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Abdalla S, Pair E, Mehta K, Ward V, Mahapatra T, Darmstadt GL. Improving the precision of maternal, newborn, and child health impact through geospatial analysis of the association of contextual and programmatic factors with health trends in Bihar, India. J Glob Health 2022; 12:04064. [PMID: 36412069 PMCID: PMC9679706 DOI: 10.7189/jogh.12.04064] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background There is a scarcity of research that comprehensively examines programme impact from a context-specific perspective. We aimed to determine the conditions under which the Bihar Technical Support Programme led to more favourable outcomes for maternal and child health in Bihar. Methods We obtained block-level data on maternal and child health indicators during the state-wide scale-up of the pilot Ananya programme and data on health facility readiness, along with geographical and sociodemographic variables. We examined the associations of these factors with increases in the levels of indicators using multilevel logistic regression, and the associations with rates of change in the indicators using Bayesian Hierarchical modelling. Results Frontline worker (FLW) visits between 2014-2017 were more likely to increase in blocks with better night lighting (odds ratio (OR) = 1.23, 95% confidence interval (CI) = 1.01-1.51). Birth preparedness increased in blocks with increasing FLW visits (OR = 3.43, 95% CI = 1.15-10.21), while dry cord care practice increased in blocks where satisfaction with FLW visits was increasing (OR = 1.52, 95% CI = 1.10-2.11). Age-appropriate frequency of complementary feeding increased in blocks with higher development index (OR = 1.55, 95% CI = 1.16-2.06) and a higher percentage of scheduled caste or tribe (OR = 3.21, 95% CI = 1.13-9.09). An increase in most outcomes was more likely in areas with lower baseline levels. Conclusions Contextual factors (eg, night lighting and development) not targeted by the programme and FLW visits were associated with favourable programme outcomes. Intervention design, including intervention selection for a particular geography, should be modified to fit the local context in the short term. Expanding collaborations beyond the health sector to influence modifiable contextual factors in the long term can result in a higher magnitude and more sustainable impact. Registration ClinicalTrials.gov: NCT02726230.
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Affiliation(s)
- Safa Abdalla
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Emma Pair
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Kala Mehta
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Victoria Ward
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | | | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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Mehta K, Panse C. Effect of Covid-19 pandemic: tourism and hospitality industry. CM 2022. [DOI: 10.18137/cardiometry.2022.22.406414] [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: 11/08/2022] Open
Abstract
The coronavirus, which causes COVID-19 disease, has unimaginably affected every industry. Among all industries, the tourism and hospitality industry is considered the worst-hit industry, contributing 9% of India’s total GDP; this paper presents an overview of the Indian tourism and hospitality industry before COVID-19. While sending out survey forms, we included general questions like gender, occupation, age, level of education, yearly income, what used to be their choice of location for a holiday before COVID-19, how much they yearly spent on holiday, how they plan their holiday trip, to understand the basic details and reliability of participants, also we did not ask the name of a participant to maintain the anonymity and privacy of a participant, which helped us to get an accurate data. How customers’ changed mindsets different priorities forced the tourism and hospitality industry to change the way of providing service also how the changed time has forced businesses to look for other opportunities to survive in the industry, Moreover here we have test different Sanitization and safety measurements using Friedman test to understand what are the factors that can affect the business of tourism and hospitality industry after the COVID-19 pandemic, as observed by Assaf & Scuderi.
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Moss K, Russell L, Mehta K, Faisal M, Armstrong D, Verdu E, Dowhaniuk J, Pinto-Sanchez MI. A194 THE ADDITION OF DEAMIDATED GLIADIN PEPTIDE TO TISSUE TRANSGLUTAMINASE ANTIBODIES DOES NOT INCREASE THE ODDS OF CELIAC DISEASE DIAGNOSIS IN AN IGA SUFFICIENT POPULATION. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859345 DOI: 10.1093/jcag/gwab049.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Previous studies proposed that the combination of IgA anti-tissue transglutaminase 2 IgA (TTG) and IgG deamidated gliadin peptide IgG (DGP) antibodies increases celiac disease (CeD) detection rates. However, this remains controversial.
Aims
To evaluate the performance of adding DGP to TTG antibodies, for the diagnosis of celiac disease (CeD) in the immunoglobulin A (IgA)-sufficient population.
Methods
We included consecutive patients with suspected CeD who had both TTG and DGP serology performed simultaneously from 2017–2020 in Hamilton, Canada. Chart review was performed by 3 reviewers to extract data on biopsies, diagnosis of CeD and genetic HLA-DQ2/DQ8. CeD was defined as positive serology (either TTG and/or DGP) and villous atrophy in duodenal biopsies (≥Marsh-3a). A case was defined as an instance of TTG and DGP performed at a single timepoint. A single patient could have represented multiple cases if TTG and DGP were measured at multiple time points. Sensitivity, specificity, negative and positive predictive values were calculated, and ROC curves were generated. Diagnostic odds ratios (DOR) assessed the performance of each serological strategy compared to duodenal biopsies.
Results
There were 580 patients constituting 823 cases that met inclusion criteria, of whom 441 had CeD. IgA-deficient patients (n=100) were excluded. Of the 723 cases remaining, 337 (214 adult;123 pediatric) had serology performed at the time of CeD diagnosis. TTG increased the odds of CeD diagnosis compared with DGP, Diagnostic Odds Ratio (DOR)=53.22 (95% CI 22.63–119.80) vs DOR=21.28 (95% CI 10.67–42.46). The addition of DGP to TTG did not increase the odds of CeD diagnosis [DGP+TTG DOR=51.39 (95% CI 19.36–135.61) vs TTG alone DOR=53.22 (95% CI 22.63–119.80)]. There were 37 discordant cases where only one of either TTG or DGP was positive. HLA-DQ2/DQ8 were absent in 2/9 cases with isolated increased DGP. Among the discordant cases, TTG outperformed DGP (DOR TTG= 4.29; 95% CI 1.09–16.83 vs DOR DGP=0.23; 95% CI 0.06–0.92).
Conclusions
In the IgA-sufficient population, the addition of DGP to TTG testing does not increase the diagnostic accuracy of CeD serologic screening. This has implications in health-care costs as false positive results prompt further investigations. Given these findings, larger prospective studies should be completed prior to adding DGP antibodies to routine TTG serology.
Funding Agencies
None
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Affiliation(s)
- K Moss
- McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - L Russell
- McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - K Mehta
- McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - M Faisal
- McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - D Armstrong
- McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - E Verdu
- McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - J Dowhaniuk
- McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - M I Pinto-Sanchez
- McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
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Mehta K, Kaur B, Pandey KK, Dhar P, Kaler S. Resveratrol protects against inorganic arsenic-induced oxidative damage and cytoarchitectural alterations in female mouse hippocampus. Acta Histochem 2021; 123:151792. [PMID: 34634674 DOI: 10.1016/j.acthis.2021.151792] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 01/04/2023]
Abstract
Prolonged inorganic arsenic (iAs) exposure is widely associated with brain damage particularly in the hippocampus via oxidative and apoptotic pathways. Resveratrol (RES) has gained considerable attention because of its benefits to human health. However, its neuroprotective potential against iAs-induced toxicity in CA1 region of hippocampus remains unexplored. Therefore, we investigated the neuroprotective efficacy of RES against arsenic trioxide (As2O3)-induced adverse effects on neuronal morphology, apoptotic markers and oxidative stress parameters in mouse CA1 region (hippocampus). Adult female Swiss albino mice of reproductive maturity were orally exposed to either As2O3 (2 and 4 mg/kg bw) alone or in combination with RES (40 mg/kg bw) for a period of 45 days. After animal sacrifice on day 46, the perfusion fixed brain samples were used for the observation of neuronal morphology and studying the morphometric features. While the freshly dissected hippocampi were processed for biochemical estimation of oxidative stress markers and western blotting of apoptosis-associated proteins. Chronic iAs exposure led to significant decrease in Stratum Pyramidale layer thickness along with reduction in cell density and area of Pyramidal neurons in contrast to the controls. Biochemical analysis showed reduced hippocampal GSH content but no change in total nitrite (NO) levels following iAs exposure. Western blotting showed apparent changes in the expression levels of Bax and Bcl-2 proteins following iAs exposure, however the change was statistically insignificant. Contrastingly, iAs +RES co-treatment exhibited substantial reversal in morphological and biochemical observations. Together, these findings provide preliminary evidence of neuroprotective role of RES on structural and biochemical alterations pertaining to mouse hippocampus following chronic iAs exposure.
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Affiliation(s)
- K Mehta
- Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - B Kaur
- Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - K K Pandey
- Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - P Dhar
- Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - S Kaler
- Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
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Ward V, Abdalla S, Raheel H, Weng Y, Godfrey A, Dutt P, Mitra R, Sastry P, Chamberlain S, Shannon M, Mehta K, Bentley J, Darmstadt Md GL. Implementing health communication tools at scale: mobile audio messaging and paper-based job aids for front-line workers providing community health education to mothers in Bihar, India. BMJ Glob Health 2021; 6:bmjgh-2021-005538. [PMID: 34312155 PMCID: PMC8728373 DOI: 10.1136/bmjgh-2021-005538] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/19/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION As part of an investment by the Bill & Melinda Gates Foundation to support the Government of Bihar to improve reproductive, maternal, newborn and child health and nutrition (RMNCHN) statewide, BBC Media Action implemented multiple communication tools to support front-line worker (FLW) outreach. We analyse the impacts of a package of mHealth audio messaging and paper-based job aids used by FLWs during government-sponsored village health, sanitation and nutrition days (VHSNDs) on knowledge and practices of childbearing women across the RMNCHN continuum of care. METHODS Data from two surveys collected between July and September 2016 were analysed using logistic regression to compare health-related knowledge and behaviours between women who had been exposed at VHSNDs to the mHealth GupShup Potli (GSP) audio recordings or interpersonal communication (IPC) tools versus those who were unexposed. RESULTS Exposure to GSP recordings (n=2608) was associated with improved knowledge across all continuum-of-care domains, as well as improved health-related behaviours in some domains. The odds of having taken iron-folic acid (IFA) tablets were significantly higher in exposed women (OR 1.5, 95% CI 1.1 to 2.2), as was contraceptive use (OR 2.0, 95% CI 1.2 to 3.2). There were no differences in birth preparedness or complementary feeding practices between groups. Exposure to IPC paper-based tools (n=2002) was associated with a twofold increased odds of IFA consumption (OR 2.3, 95% CI 1.7 to 3.2) and contraceptive use (OR 1.8, 95% CI 1.2 to 2.8). Women exposed to both tools were generally at least twice as likely to subsequently discuss the messages with others. CONCLUSION BBC Media Action's mHealth audio messaging job aids and paper-based IPC tools were associated with improved knowledge and practices of women who were exposed to them across multiple domains, suggesting their important potential for improving health outcomes for beneficiaries at scale in low-resource settings. TRIAL REGISTRATION NUMBER NCT02726230.
