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Fouda AEA, Lindblom V, Southworth SH, Doumy G, Ho PJ, Young L, Cheng L, Sorensen SL. Influence of Selective Carbon 1s Excitation on Auger-Meitner Decay in the ESCA Molecule. J Phys Chem Lett 2024; 15:4286-4293. [PMID: 38608168 DOI: 10.1021/acs.jpclett.3c03611] [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: 04/14/2024]
Abstract
Two-dimensional spectral mapping is used to visualize how resonant Auger-Meitner spectra are influenced by the site of the initial core-electron excitation and the symmetry of the core-excited state in the trifluoroethyl acetate molecule (ESCA). We observe a significant enhancement of electron yield for excitation of the COO 1s → π* and CF3 1s → σ* resonances unlike excitation at resonances involving the CH3 and CH2 sites. The CF3 1s → π* and CF3 1s → σ* resonance spectra are very different from each other, with the latter populating most valence states equally. Two complementary electronic structure calculations for the photoelectron cross section and Auger-Meitner intensity are shown to effectively reproduce the site- and state-selective nature of the resonant enhancement features. The site of the core-electron excitation and the respective final state hole locality increase the sensistivity of the photoelectron signal at specific functional group sites. This showcases resonant Auger-Meitner decay as a potentially powerful tool for selectively probing structural changes at specific functional group sites of polyatomic molecules.
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Affiliation(s)
- A E A Fouda
- Chemical Sciences and Engineering Division, Argonne National Laboratory, 9700 S. Cass Avenue, Lemont, Illinois 60439, United States
- Department of Physics and James Franck Institute, The University of Chicago, Chicago, Illinois 60637, United States
| | - V Lindblom
- Department of Physics, Lund University, Box 118, 22100 Lund, Sweden
| | - S H Southworth
- Chemical Sciences and Engineering Division, Argonne National Laboratory, 9700 S. Cass Avenue, Lemont, Illinois 60439, United States
| | - G Doumy
- Chemical Sciences and Engineering Division, Argonne National Laboratory, 9700 S. Cass Avenue, Lemont, Illinois 60439, United States
| | - P J Ho
- Chemical Sciences and Engineering Division, Argonne National Laboratory, 9700 S. Cass Avenue, Lemont, Illinois 60439, United States
| | - L Young
- Chemical Sciences and Engineering Division, Argonne National Laboratory, 9700 S. Cass Avenue, Lemont, Illinois 60439, United States
- Department of Physics and James Franck Institute, The University of Chicago, Chicago, Illinois 60637, United States
| | - L Cheng
- Department of Chemistry, Johns Hopkins University, 3400 North Charles St, Baltimore, Maryland 21218, United States
| | - S L Sorensen
- Department of Physics, Lund University, Box 118, 22100 Lund, Sweden
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Young L, Ferrara F, Kelly L, Martin T, Thompson-Iritani S, LaFollette MR. Professional quality of life in animal research personnel is linked to retention & job satisfaction: A mixed-methods cross-sectional survey on compassion fatigue in the USA. PLoS One 2024; 19:e0298744. [PMID: 38626016 PMCID: PMC11020707 DOI: 10.1371/journal.pone.0298744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/29/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Working with research animals can be both rewarding and challenging. The rewarding part of the work is associated with understanding the necessity for animal research to improve the health of humans and animals and the knowledge that one can provide care and compassion for the animals. Challenges with animal research include witnessing stress/pain in animals necessitated by scientific requirements, end of study euthanasia, and societal stigmatization about animal research. These challenges could be compounded with more general workplace stresses, in turn, impacting job retention and satisfaction. However, these factors have yet to be formally evaluated. Therefore, the purpose of this survey was to comprehensively evaluate professional quality of life's correlation with key workplace metrics. METHODS Six institutions were recruited to participate in a longitudinal intervention trial on compassion fatigue resiliency. This manuscript reports key baseline metrics from this survey. A cross-sectional mixed methods survey was developed to evaluate professional quality of life, job satisfaction, retention, and factors influencing compassion fatigue resiliency. Quantitative data were analyzed via general linear models and qualitative data were analyzed by theme. RESULTS Baseline data was collected from 198 participants. Personnel who reported higher compassion satisfaction also reported higher retention and job satisfaction. Conversely, personnel who reported higher burnout also reported lower job satisfaction. In response to open-ended questions, participants said their compassion fatigue was impacted by institutional culture (70% of participants), animal research (58%), general mental health (41%), and specific compassion fatigue support (24%). CONCLUSIONS In conclusion, these results show that professional quality of life is related to important operational metrics of job satisfaction and retention. Furthermore, compassion fatigue is impacted by factors beyond working with research animals, including institutional culture and general mental health support. Overall, this project provides rationale and insight for institutional support of compassion fatigue resiliency.
