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Zhang F, McGuire K, Skeeters M, Barbara M, Chang PF, Zhang N, Xiang J, Huang B. Cognitive Functions and Subjective Hearing in Cochlear Implant Users. J Audiol Otol 2024:jao.2023.00276. [PMID: 38685833 DOI: 10.7874/jao.2023.00276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/15/2023] [Indexed: 05/02/2024] Open
Abstract
Background and Objectives : A cochlear implant (CI) is an effective prosthetic device used to treat severe-to-profound hearing loss. The present study examined cognitive function in CI users by employing a web-based cognitive testing platform, i.e., BrainCheck, and explored the correlation between cognitive function and subjective evaluation of hearing. Subjects and Methods : Forty-two CI users (mean age: 58.90 years) were surveyed in the subjective evaluation of hearing, and 20/42 participated in the BrainCheck cognitive tests (immediate recognition, Trail Making A, Trail Making B, Stroop, digit symbol substitution, and delayed recognition). As controls for cognitive function, young normal-hearing (YNH, mean age=23.83 years) and older normal-hearing (ONH, mean age=52.67 years) listener groups were subjected to Brain- Check testing. Results : CI users exhibited poorer cognitive function than the normal hearing groups in all tasks except for immediate and delayed recognition. The highest percentage of CI users who had "possible" and "likely" cognitive impairment, based on BrainCheck scores (ranging from 0-200), was observed in tests assessing executive function. The composite cognitive score across domains tended to be related to subjective hearing (p=0.07). Conclusions : The findings of the current study suggest that CI users had a higher likelihood of cognitive impairment in the executive function domain than in lower-level domains. BrianCheck online cognitive testing affords a convenient and effective tool to self-evaluate cognitive function in CI users.
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Affiliation(s)
- Fawen Zhang
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Kelli McGuire
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Madeline Skeeters
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Matthew Barbara
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Pamara F Chang
- Department of Information & Logistics Technology, College of Technology, University of Houston, Houston, TX, USA
| | - Nanhua Zhang
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jing Xiang
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Baramidze A, Gogishvili M, Melkadze T, Giorgadze D, Penkov K, Makharadze T, Kalinka E, Nechaeva M, Laktionov K, Gessner C, Moreno Jaime B, Passalacqua R, Garassino M, Li S, Pouliot JF, McGuire K, Quek R, Kaul M, Gullo G, Rietschel P. 122MO Cemiplimab (cemi) + platinum doublet chemotherapy (chemo) + ipilimumab (ipi) for first-line treatment of advanced non-small cell lung cancer (NSCLC): EMPOWER-Lung 3 part I. Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100234] [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: 12/14/2022]
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3
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Gogishvili M, Melkadze T, Makharadze T, Giorgadze D, Dvorkin M, Penkov K, Laktionov K, Nemsadze G, Nechaeva M, Rozhkova I, Kalinka E, Gessner C, Moreno Jaime B, Passalacqua R, Li S, McGuire K, Quek R, Gullo G, Rietschel P. 318P EMPOWER-Lung 3: Cemiplimab in combination with platinum doublet chemotherapy for first-line (1L) treatment of advanced non-small cell lung cancer (NSCLC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.361] [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: 12/05/2022] Open
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Kerr K, Perez J, McGuire K, Baker B, Fang F, Li J, Wlasiuk G, Li S, Gao B, Pouliot JF, Seebach F, Lowy I, Gullo G, Rietschel P. 114P Clinical interchangeability of programmed cell death-ligand 1 (PD-L1) immunohistochemistry (IHC) assays for the treatment of first-line (1L) non-small cell lung cancer (NSCLC) with cemiplimab. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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McGuire K, Firestone GM, Zhang N, Zhang F. The Acoustic Change Complex in Response to Frequency Changes and Its Correlation to Cochlear Implant Speech Outcomes. Front Hum Neurosci 2021; 15:757254. [PMID: 34744668 PMCID: PMC8566680 DOI: 10.3389/fnhum.2021.757254] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/01/2021] [Indexed: 12/12/2022] Open
Abstract
One of the biggest challenges that face cochlear implant (CI) users is the highly variable hearing outcomes of implantation across patients. Since speech perception requires the detection of various dynamic changes in acoustic features (e.g., frequency, intensity, timing) in speech sounds, it is critical to examine the ability to detect the within-stimulus acoustic changes in CI users. The primary objective of this study was to examine the auditory event-related potential (ERP) evoked by the within-stimulus frequency changes (F-changes), one type of the acoustic change complex (ACC), in adult CI users, and its correlation to speech outcomes. Twenty-one adult CI users (29 individual CI ears) were tested with psychoacoustic frequency change detection tasks, speech tests including the Consonant-Nucleus-Consonant (CNC) word recognition, Arizona Biomedical Sentence Recognition in quiet and noise (AzBio-Q and AzBio-N), and the Digit-in-Noise (DIN) tests, and electroencephalographic (EEG) recordings. The stimuli for the psychoacoustic tests and EEG recordings were pure tones at three different base frequencies (0.25, 1, and 4 kHz) that contained a F-change at the midpoint of the tone. Results showed that the frequency change detection threshold (FCDT), ACC N1' latency, and P2' latency did not differ across frequencies (p > 0.05). ACC N1'-P2 amplitude was significantly larger for 0.25 kHz than for other base frequencies (p < 0.05). The mean N1' latency across three base frequencies was negatively correlated with CNC word recognition (r = -0.40, p < 0.05) and CNC phoneme (r = -0.40, p < 0.05), and positively correlated with mean FCDT (r = 0.46, p < 0.05). The P2' latency was positively correlated with DIN (r = 0.47, p < 0.05) and mean FCDT (r = 0.47, p < 0.05). There was no statistically significant correlation between N1'-P2' amplitude and speech outcomes (all ps > 0.05). Results of this study indicated that variability in CI speech outcomes assessed with the CNC, AzBio-Q, and DIN tests can be partially explained (approximately 16-21%) by the variability of cortical sensory encoding of F-changes reflected by the ACC.
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Affiliation(s)
- Kelli McGuire
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH, United States
| | - Gabrielle M. Firestone
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH, United States
| | - Nanhua Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Fawen Zhang
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH, United States
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Banti C, Kourkoumelis N, Hatzidimitriou A, Antoniadou I, Dimou A, Rallis M, Hoffmann A, Schmidtke M, McGuire K, Busath D, Kolocouris A, Hadjikakou S. Amantadine copper(II) chloride conjugate with possible implementation in influenza virus inhibition. Polyhedron 2020. [DOI: 10.1016/j.poly.2020.114590] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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McGuire K, Lorenz R. 0229 Exploring the Relationships Between Sleep, Stress, and Performance in Simulation-Based Learning. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.227] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
Sleep deprivation and stress may affect performance among students. Simulation-based learning (SBL) in undergraduate nursing programs provides the opportunity for students to practice critical decision-making without fear of patient harm; however, students still report experiencing stress during SBL. Current research is unclear on the effect of sleep deprivation combined with stress on performance in SBL. The purpose of this study was to explore the association between stress, functional outcomes of sleep, and performance in SBL.
Methods
Elements of the Theory of Stress, Appraisal, and Coping and the National League for Nursing Jeffries Nursing Education Simulation Framework guided this study. Baccalaureate nursing students consented to participate in a 1-hour SBL experience that included the collection of one hair and 4 saliva samples for cortisol concentration. Participants completed the Functional Outcomes of Sleep- Short Form and the Perceived Stress Questionnaire. An experienced faculty member evaluated student performance using the Creighton Competency Evaluation Inventory.
Results
Participants (N=35) were mainly female (n=32, 91.4%), white (n=29, 82.9%), with ages ranging between 18–22 years (n=32, 91.4%), and employed outside of nursing school (n=32, 91.4%). Other ethnicities represented include Asian and African American. Kendall’s Tau correlations revealed a significant relationship between functional outcomes of sleep and perceived stress (r=-.281, p=.020). Although not significant, a small relationship was observed between functional outcomes of sleep and performance (r=.145, p=.236). No significant relationship between performance and perceived stress (r=-.099, p=.423) was identified.
Conclusion
This study suggests that daytime dysfunction related to sleep is related to perceived stress and performance in undergraduate nursing students during participation in SBL. Due likely to small sample size, the relationship between sleep and performance was unable to achieve significance. These findings support the need for future research exploring the effects of sleep on stress and performance with larger more heterogeneous samples of students.
Support
This researcher would like to acknowledge and thank the following funding sources for their generous support of this work: Marion Bender Scholarship (Saint Louis University School of Nursing), Dissertation Award from Sigma Theta Tau International-Epsilon Eta Chapter, and Southern Illinois University Edwardsville School of Nursing Faculty Scholar Award.
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Affiliation(s)
- K McGuire
- Southern Illinois University Edwardsville, Edwardsville, IL
| | - R Lorenz
- State University of New York at Buffalo, Buffalo, NY
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Firestone GM, McGuire K, Liang C, Zhang N, Blankenship CM, Xiang J, Zhang F. A Preliminary Study of the Effects of Attentive Music Listening on Cochlear Implant Users' Speech Perception, Quality of Life, and Behavioral and Objective Measures of Frequency Change Detection. Front Hum Neurosci 2020; 14:110. [PMID: 32296318 PMCID: PMC7136537 DOI: 10.3389/fnhum.2020.00110] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 03/11/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Most cochlear implant (CI) users have difficulty in listening tasks that rely strongly on perception of frequency changes (e.g., speech perception in noise, musical melody perception, etc.). Some previous studies using behavioral or subjective assessments have shown that short-term music training can benefit CI users’ perception of music and speech. Electroencephalographic (EEG) recordings may reveal the neural basis for music training benefits in CI users. Objective To examine the effects of short-term music training on CI hearing outcomes using a comprehensive test battery of subjective evaluation, behavioral tests, and EEG measures. Design Twelve adult CI users were recruited for a home-based music training program that focused on attentive listening to music genres and materials that have an emphasis on melody. The participants used a music streaming program (i.e., Pandora) downloaded onto personal electronic devices for training. The participants attentively listened to music through a direct audio cable or through Bluetooth streaming. The training schedule was 40 min/session/day, 5 days/week, for either 4 or 8 weeks. The pre-training and post-training tests included: hearing thresholds, Speech, Spatial and Qualities of Hearing Scale (SSQ12) questionnaire, psychoacoustic tests of frequency change detection threshold (FCDT), speech recognition tests (CNC words, AzBio sentences, and QuickSIN), and EEG responses to tones that contained different magnitudes of frequency changes. Results All participants except one finished the 4- or 8-week training, resulting in a dropout rate of 8.33%. Eleven participants performed all tests except for two who did not participate in EEG tests. Results showed a significant improvement in the FCDTs as well as performance on CNC and QuickSIN after training (p < 0.05), but no significant improvement in SSQ scores (p > 0.05). Results of the EEG tests showed larger post-training cortical auditory evoked potentials (CAEPs) in seven of the nine participants, suggesting a better cortical processing of both stimulus onset and within-stimulus frequency changes. Conclusion These preliminary data suggest that extensive, focused music listening can improve frequency perception and speech perception in CI users. Further studies that include a larger sample size and control groups are warranted to determine the efficacy of short-term music training in CI users.