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Affiliation(s)
- Victoria Ward
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Safa Abdalla
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Hina Raheel
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Yingjie Weng
- Quantitaitve Sciences Unit, Department of Medicine, Stanford University, Stanford, California, USA
| | | | | | | | | | | | | | - Kala Mehta
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Jason Bentley
- Quantitaitve Sciences Unit, Department of Medicine, Stanford University, Stanford, California, USA
| | - Gary L Darmstadt Md
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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AHMAD S, Bhasin N, Sinha S, Sayed S, Bansode J, Swami R, Mehta K. POS-467 RENAL AND HEPATIC OUTCOMES AFTER REMDESIVIR THERAPY IN COVID-19 POSITIVE PATIENTS WITH RENAL DYSFUNCTION AT BASELINE OR AFTER STARTING THERAPY. Kidney Int Rep 2021. [PMCID: PMC8049664 DOI: 10.1016/j.ekir.2021.03.494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Ugarte S, Tang A, Harper Z, John RE, Mehta K, Khoury A, Knopf K. HSR21-072: Neoadjuvant Chemotherapy in Breast Cancer Care: Does Equal Access Mitigate Racial Disparities? J Natl Compr Canc Netw 2021. [DOI: 10.6004/jnccn.2020.7785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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8
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Baruah U, Varghese M, Loganathan S, Mehta K, Gallagher‐Thompson D, Zandi D, Dua T, Pot AM. A pilot randomized controlled trial on iSupport in India: Results on the use of the online program and its effectiveness. Alzheimers Dement 2020. [DOI: 10.1002/alz.038912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Upasana Baruah
- National Institute of Mental Health and Neurosciences (NIMHANS) Bangalore India
| | - Mathew Varghese
- National Institute of Mental Health & Neurosciences (NIMHANS) Bengaluru India
| | | | - Kala Mehta
- University of California, San Francisco San Francisco CA USA
| | | | | | - Tarun Dua
- World Health Organization Geneva Switzerland
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Abstract
As the demographic characteristics of the US population have changed over the past decade, the characteristics of different homeless populations have changed as well. This study tracked changes in demographic characteristics of homeless adult, veteran, and healthcare service user populations against general adult and veteran populations from 2007-2017. The results showed that changing demographics of homeless populations largely reflected broader trends in the general population, and attention is needed on the clinical needs of aging homeless populations. There may be some unique changes in the demography of some homeless populations, such as younger homeless veterans seeking healthcare services.
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Affiliation(s)
- J Tsai
- U.S. Department of Veterans Affairs, National Center on Homelessness Among Veterans, Tampa, FL, USA
- Department of Psychiatry, Yale University School of Medicine, VACT, 950 Campbell Ave., 151D, West Haven, New Haven, CT 06516, USA
| | - K Mehta
- U.S. Department of Veterans Affairs, National Center on Homelessness among Veterans, Tampa, FL, USA
| | - AE Mongtomery
- U.S. Department of Veterans Affairs, National Center on Homelessness among Veterans, Tampa, FL, USA
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - E Elbogen
- U.S. Department of Veterans Affairs, National Center on Homelessness among Veterans, Tampa, FL, USA
- Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
| | - D Hooshyar
- U.S. Department of Veterans Affairs, National Center on Homelessness among Veterans, Tampa, FL, USA
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Carmichael SL, Mehta K, Srikantiah S, Mahapatra T, Chaudhuri I, Balakrishnan R, Chaturvedi S, Raheel H, Borkum E, Trehan S, Weng Y, Kaimal R, Sivasankaran A, Sridharan S, Rotz D, Tarigopula UK, Bhattacharya D, Atmavilas Y, Pepper KT, Rangarajan A, Darmstadt GL. Use of mobile technology by frontline health workers to promote reproductive, maternal, newborn and child health and nutrition: a cluster randomized controlled Trial in Bihar, India. J Glob Health 2019; 9:0204249. [PMID: 31788233 PMCID: PMC6875677 DOI: 10.7189/jogh.09.020424] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background mHealth technology holds promise for improving the effectiveness of frontline health workers (FLWs), who provide most health-related primary care services, especially reproductive, maternal, newborn, child health and nutrition services (RMNCHN), in low-resource – especially hard-to-reach – settings. Data are lacking, however, from rigorous evaluations of mHealth interventions on delivery of health services or on health-related behaviors and outcomes. Methods The Information Communication Technology-Continuum of Care Service (ICT-CCS) tool was designed for use by community-based FLWs to increase the coverage, quality and coordination of services they provide in Bihar, India. It consisted of numerous mobile phone-based job aids aimed to improve key RMNCHN-related behaviors and outcomes. ICT-CCS was implemented in Saharsa district, with cluster randomization at the health sub-center level. In total, evaluation surveys were conducted with approximately 1100 FLWs and 3000 beneficiaries who had delivered an infant in the previous year in the catchment areas of intervention and control health sub-centers, about half before implementation (mid-2012) and half two years afterward (mid-2014). Analyses included bivariate and difference-in-difference analyses across study groups. Results The ICT-CCS intervention was associated with more frequent coordination of AWWs with ASHAs on home visits and greater job confidence among ASHAs. The intervention resulted in an 11 percentage point increase in FLW antenatal home visits during the third trimester (P = 0.04). In the post-implementation period, postnatal home visits during the first week were increased in the intervention (72%) vs the control (60%) group (P < 0.01). The intervention also resulted in 13, 12, and 21 percentage point increases in skin-to-skin care (P < 0.01), breastfeeding immediately after delivery (P < 0.01), and age-appropriate complementary feeding (P < 0.01). FLW supervision and other RMNCHN behaviors were not significantly impacted. Conclusions Important improvements in FLW home visits and RMNCHN behaviors were achieved. The ICT-CCS tool shows promise for facilitating FLW effectiveness in improving RMNCHN behaviors.
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Affiliation(s)
- Suzan L Carmichael
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.,Center for Population Health Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Kala Mehta
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.,Center for Population Health Sciences, Stanford University School of Medicine, Stanford, California, USA
| | | | | | - Indrajit Chaudhuri
- CARE India, Patna, India.,Current affiliation: Project Concern International, Delhi, India
| | | | | | - Hina Raheel
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.,Center for Population Health Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Evan Borkum
- Mathematica Policy Research, Princeton, New Jersey, USA
| | - Shamik Trehan
- Mathematica Policy Research, Princeton, New Jersey, USA.,Current address: Dr. Reddy's Foundation, Hyderabad, India
| | - Yingjie Weng
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, California, USA
| | - Rajani Kaimal
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, California, USA
| | | | | | - Dana Rotz
- Mathematica Policy Research, Princeton, New Jersey, USA
| | | | | | - Yamini Atmavilas
- India Country Office, Bill and Melinda Gates Foundation, Delhi, India
| | - Kevin T Pepper
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | | | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.,Center for Population Health Sciences, Stanford University School of Medicine, Stanford, California, USA
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Carmichael SL, Mehta K, Raheel H, Srikantiah S, Chaudhuri I, Trehan S, Mohanty S, Borkum E, Mahapatra T, Weng Y, Kaimal R, Sivasankaran A, Sridharan S, Rotz D, Tarigopula UK, Bhattacharya D, Atmavilas Y, Munar W, Rangarajan A, Darmstadt GL. Effects of team-based goals and non-monetary incentives on front-line health worker performance and maternal health behaviours: a cluster randomised controlled trial in Bihar, India. BMJ Glob Health 2019; 4:e001146. [PMID: 31543982 PMCID: PMC6730593 DOI: 10.1136/bmjgh-2018-001146] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 08/31/2018] [Revised: 05/29/2019] [Accepted: 06/01/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction We evaluated the impact of a ‘Team-Based Goals and Incentives’ (TBGI) intervention in Bihar, India, designed to improve front-line (community health) worker (FLW) performance and health-promoting behaviours related to reproductive, maternal, newborn and child health and nutrition. Methods This study used a cluster randomised controlled trial design and difference-in-difference analyses of improvements in maternal health-related behaviours related to the intervention’s team-based goals (primary), and interactions of FLWs with each other and with maternal beneficiaries (secondary). Evaluation participants included approximately 1300 FLWs and 3600 mothers at baseline (May to June 2012) and after 2.5 years of implementation (November to December 2014) who had delivered an infant in the previous year. Results The TBGI intervention resulted in significant increases in the frequency of antenatal home visits (15 absolute percentage points (PP), p=0.03) and receipt of iron-folic acid (IFA) tablets (7 PP, p=0.02), but non-significant changes in other health behaviours related to the trial’s goals. Improvements were seen in selected attitudes related to coordination and teamwork among FLWs, and in the provision of advice to beneficiaries (ranging from 8 to 14 PP) related to IFA, cord care, breast feeding, complementary feeding and family planning. Conclusion Results suggest that combining an integrated set of team-based coverage goals and targets, small non-cash incentives for teams who meet targets and team building to motivate FLWs resulted in improvements in FLW coordination and teamwork, and in the quality and quantity of FLW–beneficiary interactions. These improvements represent programmatically meaningful steps towards improving health behaviours and outcomes. Trial registration number NCT03406221
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Affiliation(s)
- Suzan L Carmichael
- Department of Pediatrics and Center for Population Health Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Kala Mehta
- Department of Pediatrics and Center for Population Health Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Hina Raheel
- Department of Pediatrics and Center for Population Health Sciences, Stanford University School of Medicine, Stanford, California, USA
| | | | | | | | | | - Evan Borkum
- Mathematica Policy Research, Princeton, New Jersey, USA
| | | | - Yingjie Weng
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, California, USA
| | - Rajani Kaimal
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, California, USA
| | | | | | - Dana Rotz
- Mathematica Policy Research, Princeton, New Jersey, USA
| | | | | | | | - Wolfgang Munar
- Department of Global Health at the George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | | | - Gary L Darmstadt
- Department of Pediatrics and Center for Population Health Sciences, Stanford University School of Medicine, Stanford, California, USA
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Martín M, Loibl S, Hyslop T, De la Haba-Rodríguez J, Aktas B, Cirrincione CT, Mehta K, Barry WT, Morales S, Carey LA, Garcia-Saenz JA, Partridge A, Martinez-Jañez N, Hahn O, Winer E, Guerrero-Zotano A, Hudis C, Casas M, Rodriguez-Martin C, Furlanetto J, Carrasco E, Dickler MN. Evaluating the addition of bevacizumab to endocrine therapy as first-line treatment for hormone receptor-positive metastatic breast cancer: a pooled analysis from the LEA (GEICAM/2006-11_GBG51) and CALGB 40503 (Alliance) trials. Eur J Cancer 2019; 117:91-98. [PMID: 31276981 DOI: 10.1016/j.ejca.2019.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/20/2019] [Accepted: 06/02/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Randomised trials comparing the efficacy of standard endocrine therapy (ET) versus experimental ET + bevacizumab (Bev) in 1st line hormone receptor-positive patients with metastatic breast cancer have thus far shown conflicting results. PATIENTS AND METHODS We pooled data from two similar phase III randomised trials of ET ± Bev (LEA and Cancer and Leukemia Group B 40503) to increase precision in estimating treatment effect. Primary end-point was progression-free survival (PFS). Secondary end-points were overall survival (OS), objective response rate (ORR), clinical benefit rate (CBR) and safety. Exploratory analyses were performed within subgroups defined by patients with recurrent disease, de novo disease, prior endocrine sensitivity or resistance and reported grades III-IV hypertension and proteinuria. RESULTS The pooled sample consisted of 749 patients randomised to ET or ET + Bev. Median PFS was 14.3 months for ET versus 19 months for ET + Bev (unadjusted hazard ratio [HR] 0.77; 95% confidence interval [CI] 0.66-0.91; p < 0.01). ORR and CBR with ET and ET + Bev were 40 versus 61% (p < 0.01) and 64 versus 77% (p < 0.01), respectively. There was no difference in OS (HR 0.96; 95% CI 0.77-1.18; p = 0.68). PFS was superior for ET + Bev for endocrine-sensitive patients (HR 0.68; 95% CI 0.53-0.89; p = 0.004). Grade III-IV hypertension (2.2 versus 20.1%), proteinuria (0 versus 9.3%), cardiovascular (0.5 versus 4.2%) and liver events (0 versus 2.9%) were significantly higher for ET + Bev (all p < 0.01). Hypertension and proteinuria were not predictors of efficacy (interaction test p = 0.33). CONCLUSION The addition of Bev to ET increased PFS overall and in endocrine-sensitive patients but not OS at the expense of significant additional toxicity. TRIALS REGISTRATION ClinicalTrial.Gov NCT00545077 and NCT00601900.
