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Evans SB, Blitzblau RC, Chapman CH, Chollet-Lipscomb C, Deville C, Ford E, Gibbs IC, Howell K, Peters GW, Ponce SB, Seldon C, Spector-Bagdady K, Tarbell N, Terezakis S, Vyfhius MAL, Wright J, Zietman A, Jagsi R. Restricted Access to Abortion, the Dobbs Ruling, and Radiation Oncology: Standing United Against Reproductive Injustice. Int J Radiat Oncol Biol Phys 2022; 114:385-389. [PMID: 35963470 DOI: 10.1016/j.ijrobp.2022.07.1843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 07/28/2022] [Accepted: 07/28/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Suzanne B Evans
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut.
| | - Rachel C Blitzblau
- Department of Radiation Oncology, Duke University, Durham, North Carolina; Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | | | | | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric Ford
- Department of Radiation Oncology, University Of Washington, Seattle, Washington
| | - Iris C Gibbs
- Stanford Medicine, School of Medicine, Stanford Cancer Institute, Stanford University, Stanford, California
| | - Krisha Howell
- Department of Radiation Oncology, Fox Chase Cancer Center, Temple Health, Philadelphia, Pennsylvania
| | - Gabrielle W Peters
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Sara Beltrán Ponce
- Medical College of Wisconsin Department of Radiation Oncology, Milwaukee, Wisconsin
| | - Crystal Seldon
- Department of Radiation Oncology, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Kayte Spector-Bagdady
- Center for Bioethics & Social Sciences in Medicine and the Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Nancy Tarbell
- Department of Radiation Oncology, Harvard Medical School and Mass General Hospital, Boston, Massachusetts
| | - Stephanie Terezakis
- University of Minnesota, Department of Radiation Oncology, Minneapolis, Minnesota
| | - Melissa A L Vyfhius
- University of Maryland School of Medicine, Chesapeake Oncology and Hematology Associates, Department of Radiation Oncology, Glen Burnie, Maryland
| | - Jean Wright
- Department of Radiation Oncology, University Of Washington, Seattle, Washington
| | - Anthony Zietman
- Department of Radiation Oncology, Harvard Medical School and Mass General Hospital, Boston, Massachusetts
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan
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Cross R, Trew C, Howell K, Dyer C. 936 IMPROVING DELIRIUM SCREENING IN OLDER ADULTS AT THE ROYAL UNITED HOSPITAL, BATH. Age Ageing 2022. [DOI: 10.1093/ageing/afac126.006] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Delirium affects up to 20% of older patients within hospital and is associated with increases in mortality, length of stay, institutionalisation and accelerated cognitive decline in patients with dementia. 30% of cases are preventable. NICE therefore advocates for delirium screening on admission in the elderly and those with cognitive impairment. We aimed to determine the compliance of the RUH Bath with delirium screening. National guidelines advocate for the use of a CAM, 4AT and/or SQiD. The RUH internal policy accepts a full AMT10, AMT4 plus an assessment of alertness, 4AT or a comment from a Consultant geriatrician about the presence of delirium.
Method
Notes of 60 patients on geriatric wards were inspected for compliance with screening in the first 24 hours of the patient’s admission. Following this, we implemented education sessions for junior doctors, changed the hospital admission proformas and re-wrote the hospital guidelines for delirium to re-emphasise the need for screening. We re-screened the notes 6 months after these changes and then again at 18 months to look for longstanding change.
Results
Initially, only 25% of patients were screened according to national standards and 63% met the hospital criteria. At 6 months 52% met the national standard and 82% met the hospital policy. At 18 months 41% the national standard and 87% met the hospital standard. There was also an increase in the proportion of patients being screened for delirium via multiple different method.
Conclusion
There has been significant, long-term improvement in delirium screening at the RUH Bath. This is particularly remarkable for the hospital standard where, despite no further intervention, the figures were maintained over 18 months. Despite a slight degradation in those meeting the national standard, the proportion was still higher than pre-intervention.
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Affiliation(s)
- R Cross
- Royal United Hospital , Bath
| | - C Trew
- Royal United Hospital , Bath
| | | | - C Dyer
- Royal United Hospital , Bath
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Welliver MX, Torres-Saavedra PA, Van Tine BA, Kirsch DG, Rudek MA, Wakely P, Schwartz GK, Pollock RE, Kane JM, Jiang SB, Rogers AD, Houghton P, Batus M, Johnston AL, Spraker M, Howell K, Harris J, Wang D. NRG-DT001 phase Ib trial of neoadjuvant navtemadlin (previously AMG232 and KRT232) concurrent with preoperative radiotherapy in wild-type p53 soft tissue sarcoma of the extremity and body wall. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.11521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11521 Background: NRG-DT001 is a phase Ib trial evaluating neoadjuvant navtemadlin with preoperative radiation therapy (RT) in patients (pts) with wild-type (WT) p53 soft tissue sarcoma (STS). The primary objective is to evaluate the safety and tolerability of the MDM2 inhibitor navtemadlin in combination with standard-dose RT in STS in two cohorts (A, extremity or body wall; B, abdomen/pelvis/retroperitoneum) to determine the maximum tolerated dose/recommended phase II dose (MTD/RP2D) of navtemadlin in combination with RT. This report contains the results for cohort A. Methods: Eligible pts had grade 2-3 STS ≥ 5 cm, age ≥ 18, and Zubrod performance status 0-1. Dose levels were 120 mg 2x/week (DL-1), 120 mg 3x/week (DL1), 4x/week (DL2), and 5x/week (DL3) 1 week prior to and during RT (50Gy/5 weeks). Surgery was 5-8 weeks after RT. A 3+3 design was used to make dose escalation/de-escalation decisions at each dose level. Five additional pts were enrolled to the MTD to ensure safety (expansion cohort) with a dose limiting toxicity (DLT) rate of ≤ 1/5 considered safe. The DLT observation period was from the start of navtemadlin until 4 weeks after completion of drug+RT. Tumor Tp53 mutation status was determined by NGS sequencing. All eligible and treated p53 WT pts who experienced DLT or completed the observation period were considered DLT-evaluable. DLT included all grade 4-5 AE definitely, probably, or possibly related to navtemadlin. Any grade 3 AE definitely, probably, or possibly related to navtemadlin was also considered DLT if any of the 2 following situations occurred: a delay of treatment > 2 weeks or ≥ 2 dose reductions due to the grade 3 AE. The decision to escalate or de-escalate was made by consensus of the study team in accordance with the protocol. Results: Between 11/3/2017 and 9/10/2021, 4 (3 WT), 7 (4 WT) and 7 (4 WT) pts were enrolled at DL1, DL2, and DL3 respectively. An additional 9 (5 WT) pts were enrolled on DL3 expansion cohort. Preoperative RT was completed for all except 1 pt (pt refusal/DL3). On DL1 and DL2, 100% of pts completed navtemadlin. On DL3 (including expansion cohort), 78% (7/9) completed navtemadlin (1 AE, 1 pt refusal). On DL1, DL2, and DL3, 3/3, 3/4 (1 disease progression), and 5/6 (1 consent withdrawal; 3 pending) completed surgery. There were no DLTs in any dose level (DL1 0/3, DL2 0/4, DL3 0/9), establishing DL3 as the MTD/RP2D. Tumor necrosis rates will be reported at the time of presentation. Conclusions: Neoadjuvant navtemadlin concurrent with standard dose preoperative RT is well tolerated in patients with WT p53 STS at extremity or body wall, and the 120 mg PO daily of navtemadlin, 5 days per week dose should be used to design future trials of RT with extremity STS. Incorporating NGS sequencing results as an integral biomarker in a clinical trial of neoadjuvant radiotherapy and a radiosensitizer is feasible. Clinical trial information: NRG-DT001 NCT03217266.
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Affiliation(s)
| | | | | | | | | | - Paul Wakely
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | | | - Steve B. Jiang
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Peter Houghton
- University of Texas Health Science Center San Antonio, San Antonio, TX
| | | | | | | | | | - Jonathan Harris
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | - Dian Wang
- Rush University Medical Center, Chicago, IL
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4
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Schuster JM, Saeed H, Puckett LL, Moran JM, Howell K, Thomas C, Offerman S, Suneja G, Jagsi R. Gender Equity in Radiation Oncology: Culture Change is a Marathon, not a Sprint. Adv Radiat Oncol 2022; 7:100937. [PMID: 35592465 PMCID: PMC9110895 DOI: 10.1016/j.adro.2022.100937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/18/2022] [Indexed: 11/03/2022] Open
Abstract
The specialty of radiation oncology's gender diversity is lagging other medical specialties. The lack of gender diversity in radiation oncology has been demonstrated at all stages of career, from medical schools to department chairs. Multiple articles have demonstrated literature-based benefits of inclusion of a diverse group of female colleagues. This editorial is intended to note areas of progress and highlight resources available to support gender equity in the field of radiation oncology.
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Soroko M, Górniak W, Godlewska M, Howell K. The effect of training on infrared thermographic images of the forelimb and hindlimb joints of healthy racehorses. Pol J Vet Sci 2022; 25:83-92. [PMID: 35575873 DOI: 10.24425/pjvs.2022.140844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The aim of this study was to evaluate the influence of training on body surface temperature over the joints in racehorses, measured by infrared thermography. The study involved monitoring of 14 Thoroughbred racehorses in 6 imaging sessions over a period of 3 months. Temperature measurements of the forelimb and hindlimb joints were made before and just after training. Joint temperature of limbs increased significantly after training. Environmental temperature had a statistically significant influence on surface temperature over the joints. The lowest surface temperatures were recorded over the metacarpophalangeal and metatarsophalangeal joint and the highest temperatures in the shoulder, elbow, hip and stifle joint. The metacarpophalangeal and metatarsophalangeal joints warmed the least during training, but were influenced the most by differences in environmental temperature. The surface temperature difference before and after training is an important indicator of the thermoregulatory response to exercise in racing horses. Understanding surface temperature changes in response to regular training is necessary for future studies on diagnosing injuries of joints.