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Affiliation(s)
- Gabrielle M Firestone
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH, United States
| | - Kelli McGuire
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH, United States
| | - Chun Liang
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH, United States
| | - Nanhua Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Chelsea M Blankenship
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH, United States
| | - Jing Xiang
- Department of Pediatrics and Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Fawen Zhang
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH, United States
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Zhang F, Underwood G, McGuire K, Liang C, Moore DR, Fu QJ. Frequency change detection and speech perception in cochlear implant users. Hear Res 2019; 379:12-20. [PMID: 31035223 DOI: 10.1016/j.heares.2019.04.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 12/03/2018] [Revised: 03/21/2019] [Accepted: 04/15/2019] [Indexed: 10/27/2022]
Abstract
Dynamic frequency changes in sound provide critical cues for speech perception. Most previous studies examining frequency discrimination in cochlear implant (CI) users have employed behavioral tasks in which target and reference tones (differing in frequency) are presented statically in separate time intervals. Participants are required to identify the target frequency by comparing stimuli across these time intervals. However, perceiving dynamic frequency changes in speech requires detection of within-interval frequency change. This study explored the relationship between detection of within-interval frequency changes and speech perception performance of CI users. Frequency change detection thresholds (FCDTs) were measured in 20 adult CI users using a 3-alternative forced-choice (3AFC) procedure. Stimuli were 1-sec pure tones (base frequencies at 0.25, 1, 4 kHz) with frequency changes occurring 0.5 s after the tone onset. Speech tests were 1) Consonant-Nucleus-Consonant (CNC) monosyllabic word recognition, 2) Arizona Biomedical Sentence Recognition (AzBio) in Quiet, 3) AzBio in Noise (AzBio-N, +10 dB signal-to-noise/SNR ratio), and 4) Digits-in-noise (DIN). Participants' subjective satisfaction with the CI was obtained. Results showed that correlations between FCDTs and speech perception were all statistically significant. The satisfaction level of CI use was not related to FCDTs, after controlling for major demographic factors. DIN speech reception thresholds were significantly correlated to AzBio-N scores. The current findings suggest that the ability to detect within-interval frequency changes may play an important role in speech perception performance of CI users. FCDT and DIN can serve as simple and rapid tests that require no or minimal linguistic background for the prediction of CI speech outcomes.
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Affiliation(s)
- Fawen Zhang
- Department of Communication Sciences and Disorders, University of Cincinnati, Ohio, USA.
| | - Gabrielle Underwood
- Department of Communication Sciences and Disorders, University of Cincinnati, Ohio, USA
| | - Kelli McGuire
- Department of Communication Sciences and Disorders, University of Cincinnati, Ohio, USA
| | - Chun Liang
- Department of Communication Sciences and Disorders, University of Cincinnati, Ohio, USA; Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, China
| | - David R Moore
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Otolaryngology, University of Cincinnati, Ohio, USA
| | - Qian-Jie Fu
- Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA, USA
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Keene KS, King T, Hwang ES, Peng B, McGuire K, Tapia C, Zhang H, Bae S, Nakhlis F, Klauber-Demore N, Meszoely I, Sabel MS, Willey SC, Eterovic KA, Hudis C, Wolff A, De Los Santos J, Thompson A, Mills GB, Meric-Bernstam F. Abstract P3-04-01: Molecular determinants of post-mastectomy breast cancer recurrence. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-04-01] [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
Introduction
The management of breast cancer (BC) patients who undergo mastectomy in the setting of 1-3 positive lymph nodes has been controversial. This retrospective Translational Breast Cancer Research Consortium study evaluated the molecular aberrations associated with locoregional recurrence (LRR) or distant metastasis (DM) compared to controls in an effort to identify molecular predictors associated with recurrence.
Methods/Materials
We identified 115 HER2 negative, therapy naïve, T 1-3 and N 0-1 BC patients treated with mastectomy and no post mastectomy radiation therapy from 1997 to present with available FFPE tissue blocks. The cohort included 32 patients with LRR, 34 with DM, and 49 controls (without recurrence) who were matched for stage, grade, hormone receptor status, age ≤ or > 50, chemotherapy receipt, and margin status. Matched primary and recurrent LRR samples were available for 3 patients. Hybrid capture next generation sequencing (NGS) of 142 cancer related genes and RNAseq were performed to identify DNA/RNA alterations associated with LRR or DM. The frequency of common alterations on NGS was compared with Fisher's exact test. Expression of each gene from mRNA-Seq was treated as an explanatory variable. Immunohistochemistry (IHC) was performed for PTEN, Ki-67 and cleaved caspase 3 (CC3). PTEN loss and percentage of Ki-67 and CC3 positive cells were compared between groups with Fisher's exact test and nonparametric methods, respectively.
Results
RNAseq was performed on 115 patients; there was no difference in RNA expression levels between the groups. DNA analysis was performed on 57 patients (17 LRR, 15 DM and 25 controls), NF1 mutation rate was significantly elevated in both the LRR (24%) and DM (27%) samples compared to controls 0%; (p=0.0070). The mitogen activated protein kinase (MAPK) pathway was significantly mutated in both LRR (47%) and DM (40%) samples compared to the controls 0%; (p<0.0001). There was no significant difference in the rate of alterations of the PI3K/Akt/mTOR pathway among the three groups. Of three patients with matched primary vs LRR samples, one had concordant mutations. The second patient had additional mutations in the LRR, including gain of a NF1 mutation. The third patient had complete discordance of mutations identified in primary and LRR and had gain of HER2 amplification, suggestive of a new primary. There was no significant association between the groups and the loss of PTEN expression or CC3 expression. There was a significant difference between Ki 67 positive cells in patients with LRR (mean 29%), DM (mean 26%) versus controls (mean 14%, p= 0.0011). HR+ patients were significantly more likely to have a positive PTEN, lower Ki-67 and lower CC3 expression, p=0.0004, p<0.0001, and p<0.0001 respectively.
Conclusions
In this matched cohort analysis, mutations in the MAPK pathway, specifically NF1, were associated with both LRR and DM, suggesting that alterations in this pathway are associated with a more aggressive tumor phenotype. However, there were no molecular features that discriminated between those likely to recur locally alone versus distantly. Further study is needed to validate these findings, and to determine whether targeting alterations in this pathway could decrease the risk of recurrence.
Citation Format: Keene KS, King T, Hwang ES, Peng B, McGuire K, Tapia C, Zhang H, Bae S, Nakhlis F, Klauber-Demore N, Meszoely I, Sabel MS, Willey SC, Eterovic KA, Hudis C, Wolff A, De Los Santos J, Thompson A, Mills GB, Meric-Bernstam F. Molecular determinants of post-mastectomy breast cancer recurrence [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-04-01.
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Affiliation(s)
- KS Keene
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - T King
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - ES Hwang
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - B Peng
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - K McGuire
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - C Tapia
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - H Zhang
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - S Bae
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - F Nakhlis
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - N Klauber-Demore
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - I Meszoely
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - MS Sabel
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - SC Willey
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - KA Eterovic
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - C Hudis
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - A Wolff
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - J De Los Santos
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - A Thompson
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - GB Mills
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
| | - F Meric-Bernstam
- University of Alabama at Birmingham, Birmingham, AL; Dana Farber Cancer Institute, Boston, MA; Duke University, Durham, NC; MD Anderson Cancer Center, Houston, TX; University of North Carolina at Chapel Hill, Chapel Hill, NC; Medical University of South Carolina, Charleston, SC; Vanderbilt University, Nashville, TN; University of Michigan, Ann Arbor, MI; Georgetown, Washington, DC; Memorial Sloan Kettering Cancer Center, New York, NY; John Hopkins University, Baltimore, MD
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Murakami M, Arunasalam V, Bell J, Bell M, Bitter M, Blanchard W, Boody F, Boyd D, Bretz N, Bush C, Callen J, Cecchi J, Colchin R, Coonrod J, Davis S, Dimock D, Dylla H, Efthimion P, Emerson L, England A, Eubank H, Fonck R, Fredrickson E, Furth H, Grisham L, von Goeler S, Goldston R, Grek B, Grove D, Hawryluk R, Hendel H, Hill K, Hulse R, Johnson D, Johnson L, Kaita R, Kamperschroer J, Kaye S, Kikuchi M, Kilpatrick S, Kugel H, LaMarche P, Little R, Ma C, Manos D, Mansfield D, McCarthy M, McCann R, McCune D, McGuire K, Meade D, Medley S, Mikkelsen D, Mueller D, Nieschmidt E, Owens D, Pare V, Park H, Prichard B, Ramsey A, Rasmussen D, Roquemore A, Rutherford P, Sauthoff N, Schivell J, Schwob JL, Scott S, Sesnic S, Shimada M, Simpkins J, Sinnis J, Stauffer F, Stratton B, Suckewer S, Tait G, Taylor G, Tenney F, Thomas C, Towner H, Ulrickson M, Wieland R, Williams M, Wong KL, Wouters A, Yamada H, Yoshikawa S, Young K, Zarnstorff M. Confinement Studies In TFTR. ACTA ACUST UNITED AC 2017. [DOI: 10.13182/fst85-a40115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- M. Murakami
- Permanent Address: Oak Ridge National Laboratory, Oak Ridge, TN
| | - V. Arunasalam
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - J.D. Bell
- Permanent Address: Oak Ridge National Laboratory, Oak Ridge, TN
| | - M.G. Bell
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - M. Bitter
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - W.R. Blanchard
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - F. Boody
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - D. Boyd
- Permanent Address: University of Maryland, College Park, MD
| | - N. Bretz
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - C.E. Bush
- Permanent Address: Oak Ridge National Laboratory, Oak Ridge, TN
| | - J.D. Callen
- Permanent Address: University of Wisconsin, Madison, WI
| | - J.L. Cecchi
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - R.J. Colchin
- Permanent Address: Oak Ridge National Laboratory, Oak Ridge, TN
| | - J. Coonrod
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - S.L. Davis
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - D. Dimock
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - H.F. Dylla
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - P.C. Efthimion
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - L.C. Emerson
- Permanent Address: Oak Ridge National Laboratory, Oak Ridge, TN
| | - A.C. England
- Permanent Address: Oak Ridge National Laboratory, Oak Ridge, TN
| | - H.P. Eubank
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - R. Fonck
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - E. Fredrickson
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - H.P. Furth
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - L.R. Grisham
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - S. von Goeler
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - R.J. Goldston
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - B. Grek
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - D.J. Grove
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - R.J. Hawryluk
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - H. Hendel
- Permanent Address: RCA David Sarnoff Research Center, Princeton, NJ
| | - K.W. Hill
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - R. Hulse
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - D. Johnson
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - L.C. Johnson
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - R. Kaita
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - J. Kamperschroer
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - S.M. Kaye
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - M. Kikuchi
- Permanent Address: Japan Atomic Energy Research Institute, Japan
| | - S. Kilpatrick
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - H. Kugel
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - P.H. LaMarche
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - R. Little
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - C.H. Ma
- Permanent Address: Oak Ridge National Laboratory, Oak Ridge, TN
| | - D. Manos
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - D. Mansfield
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - M. McCarthy
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - R.T. McCann
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - D.C. McCune
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - K. McGuire
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - D.M. Meade
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - S.S. Medley
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - D.R. Mikkelsen
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - D. Mueller
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | | | - D.K. Owens
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - V.K. Pare
- Permanent Address: Oak Ridge National Laboratory, Oak Ridge, TN
| | - H. Park
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - B. Prichard
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - A. Ramsey
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - D.A. Rasmussen
- Permanent Address: Oak Ridge National Laboratory, Oak Ridge, TN
| | - A.L. Roquemore
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - P.H. Rutherford
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - N.R. Sauthoff
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - J. Schivell
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - J-L. Schwob
- Permanent Address: Hebrew University of Jerusalem, Israel
| | - S.D Scott
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - S. Sesnic
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - M. Shimada
- Permanent Address: Japan Atomic Energy Research Institute, Japan
| | - J.E. Simpkins
- Permanent Address: Oak Ridge National Laboratory, Oak Ridge, TN
| | - J. Sinnis
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - F. Stauffer
- Permanent Address: University of Maryland, College Park, MD
| | - B. Stratton
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - S. Suckewer
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - G.D. Tait
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - G. Taylor
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - F. Tenney
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - C.E. Thomas
- Permanent Address: Oak Ridge National Laboratory, Oak Ridge, TN
| | - H.H. Towner
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - M. Ulrickson
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - R. Wieland
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - M. Williams
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - K-L. Wong
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - A. Wouters
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - H. Yamada
- Permanent Address: Univeristy of Tokyo, Japan
| | - S. Yoshikawa
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - K.M Young
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
| | - M.C. Zarnstorff
- Plasma Physics Laboratory, Princeton University P.O. Box 451, Princeton, NJ 08544
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Hyslop T, Alvarado M, Forero A, Golshan M, Hieken T, Horton J, Hudis C, McGuire K, Meric-Bernstam F, Nanda R, Zagar T, Hwang S. Abstract S3-06: Treatment outcomes in patients with invasive breast cancer treated with neoadjuvant systemic therapy and breast MR imaging: Results of a secondary analysis of TBCRC 017. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-s3-06] [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:Neoadjuvant chemotherapy (NCT) is used frequently to downstage locally advanced tumors and facilitate breast conservation. However, we have previously reported that achievement of radiographic complete response (rCR) or pathologic complete response (pCR) does not impact choice of surgery for many patients. This secondary analysis reports treatment outcomes across 9 NCI comprehensive cancer centers in women receiving both NCT and breast MR imaging to assess whether treatment outcomes among women receiving NCT differs according to choice of locoregional treatment.