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Affiliation(s)
- M Martín
- Medical Oncology, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense Madrid, Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, GEICAM Spanish Breast Cancer Group, Spain.
| | - S Loibl
- GBG (German Breast Group), Neu-Isenburg, Germany
| | - T Hyslop
- Alliance Statistics and Data Center, Duke University, Durham, NC, USA
| | - J De la Haba-Rodríguez
- Oncology Department and Research Unit, Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Reina Sofía, Universidad de Córdoba Spain. Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, GEICAM Spanish Breast Cancer Group, Spain
| | - B Aktas
- University Women's Hospital Leipzig, Leipzig, Germany
| | - C T Cirrincione
- Alliance Statistics and Data Center, Duke University, Durham, NC, USA
| | - K Mehta
- GBG (German Breast Group), Neu-Isenburg, Germany
| | - W T Barry
- Alliance Statistics and Data Center, Dana-Farber/Partners Cancer Care, Boston, MA, USA
| | - S Morales
- Medical Oncology, Hospital Arnau de Vilanova de Lérida, GEICAM Spanish Breast Cancer Group, Spain
| | - L A Carey
- University of North Carolina, Chapel Hill, NC, USA
| | - J A Garcia-Saenz
- Medical Oncology, Instituto de Investigación Sanitaria del Hospital Clinico San Carlos (IdISSC) Madrid, Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, GEICAM Spanish Breast Cancer Group, Spain
| | - A Partridge
- Dana-Farber/Partners CancerCare, Boston, MA, USA
| | - N Martinez-Jañez
- Medical Oncology. Universitary Hospital Ramon y Cajal. GEICAM, Spanish Breast Cancer Group; Madrid, Spain
| | - O Hahn
- Alliance Protocol Operations Office, University of Chicago, Chicago, IL, USA
| | - E Winer
- Dana-Farber/Partners CancerCare, Boston, MA, USA
| | - A Guerrero-Zotano
- Medical Oncology. Valencian Institute of Oncology. GEICAM Spanish Breast Cancer Group, Valencia, Spain
| | - C Hudis
- American Society of Clinical Oncology (ASCO), Alexandria, VA, USA
| | - M Casas
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | | | - J Furlanetto
- GBG (German Breast Group), Neu-Isenburg, Germany
| | - E Carrasco
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
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Kjaer TW, Faurholt-Jepsen D, Medrano R, Elwan D, Mehta K, Christensen VB, Wojcicki JM. Higher Birthweight and Maternal Pre-pregnancy BMI Persist with Obesity Association at Age 9 in High Risk Latino Children. J Immigr Minor Health 2019; 21:89-97. [PMID: 29397484 DOI: 10.1007/s10903-018-0702-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Childhood obesity is increasing especially in Latinos and early intervention is essential to prevent later obesity complications. Latino children (n = 201) recruited at two San Francisco hospitals were assessed at birth including infant anthropometrics and feeding practices and followed to age 9 with annual anthropometric assessments. We evaluated the relationship between perinatal risk factors and obesity at age 9 and chronic obesity (obesity at both 5 and 9 years). Higher birthweight [odds ratio (OR) 2.48, 95% confidence interval (CI) 1.06-5.81] and maternal pre-pregnancy body mass index (BMI) (OR 1.09, 95% CI 1.00-1.18) were associated with increased risk for obesity at 9 years. Higher maternal pre-pregnancy BMI (OR 1.10, 95% CI 1.01-1.20) was associated with chronic obesity. Additionally, prenatal depression symptoms were protective (OR 0.33, 95% CI 0.11-0.94) against chronic obesity. We found no association between maternal age and education, exclusive breastfeeding at 4-6 weeks, rapid infant weight gain, and obesity or chronic obesity. Perinatal risk factors for obesity including higher birthweight and maternal pre-pregnancy BMI persisted until age 9, whereas, other variables significant at age 5 in our cohort and other populations including exclusive breastfeeding and rapid infant weight gain were no longer associated with increased risk.
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Affiliation(s)
- Thora Wesenberg Kjaer
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.,School of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Daniel Faurholt-Jepsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg C, Denmark
| | - Rosalinda Medrano
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Deena Elwan
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Kala Mehta
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Vibeke Brix Christensen
- Department of Pediatrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Janet M Wojcicki
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
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Flühmann C, Nguyen TL, Marinelli M, Negnevitsky V, Mehta K, Home JP. Encoding a qubit in a trapped-ion mechanical oscillator. Nature 2019; 566:513-517. [DOI: 10.1038/s41586-019-0960-6] [Citation(s) in RCA: 152] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 01/04/2019] [Indexed: 11/09/2022]
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15
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Huober J, Schneeweiss A, Blohmer JU, Denkert C, Tesch H, Hanusch CA, Salat C, Rhiem K, Rezai M, Solbach C, Fasching PA, Jackisch C, Mehta K, Nekljudova V, Seither F, von Minckwitz G, Loibl S, Untch M. Abstract P2-08-01: Factors predicting relapse in early breast cancer patients with a pathological complete response after neoadjuvant therapy – Results of a pooled analysis based on the GBG meta-database. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-08-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Even though patients with a pCR following neoadjuvant chemotherapy have an excellent prognosis still some of these patients will eventually relapse. A better identification of pts with an increased risk of relapse despite a pCR would be helpful to select these patients for additional post-neoadjuvant treatment strategies. Thus, the rationale of this retrospective analysis was to identify factors predicting relapse despite a pCR.
Methods
This pooled retrospective analysis based on the GBG meta-database includes the neoadjuvant trials GeparTrio, GeparQuattro, GeparQuinto, GeparSixto and GeparSepto. In these trials 2188 (27%) of 7933 pts had a pCR according to ypT0/ypTis ypN0 Definition and were included. The primary endpoint was disease-free survival (DFS), secondary endpoints were distant DFS (DDFS) and overall survival (OS). A multivariate Cox proportional hazards model was used to report hazard ratios with 95% confidence interval (CI). The two-sided significance level was set to α=0.05. Endpoints were analysed for all pts and in subgroups defined by intrinsic subtypes. The potential risk factors intrinsic subtype (HER2 negative/hormone receptor (HR) positive, triple negative, HER2 positive/HR positive, HER2 positive/HR negative), histological tumor type (lobular vs other), grade (G1/G2 vs G3), KI67 (≤20% vs higher), initial cT and cN stadium (cT1 vs cT2 vs cT3/4; cN0 vs cN+), age (≤40 vs 41-59 vs ≥60), BMI (< 25 vs 25-29 vs ≥ 30), planned number of cycles of chemotherapy (≤6 vs > 6), menopausal status (pre- vs postmenopausal) and clinical response after 2-4 cycles (SD vs PR vs CR vs PD) were included as covariates in multivariate Cox regression models as well as study identification.
Results
From 2188 evaluable patients DFS, DDFS and OS events were observed in 290/197/130 pts respectively; the median follow-up over all studies was 59 months. In multivariate analysis including study and all potential risk factors DFS was significantly different with regard to the initial cN status (cN+ vs cN0, hazard ratio (HR) 1.70; 95% CI [1.2, 2.4], p=0.002). Of borderline significance was histological type (non-lobular vs lobular, HR 0.52 95% CI [0.3, 1.1]; p=0.076) and initial tumor stage (cT3/4 vs cT1, HR 1.61 95% CI [1.0, 2.7]; p=0.064). In terms of DDFS significant differences were seen for the initial cN status (cN+ vs cN0, HR 2.34; 95% CI [1.5, 3.6], p<0.001) and initial tumor stage (cT3/4 vs cT1, HR 1.83 95% CI [1.0, 3.3]; p=0.044); histological type was again close to significance (non-lobular vs lobular, HR 0.46 95% CI [0.2, 1.1]; p=0.067). Multivariate analysis showed significantly worse OS with initial cT3/4 tumors (cT3/4 vs cT1, HR 2.48 95%CI [1.1, 5.7]; p=0.030), and the lobular type (non-lobular vs lobular, HR 0.35 95% CI [0.1, 0.9]; p=0.026) and a trend for worse OS in pts with cN+ (cN+ vs cN0, HR 1.67 95% CI [1.0, 2.9]; p=0.067).
Conclusions
Initial tumor load before start of neoadjuvant chemotherapy (tumor stage and nodal status) and lobular subtype were predictors of long term outcome after a pCR following neoadjuvant chemotherapy. Intrinsic subtype, KI67, grade and planned number of cycles were not predictive for a relapse.
Citation Format: Huober J, Schneeweiss A, Blohmer J-U, Denkert C, Tesch H, Hanusch CA, Salat C, Rhiem K, Rezai M, Solbach C, Fasching PA, Jackisch C, Mehta K, Nekljudova V, Seither F, von Minckwitz G, Loibl S, Untch M. Factors predicting relapse in early breast cancer patients with a pathological complete response after neoadjuvant therapy – Results of a pooled analysis based on the GBG meta-database [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-08-01.