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Affiliation(s)
- M Soroko
- Institute of Animal Breeding, Wroclaw University of Environmental and Life Sciences, Chelmonskiego 38C, 51-630 Wroclaw, Poland
| | - W Górniak
- Department of Automotive Engineering, Wroclaw University of Science and Technology, Na Grobli 13, 50-421 Wroclaw, Poland
| | - M Godlewska
- Institute of Animal Breeding, Wroclaw University of Environmental and Life Sciences, Chelmonskiego 38C, 51-630 Wroclaw, Poland
| | - K Howell
- Microvascular Diagnostics, Institute of Immunity and Transplantation, Royal Free Hospital, Pond Street, London NW3 2QG, UK
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Atwood TF, Lamichhane N, Howell K, Weiss SE, Bird L, Pearson C, Joiner MC, Dominello MM, Burmeister J. Three discipline collaborative radiation therapy (3DCRT) special debate: A physicist's time is better spent in direct patient/provider interaction than in the patient's chart. J Appl Clin Med Phys 2022; 23:e13559. [PMID: 35170198 PMCID: PMC9194975 DOI: 10.1002/acm2.13559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Todd F Atwood
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, California, USA
| | - Narottam Lamichhane
- Department of Radiation Oncology, University of Maryland, Baltimore, Maryland, USA
| | - Krisha Howell
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Stephanie E Weiss
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | | | | | - Michael C Joiner
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Michael M Dominello
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Jay Burmeister
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, USA.,Gershenson Radiation Oncology Center, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
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Soroko M, Howell K, Dudek K, Waliczek A, Micek P, Flaga J. Relationship between maximum eye temperature and plasma cortisol concentration in racehorses during intensive training. Pol J Vet Sci 2021; 24:393-397. [PMID: 34730308 DOI: 10.24425/pjvs.2021.138730] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The aim of the study was to determine the utility of maximum eye temperature measured by infrared thermography (IRT) as a stress indicator compared with plasma cortisol concentration in Thoroughbred and Arabian racehorses. The study included thirty racehorses undergoing standard training for racing. Measurements of maximum eye temperature and blood collection for plasma cortisol concentration were carried out before training (BT), and within 5 (5AT) and 120 minutes (120AT) after the end of the each training session in three repetitions, with a monthly interval. Both parameters were elevated at 5AT compared to BT (p⟨0.001). Compared to BT, at 120AT the maximum eye temperature remained elevated (p⟨0.001) and plasma cortisol concentration decreased (p⟨0.001). The study indicated significant weak correlations (r=0.220; p⟨0.001) between both measurements at all time points. The results support the use of IRT technique to monitor the response of horses to stress, potentially improving animal management and welfare.
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Affiliation(s)
- M Soroko
- Institute of Animal Breeding, Wroclaw University of Environmental and Life Sciences, Chelmonskiego 38C, 51-630 Wroclaw, Poland
| | - K Howell
- Microvascular Diagnostics, Institute of Immunity and Transplantation, Royal Free Hospital, Pond Street, London NW3 2QG, UK
| | - K Dudek
- Faculty of Mechanical Engineering, Wroclaw University of Technology, Lukasiewicza 7/9, 50-231 Wroclaw, Poland
| | - A Waliczek
- Department of Animal Nutrition and Biotechnology, and Fisheries, University of Agriculture in Krakow, Al. Mickiewicza 24/28, 30-059 Krakow, Poland
| | - P Micek
- Department of Animal Nutrition and Biotechnology, and Fisheries, University of Agriculture in Krakow, Al. Mickiewicza 24/28, 30-059 Krakow, Poland
| | - J Flaga
- Department of Animal Nutrition and Biotechnology, and Fisheries, University of Agriculture in Krakow, Al. Mickiewicza 24/28, 30-059 Krakow, Poland
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Staley JT, Redhead JW, O'Connor RS, Jarvis SG, Siriwardena GM, Henderson IG, Botham MS, Carvell C, Smart SM, Phillips S, Jones N, McCracken ME, Christelow J, Howell K, Pywell RF. Designing a survey to monitor multi-scale impacts of agri-environment schemes on mobile taxa. J Environ Manage 2021; 290:112589. [PMID: 33906116 DOI: 10.1016/j.jenvman.2021.112589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/09/2021] [Accepted: 04/09/2021] [Indexed: 06/12/2023]
Abstract
Agri-environment schemes (AES) are key mechanisms to deliver conservation policy, and include management to provide resources for target taxa. Mobile species may move to areas where resources are increased, without this necessarily having an effect across the wider countryside or on populations over time. Most assessments of AES efficacy have been at small spatial scales, over short timescales, and shown varying results. We developed a survey design based on orthogonal gradients of AES management at local and landscape scales, which will enable the response of several taxa to be monitored. An evidence review of management effects on butterflies, birds and pollinating insects provided data to score AES options. Predicted gradients were calculated using AES uptake, weighted by the evidence scores. Predicted AES gradients for each taxon correlated strongly, and with the average gradient across taxa, supporting the co-location of surveys across different taxa. Nine 1 × 1 km survey squares were selected in each of four regional blocks with broadly homogenous background habitat characteristics. Squares in each block covered orthogonal contrasts across the range of AES gradients at local and landscape scales. This allows the effects of AES on species at each scale, and the interaction between scales, to be tested. AES options and broad habitats were mapped in field surveys, to verify predicted gradients which were based on AES option uptake data. The verified AES gradient had a strong positive relationship with the predicted gradient. AES gradients were broadly independent of background habitat within each block, likely allowing AES effects to be distinguished from potential effects of other habitat variables. Surveys of several mobile taxa are ongoing. This design will allow mobile taxa responses to AES to be tested in the surrounding countryside, as well as on land under AES management, and potentially in terms of population change over time. The design developed here provides a novel, pseudo-experimental approach for assessing the response of mobile species to gradients of management at two spatial scales. A similar design process could be applied in other regions that require a standardized approach to monitoring the impacts of management interventions on target taxa at landscape scales, if equivalent spatial data are available.
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Affiliation(s)
- J T Staley
- UK Centre for Ecology and Hydrology (UKCEH), Maclean Building, Benson Lane, Crowmarsh Gifford, Oxfordshire, OX10 8BB, UK.
| | - J W Redhead
- UK Centre for Ecology and Hydrology (UKCEH), Maclean Building, Benson Lane, Crowmarsh Gifford, Oxfordshire, OX10 8BB, UK
| | - R S O'Connor
- UK Centre for Ecology and Hydrology (UKCEH), Maclean Building, Benson Lane, Crowmarsh Gifford, Oxfordshire, OX10 8BB, UK
| | - S G Jarvis
- UKCEH, Lancaster Environment Centre, Library Avenue, Bailrigg, Lancaster, LA1 4AP, UK
| | - G M Siriwardena
- British Trust for Ornithology (BTO), The Nunnery, Thetford, Norfolk, IP24 2PU, UK
| | - I G Henderson
- British Trust for Ornithology (BTO), The Nunnery, Thetford, Norfolk, IP24 2PU, UK
| | - M S Botham
- UK Centre for Ecology and Hydrology (UKCEH), Maclean Building, Benson Lane, Crowmarsh Gifford, Oxfordshire, OX10 8BB, UK
| | - C Carvell
- UK Centre for Ecology and Hydrology (UKCEH), Maclean Building, Benson Lane, Crowmarsh Gifford, Oxfordshire, OX10 8BB, UK
| | - S M Smart
- UKCEH, Lancaster Environment Centre, Library Avenue, Bailrigg, Lancaster, LA1 4AP, UK
| | - S Phillips
- Natural England, Foss House, Kings Pool, 1-2 Peasholme Green, York, YO1 7PX, UK
| | - N Jones
- FERA Science Ltd, National Agri-food Innovation Campus, Sand Hutton, York, YO41 1LZ, UK
| | - M E McCracken
- UK Centre for Ecology and Hydrology (UKCEH), Maclean Building, Benson Lane, Crowmarsh Gifford, Oxfordshire, OX10 8BB, UK
| | - J Christelow
- UK Centre for Ecology and Hydrology (UKCEH), Maclean Building, Benson Lane, Crowmarsh Gifford, Oxfordshire, OX10 8BB, UK
| | - K Howell
- UK Centre for Ecology and Hydrology (UKCEH), Maclean Building, Benson Lane, Crowmarsh Gifford, Oxfordshire, OX10 8BB, UK
| | - R F Pywell
- UK Centre for Ecology and Hydrology (UKCEH), Maclean Building, Benson Lane, Crowmarsh Gifford, Oxfordshire, OX10 8BB, UK
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Moten AS, von Mehren M, Reddy S, Howell K, Handorf E, Farma JM. Treatment Patterns and Distance to Treatment Facility for Soft Tissue Sarcoma of the Extremity. J Surg Res 2020; 256:492-501. [PMID: 32798997 PMCID: PMC10034971 DOI: 10.1016/j.jss.2020.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/14/2020] [Accepted: 07/11/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The impact that distance traveled to receive treatment has on treatments and outcomes among patients with soft tissue sarcoma (STS) of the extremity has yet to be thoroughly investigated. METHODS Information on patients treated for STS of the extremity between 2006 and 2015 was obtained from the National Cancer Database. Patients were stratified into two groups based on median distance traveled to receive treatment. Chi-square tests assessed associations between categorical variables and distance to treatment. Kaplan-Meier survival estimates and Cox regression were used to estimate survival. RESULTS The sample included 21,763 patients. The mean age was 59.3 y, 54.6% were men, and 83.2% were white. The median distance traveled to the treating facility was 15.6 miles. Compared with patients who traveled <15 miles, those who traveled ≥15 miles were more likely to have undifferentiated rather than well-differentiated tumors (odds ratio [OR], 1.23; 95% confidence interval [95% CI], 1.10-1.37), and stage II rather than stage I disease (OR, 1.14; 95% CI, 1.04-1.24). They were also more likely to undergo limb-sparing resection (OR, 1.58; 95% CI, 1.39-1.79) or amputation (OR, 1.72; 95% CI, 1.44-2.07) rather than no surgery and less likely to have positive margins (OR, 0.86; 95% CI, 0.79-0.93). There was no difference in the risk of death between patients who traveled ≥15 miles and those who did not (hazard ratio, 1.00; 95% CI, 0.94-1.07). CONCLUSIONS Although clinical characteristics and treatments may differ based on distance traveled, survival appears equivalent. Further research into reasons why greater distance traveled is associated with more advanced disease, but comparable survival is warranted.