Methods:1077 women from 9 institutions were retrospectively identified as having undergone NCT with MR imaging obtained both before and after systemic treatment. Systemic treatment regimen was not prespecified, but receipt of at least 80% of all planned cycles was required prior to final MR imaging. We performed a univariate analysis as well as a multivariable Cox proportional hazard regression to identify covariates associated with overall survival (OS), disease-free survival (DFS) and time to recurrence (TTR). rCR was defined as no residual enhancement on post-treatment breast MRI.
Results:1077 patients diagnosed and treated with NCT for stage I-III invasive breast cancer from January 1, 2002 to June 16, 2014 were analyzed for all endpoints. Median follow-up was 4.2 years, (range 0.1 to 13 years). Median age of the cohort was 50 years, (range 19-87 years). 473 (43.9%) had ER(+) and/or PR(+)/HER2(-) disease, 348 (32.3%) had HER2(+) disease, and 256 (23.8%) had ER(-)/PR(-)/HER2(-) (triple negative) disease. Mastectomy or breast conserving therapy (BCT) was recorded as the definitive surgery in 675 (62.7%) and 402 (37.3%) of patients, respectively. Radiation receipt was confirmed in 84.1% of BCT and 68.3% of mastectomy patients. Overall there were 134 recurrences, 168 disease events and 89 deaths. Among patients with pCR, there were 7/161 (7.2%) recurrences in those undergoing mastectomy and 6/143 (5.1%) in those undergoing lumpectomy (p=0.81). Among patients who achieved an rCR, there were recurrences in 5% of those undergoing mastectomy and 2.9% in those undergoing lumpectomy (p=0.53). In multivariable analysis of the entire cohort, only clinical stage, ER status and pCR remained independently associated with DFS. Notably, subset analysis showed that lumpectomy was independently associated with improved TTR (HR 0.40; 95% CI 0.17-0.97) in the triple negative group only, but this did not translate into improved DFS with lumpectomy in this group. Radiographic CR as determined by breast MRI accurately predicted presence or absence of pCR in 74% of cases, but was not independently associated with DFS, OS or TTP.
Conclusions:Among a contemporary cohort of women receiving neoadjuvant systemic therapy and breast MR imaging at 9 NCI designated cancer centers, type of surgery did not impact DFS, OS or TTP. The only exception was found in the triple negative group in which the lumpectomy group had a more favorable TTP compared to the mastectomy group. These findings provide additional evidence that in women who are appropriate candidates for lumpectomy after NCT, BCT does not compromise long-term cancer outcomes.
Citation Format: De Los Santos J, Hyslop T, Alvarado M, Forero A, Golshan M, Hieken T, Horton J, Hudis C, McGuire K, Meric-Bernstam F, Nanda R, Zagar T, Hwang S. Treatment outcomes in patients with invasive breast cancer treated with neoadjuvant systemic therapy and breast MR imaging: Results of a secondary analysis of TBCRC 017. [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 S3-06.
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Affiliation(s)
- T Hyslop
- University of Alabama at Birmingham, Birmingham, AL; Duke Cancer Institute, Durham, NC; University of California San Francisco, San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University School of Medicine, Durham, NC; Memorial Sloan Kettering Cancer Center, NY, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Chicago Medicine, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - M Alvarado
- University of Alabama at Birmingham, Birmingham, AL; Duke Cancer Institute, Durham, NC; University of California San Francisco, San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University School of Medicine, Durham, NC; Memorial Sloan Kettering Cancer Center, NY, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Chicago Medicine, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - A Forero
- University of Alabama at Birmingham, Birmingham, AL; Duke Cancer Institute, Durham, NC; University of California San Francisco, San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University School of Medicine, Durham, NC; Memorial Sloan Kettering Cancer Center, NY, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Chicago Medicine, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - M Golshan
- University of Alabama at Birmingham, Birmingham, AL; Duke Cancer Institute, Durham, NC; University of California San Francisco, San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University School of Medicine, Durham, NC; Memorial Sloan Kettering Cancer Center, NY, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Chicago Medicine, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - T Hieken
- University of Alabama at Birmingham, Birmingham, AL; Duke Cancer Institute, Durham, NC; University of California San Francisco, San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University School of Medicine, Durham, NC; Memorial Sloan Kettering Cancer Center, NY, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Chicago Medicine, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - J Horton
- University of Alabama at Birmingham, Birmingham, AL; Duke Cancer Institute, Durham, NC; University of California San Francisco, San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University School of Medicine, Durham, NC; Memorial Sloan Kettering Cancer Center, NY, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Chicago Medicine, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - C Hudis
- University of Alabama at Birmingham, Birmingham, AL; Duke Cancer Institute, Durham, NC; University of California San Francisco, San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University School of Medicine, Durham, NC; Memorial Sloan Kettering Cancer Center, NY, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Chicago Medicine, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - K McGuire
- University of Alabama at Birmingham, Birmingham, AL; Duke Cancer Institute, Durham, NC; University of California San Francisco, San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University School of Medicine, Durham, NC; Memorial Sloan Kettering Cancer Center, NY, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Chicago Medicine, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - F Meric-Bernstam
- University of Alabama at Birmingham, Birmingham, AL; Duke Cancer Institute, Durham, NC; University of California San Francisco, San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University School of Medicine, Durham, NC; Memorial Sloan Kettering Cancer Center, NY, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Chicago Medicine, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - R Nanda
- University of Alabama at Birmingham, Birmingham, AL; Duke Cancer Institute, Durham, NC; University of California San Francisco, San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University School of Medicine, Durham, NC; Memorial Sloan Kettering Cancer Center, NY, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Chicago Medicine, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - T Zagar
- University of Alabama at Birmingham, Birmingham, AL; Duke Cancer Institute, Durham, NC; University of California San Francisco, San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University School of Medicine, Durham, NC; Memorial Sloan Kettering Cancer Center, NY, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Chicago Medicine, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - S Hwang
- University of Alabama at Birmingham, Birmingham, AL; Duke Cancer Institute, Durham, NC; University of California San Francisco, San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University School of Medicine, Durham, NC; Memorial Sloan Kettering Cancer Center, NY, NY; University of Pittsburgh Medical Center, Pittsburgh, PA; The University of Texas MD Anderson Cancer Center, Houston, TX; The University of Chicago Medicine, Chicago, IL; University of North Carolina at Chapel Hill, Chapel Hill, NC
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Fackler MJ, Bujanda ZL, Umbricht C, Teo WW, Zhang Z, Visvanathan K, Jeter S, Argani P, Wang C, Ingle JN, Boughey J, McGuire K, King TA, Carey LA, Cope LA, Wolff AC, Sukumar S. Abstract P2-06-01: cMethDNA is a quantitative circulating methylated DNA assay for detection of metastatic breast cancer and for monitoring response to therapy. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p2-06-01] [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- The ability to consistently detect cell-free tumor-specific DNA in peripheral blood of patients with metastatic breast cancer provides the opportunity to detect changes in tumor burden and to monitor response to treatment. Studies of cell-free DNA in the peripheral blood of breast cancer patients suggest that methylated DNA markers in serum or plasma could be used for detection of advanced disease, monitoring of therapeutic response, and for early detection of disease recurrence.
Methods- A genome-wide serum DNA methylome array (Illumina HumanMethylation27 BeadChip) analysis was conducted on cell-free circulating DNA in serum from women with stage IV recurrent breast cancer, and 232 key CpG loci were identified. Methylation for this panel of 10 gene loci was evaluated using our newly developed cMethDNA assay to detect miniscule amounts of methylated DNA in Training and Test sets of sera from a total of 112 women (n = 55 normal, n = 57 metastatic breast cancer). The clinical sensitivity and specificity of the assay, along with technical reproducibility, was determined. To evaluate the concordance of DNA methylation patterns, the 10 gene panel was tested on 22 DNA sets of primary tumor, metastases and serum from the same patient. Finally, the ability of cMethDNA to monitor response to therapy was evaluated in 28 patients with metastatic disease.
Results- A normal laboratory threshold of 7 cumulative methylation units was set and assay parameters were locked, based on Receiver Operating Characteristic (ROC) analyses of DNA from 300 ul of patient sera in the Training set (normal, n = 28; cancer, n = 24; 92% sensitivity, 96% specificity, and AUC = 0.950). Evaluation of the Test set of patient sera (normal, n = 27; cancer n = 33) resulted in detection of metastatic breast cancer with 91% sensitivity, 100% specificity, and AUC = 0.994 (0.984-1.005, p<0.0001). Reproducibility of the cMethDNA assay increased with copy number; with the highest variation at 50 copies (CV = 29.1%) and the lowest at 3,200 copies (CV = 2.5%) of methylated DNA. The test was shown to be operator independent (ICC = 0.99). Evaluation of concordance between primary and disseminated tumor methylation showed that the methylation pattern from any given individual is highly conserved between serum, primary tissue and their metastases, and poorly conserved between different individuals. cMethDNA analysis of 28 patients before and after initiation of therapy showed a decrease in cumulative methylation in women with stable/responsive disease and a correlation with disease progression free survival (p<0.0001).