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Affiliation(s)
- J Huober
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - A Schneeweiss
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - J-U Blohmer
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - C Denkert
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - H Tesch
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - CA Hanusch
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - C Salat
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - K Rhiem
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - M Rezai
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - C Solbach
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - PA Fasching
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - C Jackisch
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - K Mehta
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - V Nekljudova
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - F Seither
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - G von Minckwitz
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - S Loibl
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - M Untch
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
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Goneau LW, Mehta K, Wong J, L'Huillier AG, Gubbay JB. Zoonotic Influenza and Human Health-Part 1: Virology and Epidemiology of Zoonotic Influenzas. Curr Infect Dis Rep 2018; 20:37. [PMID: 30069735 DOI: 10.1007/s11908-018-0642-9] [Citation(s) in RCA: 8] [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] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Zoonotic influenza viruses are those that cross the animal-human barrier and can cause disease in humans, manifesting from minor respiratory illnesses to multiorgan dysfunction. They have also been implicated in the causation of deadly pandemics in recent history. The increasing incidence of infections caused by these viruses worldwide has necessitated focused attention to improve both diagnostic as well as treatment modalities. In this first part of a two-part review, we describe the structure of zoonotic influenza viruses, the relationship between mutation and pandemic capacity, pathogenesis of infection, and also discuss history and epidemiology. RECENT FINDINGS We are currently witnessing the fifth and the largest wave of the avian influenza A(H7N9) epidemic. Also in circulation are a number of other zoonotic influenza viruses, including avian influenza A(H5N1) and A(H5N6); avian influenza A(H7N2); and swine influenza A(H1N1)v, A(H1N2)v, and A(H3N2)v viruses. Most recently, the first human case of avian influenza A(H7N4) infection has been documented. By understanding the virology and epidemiology of emerging zoonotic influenzas, we are better prepared to face a new pandemic. However, continued effort is warranted to build on this knowledge in order to efficiently combat the constant threat posed by the zoonotic influenza viruses.
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Affiliation(s)
- L W Goneau
- Public Health Ontario Laboratory, 661 University Avenue, Suite 1701, Toronto, ON, M5G 1M1, Canada.,University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada
| | - K Mehta
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - J Wong
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada.,Department of Paediatrics, North York General Hospital, Toronto, ON, Canada
| | - A G L'Huillier
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - J B Gubbay
- Public Health Ontario Laboratory, 661 University Avenue, Suite 1701, Toronto, ON, M5G 1M1, Canada. .,University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada. .,Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada.
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Mehta T, Desai N, Mehta K, Parikh R, Male S, Hussain M, Ollenschleger M, Spiegel G, Grande A, Ezzeddine M, Jagadeesan B, Tummala R, McCullough L. Outcomes of early carotid stenting and angioplasty in large-vessel anterior circulation strokes treated with mechanical thrombectomy and intravenous thrombolytics. Interv Neuroradiol 2018; 24:392-397. [PMID: 29697301 DOI: 10.1177/1591019918768574] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction Proximal cervical internal carotid artery stenosis greater than 50% merits revascularization to mitigate the risk of stroke recurrence among large-vessel anterior circulation strokes undergoing mechanical thrombectomy. Carotid artery stenting necessitates the use of antiplatelets, and there is a theoretical increased risk of hemorrhagic transformation given that such patients may already have received intravenous thrombolytics and have a significant infarct burden. We investigate the outcomes of large-vessel anterior circulation stroke patients treated with intravenous thrombolytics receiving same-day carotid stenting or selective angioplasty compared to no carotid intervention. Materials and methods The study cohort was obtained from the National (Nationwide) Inpatient Sample database between 2006 and 2014, using International Statistical Classification of Diseases, ninth revision discharge diagnosis and procedure codes. A total of 11,825 patients with large-vessel anterior circulation stroke treated with intravenous thrombolytic and mechanical thrombectomy on the same day were identified. The study population was subdivided into three subgroups: no carotid intervention, same-day carotid angioplasty without carotid stenting, and same-day carotid stenting. Outcomes were assessed with respect to mortality, significant disability at discharge, hemorrhagic transformation, and requirement of percutaneous endoscopic gastronomy tube placement, prolonged mechanical ventilation, or craniotomy. Results This study found no statistically significant difference in patient outcomes in those treated with concurrent carotid stenting compared to no carotid intervention in terms of morbidity or mortality. Conclusions If indicated, it is reasonable to consider concurrent carotid stenting and/or angioplasty for large-vessel anterior circulation stroke patients treated with mechanical thrombectomy who also receive intravenous thrombolytics.
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Affiliation(s)
- T Mehta
- 1 Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - N Desai
- 2 Department of Neurology, Hartford Hospital, Hartford, CT, USA
| | - K Mehta
- 3 Department of Hematology-Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - R Parikh
- 4 Department of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - S Male
- 1 Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - M Hussain
- 5 Department of Interventional Neuroradiology, Hartford Hospital, Hartford, CT, USA
| | - M Ollenschleger
- 5 Department of Interventional Neuroradiology, Hartford Hospital, Hartford, CT, USA
| | - G Spiegel
- 6 Department of Neuroradiology, University of Texas Health Sciences Center, Houston, TX, USA
| | - A Grande
- 7 Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - M Ezzeddine
- 1 Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - B Jagadeesan
- 8 Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - R Tummala
- 7 Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - L McCullough
- 9 Department of Neurology, University of Texas Health Sciences Center, Houston, TX, USA
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Kjaer TW, Faurholt-Jepsen D, Mehta K, Christensen VB, Epel E, Lin J, Blackburn E, Wojcicki JM. Shorter preschool, leukocyte telomere length is associated with obesity at age 9 in Latino children. Clin Obes 2018; 8:88-94. [PMID: 29271129 PMCID: PMC5842114 DOI: 10.1111/cob.12233] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/19/2017] [Accepted: 10/23/2017] [Indexed: 01/18/2023]
Abstract
The aim of this study was to determine the potential role of leukocyte telomere length as a biomarker for development of childhood obesity in a low-income Latino population. A birth cohort of Latino children (N = 201) in San Francisco (recruited May 2006-May 2007) was followed until age 9 and assessed annually for obesity and dietary intake. Leukocyte telomere length was measured at 4 and 5 years (n = 102) and assessed as a predictor for obesity at age 9, adjusting for known risk factors. Furthermore, leukocyte telomere length at age 4 and 5 was evaluated as a possible mediator of the relationship between excessive sugar-sweetened beverage consumption and obesity at age 9. Shorter leukocyte telomere length in preschoolers was associated with obesity at age 9 (adjusted odds ratio 0.35, 95% confidence interval 0.13-0.94) after adjustment for known risk factors. Telomere length mediated 11% of the relationship between excessive sugar-sweetened beverage consumption and obesity. Shorter leukocyte telomere length may be an indicator of future obesity risk in high-risk populations as it is particularly sensitive to damage from oxidative stress exposure, including those from sugar-sweetened beverages.
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Affiliation(s)
- Thora Wesenberg Kjaer
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
- School of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Daniel Faurholt-Jepsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg C, Denmark
| | - Kala Mehta
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Vibeke Brix Christensen
- Department of Pediatrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Elissa Epel
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Jue Lin
- Department of Biophysics and Biochemistry, University of California, San Francisco, San Francisco, CA, USA
| | - Elizabeth Blackburn
- Department of Biophysics and Biochemistry, University of California, San Francisco, San Francisco, CA, USA
| | - Janet M. Wojcicki
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
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19
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Mehta K, Pajai A, Bhurke S, Shirkande A, Bhadade R, D'Souza R. Acute Kidney Injury of Infectious Etiology in Monsoon Season: A Prospective Study Using Acute Kidney Injury Network Criteria. Indian J Nephrol 2018; 28:143-152. [PMID: 29861565 PMCID: PMC5952453 DOI: 10.4103/ijn.ijn_355_16] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The epidemiological pattern of acute kidney injury (AKI) in tropical countries during monsoon reflects infectious disease as the most important cause. AKI is a confounding factor and may be overlooked by primary health-care providers and underreported in health statistics. The present study prospectively helps estimate the burden of disease and analyze etiology, clinical profile, and outcome in a tertiary care hospital of a metropolitan city in a tropical country. The study period included monsoon season of 2012 and 2013, a total of 8 months. AKI staging was done as per the AKI Network (AKIN) criteria. Patients were treated for primary disease. Renal replacement therapy (RRT) was given as required. Patients were followed up during hospitalization till recovery/death. Out of a total of 9930 admissions during this period, 1740 (17.52%) were for infections and 230 (2.31%) had AKI secondary to infectious diseases during monsoon. The incidence of AKI (230/1740) in infectious diseases during monsoon was 13.21%. The study population (n = 230) comprised 79.5% of males and the mean age was 40.95 ± 16.55 years. Severe AKI: AKIN Stage III was seen in 48.26% of patients and AKIN Stage I in 41.74%. The most common etiology of AKI was malaria (28.3%) followed by acute gastroenteritis (23%), dengue (16.5%), leptospirosis (13%), undifferentiated fever (10.4%), more than one etiology (5.4%), and enteric fever (3.5%). RRT was required in 44.78% of patients. Requirement for RRT was maximum in patients with more than one etiology followed by leptospirosis, malaria, dengue, and least in typhoid. The overall mortality was 12.17%. In multivariate analysis, vasopressor support and assisted ventilation were risk factors for mortality.
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Affiliation(s)
- K. Mehta
- Department of Nephrology, Topiwala National Medical College and B. Y. L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - A. Pajai
- Department of Nephrology, Topiwala National Medical College and B. Y. L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - S. Bhurke
- Department of Nephrology, Topiwala National Medical College and B. Y. L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - A. Shirkande
- Department of Nephrology, Topiwala National Medical College and B. Y. L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - R. Bhadade
- Department of Medicine, Topiwala National Medical College and B. Y. L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - R. D'Souza
- Department of Medicine, Topiwala National Medical College and B. Y. L. Nair Charitable Hospital, Mumbai, Maharashtra, India
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20
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Federspiel CK, Itenov TS, Mehta K, Hsu RK, Bestle MH, Liu KD. Duration of acute kidney injury in critically ill patients. Ann Intensive Care 2018; 8:30. [PMID: 29473104 PMCID: PMC5823799 DOI: 10.1186/s13613-018-0374-x] [Citation(s) in RCA: 34] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 02/10/2018] [Indexed: 12/28/2022] Open
Abstract
Background Duration of acute kidney injury (AKI) has been recognized a risk factor for adverse outcomes following AKI. We sought to examine the relationship of AKI duration and recurrent AKI with short-term outcomes in critically ill patients who were mechanically ventilated and met criteria for the acute respiratory distress syndrome. Methods Participants in the NHLBI ARDS Network SAILS multicenter trial who developed AKI were included in this analysis and divided into groups based on AKI duration. Differences in outcomes were evaluated using t test and Chi-square test. Competing risks regression and Cox regression were used to evaluate factors associated with resolving AKI and recurrent AKI. Results In total, 238 patients were included in the study. Seventy-seven patients had short duration AKI (1–2 days), 47 medium duration AKI (3–7 days), 87 persistent AKI (> 7 days) and 38 died during their AKI episode. Persistent AKI was associated with worse outcomes including increased ICU length of stay, time on the ventilator and days with cardiovascular failure. We found no clinical differences between patients with short and medium duration AKI, even when accounting for AKI severity and recurrent AKI. Patients with resolving AKI were less likely to have oliguria or moderate/severe ARDS on the day AKI criteria were met. Recurrent AKI was associated with poorer clinical outcomes. No baseline clinical factors were found to predict development of recurrent AKI. Conclusions In critically ill patients with sepsis-associated ARDS and AKI, the impact of short and medium duration AKI on clinical outcomes was modest. Persistent and recurrent AKI were both associated with worse clinical outcomes, emphasizing the importance of identifying these patients, who may benefit from novel interventions. Electronic supplementary material The online version of this article (10.1186/s13613-018-0374-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christine K Federspiel
- Division of Nephrology, Department of Medicine, University of California, San Francisco, Box 0532, San Francisco, CA, 94143-0532, USA.,Department of Anesthesiology, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Theis S Itenov
- Department of Anesthesiology, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kala Mehta
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, USA
| | - Raymond K Hsu
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Morten H Bestle
- Department of Anesthesiology, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kathleen D Liu
- Divisions of Nephrology and Critical Care Medicine, Departments of Medicine and Anesthesia, University of California, San Francisco, Box 0532, San Francisco, CA, 94143-0532, USA.