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Affiliation(s)
- Ambria S Moten
- Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania.
| | - Margaret von Mehren
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Sanjay Reddy
- Department of Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Krisha Howell
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Elizabeth Handorf
- Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jeffrey M Farma
- Department of Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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Stockton LG, Hill MV, Deng M, Von Mehren M, Minarich MJ, Greco S, Howell K, Michael Farma J. Location of Angiosarcoma on Presentation Predicts Overall Survival and Pattern of Recurrence. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.08.557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Zaki P, Shenoy G, Gou J, Raj V, Howell K. Radiation Oncologist Perceptions and Utilization of Digital Patient Assessment Platforms. Appl Radiat Oncol 2020; 9:24-29. [PMID: 33024796 PMCID: PMC7536100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Patient engagement is increasing in the presence of digital patient assessment platforms, or physician rating websites. Despite this rapid growth, data remains insufficient regarding how these evaluations impact radiation oncologists. OBJECTIVES The purpose of this study was to assess radiation oncologists worldwide on their awareness and noted effects of digital patient assessment platforms. METHODS An electronic survey was delivered to 6,199 members of the American Society of Radiation Oncology. Subjects were radiation oncologists practicing throughout the world. The survey consisted of 14 questions focused on demographics, practice details, patient volume, institutional utilization of patient reviews, and perceptions of radiation oncologists on health care reviews provided by patients. RESULTS There were 447 responses from practicing radiation oncologists in total, 321 (72%) of which are in the US. Most respondents (228; 51%) either agreed or strongly agreed that patients consider online reviews when deciding which physician to visit. Of all respondents, 188 (42%) reported that their institution checks their online feedback, whereas 157 (36%) and 99 (22%) respectively reported not knowing, or to their knowledge their institution does not check their online feedback. Respondents who saw more than the average number of consults per week were significantly more likely to receive negative feedback (P = 0.005). Forty-five percent of respondents agreed or strongly agreed that online virtual assessment tools contribute to physician burnout. Respondents (100; 22%) who received inappropriate or misdirected feedback were significantly more likely to report that virtual reviews contribute to burnout (P = 0.001). CONCLUSIONS Radiation oncologists need to be aware that self-reported patient assessments are a data point in the quality of a physician and health care establishment. To best ensure appropriate feedback of a physician's capabilities as a doctor, leadership and employee alignment for patient experience are now more important than ever.
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Affiliation(s)
- Peter Zaki
- Department of Radiation Oncology, University of Washington, Seattle, and previously at Penn State College of Medicine, Hershey, PA
| | | | - Jiangtao Gou
- Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, PA
| | - Vijay Raj
- Thomas Jefferson University Hospital, Philadelphia, PA
| | - Krisha Howell
- Department of Radiation Oncology, Fox Chase Cancer Center
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Smeltzer M, Wynes M, Lantuejoul S, Soo R, Dalurzo L, Felip E, Hollenbeck G, Howell K, Kerr K, Kim E, Mathias C, Postmus P, Powell C, Ramalingam S, Richeimer K, Taylor M, Tsuboi M, Varella-Garcia M, Wistuba I, Wood K, Scagliotti G, Hirsch F. OA01.09 Comparing Regional Results from the IASLC Global Survey on Molecular Testing in Lung Cancer. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Garcia M, Smeltzer M, Wynes M, Lantuejoul S, Soo R, Dalurzo L, Felip E, Howell K, Kerr K, Kim E, Mathias C, Postmus P, Powell C, Ramalingam S, Richeimer K, Taylor M, Tsuboi M, Wistuba I, Wood K, Scagliotti G, Hirsch F. O.04 Results from the IASLC Global Survey on Molecular Testing in Lung Cancer. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.09.091] [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: 11/30/2022]
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Howell K, Matuszak M, Maitz CA, Eisaman SH, Padilla L, Brown SL, Joiner MC, Dominello MM, Burmeister J. Three Discipline Collaborative Radiation Therapy (3DCRT) special debate: In the future, at least 20% of NIH funding for radiotherapy research should be allocated to non-oncologic applications. J Appl Clin Med Phys 2019; 21:7-13. [PMID: 31573150 PMCID: PMC7020985 DOI: 10.1002/acm2.12729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 08/29/2019] [Accepted: 09/04/2019] [Indexed: 11/06/2022] Open
Affiliation(s)
- Krisha Howell
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Martha Matuszak
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Charles A Maitz
- Veterinary Health Center, University of Missouri, Columbia, MO, USA
| | - Subarna H Eisaman
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, PA, USA
| | - Laura Padilla
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA
| | - Stephen L Brown
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
| | - Michael C Joiner
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Michael M Dominello
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jay Burmeister
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA.,Gershenson Radiation Oncology Center, Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA
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Winters M, Panayotides D, Bayrak M, Rémont G, Viejo CG, Liu D, Le B, Liu Y, Luo J, Zhang P, Howell K. Defined co-cultures of yeast and bacteria modify the aroma, crumb and sensory properties of bread. J Appl Microbiol 2019; 127:778-793. [PMID: 31211891 DOI: 10.1111/jam.14349] [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] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/27/2019] [Accepted: 06/04/2019] [Indexed: 12/13/2022]
Abstract
AIMS Yeast and bacterial communities inhabit a sourdough starter to make artisanal bread. This study shows whether the interactions of micro-organisms derived from Australian sourdough starters provide some of the positive flavour, and aroma properties to bread by using defined sourdough cultures as the sole leaven in bread production. METHODS AND RESULTS An investigation of Australian sourdough starters found that they contained Saccharomyces cerevisiae and Kazachstania exigua yeasts. When these yeasts were inoculated alone to ferment wheat flour in an extended fermentation, the bread had a heterogeneous crumb structure, a deeper colour and a distinctive chemical aroma profile than those made with commercial baker's yeast. When bread was made combining these yeasts individually and in combinations with lactic acid bacteria also isolated from these sourdough starters, including Lactobacillus plantarum, L. brevis, L. rossiae, L. casei, the bread aroma profiles and crumb structure were more distinctive, with compounds associated with sour aromas produced, and preferred by sensory panels. CONCLUSIONS The use of defined mixed cultures as the leaven in bread making, by exploiting the microbial diversity of artisanal Australian starters, can produce bread with distinctive and attractive aromas. SIGNIFICANCE AND IMPACT OF THE STUDY Understanding and identifying the community ecosystems found in sourdough cultures and using them as the sole leaven in bread production provide novel insights into microbial interactions and how they affect food quality by removing the effects of commercial yeast strains.
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Affiliation(s)
- M Winters
- School of Agriculture and Food, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Vic, Australia
| | - D Panayotides
- School of Agriculture and Food, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Vic, Australia
| | - M Bayrak
- School of Agriculture and Food, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Vic, Australia
| | - G Rémont
- School of Agriculture and Food, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Vic, Australia.,AgroParisTech, Paris, France
| | - C G Viejo
- School of Agriculture and Food, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Vic, Australia
| | - D Liu
- School of Agriculture and Food, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Vic, Australia
| | - B Le
- School of Agriculture and Food, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Vic, Australia
| | - Y Liu
- School of Agriculture and Food, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Vic, Australia
| | - J Luo
- School of Agriculture and Food, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Vic, Australia
| | - P Zhang
- School of Agriculture and Food, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Vic, Australia
| | - K Howell
- School of Agriculture and Food, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Vic, Australia
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Moten AS, Zhao H, Howell K, Nadler A, Reddy SS, von Mehren M, Movva S, Farma JM. Soft tissue sarcoma of the extremity: Characterizing symptom duration and outcomes. Surg Oncol 2019; 29:190-195. [PMID: 31196487 DOI: 10.1016/j.suronc.2019.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 05/12/2019] [Accepted: 05/18/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND We sought to investigate how the interval between symptom onset and diagnosis of soft tissue sarcoma (STS) of the extremity was associated with survival. METHODS Patients treated for extremity STS years 2006-2015 were stratified by symptom duration: at least two, six or twelve months between symptom onset and diagnosis. Chi-square tests compared patient and tumor-related characteristics based on symptom duration. Survival analysis included Cox regression and Kaplan-Meier estimates. RESULTS Of 113 patients included, mean age was 56.7 years, 52.2% were male, and 75.2% were white. Median tumor size was 75 mm, 48.7% were grade 3, and 38.1% were stage I. With symptom duration of either at least 6 or 12 months, a greater proportion of patients who experienced the specified symptom duration had lower grade tumors (p < 0.01 and p = 0.01, respectively) and lower stage disease (p < 0.01 and p = 0.02, respectively) than those who did not. Among all patients, survival estimates were similar between those who experienced a symptom duration of 2 (p = 0.12), 6 (p = 0.18) or 12 (p = 0.61) months and those who did not. CONCLUSION Patients with extremity STS who tolerated a longer symptom duration had less advanced disease. Reasons for prolonged symptom duration and methods to address these factors warrant further investigation.
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Affiliation(s)
- Ambria S Moten
- Temple University Hospital, Department of Surgery, 3401 N Broad St, Philadelphia, PA, 19140, United States.