Conclusion- Together, our data suggest that the cMethDNA test 1) can detect tumor DNA shed into blood, 2) reflect the methylation alterations typical of the primary tumor and its metastatic lesions, and 3) reflect response to treatment after chemotherapy. Next, we will test the clinical utility of cMethDNA in independent clinical trial sample sets where it's complementary and independent roles will be examined against CA15.3 and CTC assays.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-06-01.
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Affiliation(s)
- MJ Fackler
- Johns Hopkins University School of Medicine, Baltimore, MD; Memorial Sloan-Kettering Cancer Center, NY, NY; Mayo Clinic, Rochester, MN; University of Pittsburgh Medical Center, Pittsburgh, PA; University of North Carolina, Chapel Hill, NC
| | - ZL Bujanda
- Johns Hopkins University School of Medicine, Baltimore, MD; Memorial Sloan-Kettering Cancer Center, NY, NY; Mayo Clinic, Rochester, MN; University of Pittsburgh Medical Center, Pittsburgh, PA; University of North Carolina, Chapel Hill, NC
| | - C Umbricht
- Johns Hopkins University School of Medicine, Baltimore, MD; Memorial Sloan-Kettering Cancer Center, NY, NY; Mayo Clinic, Rochester, MN; University of Pittsburgh Medical Center, Pittsburgh, PA; University of North Carolina, Chapel Hill, NC
| | - WW Teo
- Johns Hopkins University School of Medicine, Baltimore, MD; Memorial Sloan-Kettering Cancer Center, NY, NY; Mayo Clinic, Rochester, MN; University of Pittsburgh Medical Center, Pittsburgh, PA; University of North Carolina, Chapel Hill, NC
| | - Z Zhang
- Johns Hopkins University School of Medicine, Baltimore, MD; Memorial Sloan-Kettering Cancer Center, NY, NY; Mayo Clinic, Rochester, MN; University of Pittsburgh Medical Center, Pittsburgh, PA; University of North Carolina, Chapel Hill, NC
| | - K Visvanathan
- Johns Hopkins University School of Medicine, Baltimore, MD; Memorial Sloan-Kettering Cancer Center, NY, NY; Mayo Clinic, Rochester, MN; University of Pittsburgh Medical Center, Pittsburgh, PA; University of North Carolina, Chapel Hill, NC
| | - S Jeter
- Johns Hopkins University School of Medicine, Baltimore, MD; Memorial Sloan-Kettering Cancer Center, NY, NY; Mayo Clinic, Rochester, MN; University of Pittsburgh Medical Center, Pittsburgh, PA; University of North Carolina, Chapel Hill, NC
| | - P Argani
- Johns Hopkins University School of Medicine, Baltimore, MD; Memorial Sloan-Kettering Cancer Center, NY, NY; Mayo Clinic, Rochester, MN; University of Pittsburgh Medical Center, Pittsburgh, PA; University of North Carolina, Chapel Hill, NC
| | - C Wang
- Johns Hopkins University School of Medicine, Baltimore, MD; Memorial Sloan-Kettering Cancer Center, NY, NY; Mayo Clinic, Rochester, MN; University of Pittsburgh Medical Center, Pittsburgh, PA; University of North Carolina, Chapel Hill, NC
| | - JN Ingle
- Johns Hopkins University School of Medicine, Baltimore, MD; Memorial Sloan-Kettering Cancer Center, NY, NY; Mayo Clinic, Rochester, MN; University of Pittsburgh Medical Center, Pittsburgh, PA; University of North Carolina, Chapel Hill, NC
| | - J Boughey
- Johns Hopkins University School of Medicine, Baltimore, MD; Memorial Sloan-Kettering Cancer Center, NY, NY; Mayo Clinic, Rochester, MN; University of Pittsburgh Medical Center, Pittsburgh, PA; University of North Carolina, Chapel Hill, NC
| | - K McGuire
- Johns Hopkins University School of Medicine, Baltimore, MD; Memorial Sloan-Kettering Cancer Center, NY, NY; Mayo Clinic, Rochester, MN; University of Pittsburgh Medical Center, Pittsburgh, PA; University of North Carolina, Chapel Hill, NC
| | - TA King
- Johns Hopkins University School of Medicine, Baltimore, MD; Memorial Sloan-Kettering Cancer Center, NY, NY; Mayo Clinic, Rochester, MN; University of Pittsburgh Medical Center, Pittsburgh, PA; University of North Carolina, Chapel Hill, NC
| | - LA Carey
- Johns Hopkins University School of Medicine, Baltimore, MD; Memorial Sloan-Kettering Cancer Center, NY, NY; Mayo Clinic, Rochester, MN; University of Pittsburgh Medical Center, Pittsburgh, PA; University of North Carolina, Chapel Hill, NC
| | - LA Cope
- Johns Hopkins University School of Medicine, Baltimore, MD; Memorial Sloan-Kettering Cancer Center, NY, NY; Mayo Clinic, Rochester, MN; University of Pittsburgh Medical Center, Pittsburgh, PA; University of North Carolina, Chapel Hill, NC
| | - AC Wolff
- Johns Hopkins University School of Medicine, Baltimore, MD; Memorial Sloan-Kettering Cancer Center, NY, NY; Mayo Clinic, Rochester, MN; University of Pittsburgh Medical Center, Pittsburgh, PA; University of North Carolina, Chapel Hill, NC
| | - S Sukumar
- Johns Hopkins University School of Medicine, Baltimore, MD; Memorial Sloan-Kettering Cancer Center, NY, NY; Mayo Clinic, Rochester, MN; University of Pittsburgh Medical Center, Pittsburgh, PA; University of North Carolina, Chapel Hill, NC
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Polat AV, Soran A, Andacoglu O, Kamali Polat A, McGuire K, Diego E, Johnson R. The importance of pre-operative needle core breast biopsy results on resected tissue volume, margin status, and cosmesis. J BUON 2013; 18:601-607. [PMID: 24065470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE This study aimed to evaluate the relationship between pre-operative image-guided large needle core biopsy (LNCB) histopathology results and surgical resection volumes in breast conserving surgery (BCS), with attention to both margin status and cosmetic outcome. METHODS Breast volumes (BV) were calculated using the elliptical cone based formula on mammography images for each patient. Initial resected volume (IRV), final resected volume (FRV), and resected volume ratio (RVR) were calculated and compared according to histopathological diagnosis and cosmetic outcomes. Final pathology results were classified as benign, high risk lesion (HRL), ductal carcinoma in situ (DCIS), or invasive cancer. The cosmetic results were graded based on the Harvard breast cosmesis grading scale. RESULTS A total of 217 women underwent BCS by the same experienced breast surgeon. The resected volumes (mean, cm3) were higher among patients who underwent LNCB than those who did not (54.3 vs 26.5 ;p=0.005). The LNCB diagnoses were 16% benign, 19% HRLs, 16% DCIS, and 49% invasive cancers. Reexcision rates were 15.6% and 25.8% for DCIS and invasive cancer, respectively. Cosmesis was excellent in 79.8%. Age, pathological tumor size, IRV and FRV were different among the benign, HRLs and carcinoma groups (p= 0.001). CONCLUSION The diagnosis of carcinoma by LNCB leads to the planning of a wider resection, but the need for reexcision is no different than less resection. HRLs are best approached with diagnostic excision, as there is no strong evidence that larger resections reduce the incidence of involved resection margins.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biopsy
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Lobular/diagnostic imaging
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/surgery
- Female
- Follow-Up Studies
- Humans
- Mammography
- Mastectomy, Segmental
- Middle Aged
- Neoplasm Invasiveness
- Neoplasm Staging
- Preoperative Care
- Prognosis
- Tumor Burden
- Young Adult
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Affiliation(s)
- A V Polat
- Comprehensive Breast Program, Magee-Womens Hospital of University of Pittsburgh, Pittsburg, PA, USA
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O'Connor C, Reilly C, Kelly S, Leeney A, O'Farrell C, McGuire K, McKone E, Gallagher C. 213 Study evaluating the effect of weekends on activity and inflammatory markers in adult patients with cystic fibrosis. J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60383-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Shamji M, Moon ES, Glennie R, Soroceanu A, Lin C, Bailey C, Simmonds A, Fehlings M, Dodwell E, Dold A, El-Hawary R, Hashem M, Dold A, Dold A, Jones S, Bailey C, Karadimas S, Whitehurst D, Norton J, Norton J, Manson N, Kesani A, Bednar D, Lundine K, Hartig D, Fichadi A, Fehlings M, Kim S, Harris S, Lin C, Gill J, Abraham E, Shamji M, Choi S, Goldstein C, Wang Z, McCabe M, Noonan V, Nadeau M, Ferrara S, Kelly A, Melnyk A, Arora D, Quateen A, Dea N, Ranganathan A, Zhang Y, Casha S, Rajamanickam K, Santos A, Santos A, Wilson J, Wilson J, Street J, Wilson J, Lewis R, Noonan V, Street J, El-Hawary R, Egge N, Lin C, Schouten R, Lin C, Kim A, Kwon B, Huang E, Hwang P, Allen K, Jing L, Mata B, Gabr M, Richardson W, Setton L, Karadimas S, Fehlings M, Fleming J, Bailey C, Gurr K, Bailey S, Siddiqi F, Lawendy A, Sanders D, Staudt M, Canacari E, Brown E, Robinson A, McGuire K, Chrysostoum C, Rampersaud YR, Dvorak M, Thomas K, Boyd M, Gurr K, Bailey S, Nadeau M, Fisher C, Batke J, Street J, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Vaccaro A, Chapman J, Arnold P, Shaffrey C, Kopjar B, Snyder B, Wright J, Lewis S, Zeller R, El-Hawary R, Moroz P, Bacon S, Jarzem P, Hedden D, Howard J, Sturm P, Cahill P, Samdani A, Vitale M, Gabos P, Bodin N, d’Amato C, Harris C, Smith J, Parent E, Hill D, Hedden D, Moreau M, Mahood J, Lewis S, Bodrogi A, Abbas H, Goldstein S, Bronstein Y, Bacon S, Chua S, Magana S, Van Houwelingen A, Halpern E, Jhaveri S, Lewis S, Lim A, Leelapattana P, Fleming J, Siddiqqi F, Bailey S, Gurr K, Moon ES, Satkunendrarajah K, Fehlings M, Noonan V, Dvorak M, Bryan S, Aronyk K, Fox R, Nataraj A, Pugh J, Elliott R, McKeon M, Abraham E, Fleming J, Gurr K, Bailey S, Siddiqi F, Bailey C, Davis G, Rogers M, Staples M, Quan G, Batke J, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, Shamji M, Hurlbert R, Jacobs W, Duplessis S, Casha S, Jha N, Hewson S, Massicotte E, Kopjar B, Mortaz S, Coyte P, Rampersaud Y, Rampersaud Y, Goldstein S, Andrew B, Modi H, Magana S, Lewis S, Roffey D, Miles I, Wai E, Manson N, Eastwood D, Elliot R, McKeon M, Bains I, Yong E, Sutherland G, Hurlbert R, Rampersaud Y, Chan V, Persaud O, Koshkin A, Brull R, Hassan N, Petis S, Kowalczuk M, Petrisor B, Drew B, Bhandari M, DiPaola C, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, McLachlin S, Bailey S, Gurr K, Bailey C, Dunning C, Fehlings M, Vaccaro A, Wing P, Itshayek E, Biering-Sorensen F, Dvorak M, McLachlin S, Bailey S, Gurr K, Dunning C, Bailey C, Bradi A, Pokrupa R, Batke J, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, Kelly A, Wen T, Kingwell S, Chak J, Singh V, Cripton P, Fisher C, Dvorak M, Oxland T, Wali Z, Yen D, Alfllouse A, Alzahrani A, Jiang H, Mahood J, Kortbeek F, Fox R, Nataraj A, Street J, Boyd M, Paquette S, Kwon B, Batke J, Dvorak M, Fisher C, Reddy R, Rampersaud R, Hurlbert J, Yong W, Casha S, Zygun D, McGowan D, Bains I, Yong V, Hurlbert R, Mendis B, Chakraborty S, Nguyen T, Tsai E, Chen A, Atkins D, Noonan V, Drew B, Tsui D, Townson A, Dvorak M, Chen A, Atkins D, Noonan V, Drew B, Dvorak M, Craven C, Ford M, Ahn H, Drew B, Fehlings M, Kiss A, Vaccaro A, Harrop J, Grossman R, Frankowski R, Guest J, Dvorak M, Aarabi B, Fehlings M, Noonan V, Cheung A, Sun B, Dvorak M, Vaccaro A, Harrop J, Massicotte E, Dvorak M, Fisher C, Rampersaud R, Lewis S, Fehlings M, Marais L, Noonan V, Queyranne M, Fehlings M, Dvorak M, Atkins D, Hurlbert R, Fox R, Fourney D, Johnson M, Fehlings M, Ahn H, Ford M, Yee A, Finkelstein J, Tsai E, Bailey C, Drew B, Paquet J, Parent S, Christie S, Dvorak M, Noonan V, Cheung A, Sun B, Dvorak M, Sturm P, Cahill P, Samdani A, Vitale M, Gabos P, Bodin N, d’Amato C, Harris C, Smith J, Lange J, DiPaola C, Lapinsky A, Connolly P, Eck J, Rabin D, Zeller R, Lewis