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21
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Villegas SL, Darb-Esfahani S, von Minckwitz G, Huober J, Weber K, Marmé F, Furlanetto J, Schem C, Pfitzner BM, Lederer B, Engels K, Kümmel S, Müller V, Mehta K, Denkert C, Loibl S. Expression of Cyclin D1 protein in residual tumor after neoadjuvant chemotherapy for breast cancer. Breast Cancer Res Treat 2017; 168:179-187. [PMID: 29177689 DOI: 10.1007/s10549-017-4581-1] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/15/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Hormone receptor (HR)-positive breast cancer (BC) shows a poor response to neoadjuvant chemotherapy (NACT). New treatment targets like the Cyclin D1-CDK4/CDK6 complex are promising adjuvant/post-neoadjuvant therapeutic strategies. Evaluating Cyclin D1 overexpression in residual tumor could recognize those patients that benefit most from such post-neoadjuvant treatment. In this study, we determined Cyclin D1 expression in residual BC after NACT. Secondary aims were to correlate Cyclin D1 expression levels with clinicopathological parameters and to assess its prognostic value after NACT. METHODS We retrospectively assessed the nuclear expression of Cyclin D1 on tissue microarrays with residual tumor from 284 patients treated in the neoadjuvant GeparTrio (n = 186) and GeparQuattro (n = 98) trials. Evaluation was performed with a standardized immunoreactive score (IRS) after selecting a cut-off value. RESULTS A high expression level (IRS ≥ 6) of Cyclin D1 was found in 37.3% of the assessed specimens. An increased Cyclin D1 expression was observed in HR-positive tumors, compared to HR-negative tumors (p = 0.02). Low Cyclin D1 levels correlated with clinical tumor stage 1-3 (p = 0.03). Among patients with HR-positive/Her2-negative tumors and high Cyclin D1 expression, a better disease-free survival (DFS) was graphically suggested, but not significant (p = 0.21). CONCLUSION Our study demonstrates a measurable nuclear expression of Cyclin D1 in post-neoadjuvant residual tumor tissue of HR-positive BC. Cyclin D1 expression was not prognostic for DFS after NACT. Our results and defined cut-off suggest that the marker can be used to stratify tumors according to protein expression levels. Based on this, a prospective evaluation is currently performed in the ongoing Penelope-B trial.
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Affiliation(s)
- S L Villegas
- Institute of Pathology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - S Darb-Esfahani
- Institute of Pathology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Institute of Pathology Spandau, Evangelisches Waldkrankenhaus, Stadtrandstr. 555, 13589, Berlin, Germany
| | - G von Minckwitz
- German Breast Group (GBG Forschungs GmbH), Martin-Behaim-Str. 12, 63263, Neu-Isenburg, Germany
| | - J Huober
- Department of Obstetrics and Gynecology, Ulm University, Ulm, Germany
| | - K Weber
- German Breast Group (GBG Forschungs GmbH), Martin-Behaim-Str. 12, 63263, Neu-Isenburg, Germany
| | - F Marmé
- National Center for Tumor Diseases, University-Hospital Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - J Furlanetto
- German Breast Group (GBG Forschungs GmbH), Martin-Behaim-Str. 12, 63263, Neu-Isenburg, Germany
| | - C Schem
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Hostein, Kiel, Germany
| | - B M Pfitzner
- Institute of Pathology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - B Lederer
- German Breast Group (GBG Forschungs GmbH), Martin-Behaim-Str. 12, 63263, Neu-Isenburg, Germany
| | - K Engels
- Zentrum für Pathologie, Zytologie und Molekularpathologie Neuss, Neuss, Germany
| | - S Kümmel
- Breast Unit Kliniken Essen-Mitte, Essen, Germany
| | - V Müller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - K Mehta
- German Breast Group (GBG Forschungs GmbH), Martin-Behaim-Str. 12, 63263, Neu-Isenburg, Germany
| | - C Denkert
- Institute of Pathology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. .,German Cancer Consortium (DKTK), Partner Site Charité, Berlin, Germany.
| | - S Loibl
- German Breast Group (GBG Forschungs GmbH), Martin-Behaim-Str. 12, 63263, Neu-Isenburg, Germany
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22
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Yeo G, Hikoyeda N, McBride M, Tzuang M, Grudzen M, Mehta K. FACULTY DEVELOPMENT IN ETHNOGERIATRICS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- G. Yeo
- Stanford University, Stanford, California,
| | | | | | - M. Tzuang
- Stanford University, Stanford, California,
- Johns Hopkins University, Baltimore, Maryland
| | | | - K. Mehta
- Stanford University, Stanford, California,
- University of California, San Francisco, San Francisco, California,
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23
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Miller E, Viswanathan S, Li S, Mehta K, Smith H, Smotkin D, Kuo D, Goldberg G, Einstein M, Frimer M. Adjuvant pelvic radiation sandwiched between paclitaxel/carboplatin chemotherapy in women with completely resected uterine serous carcinoma (USC): A prospective phase II trial update. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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24
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Jørgensen ME, Sanders RD, Køber L, Mehta K, Torp-Pedersen C, Hlatky MA, Pallisgaard JL, Shaw RE, Gislason GH, Jensen PF, Andersson C. Beta-blocker subtype and risks of perioperative adverse events following non-cardiac surgery: a nationwide cohort study. Eur Heart J 2017; 38:2421-2428. [DOI: 10.1093/eurheartj/ehx214] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 04/05/2017] [Indexed: 11/13/2022] Open
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25
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Lindauer A, Valiathan CR, Mehta K, Sriram V, de Greef R, Elassaiss-Schaap J, de Alwis DP. Translational Pharmacokinetic/Pharmacodynamic Modeling of Tumor Growth Inhibition Supports Dose-Range Selection of the Anti-PD-1 Antibody Pembrolizumab. CPT Pharmacometrics Syst Pharmacol 2016; 6:11-20. [PMID: 27863176 PMCID: PMC5270293 DOI: 10.1002/psp4.12130] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 08/29/2016] [Indexed: 12/30/2022]
Abstract
Pembrolizumab, a humanized monoclonal antibody against programmed death 1 (PD‐1), has a manageable safety profile and robust clinical activity against advanced malignancies. The lowest effective dose for evaluation in further dose‐ranging studies was identified by developing a translational model from preclinical mouse experiments. A compartmental pharmacokinetic model was combined with a published physiologically based tissue compartment, linked to receptor occupancy as the driver of observed tumor growth inhibition. Human simulations were performed using clinical pharmacokinetic data, literature values, and in vitro parameters for drug distribution and binding. Biological and mathematical uncertainties were included in simulations to generate expectations for dose response. The results demonstrated a minimal increase in efficacy for doses higher than 2 mg/kg. The findings of the translational model were successfully applied to select 2 mg/kg as the lowest dose for dose‐ranging evaluations.
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Affiliation(s)
- A Lindauer
- Merck & Co., Inc., Rahway, New Jersey, USA
| | | | - K Mehta
- Merck & Co., Inc., Rahway, New Jersey, USA
| | - V Sriram
- Merck & Co., Inc., Rahway, New Jersey, USA
| | - R de Greef
- Merck & Co., Inc., Rahway, New Jersey, USA
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26
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Dadayal G, Weston M, Young A, Graham J, Mehta K, Wilkinson N, Spencer J. Transvaginal ultrasound (TVUS)-guided biopsy is safe and effective in diagnosing peritoneal carcinomatosis and recurrent pelvic malignancy. Clin Radiol 2016; 71:1184-92. [DOI: 10.1016/j.crad.2016.06.119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 05/08/2016] [Accepted: 06/23/2016] [Indexed: 11/29/2022]
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27
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Jindal RM, Soni R, Mehta K, Patel TG. Incidence of diabetes and hypertension in indigenous Amerindian village in Guyana, South America. Indian J Nephrol 2016; 26:389-390. [PMID: 27795642 PMCID: PMC5015526 DOI: 10.4103/0971-4065.181471] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- R M Jindal
- Department of Surgery and Preventative Medicine and Biostatistics, Uniformed Services University of the Health Sciences and Walter Reed NNMC, Bethesda, MD, USA
| | - R Soni
- Department of Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA
| | - K Mehta
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - T G Patel
- Department of Medicine, Uniformed Service University, Bethesda, MD, USA
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28
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von Minckwitz G, Rezai M, Tesch H, Huober J, Gerber B, Zahm D, Hilfrich J, Costa S, Dubsky P, Blohmer J, Denkert C, Hanusch C, Jackisch C, Kümmel S, Fasching P, Schneeweiss A, Paepke S, Untch M, Burchardi N, Mehta K, Loibl S. Zoledronate for patients with invasive residual disease after anthracyclines-taxane-based chemotherapy for early breast cancer – The Phase III NeoAdjuvant Trial Add-oN (NaTaN) study (GBG 36/ABCSG 29). Eur J Cancer 2016; 64:12-21. [DOI: 10.1016/j.ejca.2016.05.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/27/2016] [Accepted: 05/14/2016] [Indexed: 11/25/2022]
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29
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Contrera KJ, Betz J, Deal J, Choi JS, Ayonayon HN, Harris T, Helzner E, Martin KR, Mehta K, Pratt S, Rubin SM, Satterfield S, Yaffe K, Simonsick EM, Lin FR. Association of Hearing Impairment and Anxiety in Older Adults. J Aging Health 2016; 29:172-184. [PMID: 26916793 DOI: 10.1177/0898264316634571] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of the study is was investigate the association between hearing impairment and anxiety. METHOD We conducted a cross-sectional analysis of 1,732 community-based adults aged 76 to 85 years who participated in the Health Aging and Body Composition (ABC) study. Logistic regression models were adjusted for demographic and cardiovascular risk factors. Hearing impairment was defined by the speech-frequency pure tone average. Anxiety was defined as reporting two symptoms of at least "a little" or one symptom "quite a bit" on the three-item Hopkins Symptom Checklist. RESULTS Compared with individuals with no hearing impairment, the odds of prevalent anxiety were higher among individuals with mild hearing impairment (odds ratio [OR] = 1.32, 95% confidence interval [CI] = [1.01, 1.73]) and moderate or greater hearing impairment (OR = 1.59, 95% CI = [1.14, 2.22]). Hearing aid use was not significantly associated with lower odds of anxiety. DISCUSSION Hearing impairment is independently associated with greater odds of anxiety symptoms in older adults.