| | - Huaqing Zhao
- Lewis Katz School of Medicine at Temple University, Department of Clinical Sciences, 3500 N Broad St, Philadelphia, PA, 19140, United States
| | - Krisha Howell
- Fox Chase Cancer Center, Department of Radiation Oncology, 333 Cottman Ave, Philadelphia, PA, 19111, United States
| | - Ashlie Nadler
- Fox Chase Cancer Center, Department of Surgery, 333 Cottman Ave, Philadelphia, PA, 19111, United States
| | - Sanjay S Reddy
- Fox Chase Cancer Center, Department of Surgery, 333 Cottman Ave, Philadelphia, PA, 19111, United States
| | - Margaret von Mehren
- Fox Chase Cancer Center, Department of Hematology/Oncology, 333 Cottman Ave, Philadelphia, PA, 19111, United States
| | - Sujana Movva
- Fox Chase Cancer Center, Department of Hematology/Oncology, 333 Cottman Ave, Philadelphia, PA, 19111, United States
| | - Jeffrey M Farma
- Fox Chase Cancer Center, Department of Surgery, 333 Cottman Ave, Philadelphia, PA, 19111, United States
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Lee DY, Gou J, Karen Wong J, Iavor Veltchev M, Howell K, Anderson P. Single Institution Retrospective Review of a Short Brachytherapy Treatment Regime in Postoperative Endometrial Carcinoma Patients. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/s0360-3016(19)30430-4] [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: 10/27/2022]
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18
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Veltchev I, Price R, Chen X, Howell K, Meyer J, Ma CM. Application of a directional palladium-103 brachytherapy device on a curved surface. Med Phys 2019; 46:1905-1913. [PMID: 30734318 DOI: 10.1002/mp.13427] [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: 11/13/2018] [Revised: 01/28/2019] [Accepted: 01/28/2019] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The directional planar palladium-103 LDR device (CivaSheet TM ) may be used for intraoperative implantation at the interface between the tumor site and healthy tissue. Its dosimetric properties have been studied in the ideal case of application on a flat surface. The dosimetric impact of implanting this highly directional device on a curved surface that may be encountered in clinical treatments is analyzed. METHODS CivaSheet is designed as an array of directional palladium-103 sources (CivaDots). From the postoperative computed tomography (CT) scans of three patients, the shape of each implanted CivaSheet was reconstructed. In order to obtain a realistic estimate of the distribution of curvatures, the mean radius of curvature at the location of each CivaDot was calculated. A Monte Carlo simulation (FLUKA) of a single CivaDot was designed, based upon published geometry and material specifications. Both the radial dose function analog and the two-dimensional anisotropy function analog for the CivaDot were validated in comparison with film measurements and benchmarked to published Monte Carlo data. A value for the dose-rate constant Λ = 0.587(19) cGy/h/U for a CivaDot source in water was calculated as well. Knowledge of the dose distribution in the vicinity of each source allowed the dose at any point around CivaSheets of different curvatures and orientations to be calculated. RESULTS The local radius of curvature was found to be primarily between 2 and 8 cm in all three patient implants. On the unshielded side of an inward-facing curved CivaSheet implant of radius 2 cm, the calculated dose at 0.5 cm depth exceeded the prescribed dose by ∼20%, while on the shielded side the dose increased by a factor of two, thus compromising the shielding efficiency of the original design. On the unshielded side of an outward-facing curved implant, the dose at 0.5 cm depth decreased by ∼20%. CONCLUSIONS When tumor bed curvature can be estimated from the preplanning CT scan, the results from this study provide quantitative guide for modifying the source strength to achieve the desired clinical results. In many intraoperative cases, however, accurate preplanning based on surface curvature may not be practical. In such situations, knowledge of the dosimetric impact of the surface curvature provides motivation for avoiding implantation geometries that can lead to either over/underdosing the target, or excess dose to healthy tissue.
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Affiliation(s)
- I Veltchev
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - R Price
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - X Chen
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - K Howell
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - J Meyer
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
| | - C-M Ma
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA
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Leonard CE, Sobus RD, Fryman S, Sedlacek S, Kercher J, Widner J, Asmar L, Wang Y, Howell K, Barke L, Carter D. Abstract P1-10-03: A randomized trial of accelerated breast radiotherapy utilizing either 3-dimensional radiotherapy versus intensity modulated radiotherapy. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-10-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
PURPOSE: Primary objective: patient self-assessment of breast pain between 3-dimensional radiotherapy (3D-CRT) versus intensity modulated radiotherapy (IMRT). Secondary objectives: breast cosmesis as well as local-regional recurrence and survival statistics.
METHODS AND MATERIALS: 656 patients (3D-CRT n=325; IMRT n=331) were prospectively randomized to either IMRT or 3D-CRT accelerated partial breast radiotherapy to 38.5 Gy in 10 BID 3.85 Gy fractions. Follow-up was: 1, 4, 8, 12, 16, 20, 24 months then yearly. At follow-up, patients completed a cosmesis/pain self-assessment form and physicians completed a cosmesis and disease-status form.
RESULTS: 636 patients completed treatment (3D-CRT n=316; IMRT n=320). Median age was 62. Mean tumor size was 1.1 cm. Mean margin was 7mm. Histology was: 74.5% IDCA, 7% ILCA, 17% DCIS, 0.5% Tubular, 1% Mucinous. 99% were ER+. HER2/neu status by IHC was 3+ in 16% of patients. Median follow-up is 2 years. Tables 1 and 2 show there is no significant difference in patient-assessed pain and cosmesis between the two treatment arms (p=0.14, =0.68 respectively). Decreasing pain and worsening cosmesis as reported by the patient were significantly related to time (p<0.01, =0.012 respectively). MD assessed cosmesis worsened significantly from baseline in the IMRT compared to 3D-CRT cohort (p=0.045). At 2 years Grade 3 and 4 toxicities were 1.5% and 3.9% respectively for 3D-CRT versus IMRT cohorts. Overall Survival at 2 years were 99.7% for both cohorts. There were 3/319 (0.9%) and 7/328 (2.1%) ipsilateral breast recurrences in the 3D-CRT and IMRT cohorts respectively.
Patient breast pain by follow-up interval12 Months (3D n=167 and IMRT n=163)Rx ModalityNoneMildModerate-Severep value3D50.9%47.3%1.8%0.44IMRT52.1%44.2%3.7% 24 Months (3D n=111 and IMRT n=109)3D52.3%47.7% 0.07IMRT66.1%33.9% 36 Months (3D n=50 and IMRT n=34)3D60.0%40.0% 0.37IMRT58.8%41.2% 48 Months (3D n=12 and IMRT n=123D25.0%75.0% 0.19IMRT58.3%41.7% Results from mixed model for pain gradeEffectEstimateSELowerUpperp value3D vs IMRT0.0810.055-0.0260.1890.14Visit (Baseline, 12, 24, 36, 48 month-0.1010.019-0.137-0.064<0.01Table 1.
Patient breast cosmesis by follow-up interval12 Months (3D n=162 and IMRT n=158)Rx ModalityNo changeSlight changeObvious changeDrastic changep value3D40.1%38.3%19.1%2.5%0.83IMRT41.8%40.5%15.2%2.5% 24 months (3D n=108 and IMRT n=108)3D38.9%40.7%18.5%1.9%0.30IMRT41.7%29.6%26.9%1.9% 36 Months (3D n=50 and IMRT n=34)3D38.0%34.0%28.0%0%0.37IMRT32.4%35.3%26.5%5.9% 48 Months (3D n=10 and IMRT n=12)3D10.0%30.0%60.0% 0.10IMRT50.0%8.3%41.7% Patient breast cosmoses by follow-up intervalEffectEstimateSELowerUpperp value3D vs IMRT0.0260.064-0.1000.1530.68All Visit (Baseline, 12, 24, 36, 48 month)-0.0530.021-0.095-0.0120.01Table 2.
Conclusion: T here were no significant differences in patient-assessed pain and cosmesis between the two treatment arms (p=0.14, =0.68 respectively) and no significant increase in pain over time. However, MD assessed cosmesis showed worsening cosmesis in the IMRT cohort compared to the 3D-CRT cohort wen compared to baseline.
Citation Format: Leonard CE, Sobus RD, Fryman S, Sedlacek S, Kercher J, Widner J, Asmar L, Wang Y, Howell K, Barke L, Carter D. A randomized trial of accelerated breast radiotherapy utilizing either 3-dimensional radiotherapy versus intensity modulated radiotherapy [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-10-03.
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Affiliation(s)
- CE Leonard
- Rocky Mountain Cancer Center, Denver, CO; Rocky Mountain Cancer Center, Aurora, CO; SurgOne, Littleton, CO; Linasmar Consulting, Houston, TX; Invision Sally Jobe Breast Network, Greenwood Village, CO
| | - RD Sobus
- Rocky Mountain Cancer Center, Denver, CO; Rocky Mountain Cancer Center, Aurora, CO; SurgOne, Littleton, CO; Linasmar Consulting, Houston, TX; Invision Sally Jobe Breast Network, Greenwood Village, CO
| | - S Fryman
- Rocky Mountain Cancer Center, Denver, CO; Rocky Mountain Cancer Center, Aurora, CO; SurgOne, Littleton, CO; Linasmar Consulting, Houston, TX; Invision Sally Jobe Breast Network, Greenwood Village, CO
| | - S Sedlacek
- Rocky Mountain Cancer Center, Denver, CO; Rocky Mountain Cancer Center, Aurora, CO; SurgOne, Littleton, CO; Linasmar Consulting, Houston, TX; Invision Sally Jobe Breast Network, Greenwood Village, CO
| | - J Kercher
- Rocky Mountain Cancer Center, Denver, CO; Rocky Mountain Cancer Center, Aurora, CO; SurgOne, Littleton, CO; Linasmar Consulting, Houston, TX; Invision Sally Jobe Breast Network, Greenwood Village, CO
| | - J Widner
- Rocky Mountain Cancer Center, Denver, CO; Rocky Mountain Cancer Center, Aurora, CO; SurgOne, Littleton, CO; Linasmar Consulting, Houston, TX; Invision Sally Jobe Breast Network, Greenwood Village, CO
| | - L Asmar
- Rocky Mountain Cancer Center, Denver, CO; Rocky Mountain Cancer Center, Aurora, CO; SurgOne, Littleton, CO; Linasmar Consulting, Houston, TX; Invision Sally Jobe Breast Network, Greenwood Village, CO
| | - Y Wang