S, Lee R, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, DiPaola C, Street J, Bodrogi A, Goldstein S, Sofia M, Lewis S, Shin J, Tung K, Ahn H, Lee R, Batke J, Ghag R, Noonan V, Dvorak M, Goyal T, Littlewood J, Bains I, Cho R, Thomas K, Swamy G. Canadian Spine Society abstracts1.1.01 Supraspinal modulation of gait abnormalities associated with noncompressive radiculopathy may be mediated by altered neurotransmitter sensitivity1.1.02 Neuroprotective effects of the sodium-glutamate blocker riluzole in the setting of experimental chronic spondylotic myelopathy1.1.03 The effect of timing to decompression in cauda equina syndrome using a rat model1.2.04 Intraoperative waste in spine surgery: incidence, cost and effectiveness of an educational program1.2.05 Looking beyond the clinical box: the health services impact of surgical adverse events1.2.06 Brace versus no brace for the treatment of thoracolumbar burst fractures without neurologic injury: a multicentre prospective randomized controlled trial1.2.07 Adverse event rates in surgically treated spine injuries without neurologic deficit1.2.08 Functional and quality of life outcomes in geriatric patients with type II odontoid fracture: 1-year results from the AOSpine North America Multi-Center Prospective GOF Study1.3.09 National US practices in pediatric spinal fusion: in-hospital complications, length of stay, mortality, costs and BMP utilization1.3.10 Current trends in the surgical treatment of adolescent idiopathic scoliosis in Canada1.3.11 Sagittal spinopelvic parameters help predict the risk of proximal junctional kyphosis for children treated with posterior distraction-based implants1.4.12 Correlations between changes in surface topography and changes in radiograph measurements from before to 6 months after surgery in adolescents with idiopathic scoliosis1.4.13 High upper instrumented vertebra (UIV) sagittal angle is associated with UIV fracture in adult deformity corrections1.4.14 Correction of adult idiopathic scoliosis using intraoperative skeletal traction1.5.01 Cauda equina: using management protocols to reduce delays in diagnosis1.5.02 Predicting the need for tracheostomy in patients with acute traumatic spinal cord injury1.5.03 A novel animal model of cervical spondylotic myelopathy: an opportunity to identify new therapeutic targets1.5.04 A review of preference-based measures of health-related quality of life in spinal cord injury research1.5.05 Predicting postoperative neuropathic pain following surgery involving nerve root manipulation based on intraoperative electromyographic activity1.5.06 Detecting positional injuries in prone spinal surgery1.5.07 Percutaneous thoracolumbar stabilization for trauma: surgical morbidity, clinical outcomes and revision surgery1.5.08 Systemic inflammatory response syndrome in spinal cord injury patients: Does its presence at admission affect patient outcomes?2.1.15 One hundred years of spine surgery — a review of the evolution of our craft and practice in the spine surgical century [presentation]2.1.16 Prevalence of preoperative MRI findings of adjacent segment disc degeneration in patients undergoing anterior cervical discectomy and fusion2.1.17 Adverse event rates of surgically treated cervical spondylopathic myelopathy2.1.18 Morphometricand dynamic changes in the cervical spine following anterior cervical discectomy and fusion and cervical disc arthroplasty2.1.19 Is surgery for cervical spondylotic myelopathy cost-effective? A cost–utility analysis based on data from the AO Spine North American Prospective Multicentre CSM Study2.2.20 Cost–utility of lumbar decompression with or without fusion for patients with symptomatic degenerative lumbar spondylolisthesis (DLS)2.2.21 Minimally invasive surgery lumbar fusion for low-grade isthmic and degenerative spondylolisthesis: 2- to 5-year follow-up2.2.22 Results and complications of posterior-only reduction and fusion for high-grade spondylolisthesis2.3.23 Fusion versus no fusion in patients with central lumbar spinal stenosis and foraminal stenosis undergoing decompression surgery: comparison of outcomes at baseline and follow-up2.3.24 Two-year results of interspinous spacers (DIAM) as an alternative to arthrodesis for lumbar degenerative disorders2.3.25 Treatment of herniated lumbar disc by sequestrectomy or conventional discectomy2.4.26 No sustained benefit of continuous epidural analgesia for minimally invasive lumbar fusion: a randomized double-blinded placebo controlled study2.4.27 Evidence and current practice in the radiologic assessment of lumbar spine fusion2.4.28 Wiltse versus midline approach for decompression and fusion of the lumbar spine2.5.09 The effect of soft tissue restraints following type II odontoid fractures in the elderly — a biomechanical study2.5.10 Development of an international spinal cord injury (SCI) spinal column injury basic data set2.5.11 Evaluation of instrumentation techniques for a unilateral facet perch and fracture using a validated soft tissue injury model2.5.12 Decreasing neurologic consequences in patients with spinal infection: the testing of a novel diagnostic guideline2.5.13 Prospective analysis of adverse events in surgical treatment of degenerative spondylolisthesis2.5.14 Load transfer characteristics between posterior fusion devices and the lumbar spine under anterior shear loading: an in vitro investigation2.5.15 Preoperative predictive clinical and radiographic factors influencing functional outcome after lumbar discectomy2.5.16 A Thoracolumbar Injury Classification and Severity Score (TLICS) of 4: What should we really do?3.1.29 Adverse events in emergent oncologic spine surgery: a prospective analysis3.1.30 En-bloc resection of primary spinal and paraspinal tumours with critical vascular involvement3.1.31 The treatment impact of minocycline on quantitative MRI in acute spinal cord injury3.1.32 Benefit of minocycline in spinal cord injury — results of a double-blind randomized placebo-controlled study3.2.33 Improvement of magnetic resonance imaging correlation with unilateral motor or sensory deficits using diffusion tensor imaging3.2.34 Comparing care delivery for acute traumatic spinal cord injury in 2 Canadian centres: How do the processes of care differ?3.2.35 Improving access to early surgery: a comparison of 2 centres3.3.36 The effects of early surgical decompression on motor recovery after traumatic spinal cord injury: results of a Canadian multicentre study3.3.37 A clinical prediction model for long-term functional outcome after traumatic spinal cord injury based on acute clinical and imaging factors3.3.38 Effect of motor score on adverse events and quality of life in patients with traumatic spinal cord injury3.4.39 The impact of facet dislocation on neurologic recovery after cervical spinal cord injury: an analysis of data on 325 patients from the Surgical Trial in Acute Spinal Cord Injury Study (STASCIS)3.4.40 Toward a more precise understanding of the epidemiology of traumatic spinal cord injury in Canada3.4.41 Access to care (ACT) for traumatic SCI: a survey of acute Canadian spine centres3.4.42 Use of the Spine Adverse Events Severity (SAVES) instrument for traumatic spinal cord injury3.5.17 Does the type of distraction-based growing system for early onset scoliosis affect postoperative sagittal alignment?3.5.18 Comparison of radiation exposure during thoracolumbar fusion using fluoroscopic guidance versus anatomic placement of pedicle screws3.5.19 Skeletal traction for intraoperative reduction in adolescent idiopathic scoliosis3.5.20 Utility of intraoperative cone-beam computed tomography (O-ARM) and stereotactic navigation in acute spinal trauma surgery3.5.21 Use of a central compression rod to reduce thoracic level spinal osteotomies3.5.22 ICD-10 coding accuracy for spinal cord injured patients3.5.23 Feasibility of patient recruitment in acute SCI trials3.5.24 Treatment of adult degenerative scoliosis with DLIF approaches. Can J Surg 2012. [DOI: 10.1503/cjs.012212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Kiluk J, McGuire K, Lee M, Kim J, Khakpour N, Laronga C. Margin Assessment in Breast Conservation for Ductal Carcinoma In Situ. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-4122] [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
IntroductionBreast conserving surgery in the setting of ductal carcinoma in situ (DCIS) produces many challenges. Re-excision rates for close or negative margins after lumpectomy are common due to difficulty in intraoperative margin status assessment. The objective of this study was to review our experience with various margin assessment techniques in the setting of a preoperative diagnosis of DCIS on core needle biopsy (CNB).MethodsA prospectively gathered database of surgically-treated breast cancer patients was reviewed for patients with a diagnosis of DCIS as the most significant lesion on CNB from 1997 to 2009. Of 425 patients with a diagnosis of DCIS by CNB, 231 patients underwent a lumpectomy. Patients' age, tumor characteristics, type of surgery, margin assessment technique, and follow up data were recorded.Results231 patients underwent a lumpectomy following a CNB of DCIS. 138 patients (59.7%) had intra-operative touch prep (TP) analysis of all 6 margins, 39 patients (16.9%) underwent intra-operative gross evaluation of margins, 53 (22.9%) patients had no intra-operative analysis, and one patient (0.4%) had a frozen section analysis. Success at achieving negative margins (>2mm) with initial lumpectomy was 66.7% (92/138) for TP analysis, 56.4% (22/39) for gross evaluation, and 52.8% (28/53) for no margin assessment. These percentages did not reach statistical significance by odds ratios (TP to Gross p= 0.24, TP to None p=0.08, Gross to None p=0.73). After excluding patients that required mastectomy following an unsuccessful lumpectomy, ipsilateral breast recurrence rates were 6.3% (8/127) for the touch prep patients after a mean follow up of 4.0 years, 0.0% (0/31) for the gross evaluation patients after a mean follow up of 1.9 years, and 10.5% (4/38) for the patients with no intraoperative assessment after a mean follow up of 3.8 years. Characteristics of each group are listed in Table 1.ConclusionsReexcision for close or positive margins is required for a significant percentage of patients who undergo lumpectomy after a preoperative diagnosis of DCIS on CNB. Although intraoperative TP analysis had the highest success of preventing reexcision, long term data suggest that recurrence rates between intraoperative TP and gross evaluation are both acceptable with short term follow up.Table 1: Characteristics of patients undergoing lumpectomy with a preoperative diagnosis of DCIS on CNBMargin AssessmentTouch PrepGrossNoneFrozenNumber of cases13839531Patient Median Age59.758.956.359.8Cases not needing Reexcision66.7%(92/138)56.4% (22/39)52.8% (28/53)0%(0/1)Cases that received mastectomy8.0%(11/138)20.5%(8/39)26.4%(14/53)100%(1/1)DCIS Grade3- 512- 631- 22Unk- 23- 162- 151- 5Unk- 33-252-201- 7Unk- 13- 02- 01- 1Unk- 0Cases with Necrosis50%(69/138)53.9%(21/39)62.3%(33/53)0%(0/1)Cases upgraded to Invasive Cancer12.3%(17/138)15.4%(6/39)35.9%(19/53)0%(0/1)ReceivedRadiation after lumpectomy85.0%(108/127)67.7% (21/31)76.3%(29/38)0%(0/1)ReceivedTamoxifen after lumpectomy34.7%(44/127)25.8%(8/31)31.2%(12/38)0%(0/1)Ipsilateral breastRecurrence after lumpectomy6.3%(8/127)0%(0/31)10.5% (4/38)0%(0/1)Follow up after lumpectomy (years)4.0(0-10.6)1.9(0.19-5.6)3.8(0.17-9.4)6.0
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4122.