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Affiliation(s)
| | - Josh Betz
- 1 Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | - Elizabeth Helzner
- 4 State University of New York Downstate Medical Center, Brooklyn, New York City, USA
| | - Kathryn R Martin
- 5 Institute of Applied Health Sciences School of Medicine and Dentistry, Aberdeen, UK
| | - Kala Mehta
- 6 VA Pittsburgh Healthcare System, PA, USA
| | - Sheila Pratt
- 1 Johns Hopkins University, Baltimore, MD, USA.,6 VA Pittsburgh Healthcare System, PA, USA
| | | | | | | | | | - Frank R Lin
- 1 Johns Hopkins University, Baltimore, MD, USA
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30
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Jindal RM, Mehta K, Soni R, Doyle A, Patel TG. Diabetes, hypertension, sanitation, and health education by high school students in Guyana, South America. Indian J Nephrol 2016; 26:192-8. [PMID: 27194834 PMCID: PMC4862265 DOI: 10.4103/0971-4065.161522] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We initiated a program for early detection of diabetes and hypertension, the main causes of kidney failure in Guyana, South America. We trained local high school students with the goal that these students would stay in the villages for long-term, become health advocates and shift the reliance away from physicians. This project involved 7 high school students who were taught to monitor the health of one village of 1000–1500 population each. The program will be implemented for 3 years in which the entire population of seven villages (approximately 10,000 people) will be covered. This represents 1.3% population in Guyana. We present data from the pilot study from the sample of 619 people. The prevalence of diabetes mellitus was 13.9%. Among diabetics, 33.7% were using insulin and 86% oral hypoglycemic agents. Prevalence of hypertension was 29.4%, 63.2% were overweight and 17% were obese. About 9.9% patients were unaware about the existence of hypertension. We have shown in our study that high school students can be used to collect health data and monitor diabetes and hypertension. There was also a significant incidence of undetected diabetes and hypertension.
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Affiliation(s)
- R M Jindal
- Department of Surgery, Division of Global Health, Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Medicine and Surgery, The George Washington University, Washington, DC, USA
| | - K Mehta
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - R Soni
- Department of Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA
| | - A Doyle
- Department of Medicine, Drexel University School of Medicine, Philadelphia, PA, USA
| | - T G Patel
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Mehta K, Narreddy S, Rao S N. Congenital Syphilis: Complicating an already complex adoption process. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.734] [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: 11/24/2022] Open
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Contrera KJ, Betz J, Deal JA, Choi JS, Ayonayon HN, Harris T, Helzner E, Martin KR, Mehta K, Pratt S, Rubin SM, Satterfield S, Yaffe K, Garcia M, Simonsick EM, Lin FR. Association of Hearing Impairment and Emotional Vitality in Older Adults. J Gerontol B Psychol Sci Soc Sci 2016; 71:400-4. [PMID: 26883806 DOI: 10.1093/geronb/gbw005] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [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: 10/05/2015] [Accepted: 01/11/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To better understand the potential impact of hearing impairment (HI) and hearing aid use on emotional vitality and mental health in older adults. METHOD We investigated the cross-sectional association of HI with emotional vitality in 1,903 adults aged 76-85 years in the Health ABC study adjusted for demographic and cardiovascular risk factors. Hearing was defined by the speech frequency pure tone average (no impairment < 25 dB, mild impairment 25-40 dB, and moderate or greater impairment > 40 dB). Emotional vitality was defined as having a high sense of personal mastery, happiness, low depressive symptomatology, and low anxiety. RESULTS Compared with individuals with no HI, participants with moderate or greater HI had a 23% lower odds of emotional vitality (odds ratio [OR] = 0.77; 95% confidence interval [CI]: 0.59-0.99). Hearing aid use was not associated with better emotional vitality (OR = 0.98; 95% CI: 0.81-1.20). DISCUSSION HI is associated with lower odds of emotional vitality in older adults. Further studies are needed to examine the longitudinal impact of HI on mental health and well-being.
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Affiliation(s)
- Kevin J Contrera
- School of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Josh Betz
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Jennifer A Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Janet S Choi
- School of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hilsa N Ayonayon
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Tamara Harris
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, Maryland
| | - Elizabeth Helzner
- Department of Epidemiology and Biostatistics, State University of New York Downstate Medical Center, Brooklyn
| | - Kathryn R Martin
- Institute of Applied Health Sciences School of Medicine and Dentistry, University of Aberdeen, Scotland
| | - Kala Mehta
- Division of Geriatrics, Department of Medicine University of California, San Francisco
| | - Sheila Pratt
- School of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pennsylvania
| | - Susan M Rubin
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Kristine Yaffe
- Department of Psychiatry and Department of Neurology, University of California, San Francisco
| | - Melissa Garcia
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland
| | - Eleanor M Simonsick
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland
| | - Frank R Lin
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland. Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.
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Denkert C, Budczies J, Regan M, Loibl S, Dell'Orto P, von Minckwitz G, Mastropasqua M, Mehta K, Müller V, Kammler R, Pfitzner BM, Fasching PA, Viale G. Abstract P5-07-02: Systematic analysis and modulation of Ki67 interobserver variance in 9069 patients from three clinical trials – How much pathologist concordance is needed for meaningful biomarker results? Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p5-07-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Ki67 has been suggested as a marker for diagnosis of luminal A and B breast carcinomas. Interestingly, on one hand a multitude of studies have described significant results for Ki67 as a prognostic marker, while on the other hand the analytical validation and standardization of this marker has been a challenge. The best parameter for Ki67 interobserver performance is the interclass correlation coefficient (ICC). ICC values between 0.59 and 0.92 have been reported. Recently a minimum ICC of 0.8 has been suggested as a goal for the international ring trial and as a prerequisite for introduction of Ki67 into clinical practice. However, this suggested ICC is not derived from analysis of data, and the amount of pathologist variance that is allowed for meaningful biomarker results is still not defined.
Methods: This study is based on a total of 9069 tumor samples from three large clinical cohorts (IBCSG VIII+IX, BIG1-98, and GeparTrio). In a systematic modeling approach, we introduced different amounts of variance to previously generated central pathology Ki67 datasets by simulation of a total of 1800 different pathologist evaluations for each study cohort. These evaluations were grouped into groups with defined ICCs, ranging from very good concordance (ICC=0.9) to extremely poor concordance (ICC=0.1). For each of the simulated pathologist evaluations, all possible Ki67 cutoffs were systematically evaluated using the web-based software Cutoff Finder (http://molpath.charite.de/cutoff/). As endpoints, we used DFS for all three study cohorts as well as pCR for the neoadjuvant cohort.
Results: For the neoadjuvant GeparTrio study, the different groups with ICCs of 0.8, 0.6 and 0.4 showed a very similar performance resulting in significant analyses for prediction of pCR across a wide range of cutoffs. The odd ratios for pCR were slightly lower with lower ICC. Even with an extremely low ICC of 0.2, 99% of the analyses had one or more significant cutpoints.
The survival endpoint DFS was shown to be very stable despite increased interpathologist variance in all three clinical cohorts. Even with a poor ICC of 0.4, the majority of cutpoints were significant for DFS. For IBCSG VIII+IX 85% of the analyses with an ICC of 0.4 had one or more significant cutpoints for Ki67. In the large BIG 1-98 dataset (n=6090) even an ICC of 0.2 resulted in one or more significant DFS cutpoints in 100% of the analyses. Comparable results were obtained if the analysis was restricted to luminal tumors.
Conclusion: Our results suggest that Ki67 is extremely robust to pathologist variation. Even if less than 40% of the variance is attributable to true Ki67-based proliferation (ICC<0.4), this percentage of information is sufficient to obtain statistically significant differences. This stable performance of Ki67 might provide an explanation for the observation that many Ki67 studies achieve significant results despite the interobserver variance and heterogeneity issues. It might also suggest a relevant clinical utility for Ki67 despite considerable variation introduced in the evaluation. Ongoing efforts to further reduce interobserver variability, however, should be continued.
Citation Format: Denkert C, Budczies J, Regan M, Loibl S, Dell'Orto P, von Minckwitz G, Mastropasqua M, Mehta K, Müller V, Kammler R, Pfitzner BM, Fasching PA, Viale G. Systematic analysis and modulation of Ki67 interobserver variance in 9069 patients from three clinical trials – How much pathologist concordance is needed for meaningful biomarker results?. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-07-02.