- Rocky Mountain Cancer Center, Denver, CO; Rocky Mountain Cancer Center, Aurora, CO; SurgOne, Littleton, CO; Linasmar Consulting, Houston, TX; Invision Sally Jobe Breast Network, Greenwood Village, CO
| | - K Howell
- Rocky Mountain Cancer Center, Denver, CO; Rocky Mountain Cancer Center, Aurora, CO; SurgOne, Littleton, CO; Linasmar Consulting, Houston, TX; Invision Sally Jobe Breast Network, Greenwood Village, CO
| | - L Barke
- Rocky Mountain Cancer Center, Denver, CO; Rocky Mountain Cancer Center, Aurora, CO; SurgOne, Littleton, CO; Linasmar Consulting, Houston, TX; Invision Sally Jobe Breast Network, Greenwood Village, CO
| | - D Carter
- Rocky Mountain Cancer Center, Denver, CO; Rocky Mountain Cancer Center, Aurora, CO; SurgOne, Littleton, CO; Linasmar Consulting, Houston, TX; Invision Sally Jobe Breast Network, Greenwood Village, CO
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Laughlin B, Famoso J, Gloss J, Frankl J, Elquza E, Howell K. Volumetric changes of the primary esophageal tumor during radiation therapy. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
134 Background: Management of esophageal cancer with radiotherapy requires weeks of daily treatments. The objective of this study is to identify edematous/obstructive changes in the esophageal tumor occurring during therapy and quantifying its change relative to the original tumor volume. Methods: A total of 66 patients were reviewed on a retrospective IRB-approved protocol between July 2012 – July 2016. The gross tumor volume (GTV) targeted with radiation (GTVsim) was constructed on a CT-simulation image. Cone beam CT images (CBCTs) were taken daily during treatment. GTVs (GTVCT#) were contoured on the CBCT on treatment days 1, 6, 11, 16, 21, and 25. Volumes for the GTVsim and each GTVCT# per patient were calculated. A conformality index (CI) was determined by visual confirmation of overlap and calculation of GTVCT#/GTVsim. The standard deviation (SD) was calculated. A theoretical max volume (GTVCTMAX) was determined per patient based on the upper range of 2SD from the average GTVCT# value. A theoretical PTV created from a 1cm (PTV1) and 0.5cm (PTV0.5) expansions were also calculated with associated CIs for PTVCTMAX/PTV1 and PTVCTMAX/PTV0.5. Results: Twenty-one patients had a total of 94 CBCT volumes. The median age was 67 years (53-83), sixteen patients were male, 5 female. T-stage was 1/2 in 5 patients and 3/4 in 15 patients. Chemotherapy was administered concurrently in 17 patients. Median duration of radiotherapy was 35 days (2-50). Results were analyzed by absolute volume comparison and CI calculations as noted in table 1.The median CI for PTVCTMAX/PTV1 was 0.40 (0.15-0.84) and PTVCTMAX/PTV0.5was 0.65 (0.34-0.89). Conclusions: Review of the weekly CBCTs demonstrated a larger tumor volume in the first day of therapy relative to the subsequent weeks, and even relative to the volume at the time of simulation. However, in projecting potential changes in maximum size of the individual tumors, 100% remained within standard PTV volumes constructed with a 1cm and 0.5cm expansions. [Table: see text]
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Affiliation(s)
| | - Justin Famoso
- Department of Radiation Oncology, Banner-University Medical Center, Tucson, Tucson, AZ
| | - John Gloss
- Department of Radiation Oncology, Banner-University Medical Center, Tucson, Tucson, AZ
| | - Joseph Frankl
- University of Arizona School of Medicine, Tucson, AZ
| | - Emad Elquza
- Hematology and Medical Oncology, University of Arizona Cancer Center, Tucson, AZ
| | - Krisha Howell
- Radiation Oncology, University of Arizona Cancer Center, Tucson, AZ
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21
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Recio Boiles A, Howell K, Kalb BT, Malangone S, Nfonsam VN, Elquza E. An update on rectal cancer evaluation by magnetic resonance imaging in neoadjuvant therapy decision making: Retrospective case review. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
762 Background: During the last decade, MRI used for staging of rectal cancer has been reported to up or down stage rectal cancer by 20%. Poor staging affects guided pre-operative decision-making. Adequate staging would enable to stratify treatment, avoiding unnecessary surgical morbidity and allowing aggressive interventions according to patient risk. After novel techniques and image acquisition for MRI became available at our Cancer Center, we aimed to analyze perfusion pattern and qualitative T2 signal before and after chemoradiationtherapy (CRT) tumor response to the gold standard pathological stage. Methods: Data was retrospectively reviewed from our institution cancer registry. Patients were selected with a diagnosis of rectal cancer by biopsy, between 2011-2015. Inclusion criteria were to have documented radiological AJCC 7th edition < IV, accessible diffusion weighted MRI for apparent diffusion coefficient analyzes, completed CRT and pathology report. Results: A total of 57 patients were diagnosed with rectal cancer during this time period, of which 20 fulfilled inclusion criteria; median 61 years old, 80% males, stage IIA (6) IIIB (10) and IIIC (4), LAR 60% and APR 40%. After CRT, 90% of patients (N18) were downstaged (and 2 upstaged) on pathological review. 10 patients had a repeat pre-operative MRI. Post-treatment MRI re-stage correlated with surgical pathological stage in all 10 patients (Table). 4 patients received unnecessary APR and 2 may had benefit from further CRT or total pelvic exanteration. Conclusions: In retrospective, tumor response evaluation post CRT with high-resolution MRI correlated with pathological stage. Our analysis pointed 20% patients may avoid a morbid surgery while 10% would have required more aggressive therapy. Future clinical decisions will be complemented by repeat MRI analysis aiding surgical and clinical decision-making. [Table: see text]
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Affiliation(s)
| | - Krisha Howell
- Radiation Oncology, University of Arizona Cancer Center, Tucson, AZ
| | - Bobby T. Kalb
- Medical Imaging, University of Arizona Cancer Center, Tucson, AZ
| | - Steve Malangone
- Hematology and Medical Oncology, University of Arizona Cancer Center, Tucson, AZ
| | | | - Emad Elquza
- Hematology and Medical Oncology, University of Arizona Cancer Center, Tucson, AZ
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Gonzalez VJ, Howell K. 8 Gy single-fraction radiation for bone metastases: Do the data support a 1-size-fits-all approach? Pract Radiat Oncol 2016; 7:16-18. [PMID: 27720704 DOI: 10.1016/j.prro.2016.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 08/22/2016] [Accepted: 08/25/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Victor J Gonzalez
- Department of Radiation Oncology, University of Arizona, Tucson, Arizona.
| | - Krisha Howell
- Department of Radiation Oncology, University of Arizona, Tucson, Arizona
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Scoto M, Zhou H, Thompson D, Howell K, Hong Y, Imbrigiotta N, Parson S, Brogan P, Muntoni F. Exploring the microvascular abnormalities in a cohort of paediatric patients with spinal muscular atrophy. Neuromuscul Disord 2016. [DOI: 10.1016/j.nmd.2016.06.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dinsdale G, Moore T, O'Leary N, Manning J, Murray A, Berks M, Tresadern P, Allen J, Anderson M, Cutolo M, Hesselstrand R, Howell K, Pizzorni C, Pyrkotsch P, Smith V, Sulli A, Wildt M, Taylor C, Roberts C, Herrick A. FRI0530 Intra-and Inter-Observer Reliability of Nailfold Videocapillaroscopy – A Possible Outcome Measure for Systemic Sclerosis-Related Microangiopathy?: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2248] [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: 11/03/2022]
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Dhaliwal K, Griffin M, Salinas S, Howell K, Denton C, Butler P. FRI0287 The Use of A Dorsal Approach for The Injection of Botulinum Toxin A in The Treatment of Raynauds Phenomenon Secondary To Scleroderma. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2176] [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: 11/04/2022]
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Padayachee A, Day L, Howell K, Gidley MJ. Complexity and health functionality of plant cell wall fibers from fruits and vegetables. Crit Rev Food Sci Nutr 2015; 57:59-81. [DOI: 10.1080/10408398.2013.850652] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- A. Padayachee
- Department of Agriculture and Food Systems, Melbourne School of Land and Environment, The University of Melbourne, Parkville, Victoria, Australia
| | - L. Day
- CSIRO Animal, Food and Health Sciences, Werribee, Victoria, Australia
| | - K. Howell
- Department of Agriculture and Food Systems, Melbourne School of Land and Environment, The University of Melbourne, Parkville, Victoria, Australia
| | - M. J. Gidley
- ARC Centre of Excellence in Plant Cell Walls, Centre for Nutrition and Food Sciences, Queensland Agriculture and Food Innovation, The University of Queensland, St. Lucia, Queensland, Australia
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Howell K, Beresin G, Jeffries G, Liss A, Naumova E. Livestock production and antibiotic resistant pneumonia in the elderly