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Affiliation(s)
- J. Kiluk
- 1H. Lee Moffitt Cancer Center, FL,
| | | | - M. Lee
- 1H. Lee Moffitt Cancer Center, FL,
| | - J. Kim
- 2H. Lee Moffitt Cancer Center, FL,
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Mencl F, Weig J, Teermann G, Iturregui J, Rajjappannair L, Barhorst B, Evancho-Chapman M, McGuire K. 325. Ann Emerg Med 2006. [DOI: 10.1016/j.annemergmed.2006.07.788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Toll-like receptors (TLRs) are cell-surface signalling molecules that recognize a range of highly conserved pathogen molecules and instigate the appropriate immune response. Here, we report the mapping of all 10 characterized bovine TLR genes using a radiation hybrid panel. The genomic organization of the bovine TLRs is similar to that of humans and mice. TLR1, TLR6 and TLR10 map closely together on Bos taurus chromosome 6 (BTA6), while TLR7 and TLR8 map to the X chromosome. TLR2, TLR3, TLR4, TLR5 and TLR9 map to BTA17, BTA27, BTA8, BTA16 and BTA22 respectively. Our increased knowledge of the genomic organization of the bovine TLR genes may promote our understanding of their evolution and help in the identification of bovine genes underlying disease-resistance traits.
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Affiliation(s)
- K McGuire
- Division of Genetics and Genomics, Roslin Institute, Roslin, Midlothian, Edinburgh EH25 9PS, UK.
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Ganesan PG, McGuire K, Kim H, Gothard N, Mohan S, Rao AM, Ramanath G. ZnO nanowires by pulsed laser vaporization: synthesis and properties. J Nanosci Nanotechnol 2005; 5:1125-9. [PMID: 16108438 DOI: 10.1166/jnn.2005.152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
We report a new pulsed-laser vaporization (PLV) technique to synthesize nanowires of single-crystal ZnO having a wurtzite structure by using colloidal gold nanoparticles as seeding catalysts. The average diameter of the nanowires is approximately 13 nm, with a very narrow range of 7 to 25 nm. The nanowires are straight for the most part, with the axes parallel to the [0001] growth direction. Raman and photoluminescence spectra from the nanowires and bulk ZnO are similar except for a approximately 510 nm band in the nanowires due to oxygen vacancies. The bulk-like vibrational and electronic properties of the nanowires is due to the diameter being larger than the threshold below which quantum confinement-induced effects are expected.
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Affiliation(s)
- P G Ganesan
- Materials Science and Engineering Department, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
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Abstract
Interest in the effects of intense exercise training on immune function has grown over the past decade. Currently, data on the immunocompetence of female endurance athletes are limited and do not present a clear picture. The objective of this study was to compare the T-cell mediated immune function of female Master's athletes (41 +/- 4.3 yr) during peak training with age-matched non-athletes (42 +/- 3.6 yr) using non-specific and antigen-specific stimulation. Samples of peripheral venous blood were taken at rest for determination of total circulating T-cell number, sub-population number and CD4 + helper T-cell function. No significant difference in total circulating T-cell number or in the number of cells in each of the tested lymphocyte subpopulations was detected between athletes (n = 19) and non-athletes (n = 20). In athletes, 7.9 % of cells responding to non-specific (PMA and ionomycin) stimulation produced IL-2 versus 3.9 % of responding cells in non-athletes (p < 0.05). No statistical difference was noted between athletes and non-athletes in the percentages of antigen-responding CD4 + helper T-cells producing IL-2 (2.4 % and 2.3 %, respectively). Results of this study suggest that T-cell mediated immune function may not be compromised in female Master's athletes during periods of competitive training.
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Affiliation(s)
- D Beshgetoor
- Department of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA 92182-7251, USA.
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Abstract
Mannan-binding lectin (MBL) is a plasma protein involved in the innate immune response. It binds to a number of micro-organisms and promotes killing of these through complement activation either directly or through opsonization. Clinical evidence indicates that in a variety of situations genetically determined low MBL levels are associated with increased susceptibility to infections. Infusions of plasma-derived MBL into MBL-deficient individuals was found to be safe in preliminary trials, but we considered that sufficient production and product safety could only be achieved through synthesis of recombinant MBL. A transfected human cell line produces MBL showing the same biological activity as plasma-derived MBL, and an essentially identical profile on MS. The production has been scaled up and clinical trials will start this year.
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Affiliation(s)
- J C Jensenius
- Department of Medical Microbiology and Immunology, University of Aarhus, Denmark.
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Parra E, McGuire K, Hedlund G, Dohlsten M. Overexpression of p65 and c-Jun substitutes for B7-1 costimulation by targeting the CD28RE within the IL-2 promoter. J Immunol 1998; 160:5374-81. [PMID: 9605137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The role of Rel and activation protein-1 (AP-1) in IL-2 promoter activity in B7-1- and leukocyte function-associated Ag-3 (LFA. 3)-costimulated T cells has been evaluated. We demonstrate that overexpression of c-Jun but not c-Fos increases IL-2 promoter activity in both B7-1- and LFA-3-costimulated Jurkat T cells. Cotransfection of both c-Jun and c-Fos substitutes for B7-1 costimulation in driving an activation protein-1 response element but not for the IL-2 promoter. Overexpression of Rel proteins demonstrated that p65-expressing Jurkat cells transcribed equally well a nuclear factor kappabeta reporter construct when costimulated with B7-1 or LFA-3, but transcription of IL-2 promoter or CD28 response element (CD28RE)-driven reporters was superior in B7-1-costimulated cells. Combined expression of c-Jun and p65 induced vigorous transcription of IL-2 promoter- and CD28RE-driven reporter constructs in both LFA-3- and B7-1-costimulated Jurkat cells. Mutating the CD28RE but not the upstream nuclear factor kappabeta-binding site in the IL-2 promoter reduced B7-1-driven transcription >90%. The results implicates a major role of the CD28RE in the integration of p65/c-Jun-mediated transcription within the IL-2 promoter. We suggest that the transition from an autocrine LFA-3-driven immune response to a B7--induced paracrine immune response involves the activation of c-Jun and p65, which target the CD28RE region of the IL-2 promoter.
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Affiliation(s)
- E Parra
- Department of Cell and Molecular Biology, University of Lund, Sweden
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Delahay RJ, Daniels MJ, Macdonald DW, McGuire K, Balharry D. Do patterns of helminth parasitism differ between groups of wild-living cats in Scotland? J Zool (1987) 1998. [DOI: 10.1111/j.1469-7998.1998.tb00085.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
The nucleotide and deduced amino acid sequences of louping ill (LI) virus isolates, collected from representative regions of the British Isles and Norway, were determined for either the entire envelope gene (20 isolates) or for a portion of the envelope gene that spans a hypervariable region and includes an LI virus specific marker sequence (53 isolates). Phylogenetic analysis reveals the presence of three major geographical populations of LI virus in the British Isles, viz. Irish, Welsh and British LI viruses, which all cause encephalomyelitis in animals, predominantly sheep, and co-habit the same tick population. British LI virus occurs throughout Scotland, England, Ireland and Norway. Irish and Welsh LI viruses occur only in Ireland and Wales, respectively. Phylogenetic analysis also predicts that LI virus initially emerged in Ireland and that a descendant was introduced into Great Britain via Wales and was subsequently transported to the borders of Scotland, from where it was dispersed throughout Scotland, northern England and Norway. More recently, the British LI virus was reintroduced into Ireland and also into south-west England. Dates of lineage divergence, calculated from the synonymous substitution rate, indicate that LI virus emerged in the British Isles less than 800 years ago and most LI virus dispersal occurred during the last 300 years. By combining these data with historical records it appears that livestock movement can be implicated in the dispersal of LI virus.
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Affiliation(s)
- K McGuire
- Moredun Research Institute, Edinburgh, UK
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Laurenson MK, Hudson PJ, McGuire K, Thirgood SJ, Reid HW. Efficacy of acaricidal tags and pour-on as prophylaxis against ticks and louping-ill in red grouse. Med Vet Entomol 1997; 11:389-393. [PMID: 9430120 DOI: 10.1111/j.1365-2915.1997.tb00427.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
This paper examines the efficacy of 10% lambdacyhalothrin-impregnated plastic tags and a deltamethrin pour-on preparation in protecting red grouse chicks from parasitism by ticks and subsequent infection with the louping-ill virus. In 1995, ten red grouse hens (Lagopus lagopus scoticus) in a free-living population in north-east Scotland were fitted with lambdacyhalothrin-impregnated plastic tags, glued to radio transmitters. Chicks of more than 10 days of age from a further ten untreated radio-collared hens were caught and fitted with individual tags to the ptagium. Both treatments significantly reduced tick burdens in the short term. The number of larvae and nymphs on chicks up to 45 days was less under both treatments than on control chicks and tagged chicks had fewer nymphs than chicks from treated hens. Nevertheless, treatments did not reduce viral infection rates nor increase survival to 10 weeks, possibly explained by incomplete treatment of tagged broods and/or direct or indirect mortality due to tags. In 1996 chicks in ten broods from hens with radio transmitters were individually treated at 14 days of age at a rate of 1 mg/kg of chick with a deltamethrin pour-on preparation. This preparation significantly reduced the number of larvae and nymphs on grouse chicks 7-10 days after application below the number on untreated controls. At 20 days from application, however, only larval numbers were lower on treated chicks. Nevertheless louping-ill virus infection prevalences were significantly reduced at 35 days of age and survival of chicks to 10 weeks increased.