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Affiliation(s)
- Lauren Young
- Department of Integrative Biology, University of Guelph, Guelph, Ontario, Canada
- The 3Rs Collaborative, Denver, Colorado, United States of America
| | | | - Lisa Kelly
- University of Georgia, Athens, Georgia, United States of America
| | - Tara Martin
- Refinement and Enrichment Advancements Laboratory, Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Sally Thompson-Iritani
- Department of Environmental and Occupational Health Sciences, Office of Research, University of Washington, Seattle, WA, United States of America
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Smekalova EM, Martinez MG, Combe E, Kumar A, Dejene S, Leboeuf D, Chen CY, Dorkin JR, Shuang LS, Kieft S, Young L, Barrera LA, Packer MS, Ciaramella G, Testoni B, Gregoire F, Zoulim F. Cytosine base editing inhibits hepatitis B virus replication and reduces HBsAg expression in vitro and in vivo. Mol Ther Nucleic Acids 2024; 35:102112. [PMID: 38292874 PMCID: PMC10825689 DOI: 10.1016/j.omtn.2023.102112] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/21/2023] [Indexed: 02/01/2024]
Abstract
Chronic hepatitis B virus (HBV) infection remains a global health problem due to the lack of treatments that prevent viral rebound from HBV covalently closed circular (ccc)DNA. In addition, HBV DNA integrates in the human genome, serving as a source of hepatitis B surface antigen (HBsAg) expression, which impairs anti-HBV immune responses. Cytosine base editors (CBEs) enable precise conversion of a cytosine into a thymine within DNA. In this study, CBEs were used to introduce stop codons in HBV genes, HBs and Precore. Transfection with mRNA encoding a CBE and a combination of two guide RNAs led to robust cccDNA editing and sustained reduction of the viral markers in HBV-infected HepG2-NTCP cells and primary human hepatocytes. Furthermore, base editing efficiently reduced HBsAg expression from HBV sequences integrated within the genome of the PLC/PRF/5 and HepG2.2.15 cell lines. Finally, in the HBV minicircle mouse model, using lipid nanoparticulate delivery, we demonstrated antiviral efficacy of the base editing approach with a >3log10 reduction in serum HBV DNA and >2log10 reduction in HBsAg, and 4/5 mice showing HBsAg loss. Combined, these data indicate that base editing can introduce mutations in both cccDNA and integrated HBV DNA, abrogating HBV replication and silencing viral protein expression.
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Affiliation(s)
| | - Maria G. Martinez
- INSERM U1052, Cancer Research Center of Lyon, CNRS UMR 5286, 69008 Lyon, France
- University of Lyon, UMR_S1052, UCBL, 69008 Lyon, France
- Hepatology Institute of Lyon, 69008 Lyon, France
| | - Emmanuel Combe
- INSERM U1052, Cancer Research Center of Lyon, CNRS UMR 5286, 69008 Lyon, France
- University of Lyon, UMR_S1052, UCBL, 69008 Lyon, France
- Hepatology Institute of Lyon, 69008 Lyon, France
| | - Anuj Kumar
- INSERM U1052, Cancer Research Center of Lyon, CNRS UMR 5286, 69008 Lyon, France
- University of Lyon, UMR_S1052, UCBL, 69008 Lyon, France
- Hepatology Institute of Lyon, 69008 Lyon, France
| | | | | | | | | | | | | | | | | | | | | | - Barbara Testoni
- INSERM U1052, Cancer Research Center of Lyon, CNRS UMR 5286, 69008 Lyon, France
- University of Lyon, UMR_S1052, UCBL, 69008 Lyon, France
- Hepatology Institute of Lyon, 69008 Lyon, France
| | | | - Fabien Zoulim
- INSERM U1052, Cancer Research Center of Lyon, CNRS UMR 5286, 69008 Lyon, France
- University of Lyon, UMR_S1052, UCBL, 69008 Lyon, France
- Hepatology Institute of Lyon, 69008 Lyon, France
- Hepatology Department, Hospices Civils de Lyon (HCL), 69004 Lyon, France
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McQuilten Z, Heritier S, Fox L, Fox V, Young L, Blombery P, Cunningham I, Curnow J, Higgins A, Hiwase DK, Filshie R, Firkin F, Lacaze P, Mason K, Mills AK, Pepperell D, Patil S, Stevenson W, Szer J, Waters N, Wilson K, Ting S, Wood E. Efficacy and safety of avatrombopag in combination with immunosuppressive therapy in treatment-naïve and relapsed/refractory severe aplastic anaemia: protocol for the DIAAMOND-Ava-FIRST and DIAAMOND-Ava-NEXT Bayesian Optimal Phase II trials. BMJ Open 2024; 14:e076246. [PMID: 38238183 PMCID: PMC10806710 DOI: 10.1136/bmjopen-2023-076246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/14/2023] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION Immunosuppressive therapy (IST) with antithymocyte globulin (ATG) and ciclosporin is standard of care for patients with severe aplastic anaemia (sAA) not eligible or suitable for allogeneic stem cell transplant. While patients respond to IST, few achieve complete responses and a significant proportion are refractory or relapse. The addition of eltrombopag, a thrombopoietin-receptor agonist (TPO-A), to IST has been shown to improve haematological responses in sAA. Avatrombopag is a second-generation TPO-A with potential advantages over eltrombopag. However, to date avatrombopag has not been studied in sAA. METHODS AND ANALYSIS Investigator-initiated, single-arm registry-based Bayesian Optimal Phase II trial of avatrombopag conducted