population of the United States. Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Backhouse MR, Vinall KA, Redmond A, Helliwell P, Keenan AM, Dale RM, Thomas A, Aronson D, Turner-Cobb J, Sengupta R, France B, Hill I, Flurey CA, Morris M, Pollock J, Hughes R, Richards P, Hewlett S, Ryan S, Lille K, Adams J, Haq I, McArthur M, Goodacre L, Birt L, Wilson O, Kirwan J, Dures E, Quest E, Hewlett S, Rajak R, Thomas T, Lawson T, Petford S, Hale E, Kitas GD, Ryan S, Gooberman-Hill R, Jinks C, Dziedzic K, Boucas SB, Hislop K, Rhodes C, Adams J, Ali F, Jinks C, Ong BN, Backhouse MR, White D, Hensor E, Keenan AM, Helliwell P, Redmond A, Ferguson AM, Douiri A, Scott DL, Lempp H, Halls S, Law RJ, Jones J, Markland D, Maddison P, Thom J, Law RJ, Thom JM, Maddison P, Breslin A, Kraus A, Gordhan C, Dennis S, Connor J, Chowdhary B, Lottay N, Juneja P, Bacon PA, Isaacs D, Jack J, Keller M, Tibble J, Haq I, Hammond A, Gill R, Tyson S, Tennant A, Nordenskiold U, Pease EE, Pease CT, Trehane A, Rahmeh F, Cornell P, Westlake SL, Rose K, Alber CF, Watson L, Stratton R, Lazarus M, McNeilly NE, Waterfield J, Hurley M, Greenwood J, Clayton AM, Lynch M, Clewes A, Dawson J, Abernethy V, Griffiths AE, Chamberlain VA, McLoughlin Y, Campbell S, Hayes J, Moffat C, McKenna F, Shah P, Rajak R, Williams A, Rhys-Dillon C, Goodfellow R, Martin JC, Rajak R, Bari F, Hughes G, Thomas E, Baker S, Collins D, Price E, Williamson L, Dunkley L, Youll MJ, Rodziewicz M, Reynolds JA, Berry J, Pavey C, Hyrich K, Gorodkin R, Wilkinson K, Bruce I, Barton A, Silman A, Ho P, Cornell T, Westlake SL, Richards S, Holmes A, Parker S, Smith H, Briggs N, Arthanari S, Nisar M, Thwaites C, Ryan S, Kamath S, Price S, Robinson SM, Walker D, Coop H, Al-Allaf W, Baker S, Williamson L, Price E, Collins D, Charleton RC, Griffiths B, Edwards EA, Partlett R, Martin K, Tarzi M, Panthakalam S, Freeman T, Ainley L, Turner M, Hughes L, Russell B, Jenkins S, Done J, Young A, Jones T, Gaywood IC, Pande I, Pradere MJ, Bhaduri M, Smith A, Cook H, Abraham S, Ngcozana T, Denton CP, Parker L, Black CM, Ong V, Thompson N, White C, Duddy M, Jobanputra P, Bacon P, Smith J, Richardson A, Giancola G, Soh V, Spencer S, Greenhalgh A, Hanson M, De Lord D, Lloyd M, Wong H, Wren D, Grover B, Hall J, Neville C, Alton P, Kelly S, Bombardieri M, Humby F, Ng N, Di Cicco M, Hands R, Epis O, Filer A, Buckley C, McInnes I, Taylor P, Pitzalis C, Freeston J, Conaghan P, Grainger A, O'Connor PJ, Evans R, Emery P, Hodgson R, Emery P, Fleischmann R, Han C, van der Heijde D, Conaghan P, Xu W, Hsia E, Kavanaugh A, Gladman D, Chattopadhyay C, Beutler A, Han C, Zayat AS, Conaghan P, Freeston J, Hensor E, Ellegard K, Terslev L, Emery P, Wakefield RJ, Ciurtin C, Leandro M, Dey D, Nandagudi A, Giles I, Shipley M, Morris V, Ioannou J, Ehrenstein M, Sen D, Chan M, Quinlan TM, Brophy R, Mewar D, Patel D, Wilby MJ, Pellegrini V, Eyes B, Crooks D, Anderson M, Ball E, McKeeman H, Burns J, Yau WH, Moore O, Foo J, Benson C, Patterson C, Wright G, Taggart A, Drew S, Tanner L, Sanyal K, Bourke BE, Lloyd M, Alston C, Baqai C, Chard M, Sandhu V, Neville C, Jordan K, Munns C, Zouita L, Shattles W, Davies U, Makadsi R, Griffith S, Kiely PD, Ciurtin C, Dimofte I, Dabu M, Dabu B, Dobarro D, Schreiber BE, Warrell C, Handler C, Coghlan G, Denton C, Ishorari J, Bunn C, Beynon H, Denton CP, Stratton R, George Malal JJ, Boton-Maggs B, Leung A, Farewell D, Choy E, Gullick NJ, Young A, Choy EH, Scott DL, Wincup C, Fisher B, Charles P, Taylor P, Gullick NJ, Pollard LC, Kirkham BW, Scott DL, Ma MH, Ramanujan S, Cavet G, Haney D, Kingsley GH, Scott D, Cope A, Singh A, Wilson J, Isaacs A, Wing C, McLaughlin M, Penn H, Genovese MC, Sebba A, Rubbert-Roth A, Scali J, Zilberstein M, Thompson L, Van Vollenhoven R, De Benedetti F, Brunner H, Allen R, Brown D, Chaitow J, Pardeo M, Espada G, Flato B, Horneff G, Devlin C, Kenwright A, Schneider R, Woo P, Martini A, Lovell D, Ruperto N, John H, Hale ED, Treharne GJ, Kitas GD, Carroll D, Mercer L, Low A, Galloway J, Watson K, Lunt M, Symmons D, Hyrich K, Low A, Mercer L, Galloway J, Davies R, Watson K, Lunt M, Dixon W, Hyrich K, Symmons D, Balarajah S, Sandhu A, Ariyo M, Rankin E, Sandoo A, van Zanten JJV, Toms TE, Carroll D, Kitas GD, Sandoo A, Smith JP, Kitas GD, Malik S, Toberty E, Thalayasingam N, Hamilton J, Kelly C, Puntis D, Malik S, Hamilton J, Saravanan V, Rynne M, Heycock C, Kelly C, Rajak R, Goodfellow R, Rhys-Dillon C, Winter R, Wardle P, Martin JC, Toms T, Sandoo A, Smith J, Cadman S, Nightingale P, Kitas G, Alhusain AZ, Verstappen SM, Mirjafari H, Lunt M, Charlton-Menys V, Bunn D, Symmons D, Durrington P, Bruce I, Cooney JK, Thom JM, Moore JP, Lemmey A, Jones JG, Maddison PJ, Ahmad YA, Ahmed TJ, Leone F, Kiely PD, Browne HK, Rhys-Dillon C, Wig S, Chevance A, Moore T, Manning J, Vail A, Herrick AL, Derrett-Smith E, Hoyles R, Moinzadeh P, Chighizola C, Khan K, Ong V, Abraham D, Denton CP, Schreiber BE, Dobarro D, Warrell CE, Handler C, Denton CP, Coghlan G, Sykes R, Muir L, Ennis H, Herrick AL, Shiwen X, Thompson K, Khan K, Liu S, Denton CP, Leask A, Abraham DJ, Strickland G, Pauling J, Betteridge Z, Dunphy J, Owen P, McHugh N, Abignano G, Cuomo G, Buch MH, Rosenberg WM, Valentini G, Emery P, Del Galdo F, Jenkins J, Pauling JD, McHugh N, Khan K, Shiwen X, Abraham D, Denton CP, Ong V, Moinzadeh P, Howell K, Ong V, Nihtyanova S, Denton CP, Moinzadeh P, Fonseca C, Khan K, Abraham D, Ong V, Denton CP, Malaviya AP, Hadjinicolaou AV, Nisar MK, Ruddlesden M, Furlong A, Baker S, Hall FC, Hadjinicolaou AV, Malaviya AP, Nisar MK, Ruddlesden M, Raut-Roy D, Furlong A, Baker S, Hall FC, Peluso R, Dario Di Minno MN, Iervolino S, Costa L, Atteno M, Lofrano M, Soscia E, Castiglione F, Foglia F, Scarpa R, Wallis D, Thomas A, Hill I, France B, Sengupta R, Dougados M, Keystone E, Heckaman M, Mease P, Landewe R, Nguyen D, Heckaman M, Mease P, Winfield RA, Dyke C, Clemence M, Mackay K, Haywood KL, Packham J, Jordan KP, Davies H, Brophy S, Irvine E, Cooksey R, Dennis MS, Siebert S, Kingsley GH, Ibrahim F, Scott DL, Kavanaugh A, McInnes I, Chattopadhyay C, Krueger G, Gladman D, Beutler A, Gathany T, Mudivarthy S, Mack M, Tandon N, Han C, Mease P, McInnes I, Sieper J, Braun J, Emery P, van der Heijde D, Isaacs J, Dahmen G, Wollenhaupt J, Schulze-Koops H, Gsteiger S, Bertolino A, Hueber W, Tak PP, Cohen CJ, Karaderi T, Pointon JJ, Wordsworth BP, Cooksey R, Davies H, Dennis MS, Siebert S, Brophy S, Keidel S, Pointon JJ, Farrar C, Karaderi T, Appleton LH, Wordsworth BP, Adshead R, Tahir H, Greenwood M, Donnelly SP, Wajed J, Kirkham B. BHPR research: qualitative * 1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/kes110] [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: 11/14/2022] Open
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Stefanich EG, Danilenko DM, Wang H, O'Byrne S, Erickson R, Gelzleichter T, Hiraragi H, Chiu H, Ivelja S, Jeet S, Gadkari S, Hwang O, Fuh F, Looney C, Howell K, Albert V, Balazs M, Refino C, Fong S, Iyer S, Williams M. A humanized monoclonal antibody targeting the β7 integrin selectively blocks intestinal homing of T lymphocytes. Br J Pharmacol 2011; 162:1855-70. [PMID: 21232034 DOI: 10.1111/j.1476-5381.2011.01205.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND PURPOSE rhuMAb Beta7 is a humanized anti-human β7 monoclonal antibody currently in phase I in inflammatory bowel disease. rhuMAb Beta7 binds the β7 subunit of the integrins α4β7 and αEβ7, blocking interaction with their ligands. These integrins play key roles in immune cell homing to and retention in mucosal sites, and are associated with chronic inflammatory diseases of the gastrointestinal tract. The goal of this study was to evaluate the mucosal specificity of rhuMAb Beta7. EXPERIMENTAL APPROACH We assessed the effect of murine anti-Beta7 on lymphocyte homing in mouse models of autoimmune disease. We also compared the effect of rhuMAb Beta7 on circulating mucosal-homing versus peripheral-homing T cells in naïve non-human primates. KEY RESULTS In cynomolgus monkeys, occupancy of β7 integrin receptors by rhuMAb Beta7 correlated with an increase in circulating β7(+) mucosal-homing lymphocytes, with no apparent effect on levels of circulating β7(-) peripheral-homing lymphocytes. rhuMAb Beta7 also inhibited lymphocyte homing to the inflamed colons of severe combined immunodeficient mice in CD45RB(high) CD4(+) T-cell transfer models. Consistent with a lack of effect on peripheral homing, in a mouse model of experimental autoimmune encephalomyelitis, anti-β7 treatment resulted in no amelioration of CNS inflammation. CONCLUSIONS AND IMPLICATIONS The results presented here suggest that rhuMAb Beta7 selectively blocks lymphocyte homing to the gastrointestinal tract without affecting lymphocyte trafficking to non-mucosal tissues. rhuMAb Beta7 provides a targeted therapeutic approach with the potential for a more attractive benefit:risk ratio than currently available inflammatory bowel disease therapies.
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Affiliation(s)
- E G Stefanich
- Department of Pharmacodynamic Biomarkers, Genentech, Inc., South San Francisco, CA 94080, USA
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Howell K, Costello CM, Sands M, Dooley I, McLoughlin P. L-Arginine promotes angiogenesis in the chronically hypoxic lung: a novel mechanism ameliorating pulmonary hypertension. Am J Physiol Lung Cell Mol Physiol 2009; 296:L1042-50. [PMID: 19346433 DOI: 10.1152/ajplung.90327.2008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Chronic alveolar hypoxia, whether due to residence at high altitude or lung disease, leads to a sustained increase in pulmonary vascular resistance and pulmonary hypertension (PH). Strategies that augment endogenous nitric oxide production or activity, including l-arginine supplementation, attenuate the development of PH. This action has been attributed to inhibition of vessel wall remodeling, thus preventing structural narrowing of the vascular lumen. However, more recent evidence suggests that structural changes are not responsible for the elevated vascular resistance observed in chronic hypoxic PH, calling into question the previous explanation for the action of l-arginine. We examined the effect of dietary l-arginine supplementation on pulmonary vasoconstriction, structurally determined maximum vascular lumen diameter, and vessel length in rats during 2 wk of exposure to hypoxia. l-Arginine attenuated the development of hypoxic PH by preventing increased arteriolar resistance. It did not alter mean maximal vascular lumen diameter, nor did it augment nitric oxide-mediated vasodilatation, in chronically hypoxic lungs. However, the total length of vessels within the gas exchange region of the hypoxic lungs was significantly increased after l-arginine supplementation. These findings suggest that dietary l-arginine ameliorated hypoxic PH, but not by an effect on the structurally determined lumen diameter of pulmonary blood vessels. l-Arginine enhanced angiogenesis in the hypoxic pulmonary circulation, which may attenuate hypoxic PH by producing new parallel vascular pathways through the lung.