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Janos A, Hastie J, McGuire K, Fredrickson E, Park W. Bursts of electron cyclotron emission during disruptions of high β discharges in TFTR. Fusion Engineering and Design 1997. [DOI: 10.1016/s0920-3796(96)00650-3] [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: 10/18/2022]
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Walker AR, Lloyd CM, McGuire K, Harrison SJ, Hamilton JG. Integument and sensillum auriforme of the opisthosoma of Rhipicephalus appendiculatus (Acari:Ixodidae). J Med Entomol 1996; 33:734-742. [PMID: 8840679 DOI: 10.1093/jmedent/33.5.734] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The opisthosomal integument and sensilla auriformia of Rhipicephalus appendiculatus Neumann larvae, nymphs, females and males, both unfed, fed, and during molt, were examined by light and electron microscopy in relation to semiochemical production. The integument consists of epidermis, endocuticle, exocuticle, epicuticle, a superficial wax layer and a variable additional deposit. The integument of immature instars and females grows greatly during feeding. The integument is traversed by pore canals from the epidermis to the outer wax canals. The epidermis can secrete material to the exterior by way of the pore canals and wax canals. The sensillum auriforme is a common disk-shaped organ, with a complex internal chamber open to the exterior by way of a pore. It has no apparent secretory capacity and is of presumed sensory function. It is located in the integument of scutum and alloscutum of all instars.
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Affiliation(s)
- A R Walker
- Centre for Tropical Veterinary Medicine, University of Edinburgh, Roslin, Midlothian, Scotland
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Walker AR, Lloyd CM, McGuire K, Harrison SJ, Hamilton JG. Integumental glands of the tick Rhipicephalus appendiculatus (Acari:Ixodidae) as potential producers of semiochemicals. J Med Entomol 1996; 33:743-759. [PMID: 8840680 DOI: 10.1093/jmedent/33.5.743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The opisthosomal integument and associated secretory organs of Rhipicephalus appendiculatus Neumann larvae, nymphs, females and males, both unfed and fed were examined by light and electron microscopy. Type 1 dermal glands were found on the alloscutum and scutum of all ticks. They were undeveloped in unfed ticks and reached full development in engorging ticks. They produced secretory granules from 2 glandular cells but without accumulation of a reservoir of secreted material. Type 2 dermal glands were found in all ticks, with pores on the alloscutum, edge of scutum, and on anal plates. These glands produced secretion during feeding and accumulated large reservoirs of secreted material that were present in engorging, recently detached and questing ticks. Spiracular glands were found in all ticks below the spiracle plate. They produced small amounts of secretion and had pores to the exterior by way of spiracle goblets. No obvious cycle of secretory activity was recorded. Foveal glands were present and produced secretions in nymphs, females, and males. They were largest in females with an accumulation of secretory vesicles in feeding ticks. The potential function of these glands is discussed in the context of the chemical ecology of this tick.
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Affiliation(s)
- A R Walker
- Centre for Tropical Veterinary Medicine, University of Edinburgh, Roslin, Midlothian, Scotland
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Xu X, Heidenreich O, Kitajima I, McGuire K, Li Q, Su B, Nerenberg M. Constitutively activated JNK is associated with HTLV-1 mediated tumorigenesis. Oncogene 1996; 13:135-42. [PMID: 8700539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Human T cell leukemia virus type I (HTLV-1) is the etiologic agent of adult T-cell leukemia (ATL) and HTLV-1 associated myelopathy, also called tropical spastic paraparesis (HAM/TSP). Both clinical and in vitro evidence have demonstrated that the virus or its transactivator Tax, are transforming. However, transformation appears to require additional, as yet poorly characterized, genetic changes in infected cells. JNK is a recently characterized member of the MAP kinase family. Its signaling cascade is distinct from other members and has been demonstrated to play an important role in T-cell activation, at least partially through its downstream targets, c-jun and ATF-2. Here we demonstrate constitutive activation of the JNK cascade in human lymphocytes transformed in vitro by HTLV-1 and also in Tax transformed murine fibroblasts. Such activation is not induced by Tax expression alone, and occurs only when infected lymphocytes become IL-2 independent or immortalized. Constitutive JNK activation was also found in leukocytes isolated from ATL patients. The acquisition of constitutive JNK activation may represent an important later event in HTLV-1 tumorigenesis.
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Affiliation(s)
- X Xu
- Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, California 92307, USA
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31
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Abstract
Two systems of telephone follow-up of discharged patients were compared in this 3-month study. All medical and surgical patients on five nursing units of one acute care institution were included, yielding a sample of over 1,400 patients. One group of patients was called 2 to 3 days after discharge; another group received a brochure describing a nurse-run telephone service they could call. A third group of patients received no intervention. More than 90% of patients who were called had questions about self-care and recovery at home. Only nine patients initiated calls to the nurse telephone service. The three groups did not differ in patient satisfaction with health education or readmission rates within 30 days of discharge. This study suggests that patients have continued health education needs after discharge but are unlikely to actively seek needed information from a hospital-based telephone service.
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Affiliation(s)
- J Bostrom
- Patient Care Services, Stanford University Hospital, CA 94305, USA
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Abstract
Menarche age was assessed in 93 adolescent females in a sample of public schools in East Hawaii. Native Hawaiian girls had significantly lower reported age at menarche than non-Hawaiian classmates. Age at menarche was significantly correlated with total fatness as measured by the sum of six skinfolds in girls who had reached menarche at least 2 years previous to measurement. When fatness was controlled in comparisons, the ethnic differences were not significant. Fat distribution, independent of fatness, was also significantly related to age at menarche. Socioeconomic, cultural, and admixture variables were not significantly related to age at menarche. Adiposity appears to be both a cause and a consequence of early age at menarche, with the relationship dependent on the elapsed time between menarche and measurement. This suggests that studies relating body composition to age at menarche must carefully control for the time interval between measurement and the date of menarche.
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Affiliation(s)
- D E Brown
- Department of Anthropology, University of Hawaii at Hilo 96720-4091, USA
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Rohwer F, Macmaster W, Haseltine W, Tsoukas C, McGuire K. Characterization of an IL-2 dependent human T-cell leukemia-virus type-I (HTLV-I) infected cell-line - a system for studying HTLV-I mediated transformation. Int J Oncol 1994; 5:1163-9. [PMID: 21559695 DOI: 10.3892/ijo.5.5.1163] [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: 11/06/2022] Open
Abstract
The retrovirus Human T cell Leukemia Virus type I (HTLV-I) is the causative agent of Adult T cell Leukemia Lymphoma (ATLL) and is associated with HTLV-I Myelopathy. HTLV-I mediated transformation of CD4(+) T cells, during the course of ATLL, is poorly understood. It has been suggested that HTLV-I is responsible for the immortalization of infected cells, but transformation is dependent on secondary events. To investigate this hypothesis, we have isolated an HTLV-I infected T cell line that is dependent on IL-2 for growth in tissue culture. Further, a subclone of this cell line that is able to grow in the absence of IL-2 has been isolated. Both cell lines have identical TCR chain rearrangements and cell surface markers. Each,cell line produces viral mRNAs and proteins. Finally, both of these cell lines are sensitive to rapamycin and cyclosporin A regardless of the presence of IL-2. We propose that this system will provide a unique opportunity to study transformation to IL-2 independence in HTLV-I infected cells.
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Affiliation(s)
- F Rohwer
- SAN DIEGO STATE UNIV,DEPT BIOL,SAN DIEGO,CA 92182. SAN DIEGO STATE UNIV,INST MOLEC BIOL,SAN DIEGO,CA 92182
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Fisher BE, McGuire K, Honeyman K. Relationships between nocturnal activity, parental ratings of daytime activity and measues from the Children's Sleep Behaviour Scale. Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement 1994. [DOI: 10.1037/0008-400x.26.4.476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Colter M, Fogarty B, McGuire K, Berenson R, Heimfeld S. Rapid isolation of CD4 or CD8 T-cell subsets using the CEPRATE LC laboratory cell separation system. Transplant Proc 1992; 24:2801-2. [PMID: 1361266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Affiliation(s)
- M Colter
- CellPro, Incorporated, Bothell, Washington 98021
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Heimfeld S, Fogarty B, McGuire K, Williams S, Berenson RJ. Peripheral blood stem cell mobilization after stem cell factor or G-CSF treatment: rapid enrichment for stem and progenitor cells using the CEPRATE immunoaffinity separation system. Transplant Proc 1992; 24:2818. [PMID: 1281575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- S Heimfeld
- CellPro, Incorporated, Bothell, Washington 98021
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Phillips CK, Hosea J, Marmar E, Phillips MW, Snipes J, Stevens J, Terry J, Wilson JR, Bell M, Bitter M, Boivin R, Bush C, Cheng CZ, Darrow D, Fredrickson E, Goldfinger R, Hammett GW, Hill K, Hoffman D, Houlberg W, Hsuan H, Hughes M, Jassby D, McCune D, McGuire K, Nagayama Y, Owens DK, Park H, Ramsey A, Schilling G, Schivell J, Smithe DN, Stratton B, Synakowski E, Taylor G, Towner H, White R, Zweben S. Ion cyclotron range of frequencies stabilization of sawteeth on Tokamak Fusion Test Reactor. ACTA ACUST UNITED AC 1992. [DOI: 10.1063/1.860484] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Heard SO, McGuire K, Haw MP, Forse RA, Blackburn GL, Fink MP. Dietary enrichment with omega-3 fatty acids partially protects against lipopolysaccharide-induced atrial depression in rats. Circ Shock 1992; 36:140-6. [PMID: 1582005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We tested the hypothesis that pretreatment with a diet enriched with omega-3 fatty acids can prevent lipopolysaccharide (LPS)-induced atrial dysfunction. Sprague-Dawley rats were fed a diet containing 20% safflower oil (control diet; CD) or 19.5% menhaden/0.5% safflower oil (experimental diet; ED). After 28 days, the animals were injected I.V. with LPS (20 mg/kg) or normal saline (S). Two hours later, the atria were harvested, connected to a force displacement transducer-amplifier-recorder system and maintained in vitro in oxygenated 37.5 degrees C Krebs-Henseleit buffer. Force of contraction indexed to body weight (FOCI; g/kg) and maximal rate of rise of contraction (dF/dt, g/sec) and relaxation (-dF/dt, g/sec) were similar in the CD-S (n = 6) and ED-S (n = 6) groups. FOCI, dF/dt, and -dF/dt were lower (P less than 0.05) in rats injected with LPS compared with rats injected with S irrespective of diet, but were significantly higher (P less than 0.05) in LPS-ED rats (n = 11) compared with LPS-CD rats (n = 11). Chronotropic and inotropic responses to graded doses (0.1, 0.5, 1.0, and 5.0 microM) of isoproterenol were not significantly different among groups. LPS-induced production of thromboxane B2 but not 6-keto-prostaglandin F1 alpha, was inhibited in ED fed rats. The ED did not enhance survival when rats were challenged with a 20 mg/kg I.V. dose of LPS. These results indicate that dietary enrichment with omega-3 fatty acids in rats partially protects against LPS-induced alterations in atrial function but does not change mortality after an LD100 dose of LPS.