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Affiliation(s)
- C Denkert
- Charité University Hospital - Institute of Pathology, Berlin, Germany; Dana-Farber Cancer Institute, Boston; German Breast Group, Neu-Isenburg, Germany; Istituto Europeo di Oncologia, Milano, Italy; Universitätsklinikum Eppendorf, Hamburg, Germany; IBCSG Coordinating Center, Bern, Switzerland; University of Erlangen, Erlangen, Germany
| | - J Budczies
- Charité University Hospital - Institute of Pathology, Berlin, Germany; Dana-Farber Cancer Institute, Boston; German Breast Group, Neu-Isenburg, Germany; Istituto Europeo di Oncologia, Milano, Italy; Universitätsklinikum Eppendorf, Hamburg, Germany; IBCSG Coordinating Center, Bern, Switzerland; University of Erlangen, Erlangen, Germany
| | - M Regan
- Charité University Hospital - Institute of Pathology, Berlin, Germany; Dana-Farber Cancer Institute, Boston; German Breast Group, Neu-Isenburg, Germany; Istituto Europeo di Oncologia, Milano, Italy; Universitätsklinikum Eppendorf, Hamburg, Germany; IBCSG Coordinating Center, Bern, Switzerland; University of Erlangen, Erlangen, Germany
| | - S Loibl
- Charité University Hospital - Institute of Pathology, Berlin, Germany; Dana-Farber Cancer Institute, Boston; German Breast Group, Neu-Isenburg, Germany; Istituto Europeo di Oncologia, Milano, Italy; Universitätsklinikum Eppendorf, Hamburg, Germany; IBCSG Coordinating Center, Bern, Switzerland; University of Erlangen, Erlangen, Germany
| | - P Dell'Orto
- Charité University Hospital - Institute of Pathology, Berlin, Germany; Dana-Farber Cancer Institute, Boston; German Breast Group, Neu-Isenburg, Germany; Istituto Europeo di Oncologia, Milano, Italy; Universitätsklinikum Eppendorf, Hamburg, Germany; IBCSG Coordinating Center, Bern, Switzerland; University of Erlangen, Erlangen, Germany
| | - G von Minckwitz
- Charité University Hospital - Institute of Pathology, Berlin, Germany; Dana-Farber Cancer Institute, Boston; German Breast Group, Neu-Isenburg, Germany; Istituto Europeo di Oncologia, Milano, Italy; Universitätsklinikum Eppendorf, Hamburg, Germany; IBCSG Coordinating Center, Bern, Switzerland; University of Erlangen, Erlangen, Germany
| | - M Mastropasqua
- Charité University Hospital - Institute of Pathology, Berlin, Germany; Dana-Farber Cancer Institute, Boston; German Breast Group, Neu-Isenburg, Germany; Istituto Europeo di Oncologia, Milano, Italy; Universitätsklinikum Eppendorf, Hamburg, Germany; IBCSG Coordinating Center, Bern, Switzerland; University of Erlangen, Erlangen, Germany
| | - K Mehta
- Charité University Hospital - Institute of Pathology, Berlin, Germany; Dana-Farber Cancer Institute, Boston; German Breast Group, Neu-Isenburg, Germany; Istituto Europeo di Oncologia, Milano, Italy; Universitätsklinikum Eppendorf, Hamburg, Germany; IBCSG Coordinating Center, Bern, Switzerland; University of Erlangen, Erlangen, Germany
| | - V Müller
- Charité University Hospital - Institute of Pathology, Berlin, Germany; Dana-Farber Cancer Institute, Boston; German Breast Group, Neu-Isenburg, Germany; Istituto Europeo di Oncologia, Milano, Italy; Universitätsklinikum Eppendorf, Hamburg, Germany; IBCSG Coordinating Center, Bern, Switzerland; University of Erlangen, Erlangen, Germany
| | - R Kammler
- Charité University Hospital - Institute of Pathology, Berlin, Germany; Dana-Farber Cancer Institute, Boston; German Breast Group, Neu-Isenburg, Germany; Istituto Europeo di Oncologia, Milano, Italy; Universitätsklinikum Eppendorf, Hamburg, Germany; IBCSG Coordinating Center, Bern, Switzerland; University of Erlangen, Erlangen, Germany
| | - BM Pfitzner
- Charité University Hospital - Institute of Pathology, Berlin, Germany; Dana-Farber Cancer Institute, Boston; German Breast Group, Neu-Isenburg, Germany; Istituto Europeo di Oncologia, Milano, Italy; Universitätsklinikum Eppendorf, Hamburg, Germany; IBCSG Coordinating Center, Bern, Switzerland; University of Erlangen, Erlangen, Germany
| | - PA Fasching
- Charité University Hospital - Institute of Pathology, Berlin, Germany; Dana-Farber Cancer Institute, Boston; German Breast Group, Neu-Isenburg, Germany; Istituto Europeo di Oncologia, Milano, Italy; Universitätsklinikum Eppendorf, Hamburg, Germany; IBCSG Coordinating Center, Bern, Switzerland; University of Erlangen, Erlangen, Germany
| | - G Viale
- Charité University Hospital - Institute of Pathology, Berlin, Germany; Dana-Farber Cancer Institute, Boston; German Breast Group, Neu-Isenburg, Germany; Istituto Europeo di Oncologia, Milano, Italy; Universitätsklinikum Eppendorf, Hamburg, Germany; IBCSG Coordinating Center, Bern, Switzerland; University of Erlangen, Erlangen, Germany
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Tzuang M, Mehta K, Askari N, Gallagher-Thompson D. O3‐08‐01: Tailoring the coping with caregiving evidence‐based program for ethnic/racial minority communities. Alzheimers Dement 2015. [DOI: 10.1016/j.jalz.2015.07.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Kala Mehta
- University of CaliforniaSan FranciscoCAUSA
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Singh S, Pokharel P, Raut P, Mehta K. Study of the effects of pesticide exposure among the workers of tea
estates. Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.1026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Hong M, Bendavid E, Mehta K. HealthTrax: A new tool to identify and navigate dirt roads for health
outreach work in Southern Zambia. Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.939] [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: 11/26/2022] Open
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Tartaglia MC, Hu B, Mehta K, Neuhaus J, Yaffe K, Miller BL, Boxer A. Demographic and neuropsychiatric factors associated with off-label medication use in frontotemporal dementia and Alzheimer's disease. Alzheimer Dis Assoc Disord 2015; 28:182-9. [PMID: 23995817 DOI: 10.1097/wad.0b013e3182a7159d] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Off-label medication use for treating cognitive impairments and neuropsychiatric symptoms occurs in frontotemporal dementia (FTD) and Alzheimer disease (AD). We compared the use of cognitive and psychiatric medications in FTD and AD and evaluated the relationship between neuropsychiatric symptoms and medication use. METHODS Cognitive and psychiatric medication use, demographic variables, and Neuropsychiatric Inventory (NPI) subscale symptoms were obtained from the National Alzheimer's Coordinating Center Uniform Data Set (n=3958, 8.1% FTD). Bivariate statistics and logistic regressions were calculated to evaluate which demographic or NPI subscale symptoms predicted medication use. RESULTS Although cognitive medication was used more commonly in AD (78%), it was also commonly used off-label in FTD (56%). Psychiatric medications were in greater use in FTD than in AD (68% vs. 45%, respectively, P<0.001). In FTD, cognitive medication use was associated with elevated NPI elation scores and psychiatric medication use was associated with history of prior psychiatric disease. In AD, demographic variables (white, longer disease duration, higher education, more severe disease, or being male) were most predictive of cognitive medication use, whereas having psychiatric disease, being white, having longer disease duration, being younger, greater disease severity, and being disinhibited or anxious were associated with psychiatric medication use. Off-label antipsychotics were used by 4.7% of patients with AD and 10% of patients with FTD. CONCLUSIONS Our results revealed significant off-label medication use in both FTD and AD. A notable finding from this study was the lack of consistent relationships between medication use and neuropsychiatric symptoms across the 2 illnesses.
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Affiliation(s)
- Maria Carmela Tartaglia
- *Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, ON †Department of Neurology, Memory and Aging Center §Department of Psychiatry, University of California, San Francisco ‡Stanford Geriatric Education Center, Stanford University School of Medicine, Palo Alto, CA
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Kuo H, Tome W, FOX J, Hong L, Yaparpalvi R, Mehta K, Huang Y, Bodner W, Kalnicki S. TU-F-18C-09: Mammogram Surveillance Using Texture Analysis for Breast Cancer Patients After Radiation Therapy. Med Phys 2014. [DOI: 10.1118/1.4889354] [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: 11/07/2022] Open
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Abstract
The findings of the 4 preceding country studies are examined here from a comparative perspective identifying some of the similarities and differences that underlie living arrangements of the elderly. More specifically, we compare the normative basis underlying living arrangements, mechanisms that help perpetuate co-residence, strains inherent to co-residence, preferences for co-residents, alternative forms of living arrangements, and views of social changes in relation to living arrangements. Overall, the focus group data on which the studies are based highlight the importance of culture in influencing the living arrangements of elderly people in Asia. The results suggest that at least for the next generation, co-residential living by elderly with children will continue to be a viable option, although the extent to which it persists is likely to vary among the 4 countries studied.
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Affiliation(s)
- M M Asis
- Department of Sociology, University of the Philippines, Dilman, 1101, Quexon City, Philippines
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Cortazar P, Zhang L, Untch M, Mehta K, Constantino J, Wolmark N, Bonnefoi H, Piccart M, Gianni L, Valagussa P, Zujewski JA, Justice R, Loibl S, Swain SM, Bogaerts J, Baselga J, Prowell TM, Rastogi P, Sridhara R, Tang S, Pazdur R, Mamounas E, von Minckwitz G. Abstract P5-17-01: A definition of a high-risk early-breast cancer population based on data from the collaborative trials in neoadjuvant breast cancer (CTNeoBC) meta-analysis. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p5-17-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Pathological complete response (pCR) is a proposed surrogate endpoint for predicting long-term clinical benefit on endpoints such as event-free survival (EFS) or overall survival (OS). The CTNeoBC meta-analysis did not validate the surrogacy of pCR for EFS or OS, and there is no precedent for its use as a regulatory endpoint in oncology. Use of the accelerated approval pathway has been proposed for neoadjuvant therapies that substantially improve pCR as a means to expedite widespread access to highly effective therapies for high-risk, early breast cancer. Potential risks of this approach include approving an agent that ultimately does not demonstrate clinical benefit and, in the interim, exposing curable patients to the toxicity of therapy without certainty of benefit. To mitigate the risks of this pathway, enrollment to neoadjuvant trials intended to support accelerated approval should be restricted to patients presenting with high-risk early-stage breast cancer. The 5-year EFS rate by breast cancer subtype in the CTNeoBC meta-analysis population is presented. Methods: We identified 12 neoadjuvant randomized trials (N = 12,993) with pCR clearly defined and long-term follow-up available for EFS and OS. Trials included AGO 1 (n = 668), ECTO (n = 1355), EORTC 10994/BIG 1-00 (n = 1856), GeparDuo (n = 907), GeparQuattro (n = 1495), GeparTrio (n = 2072), GeparTrio-Pilot (n = 285), NOAH (n = 234), NSABP B18 (n = 760), NSABP B27 (n = 2411), PREPARE (n = 733), and TECHNO (n = 217). The key objective of this analysis was to establish a definition of “high-risk” based on the Kaplan-Meier estimates of the 5-year EFS rate in the different clinical breast cancer subtypes (hormone receptor-positive, HER2-positive and triple-negative) analyzed by tumor stage and tumor grade at presentation. Results: The 5-year EFS rate was less than 65% in all the breast cancer subtypes with stage III disease. For patients with stage II disease, the impact of tumor grade varied by hormone receptor status. Patients with hormone receptor-negative breast cancer, regardless of HER2 status had a poor prognosis that was independent of tumor grade. For patients with hormone receptor-positive tumors, regardless of HER2 status, high grade histology was associated with an increased risk of recurrence.
5-year Event-Free Survival Rate (EFS) 5-year EFS Rate Estimate (95% confidence interval)TNMStage IIStage III Grade IIGrade IIIGrade IIGrade IIIHormone Receptor + HER2-83% (80%, 85%)71% (65%, 77%)63% (58%, 69%)51% (42%, 59%)HER2+ HR+81% (75%, 86%)69% (60%, 76%)50% (41%, 59%)48% (37%, 59%)HER2+ HR-61% (51%, 70%)66% (57%, 73%)58% (46%, 69%)46% (36%, 55%)Triple Negative66% (58%, 72%)72% (67%, 76%)38% (27%, 48%)37% (29%, 45%)
Conclusions: This analysis estimated the 5-year EFS rate in the breast cancer subtypes from the CTNeoBC meta-analysis population. The HER2-positive population in the meta-analysis was at particularly high risk because most of the patients had locally advanced breast cancer and only 39% of these patients received trastuzumab therapy. We propose defining less than 75% 5-year EFS rate as “high-risk” for the purposes of designing neoadjuvant trials that intend to use pCR to support accelerated approval.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-17-01.