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Affiliation(s)
- K Howell
- School of Medicine and Medical Science, Conway Institute of Biomolecular and Biomedical Sciences, University College Dublin, Dublin, Ireland
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Leonard C, Carter D, Howell K, Kaske T, Kercher J, Henkenberns P. A Prospective Trial of Accelerated Partial Breast Intensity Modulated Radiotherapy. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Carter D, Reeder R, Howell K, Henkenberns P, Tallhamer M, Kercher J, Leonard C. Predictors for Clinical Outcomes Following Accelerated Partial Breast Intensity Modulated Radiation Therapy. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.750] [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: 10/21/2022]
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Pakozdi A, Howell K, Wilson H, Fox S, Gonzalez L, Black CM, Denton CP. Inhaled iloprost for the treatment of Raynaud's phenomenon. Clin Exp Rheumatol 2008; 26:709. [PMID: 18799113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Affiliation(s)
- K Howell
- Bacteriological Laboratory, University of Chicago
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Cherkas LF, Williams FMK, Carter L, Howell K, Black CM, Spector TD, MacGregor AJ. Heritability of Raynaud's phenomenon and vascular responsiveness to cold: A study of adult female twins. ACTA ACUST UNITED AC 2007; 57:524-8. [PMID: 17394182 DOI: 10.1002/art.22626] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- L F Cherkas
- Twin Research and Genetic Epidemiology Unit, St. Thomas' Hospital, Kings College, London, UK.
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Leonard MO, Kieran NE, Howell K, Burne MJ, Varadarajan R, Dhakshinamoorthy S, Porter AG, O'Farrelly C, Rabb H, Taylor CT. Reoxygenation-specific activation of the antioxidant transcription factor Nrf2 mediates cytoprotective gene expression in ischemia-reperfusion injury. FASEB J 2006. [DOI: 10.1096/fj.05-5097fje] [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: 11/11/2022]
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Leonard C, Howell K, Henkenberns P, Cornish P, Carter D, Kondrat J. An IRB Approved Prospective Accelerated Partial Breast Intensity Modulated Radiotherapy Protocol. Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
BACKGROUND Cynomolgus monkeys (Macaca fascicularis) are widely used animal models in biomedical research. However, the phenotypic characteristics of cynomolgus monkey (CM) B cells in peripheral blood (PB) and lymphoid organs are poorly understood. METHODS FACS analyses of PB-, spleen-, lymph node (LN)-, and bone marrow (BM)-derived B cells were performed. RESULTS CM peripheral blood B cells have a smaller fraction of CD27(-) (naive) cells ( approximately 40%), as compared to human blood samples ( approximately 70%). Similar to humans, an early activation marker, CD23, is expressed more on CD27(-) CM naive B cells, as compared to CD27(+) B cells. The mean fraction of B cells exhibiting a memory phenotype is similar to that seen in human blood. Unlike humans, CM blood contains a subset of CD20(++)CD80(+)CD21(-)IgM(+/-)CD27(+)CD19(+)FSC(++)BAFF-R(low) B cells that are likely of germinal center origin. Thus, CM blood contains (i) a higher percentage of B cells that express the co-stimulatory molecule CD80, and (ii) a lower fraction of B cells that are CD21(+), as compared to human blood. Due to the relative paucity of information on B-cell subsets in organs of healthy humans, a direct comparison between human and CM lymphoid organ data is limited. The fraction of CD27(+) and CD23(+) B cells appears to be similar, while the fraction of CD80(+) B cells appears to be higher than that seen in human lymphoid organs. CM spleens and to some extent lymph nodes have a distinct subset of CD21(++) cells that are also CD80(+/-)CD23(low)IgM(++)CD27(+/-)FSC(++). This subset is phenotypically similar to the marginal zone B cells present in human spleen and LN samples. We also provide detailed analyses on the fraction of lymphoid organ B cells that express CD21, CD23, CD32, and/or CD80 B-cell markers. CONCLUSIONS In general, cynomolgus monkey B-cell subsets are similar to those seen in humans, as well as to those seen in other nonhuman primates. However, there are some clear differences between human and cynomolgus monkey B-cell subsets. These findings have direct implications for a variety of in vivo studies in cynomolgus monkeys, ranging from basic research on primate B-cell differentiation to models of infectious diseases and trials of new B-cell targeting therapeutic agents.
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Affiliation(s)
- Y Vugmeyster
- Bioanalytical Research and Development, Genentech Inc., South San Francisco, California, USA.
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Howell K, Fontes D, Hamvas A, Mathur A, Holzmann-Pazgal G. Compliance with contact precautions in a neonatal intensive care unit. Am J Infect Control 2005. [DOI: 10.1016/j.ajic.2005.04.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Riggs J, Howell K, Matechin B, Matlack R, Pennello A, Chiasson R. X-chromosome-linked immune-deficient mice have B-1b cells. Immunology 2003; 108:440-51. [PMID: 12667205 PMCID: PMC1782925 DOI: 10.1046/j.1365-2567.2003.01624.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2002] [Revised: 12/05/2002] [Accepted: 01/30/2003] [Indexed: 11/20/2022] Open
Abstract
The B lymphocyte subsets of X-chromosome-linked immune-deficient (XID) mice were examined by flow cytometric analyses of spleen and peritoneal cells. As shown in prior studies, young adult XID mice had reduced representation of the CD5+ (B-1a) subset in their peritoneal cavity. However, the CD11b+ (B-1b) B-cell subset was present and exhibited the IgM(hi) CD45(lo) CD23- phenotype characteristic of most B-1 cells. Although present at a lower frequency than that found in their normal counterparts, B-1b cells were evident in CBA/N and (XD2J)F1 male mice. With increasing age, B-1b cell number increased and in the oldest XID mice were present as B-cell chronic lymphocytic leukaemia. These results show that XID mice do have B-1 cells, particularly the B-1b subset.
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Affiliation(s)
- J Riggs
- Department of Biology, Rider University, Lawrenceville, NJ 08648-3099, USA.
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Cherkas LF, Howell K, Carter L, Black CM, MacGregor AJ. The use of portable radiometry to assess Raynaud's phenomenon: a practical alternative to thermal imaging. Rheumatology (Oxford) 2001; 40:1384-7. [PMID: 11752509 DOI: 10.1093/rheumatology/40.12.1384] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To compare the performance of a portable radiometer with thermal imaging and to assess the potential for radiometry to provide a practical alternative for assessing vascular responsiveness in Raynaud's phenomenon (RP). METHODS Subjects comprised 18 patients with diagnosed RP and 19 non-RP subjects. A thermal imager (Starsight) and a portable radiometer (Cyclops) measured digital temperature at baseline and the subsequent drop and rise in temperature following a cold challenge test. RESULTS The intra-class correlations between the two instruments for all three measures exceeded 80%. The overall performance of each instrument was almost the same, the Starsight thermal imager correctly classifying 84% of subjects as RP or non-RP and the Cyclops portable radiometer correctly classifying 86% of subjects. The sensitivity of the thermal imager was 83%, compared with 89% for the portable radiometer; the specificity of both instruments was 84%. The positive and negative predictive values of the thermal imager were 83 and 84% respectively, and those for the portable radiometer were 84 and 89%. CONCLUSIONS The two instruments performed equally well and the differences between them in their absolute measurements did not influence their ability to detect RP. Portable radiometry provides a practical, cheap, accurate and reliable alternative to thermal imaging and has the potential to be used in range of clinical and epidemiological settings.
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Affiliation(s)
- L F Cherkas
- Twin Research and Genetic Epidemiology Unit, St Thomas' Hospital, London, UK
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Coleiro B, Marshall SE, Denton CP, Howell K, Blann A, Welsh KI, Black CM. Treatment of Raynaud's phenomenon with the selective serotonin reuptake inhibitor fluoxetine. Rheumatology (Oxford) 2001; 40:1038-43. [PMID: 11561116 DOI: 10.1093/rheumatology/40.9.1038] [Citation(s) in RCA: 139] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare fluoxetine, a selective serotonin reuptake inhibitor, with nifedipine as treatment for primary or secondary Raynaud's phenomenon. METHODS Twenty-six patients with primary and 27 patients with secondary Raynaud's phenomenon were assigned randomly to receive 6 weeks of treatment with fluoxetine (20 mg daily) or nifedipine (40 mg daily). Following a 2-week washout period, each group was crossed over to the other treatment arm. The primary outcome variable was the frequency of attacks of Raynaud's phenomenon. Self-reported attack severity, thermographic recovery from cold challenge and plasma levels of von Willebrand factor and soluble P-selectin were also measured. RESULTS There was a reduction in attack frequency and severity of Raynaud's phenomenon in patients treated with either fluoxetine or nifedipine, but the effect was statistically significant only in the fluoxetine-treated group (P=0.0002 for attack severity and P=0.003 for attack frequency). Subgroup analysis showed that the greatest response was seen in females and in patients with primary Raynaud's phenomenon. A significant improvement in the thermographic response to cold challenge was also seen in female patients with primary Raynaud's phenomenon treated with fluoxetine but not in those treated with nifedipine. There was no significant treatment effect on von Willebrand factor or soluble P-selectin. No significant adverse effects occurred in the fluoxetine-treated group. CONCLUSION This pilot study confirms the tolerability of fluoxetine and suggests that it would be effective as a novel treatment for Raynaud's phenomenon. Larger and placebo-controlled trials are warranted to assess fluoxetine's therapeutic potential further in this vasospastic condition.