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Affiliation(s)
- S O Heard
- Department of Anesthesiology, University of Massachusetts Medical Center, Worcester 01655
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Abstract
Although visuoconstructive impairment has been reported in both Alzheimer's (DAT) and Huntington's (HD) disease, there is little knowledge concerning how this cognitive deficit differs quantitatively and qualitatively in these two progressive dementias. To address this issue, the present study compared performances on the Clock Drawing Test (CDT: command and copy) of 25 DAT patients, 25 equally demented HD patients, and 25 elderly normal controls (NC). In the command condition, both patients groups were significantly impaired compared to the NC group. Although there was no significant difference between DAT and HD patients' total quantitative scores, a qualitative error analysis revealed a number of dissociations between the two patient groups. Graphic difficulties, very common in HD patients, were virtually absent in DAT patients; in contrast, conceptual errors were almost exclusively seen in DAT patients and were related to the severity of their dementia. Perseveration and "stimulus-bound" responses were also more frequent in DAT patients, and both groups made visuospatial errors. In the copy condition, the DAT, but not the HD, patients evidenced a marked improvement in performance. These results indicate that while both DAT and HD patients have significant visuoconstructive difficulties even in the early stages of their disorders, the specific cognitive processes underlying their quantitative impairments are quite different. It is possible that the DAT patients' conceptual errors are yet another indicator of the deterioration of their semantic knowledge.
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Affiliation(s)
- I Rouleau
- Department of Psychiatry, University of California, San Diego
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Fredrickson ED, McGuire K, Cavallo A, Budny R, Janos A, Monticello D, Nagayama Y, Park W, Taylor G, Zarnstorff MC. Ballistic contributions to heat-pulse propagation in the TFTR tokamak. Phys Rev Lett 1990; 65:2869-2872. [PMID: 10042719 DOI: 10.1103/physrevlett.65.2869] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Wootton AJ, Carreras BA, Matsumoto H, McGuire K, Peebles WA, Ritz CP, Terry PW, Zweben SJ. Fluctuations and anomalous transport in tokamaks. ACTA ACUST UNITED AC 1990. [DOI: 10.1063/1.859358] [Citation(s) in RCA: 419] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Bush CE, Goldston RJ, Scott SD, Fredrickson ED, McGuire K, Schivell J, Taylor G, Barnes CW, Bell MG, Boivin RL, Bretz N, Budny RV, Cavallo A, Efthimion PC, Grek B, Hawryluk R, Hill K, Hulse RA, Janos A, Johnson DW, Kilpatrick S, Manos DM, Mansfield DK, Meade DM, Park H, Ramsey AT, Stratton B, Synakowski EJ, Towner HH, Wieland RM, Zarnstorff MC, Zweben S. Peaked density profiles in circular-limiter H modes on the TFTR tokamak. Phys Rev Lett 1990; 65:424-427. [PMID: 10042917 DOI: 10.1103/physrevlett.65.424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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McGuire K, Arunasalam V, Barnes CW, Bell MG, Bitter M, Boivin R, Bretz NL, Budny R, Bush CE, Cavallo A, Chu TK, Cohen SA, Colestock P, Davis SL, Dimock DL, Dylla HF, Efthimion PC, Ehrhrardt AB, Fonck RJ, Fredrickson E, Furth HP, Gammel G, Goldston RJ, Greene G, Grek B, Grisham LR, Hammett G, Hawryluk RJ, Hendel HW, Hill KW, Hinnov E, Hoffman DJ, Hosea J, Howell RB, Hsuan H, Hulse RA, Janos AC, Jassby D, Jobes F, Johnson DW, Johnson LC, Kaita R, Kieras‐Phillips C, Kilpatrick SJ, LaMarche PH, LeBlanc B, Manos DM, Mansfield DK, Mazzucato E, McCarthy MP, McCune MC, McNeill DH, Meade DM, Medley SS, Mikkelsen DR, Monticello D, Motley R, Mueller D, Murphy JA, Nagayama Y, Nazakian DR, Neischmidt EB, Owens DK, Park H, Park W, Pitcher S, Ramsey AT, Redi MH, Roquemore AL, Rutherford PH, Schilling G, Schivell J, Schmidt GL, Scott SD, Sinnis JC, Stevens J, Stratton BC, Stodiek W, Synakowski EJ, Tang WM, Taylor G, Timberlake JR, Towner HH, Ulrickson M, von Goeler S, Wieland R, Williams M, Wilson JR, Wong K, Yamada M, Yoshikawa S, Young KM, Zarnstorff MC, Zweben SJ. High‐beta operation and magnetohydrodynamic activity on the TFTR tokamak. ACTA ACUST UNITED AC 1990. [DOI: 10.1063/1.859544] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
We investigated the factor structure of the Children's Sleep Behavior Scale in an unselected sample of children (N = 838), ages 6 to 12.5 years, drawn from an elementary school population. Although no factor emerged that corresponded exactly to the parasomnias, as described by the Association of Sleep Disorders Centers (1979), all of the variables that loaded on Factor 1 were behaviors characteristic of the parasomnias, with the exception of recalled nightmares. Variables that were expected to load on this factor, but did not, were sleeptalking, teeth grinding, and enuresis. Enuresis was not related to any of the sleep behaviors assessed, and teeth grinding shared less than 9% of the variance with any of the other variables. Many of the variables loaded on more than one factor. The second factor, which was labeled bedtime resistance, was the only clearly unambiguous factor. Of the five factors that emerged, the third reflected positive affect, the fourth was a motor factor, and the fifth was an anxiety factor. Nightmares loaded on the anxiety factor as well as the first factor. The results of the study offered no support for the category of Disorders of Initiating and Maintaining sleep (DIMS), which has a childhood onset.
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Affiliation(s)
- B E Fisher
- University of New Brunswick, Saint John, Canada
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Grassmann R, Dengler C, Müller-Fleckenstein I, Fleckenstein B, McGuire K, Dokhelar MC, Sodroski JG, Haseltine WA. Transformation to continuous growth of primary human T lymphocytes by human T-cell leukemia virus type I X-region genes transduced by a Herpesvirus saimiri vector. Proc Natl Acad Sci U S A 1989; 86:3351-5. [PMID: 2541443 PMCID: PMC287130 DOI: 10.1073/pnas.86.9.3351] [Citation(s) in RCA: 292] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The role of the X region of the genome of the human T-cell leukemia virus type I (HTLV-I) in the immortalization of lymphocytes has been difficult to distinguish from its role in viral replication as this region encodes at least two genes, tax and rex, required for replication and the expression of viral proteins. To determine whether the X region does encode immortalizing functions, a fragment of the HTLV-I provirus capable of expressing known X-region proteins was inserted into the genome of a transformation-defective, replication-competent Herpesvirus saimiri. Infection of fresh mitogen-activated human cord blood and thymocytes yielded immortal T-cell lines that had the same phenotype (CD4+, CD5+, HLA class II+, interleukin 2 receptor alpha-chain +) as lymphocytes transformed by cocultivation with HTLV-I. These experiments demonstrate that the X region encodes the functions of HTLV-I that immortalize a distinct subpopulation of human T cells. The experiments also demonstrate the utility of the H. saimiri vector for the transduction of heterologous genes into human T cells.
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Affiliation(s)
- R Grassmann
- Institut für Klinische und Molekulare Virologie, Universitat Erlangen-Nürnberg, Federal Republic of Germany
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Poteat HT, Kadison P, McGuire K, Park L, Park RE, Sodroski JG, Haseltine WA. Response of the human T-cell leukemia virus type 1 long terminal repeat to cyclic AMP. J Virol 1989; 63:1604-11. [PMID: 2538645 PMCID: PMC248402 DOI: 10.1128/jvi.63.4.1604-1611.1989] [Citation(s) in RCA: 67] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The sequences that control transcriptional initiation of the provirus of the human T-cell leukemia virus type 1 (HTLV-1) are shown to be responsive to intracellular levels of cyclic AMP. A heptanucleotide sequence present within the 21-nucleotide repeat sequence that is similar to the cyclic AMP-responsive consensus (CRE) sequence was required for cyclic AMP-mediated increase in gene expression. Although the CRE-like sequences were contained within sequences that were responsive to the virally encoded trans-activator (tax), the evidence presented indicates that the mechanisms of promoter induction by the tax product and cyclic AMP are independent. The implication of cyclic AMP stimulation of HTLV-1 provirus gene expression for long-term persistence of infected T cells and for virus-induced transformation is discussed.
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Affiliation(s)
- H T Poteat
- Department of Cancer Biology, Harvard School of Public Health, Boston, Massachusetts
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48
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Abstract
A 22-item Likert-type rating scale for parents was developed for screening a broad range of specific sleep-related behaviors of elementary school children. The prevalence of these behaviors was reported by parents for boys (n = 459) and girls (n = 411) in three age groups, less than 8.5 yr., between 8.5 and 11.5 yr., and greater than 11.5 yr. For all age groups, the most prevalent behaviors were restlessness, waking up at night, pleasant dreams, getting up to go to the bathroom, talking while asleep, and complaints about not being able to sleep, while the least frequent were rhythmical movements and crying while asleep. The self-reports suggest that many of the behaviors are underestimated in the literature. Some sex and age differences were found, but the number of siblings, birth order, change in family structure, and educational status of father and mother were unrelated to the sleep variables. Test-retest reliabilities of self-reports by these parents to individual items were adequate.
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Affiliation(s)
- B E Fisher
- University of New Brunswick, St. John, Canada
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49
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Strachan JD, Bitter M, Ramsey AT, Zarnstorff MC, Arunasalam V, Bell MG, Bretz NL, Budny R, Bush CE, Davis SL, Dylla HF, Efthimion PC, Fonck RJ, Fredrickson E, Furth HP, Goldston RJ, Grisham LR, Grek B, Hawryluk RJ, Heidbrink WW, Hendel HW, Hill KW, Hsuan H, Jaehnig KP, Jassby DL, Jobes F, Johnson DW, Johnson LC, Kaita R, Kampershroer J, Knize RJ, Kozub T, LeBlanc B, Levinton F, Manos DM, Mansfield DK, McGuire K, McNeill DH, Meade DM, Medley SS, Morris W, Mueller D, Nieschmidt EB, Owens DK, Park H, Schivell J, Schilling G, Schmidt GL, Scott SD, Sesnic S, Sinnis JC, Stauffer FJ, Stratton BC, Tait GD, Taylor G, Towner HH, Ulrickson M, Wieland R, Williams MD, Wong KL, Yoshikawa S, Young KM. High-temperature plasmas in a tokamak fusion test reactor. Phys Rev Lett 1987; 58:1004-1007. [PMID: 10034307 DOI: 10.1103/physrevlett.58.1004] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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50
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Abstract
Schizophrenia is often said to cause dementia, and previous studies have found cognitive impairment to be associated with schizophrenia. It is possible, however, that other causes of dementia and the study of patients not representative of all schizophrenics have contributed to these findings. The neuropsychological test scores of 26 schizophrenic outpatients were compared to those of 82 other patients with a history of psychosis. After other known causes of cognitive impairment were controlled for, the schizophrenics were not found to have cognitive impairment when compared to the other patients.
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