Unfortunately, there is limited activity of targeted agents in leiomyosarcomas. These results suggest opportunities to develop therapy against TP53, cell cycle, and kinase signaling pathways. Further validation and prospective evaluation is warranted to investigate the clinical utility of ctDNA for patients with leiomyosarcoma.[Table: see text]
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Affiliation(s)
- Junaid Arshad
- University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL
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Ali A, Shah GA, Arshad J. Energy Efficient Resource Allocation for M2M Devices in 5G. Sensors (Basel) 2019; 19:s19081830. [PMID: 30999622 PMCID: PMC6514869 DOI: 10.3390/s19081830] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 03/20/2019] [Accepted: 03/25/2019] [Indexed: 11/16/2022]
Abstract
Resource allocation for machine-type communication (MTC) devices is one of the keys challenges in the 5G network as it affects the lifetime of battery powered devices and also the quality of service of the applications. MTC devices are battery restrained and cannot afford a lot of power consumption due to spectrum usage. In this paper, we propose a novel resource allocation algorithm termed threshold controlled access (TCA) protocol. We propose a novel technique of uplink resource allocation in which the devices make a decision of resource allocation blocks based on their battery status and related application’s power profile that eventually leads to required quality of service (QoS) metric. The first phase of the TCA algorithm selects the number of carriers to be allocated to a certain device for the better lifetime of low power MTC devices. In the second phase, the efficient solution is implemented through inducing a threshold value. A certain value of the threshold is selected through a mapping based on a QoS metric. The threshold enhances the selection of subcarriers for less powered devices, such as small e-health sensors. The algorithm is simulated for the physical layer of the 5G network. Simulation results show that the proposed algorithm is less complex and achieves better performance when compared to existing solutions in the literature.
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Affiliation(s)
- Anum Ali
- Department of Computer Science and Engineering, University of Engineering and Technology, Lahore 54890, Pakistan.
| | - Ghalib A Shah
- Sultan Quboos IT Chair, University of Engineering and Technology, Lahore 54890, Pakistan.
| | - Junaid Arshad
- Department of Computer Science and Engineering, University of Engineering and Technology, Lahore 54890, Pakistan.
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Ali R, Arshad J, Palacio S, Mudad R. Brigatinib for ALK-positive metastatic non-small-cell lung cancer: design, development and place in therapy. Drug Des Devel Ther 2019; 13:569-580. [PMID: 30804663 PMCID: PMC6372006 DOI: 10.2147/dddt.s147499] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Despite the benefits of first and second generation anaplastic lymphoma kinase (ALK) inhibitors in the management of ALK-rearranged advanced non-small-cell lung cancer (NSCLC), the development of acquired resistance poses an ongoing dilemma. Brigatinib has demonstrated a wider spectrum of preclinical activity against crizotinib-resistant ALK mutant advanced NSCLC. The current review narrates a brief history of tyrosine kinases, the development and clinical background of brigatinib (including its pharmacology and molecular structure) and its use in ALK-positive NSCLC.
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Affiliation(s)
- Robert Ali
- Department of Medicine, Division of Oncology, Jackson Memorial Hospital, University of Miami, Miller School of Medicine, Sylvester Comprehensive Cancer Centre, Miami, FL 33131, USA,
| | - Junaid Arshad
- Department of Medicine, Division of Oncology, Jackson Memorial Hospital, University of Miami, Miller School of Medicine, Sylvester Comprehensive Cancer Centre, Miami, FL 33131, USA,
| | - Sofia Palacio
- Department of Medicine, Division of Oncology, Jackson Memorial Hospital, University of Miami, Miller School of Medicine, Sylvester Comprehensive Cancer Centre, Miami, FL 33131, USA,
| | - Raja Mudad
- Department of Medicine, Division of Oncology, University of Miami, Miller School of Medicine, Sylvester Comprehensive Cancer Centre, Miami, FL 33136, USA,
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Arshad J, Azad MA, Mahmoud Abdellatif M, Ur Rehman MH, Salah K. COLIDE: a collaborative intrusion detection framework for Internet of Things. IET Networks 2019. [DOI: 10.1049/iet-net.2018.5036] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Junaid Arshad
- School of Computing and Engineering, University of West LondonLondonUK
| | | | | | - Muhammad Habib Ur Rehman
- Department of Computer ScienceNational University of Computer and Emerging SciencesLahorePakistan
| | - Khaled Salah
- ECE DepartmentKhalifa UniversityAbu DhabiUnited Arab Emirates