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Affiliation(s)
- P Cortazar
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - L Zhang
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - M Untch
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - K Mehta
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - J Constantino
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - N Wolmark
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - H Bonnefoi
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - M Piccart
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - L Gianni
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - P Valagussa
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - JA Zujewski
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - R Justice
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - S Loibl
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - SM Swain
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - J Bogaerts
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - J Baselga
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - TM Prowell
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - P Rastogi
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - R Sridhara
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - S Tang
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - R Pazdur
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - E Mamounas
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - G von Minckwitz
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
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von Minckwitz G, Rezai M, Eidtmann H, Tesch H, Huober J, Gerber B, Zahn DM, Costa S, Gnant M, Blohmer JU, Denkert C, Hanusch C, Jackisch C, Kümmel S, Fasching PA, Schneeweiss A, Paepke S, Untch M, Nekljudova V, Mehta K, Loibl S. Abstract S5-05: Postneoadjuvant treatment with zoledronate in patients with tumor residuals after anthracyclines-taxane-based chemotherapy for primary breast cancer – The phase III NATAN study (GBG 36/ABCSG XX). Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-s5-05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Patients with residual disease after neoadjuvant chemotherapy (NACT) are considered to have chemoresistant breast cancer. Adjuvant treatment with bisphosphonates is considered to reduce the relapse risk predominantly in estrogen-deprivated patients.
Methods: Patients who had invasive tumor residuals (ypT1-4 or ypN+) after a minimum of 4 cycles of anthracycline-taxane-containing NACT were eligible to the NATAN study. Patients were randomized within 3 years after surgery to receive zoledronate 4 mg i.v. (plus 1000 mg Ca2+ and 880 I.U. vitamin D daily) for 5 years vs. observation. Zoledronate was given q 4 weeks for the first 6 months, q 3 months the following 2 years, and q 6 months for the last 2.5 years. Patients with hormone receptor (HR)-positive disease received letrozole for 5 years if postmenopausal, or tamoxifen, if premenopausal. Adjuvant trastuzumab for HER2-positive disease was allowed since an amendment in 2007. Stratification factors were HR, time since surgery, age, and center. Primary objective was event-free survival (EFS). 654 patients and 316 events were required to observe an increase of 5yr EFS from 58% to 67.2% (hazard ratio 0.73). Secondary objectives were to determine overall survival, EFS with respect to the interval between surgery and randomization, bone-metastasis-free-survival, toxicity of and compliance to zoledronate, the predictive value of breast tumor response to NACT on the effect of postoperative treatment and the prognostic impact of chemotherapy induced amenorrhea in premenopausal patients. An interim analysis for high efficacy at 158 observed events was planned in the protocol; in agreement with study IDMC a Bayesian analysis for futility with futility boundary of 15% will be performed at the same time.
Results: Between 2/2005 and 5/2009 693 patients were enrolled. Time between surgery and randomization was <4 months in 48.4%, 4-12 months in 34.5%, and 13-36 months in 17.1% of patients. The median age was 50.9 yrs (range 33.7-88.2), 72.3% of patients were postmenopausal. 82% had HR-positive and 19% HER2-positive disease. During a median follow up of 48 months 154 events were observed so far.
Conclusion: This is the first post-neoadjuvant phase III study. Analysis of the primary endpoint will be presented in case the IDMC will release of the results of the futility analysis.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr S5-05.
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Affiliation(s)
- G von Minckwitz
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - M Rezai
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - H Eidtmann
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - H Tesch
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - J Huober
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - B Gerber
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - DM Zahn
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - S Costa
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - M Gnant
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - JU Blohmer
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - C Denkert
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - C Hanusch
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - C Jackisch
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - S Kümmel
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - PA Fasching
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - A Schneeweiss
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - S Paepke
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - M Untch
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - V Nekljudova
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - K Mehta
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - S Loibl
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
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von Minckwitz G, Rezai M, Fasching PA, Huober J, Tesch H, Bauerfeind I, Hilfrich J, Eidtmann H, Gerber B, Hanusch C, Blohmer JU, Costa SD, Jackisch C, Paepke S, Schneeweiss A, Kümmel S, Denkert C, Mehta K, Loibl S, Untch M. Survival after adding capecitabine and trastuzumab to neoadjuvant anthracycline-taxane-based chemotherapy for primary breast cancer (GBG 40--GeparQuattro). Ann Oncol 2013; 25:81-9. [PMID: 24273046 DOI: 10.1093/annonc/mdt410] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [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: 01/19/2023] Open
Abstract
BACKGROUND The GeparQuattro study showed that adding capecitabine or prolonging the duration of anthracycline-taxane-based neoadjuvant chemotherapy from 24 to 36 weeks did not increase pathological complete response (pCR) rates. Trastuzumab-treated patients with HER2-positive disease showed a higher pCR rate than patients with HER2-negative disease treated with chemotherapy alone. We here present disease-free (DFS) and overall survival (OS) analyses. PATIENTS AND METHODS Patients (n = 1495) with cT ≥ 3 tumors, or negative hormone-receptor status, or positive hormone-receptor and clinically node-positive disease received four times epirubicin/cyclophosphamide and were thereafter randomly assigned to four times docetaxel (Taxotere), or four times docetaxel/capecitabine over 24 weeks, or four times docetaxel followed by capecitabine over 36 weeks. Patients with HER2-positive tumors received 1 year of trastuzumab, starting with the first chemotherapy cycle. Follow-up was available for a median of 5.4 years. RESULTS Outcome was not improved for patients receiving capecitabine (HR 0.92; P = 0.463 for DFS and HR 93; P = 0.618 for OS) as well as for patients receiving 36 weeks of chemotherapy (HR 0.97; P = 0.818 for DFS and HR 0.97; P = 0.825 for OS). Trastuzumab-treated patients with HER2-positive disease showed similar DFS (P = 0.305) but a significantly better adjusted OS (P = 0.040) when compared with patients with HER2-negative disease treated with chemotherapy alone. Recorded long-term cardiac toxicity was low. CONCLUSIONS Long-term results, similar to the results of pCR, do not support the use of capecitabine in the neoadjuvant setting in addition to an anthracycline-taxane-based chemotherapy. However, the results support previous data showing a benefit of trastuzumab as predicted by higher pCR rates.
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Baliga S, Mehta K, Goldberg G, Kalnicki S. Stereotactic Body Radiation Therapy in Oligo-Metastatic Recurrent Ovarian Cancer. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Pahlajani D, Kaul U, Mishra A, Mullasari A, Sawhney J, Dargad R, Mehta K, Sinha N. Prospective pre-test and clinical scoring in subjects with suspected coronary disease estimates the probability of coronary artery disease: the Prospective Stable Angina Observational registry, India. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sinn BV, von Minckwitz G, Denkert C, Eidtmann H, Darb-Esfahani S, Tesch H, Kronenwett R, Hoffmann G, Belau A, Thommsen C, Holzhausen HJ, Grasshoff ST, Baumann K, Mehta K, Dietel M, Loibl S. Evaluation of Mucin-1 protein and mRNA expression as prognostic and predictive markers after neoadjuvant chemotherapy for breast cancer. Ann Oncol 2013; 24:2316-24. [PMID: 23661292 DOI: 10.1093/annonc/mdt162] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Mucin-1 (MUC1) is a promising antigen for the development of tumor vaccines. We evaluated the frequency of MUC1 expression and its impact on therapy response and survival after neoadjuvant chemotherapy for breast cancer. PATIENTS AND METHODS Pre-treatment core biopsies of patients from the GeparTrio neoadjuvant trial (NCT 00544765) were evaluated for MUC1 by immunohistochemistry (IHC; N = 691) and quantitative RT-PCR (qRT-PCR; N = 286) from formalin-fixed paraffin-embedded (FFPE) samples. RESULTS MUC1 protein and mRNA was detectable in the majority of cases and was associated with hormone-receptor-positive status (P < 0.001). High MUC1 protein and mRNA expression were associated with lower probability of pathologic complete response (P = 0.017 and P < 0.001) and with longer patient survival (P = 0.03 and P < 0.001). In multivariable analysis, MUC1 protein and mRNA expression were independently predictive (P = 0.001 and P < 0.001). MUC1 protein and mRNA expression were independently prognostic for overall survival (P = 0.029 and P = 0.015). CONCLUSIONS MUC1 is frequently expressed in breast cancer and detectable on mRNA and protein level from FFPE tissue. It provides independent predictive information for therapy response and survival after neoadjuvant chemotherapy. In clinical immunotherapy trials, MUC1 expression may serve as a predictive marker.
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Affiliation(s)
- B V Sinn
- Department of Pathology, Charité-Universitätsmedizin Berlin, Berlin.
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Mayo AM, Wallhagen M, Cooper BA, Mehta K, Ross L, Miller B. The relationship between functional status and judgment/problem solving among individuals with dementia. Int J Geriatr Psychiatry 2013; 28:514-21. [PMID: 22786576 PMCID: PMC3496819 DOI: 10.1002/gps.3854] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 02/02/2012] [Accepted: 06/14/2012] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine the relationship between functional status (independent activities of daily living) and judgment/problem solving and the extent to which select demographic characteristics such as dementia subtype and cognitive measures may moderate that relationship in older adult individuals with dementia. METHODS The National Alzheimer's Coordinating Center Universal Data Set was accessed for a study sample of 3,855 individuals diagnosed with dementia. Primary variables included functional status, judgment/problem solving, and cognition. RESULTS Functional status was related to judgment/problem solving (r = 0.66; p < 0.0005). Functional status and cognition jointly predicted 56% of the variance in judgment/problem solving (R(2) = 0.56, p < 0.0005). As cognition decreases, the prediction of poorer judgment/problem solving by functional status became stronger. CONCLUSIONS Among individuals with a diagnosis of dementia, declining functional status as well as declining cognition should raise concerns about judgment/problem solving.
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Affiliation(s)
- Ann M. Mayo
- Hahn School of Nursing & Health Science; University of San Diego; San Diego CA USA
| | | | - Bruce A. Cooper
- University of California San Francisco; San Francisco CA USA
| | - Kala Mehta
- University of California San Francisco; San Francisco CA USA
| | - Leslie Ross
- University of California San Francisco; San Francisco CA USA
| | - Bruce Miller
- University of California San Francisco; San Francisco CA USA
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Mansor L, Mehta K, L Page L, Carr C, Clarke K, Heather L. 234 IMPAIRED METABOLIC AND FUNCTIONAL ADAPTATION TO HYPOXIA IN THE TYPE 2 DIABETIC HEART. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bernstein M, Yaparpalvi R, Kuo H, Kalnicki S, Mehta K. CT-Guidance Allows Interstitial Implantation in an Outpatient Setting for Cervical Cancer Patients. Pract Radiat Oncol 2013; 3:S1. [PMID: 24674470 DOI: 10.1016/j.prro.2013.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - H Kuo
- Montefiore Medical Center, Bronx, NY
| | | | - K Mehta
- Montefiore Medical Center, Bronx, NY
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Glanzman J, Weiss P, Mehta K, Bodner W, Kalnicki S, Garg M. PO-0986: Surgical resection followed by HDR brachytherapy for management of keloids at high risk for recurrence. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33292-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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