in two cohorts, patients with untreated sAA (FIRST cohort) and in patients with sAA that has relapsed or is refractory to IST (NEXT cohort). In the FIRST cohort, participants receive IST (equine ATG and ciclosporin) plus avatrombopag from day 1 until day 180 at 60 mg oral daily, with dose adjusted according to platelet count. Participants in the NEXT cohort receive avatrombopag at 60 mg oral daily from day 1 until day 180, with or without additional IST at the discretion of the treating clinician.For each cohort, two primary endpoints (haematological response and acquired clonal evolution) are jointly monitored and the trial reviewed at each interim analysis where a 'go/no-go' decision is made by evaluating the posterior probability of the events of interests. ETHICS AND DISSEMINATION The trial has received ethics approval (Monash Health RES-18-0000707A). The trial conduct will comply with ICH-GCP and all applicable regulatory requirements. The results of the trial will be submitted to a peer-review journal for publication. TRIAL REGISTRATION NUMBER ACTRN12619001042134, ACTRN12619001043123.
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Affiliation(s)
- Zoe McQuilten
- Department of Haematology, Monash Health, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Stephane Heritier
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lucy Fox
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Clinical Haematology, Peter MacCallum Cancer Centre & The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Vanessa Fox
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lauren Young
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Piers Blombery
- Department of Clinical Haematology, Peter MacCallum Cancer Centre & The Royal Melbourne Hospital, Parkville, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Ilona Cunningham
- Concord Repatriation General Hospital, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Jennifer Curnow
- Department of Haematology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Alisa Higgins
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Devendra K Hiwase
- Department of Haematology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- South Australian Health & Medical Research Institute, Adelaide, South Australia, Australia
| | - Robin Filshie
- Haematology Department, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Frank Firkin
- Haematology Department, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Paul Lacaze
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kylie Mason
- Department of Clinical Haematology, Peter MacCallum Cancer Centre & The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Anthony K Mills
- University of Queensland, Brisbane, Queensland, Australia
- Department of Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Dominic Pepperell
- Department of Haematology, Fiona Stanley Hospital, Murdoch, Perth, Australia
| | - Sushrut Patil
- Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia
| | - William Stevenson
- Department of Haematology, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Jeff Szer
- Department of Clinical Haematology, Peter MacCallum Cancer Centre & The Royal Melbourne Hospital, Parkville, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Neil Waters
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kate Wilson
- University of Sydney, Sydney, New South Wales, Australia
| | - Stephen Ting
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Haematology, Eastern Health, Melbourne, Victoria, Australia
| | - Erica Wood
- Department of Haematology, Monash Health, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Fox LC, McQuilten ZK, Firkin F, Fox V, Badoux X, Bajel A, Barbaro P, Cole-Sinclair MF, Forsyth C, Gibson J, Hiwase DK, Johnston A, Mills A, Roncolato F, Sutherland R, Szer J, Ting SB, Vilcassim S, Young L, Waters NA, Wood EM. The Australian Aplastic Anaemia and other Bone Marrow Failure Syndromes Registry. Best Pract Res Clin Haematol 2023; 36:101516. [PMID: 38092475 DOI: 10.1016/j.beha.2023.101516] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/14/2023] [Indexed: 12/18/2023]
Abstract
The bone marrow failure syndromes (BMFS) are a diverse group of acquired and inherited diseases which may manifest in cytopenias, haematological malignancy and/or syndromic multisystem disease. Patients with BMFS frequently experience poor outcomes, and improved treatment strategies are needed. Collation of clinical characteristics and patient outcomes in a national disease-specific registry represents a powerful tool to identify areas of need and support clinical and research collaboration. Novel treatment strategies such as gene therapy, particularly in rare diseases, will depend on the ability to identify eligible patients alongside the molecular genetic features of their disease that may be amenable to novel therapy. The Australian Aplastic Anaemia and other Bone Marrow Failure Syndromes Registry (AAR) aims to improve outcomes for all paediatric and adult patients with BMFS in Australia by describing the demographics, treatments (including supportive care) and outcomes, and serving as a resource for research and practice improvement.