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Palacio S, Pontes L, Prado E, Arshad J, Ali R, Piha T, Bacchi CE, Mudad R, Lopes G. EGFR Mutation Testing: Changing Patterns of Molecular Testing in Brazil. Oncologist 2018; 24:e137-e141. [PMID: 30446583 DOI: 10.1634/theoncologist.2018-0254] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 10/16/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND In Brazil, cancer is the second most common cause of death. Most patients in resource-limited countries are diagnosed in advanced stages. Current guidelines advocate for EGFR mutation testing in all patients with metastatic adenocarcinoma. Tyrosine kinase inhibitors are recommended in patients with advanced or metastatic disease harboring sensitizing mutations. In Brazil, there are limited data regarding the frequency of EGFR testing and the changes in patterns of testing overtime. MATERIALS AND METHODS This was an observational, retrospective study. We obtained deidentified data from a commercial database, which included 11,684 patients with non-small cell lung cancer treated between 2011 and 2016 in both public and private settings. We analyzed the frequency of EGFR mutation testing over time. We also directly studied 3,664 tumor samples, which were analyzed between 2011 and 2013. These samples were tested for EGFR mutations through an access program to tyrosine kinase inhibitors in Brazil. RESULTS Overall, 38% of patients were tested for EGFR mutations; 76% of them were seen in the private sector, and 24% were seen in the public center. The frequency of testing for EGFR mutations increased significantly over time: 13% (287/2,228 patients) in 2011, 34% (738/2,142) in 2012, 39% (822/2,092) in 2013, 44% (866/1,972) in 2014, 53% (1,165/2,184) in 2015, and 42% (1,359/3,226) in 2016. EGFR mutations were detected in 25.5% of analyzed samples (857/3,364). Deletions in Exon 19 were the most frequent mutations, detected in 54% of patients (463/857). CONCLUSION Our findings suggest that the frequency of EGFR mutation in this cohort was lower than that found in Asia but higher than in North American and Western European populations. The most commonly found mutations were in Exon 19 and Exon 21. Our study shows that fewer than half of patients are being tested and that the disparity is greater in the public sector. IMPLICATIONS FOR PRACTICE These data not only indicate the shortage of testing but also show that the rates of positivity in those tested seem to be higher than in other cohorts for which data have been published. This study further supports the idea that awareness and access to testing should be improved in order to improve survival rates in lung cancer in Brazil.
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MESH Headings
- Adenocarcinoma of Lung/drug therapy
- Adenocarcinoma of Lung/epidemiology
- Adenocarcinoma of Lung/genetics
- Adenocarcinoma of Lung/pathology
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/genetics
- Brazil/epidemiology
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/epidemiology
- Carcinoma, Non-Small-Cell Lung/genetics
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/epidemiology
- Carcinoma, Squamous Cell/genetics
- Carcinoma, Squamous Cell/pathology
- ErbB Receptors/genetics
- Female
- Follow-Up Studies
- Genetic Testing/statistics & numerical data
- Humans
- Lung Neoplasms/drug therapy
- Lung Neoplasms/epidemiology
- Lung Neoplasms/genetics
- Lung Neoplasms/pathology
- Male
- Middle Aged
- Mutation
- Practice Guidelines as Topic/standards
- Practice Patterns, Physicians'/statistics & numerical data
- Prognosis
- Retrospective Studies
- Young Adult
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Affiliation(s)
- Sofia Palacio
- Department of Medicine, Miller School of Medicine and Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
| | - Luciola Pontes
- Hospital das Clínicas Instituto do Coração, São Paulo, Brazil
| | - Edna Prado
- Close-Up International, São Paulo, Brazil
| | - Junaid Arshad
- Department of Medicine, Miller School of Medicine and Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
| | - Robert Ali
- Department of Medicine, Miller School of Medicine and Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
| | | | | | - Raja Mudad
- Department of Medicine, Miller School of Medicine and Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
| | - Gilberto Lopes
- Department of Medicine, Miller School of Medicine and Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
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Arshad J, Roberts A, Nagy RJ, Wilky BA, Trent JC. Utility of circulating tumor DNA (ctDNA) in the management of patients with gastrointestinal stromal tumor (GIST): Analysis of 152 patients. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.11539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Khan KM, Arshad J, Khan MM. Secure Digital Voting System Based on Blockchain Technology. International Journal of Electronic Government Research 2018. [DOI: 10.4018/ijegr.2018010103] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Electronic voting or e-voting has been used in varying forms since 1970s with fundamental benefits over paper-based systems such as increased efficiency and reduced errors. However, challenges remain to the achieving of wide spread adoption of such systems, especially with respect to improving their resilience against potential faults. Blockchain is a disruptive technology of the current era and promises to improve the overall resilience of e-voting systems. This article presents an effort to leverage benefits of blockchain such as cryptographic foundations and transparency to achieve an effective scheme for e-voting. The proposed scheme conforms to the fundamental requirements for e-voting schemes and achieves end-to-end verifiability. The article presents details of the proposed e-voting scheme along with its implementation using Multichain platform. The article also presents an in-depth evaluation of the scheme which successfully demonstrates its effectiveness to achieve an end-to-end verifiable e-voting scheme.
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Arshad J, Johal B. Culture club. Nurs Times 1999; 95:66-7. [PMID: 10197000] [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: 02/11/2023]
Affiliation(s)
- J Arshad
- Broad Street Health Centre, Coventry
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