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Affiliation(s)
- B Coleiro
- Centre for Rheumatology (Royal Free Campus), Royal Free and University College School of Medicine, Rowland Hill Street, London, UK
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Howell J, Duggal H, Howell K. Health professionals' attitudes to MMR vaccine. "Green book" should be updated every six months. BMJ 2001; 322:1120. [PMID: 11360901 PMCID: PMC1120245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
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Abstract
BACKGROUND Travelers' diarrhea is the most frequent health problem in those participating in international journeys, and is responsible for many consultations abroad and on return home. METHODS A questionnaire assessing attitudes toward treatment and management of travel-related and nontravel-related diarrhea was administered to 542 GPs, nurses and pharmacists. RESULTS Health professionals' attitudes to management of acute diarrhea are variable, with marked divergence regarding adherence to published "good practice" guidelines and recommendations. Inconsistencies exist in stated attitudes toward prescribing antispasmodics and antimotility agents and actual prescribing behavior. CONCLUSIONS Current treatment guidelines may be outdated. Inappropriate or delayed treatment disadvantages the patient. Limiting the use of antidiarrheal agents can deny access, for those inflicted with diarrhea, to a medication which may shorten symptomatology and morbidity, and speed the return to normality. Review of guidelines for diarrhea management in adults is overdue, as is standardization of treatment response. Educational initiatives are required to encourage active intervention and improved provision of care.
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Affiliation(s)
- I B McIntosh
- Travel Medicine, Scottish Council for Post Graduate Medical Education, United Kingdom
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Denton CP, Howell K, Stratton RJ, Black CM. Long-term low molecular weight heparin therapy for severe Raynaud's phenomenon: a pilot study. Clin Exp Rheumatol 2000; 18:499-502. [PMID: 10949727] [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: 02/17/2023]
Abstract
OBJECTIVE To investigate tolerability and efficacy of low molecular weight (LMW) heparin therapy in patients with severe Raynaud's phenomenon. METHODS A prospective parallel group study comparing patients receiving regular subcutaneous LMW heparin (n = 16) with a matched control group (n = 14). Endpoints were change in Raynaud's attack severity, non-invasive vascular studies or serum levels of circulating soluble adhesion molecules. RESULTS There was overall improvement in Raynaud's attack severity during heparin therapy (p = 0.0002). This was observed after 4 weeks, and was maximal by 20 weeks. Mean finger blood flow recovery time improved, and serum levels of circulating ICAM-1, VCAM-1 and E-selectin were lower at completion of heparin therapy, but changes did not reach statistical significance. CONCLUSION This study suggests that LMW heparin therapy is well tolerated, and potentially beneficial, in patients with severe Raynaud's phenomenon, and justifies further evaluation.
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Affiliation(s)
- C P Denton
- Centre for Rheumatology (Royal Free Campus), Royal Free and University College Medical School, London, UK
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Abstract
Chronic hypercapnia is commonly found in patients with severe hypoxic lung disease and is associated with a greater elevation of pulmonary arterial pressure than that due to hypoxia alone. We hypothesized that hypercapnia worsens hypoxic pulmonary hypertension by augmenting pulmonary vascular remodeling and hypoxic pulmonary vasoconstriction (HPV). Rats were exposed to chronic hypoxia [inspiratory O(2) fraction (FI(O(2))) = 0.10], chronic hypercapnia (inspiratory CO(2) fraction = 0.10), hypoxia-hypercapnia (FI(O(2)) = 0.10, inspiratory CO(2) fraction = 0.10), or room air. After 1 and 3 wk of exposure, muscularization of resistance blood vessels and hypoxia-induced hematocrit elevation were significantly inhibited in hypoxia-hypercapnia compared with hypoxia alone (P < 0.001, ANOVA). Right ventricular hypertrophy was reduced in hypoxia-hypercapnia compared with hypoxia at 3 wk (P < 0.001, ANOVA). In isolated, ventilated, blood-perfused lungs, basal pulmonary arterial pressure after 1 wk of exposure to hypoxia (20.1 +/- 1.8 mmHg) was significantly (P < 0.01, ANOVA) elevated compared with control conditions (12.1 +/- 0.1 mmHg) but was not altered in hypoxia-hypercapnia (13.5 +/- 0.9 mmHg) or hypercapnia (11.8 +/- 1.3 mmHg). HPV (FI(O(2)) = 0.03) was attenuated in hypoxia, hypoxia-hypercapnia, and hypercapnia compared with control (P < 0.05, ANOVA). Addition of N(omega)-nitro-L-arginine methyl ester (10(-4) M), which augmented HPV in control, hypoxia, and hypercapnia, significantly reduced HPV in hypoxia-hypercapnia. Chronic hypoxia caused impaired endothelium-dependent relaxation in isolated pulmonary arteries, but coexistent hypercapnia partially protected against this effect. These findings suggest that coexistent hypercapnia inhibits hypoxia-induced pulmonary vascular remodeling and right ventricular hypertrophy, reduces HPV, and protects against hypoxia-induced impairment of endothelial function.
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Affiliation(s)
- H Ooi
- Department of Medicine and Therapeutics, Mater Misericordiae Hospital, University College Dublin, Dublin 2, Ireland
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Dziadzio M, Denton CP, Smith R, Howell K, Blann A, Bowers E, Black CM. Losartan therapy for Raynaud's phenomenon and scleroderma: clinical and biochemical findings in a fifteen-week, randomized, parallel-group, controlled trial. Arthritis Rheum 1999; 42:2646-55. [PMID: 10616013 DOI: 10.1002/1529-0131(199912)42:12<2646::aid-anr21>3.0.co;2-t] [Citation(s) in RCA: 170] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To compare the efficacy and tolerability of losartan, an antagonist of angiotensin II receptor type 1, with nifedipine for the treatment of primary and secondary Raynaud's phenomenon (RP) in a pilot study. METHODS In a randomized, parallel-group, controlled trial, patients with primary RP (n = 25) or RP secondary to systemic sclerosis (SSc [scleroderma]; n = 27) were allocated to receive 12 weeks' treatment with either losartan (50 mg/day) or nifedipine (40 mg/day). Primary outcome variables were the severity and frequency of RP episodes and findings on vascular measurements, including thermography and laser Doppler flowmetry. Serum levels of soluble adhesion molecules, endothelin 1, fibrinogen, von Willebrand factor, and procollagen type I N-terminal propeptide (PINP) were also measured. RESULTS There was a reduction in the severity of RP episodes following treatment with losartan and with nifedipine, but this effect was greater in the losartan arm of the study (P<0.05): episode frequency was reduced only in the losartan group (P<0.01 versus baseline). Symptomatic improvement was associated with a significant reduction in soluble vascular cell adhesion molecule 1 and PINP (P<0.01). Subgroup analysis suggested that although these biochemical changes occurred mainly in SSc patients, the clinical benefit was greater in the primary RP group. CONCLUSION This study confirms the tolerability of short-term treatment of RP with losartan, and our data suggest its clinical benefit. Further evaluation of this drug as a long-term treatment for SSc-associated RP should be considered, since it may have additional disease-modifying potential.
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Denton CP, Bunce TD, Dorado MB, Roberts Z, Wilson H, Howell K, Bruckdorfer KR, Black CM. Probucol improves symptoms and reduces lipoprotein oxidation susceptibility in patients with Raynaud's phenomenon. Rheumatology (Oxford) 1999; 38:309-15. [PMID: 10378706 DOI: 10.1093/rheumatology/38.4.309] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Reactive oxygen species have been implicated in the pathogenesis of inflammatory and vascular disease. We have undertaken a controlled trial to evaluate probucol, a synthetic antioxidant, as a potential therapy for Raynaud's phenomenon. METHODS The study cohort included patients with systemic sclerosis (SSc; n = 20), primary Raynaud's phenomenon (n = 15) or 'autoimmune Raynaud's' (n = 5). Patients were allocated to receive either probucol (500 mg daily) or nifedipine (20 mg daily) for 12 weeks. Clinical and biochemical variables at baseline were compared with those at completion of treatment. Evaluation included assessment of Raynaud's attack frequency and severity by visual analogue scale, measurement of low-density lipoprotein (LDL) oxidation lag time, and plasma concentrations of cholesterol, triglyceride, vitamin E and vitamin C. RESULTS There was a significant reduction of both the frequency and severity of Raynaud's attacks in the patients who received probucol, but not in the control group. LDL oxidation lag time, reflecting in vitro susceptibility to oxidation, was also increased by probucol therapy and serum cholesterol levels were significantly reduced. Similar changes were observed in both SSc- and non-SSc-associated Raynaud's cases. CONCLUSION These data suggest that probucol may be useful for the symptomatic treatment of Raynaud's phenomenon and also reduces LDL oxidation susceptibility. Since oxidized lipoproteins may mediate vascular damage in SSc, the use of probucol could have additional disease-modifying benefits. Based upon the results of this pilot study, further evaluation of this novel form of therapy is warranted.
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Affiliation(s)
- C P Denton
- Academic Unit of Rheumatology, Royal Free Hospital School of Medicine, London, UK
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Leonard CE, Philpott P, Shapiro H, Corkill M, Gonzales C, Ponce J, Howell K, Aarestad N, Sedlacek SM. Clinical observations of axillary involvement for tubular, lobular, and ductal carcinomas of the breast. J Surg Oncol 1999; 70:13-20. [PMID: 9989415 DOI: 10.1002/(sici)1096-9098(199901)70:1<13::aid-jso3>3.0.co;2-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES Recently, there has been much interest in identifying primary breast cancer characteristics which have predictive value for axillary metastases. We studied breast cancer patients to determine variables associated with the incidence/extent of axillary involvement and to construct a modeled analysis. METHODS Patients with invasive ductal, lobular, and tubular breast cancer (group 1, n = 15,719) were analyzed by tumor size and histology for the probability/extent of axillary metastases. A subgroup of patients was analyzed separately for any association of axillary involvement and other variables (group 2). RESULTS In group 1, the incidence and extent (number of positive lymph nodes) of axillary metastases correlated significantly with histology and increasing tumor size of ductal and lobular histologies. Significant associations for < or = 10% axillary involvement in group 2 were age and S phase for tubular histology and differentiation for ductal histology. In a multivariate analysis, increasing tumor size was the only statistically significant correlate for axillary involvement (group 2) and for increasing number of positive nodes (group 1). CONCLUSIONS A multivariate model of tumor size and age combined with staging techniques can successfully confirm or assess extent of axillary metastases in breast carcinoma.
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Affiliation(s)
- C E Leonard
- Department of Radiation Oncology, Swedish Medical Center, Englewood, Colorado 80110, USA
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Howell K. Traveller's diarrhoea. Community Nurse 1998; 4:33-5. [PMID: 9763944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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