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Affiliation(s)
- Lucy C Fox
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Austin Health, Melbourne, Australia
| | - Zoe K McQuilten
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Monash Health, Melbourne, Australia
| | | | - Vanessa Fox
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Ashish Bajel
- Peter MacCallum Cancer Centre, Melbourne, Australia; The Royal Melbourne Hospital, Melbourne, Australia
| | | | - Merrole F Cole-Sinclair
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; St Vincent's Hospital, Melbourne, Australia
| | | | - John Gibson
- Royal Prince Alfred Hospital, Sydney, Australia
| | | | | | | | | | - Robyn Sutherland
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jeff Szer
- Peter MacCallum Cancer Centre, Melbourne, Australia; The Royal Melbourne Hospital, Melbourne, Australia
| | - Stephen B Ting
- Eastern Health, Melbourne, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Shahla Vilcassim
- Monash Health, Melbourne, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Lauren Young
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Neil A Waters
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Erica M Wood
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Monash Health, Melbourne, Australia.
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Sigman B, Linder DF, Waller JL, Bollag WB, Baer SL, Tran S, Kheda M, Young L, Mohammed A, Isales CM, Siddiqui B. Hashimoto's thyroiditis and renal transplant rejection. J Endocrinol Invest 2023; 46:2125-2132. [PMID: 37012521 DOI: 10.1007/s40618-023-02065-9] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/09/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE Hashimoto's thyroiditis (HT) is a common autoimmune thyroid disorder that can disrupt thyroid function and homeostasis. As HT results from a dysregulated immune system, we hypothesized that these patients might be more susceptible to transplant failure; however, literature on this association is limited. The purpose of this study is to examine the association of HT with the risk of renal transplant failure. METHODS We utilized the United States Renal Database System dataset collected from 2005 to 2014 and compared the time from first renal transplant to transplant failure in end-stage renal disease (ESRD) patients with a HT diagnosis to ESRD patients without a HT diagnosis that underwent renal transplant. RESULTS A total of 144 ESRD patients had International Classification of Disease-9 claim codes for HT prior to renal transplant, amongst a total cohort of 90,301 renal transplant patients aged 18-100 and meeting criteria. Patients with HT were significantly more likely to be female, white, and to have a diagnosis of cytomegalovirus compared to patients without. ESRD patients with a HT diagnosis that underwent renal transplant had a significantly increased risk of renal transplant failure compared to those ESRD renal transplant patients without an HT diagnosis. There was a significantly increased adjusted hazard ratio for graft failure in patients with a HT diagnosis compared to those without. CONCLUSION Thyroid health and HT may play a significant role in the development of the increased risk of renal transplant failure observed in this study. Additional studies are needed to investigate the underlying mechanisms for this association.
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Affiliation(s)
- B Sigman
- Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA, 30912, USA
| | - D F Linder
- Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA, 30912, USA
| | - J L Waller
- Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA, 30912, USA
| | - W B Bollag
- Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA, 30912, USA.
- Charlie Norwood VA Medical Center, Augusta, GA, USA.
| | - S L Baer
- Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA, 30912, USA
- Charlie Norwood VA Medical Center, Augusta, GA, USA
| | - S Tran
- Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA, 30912, USA
| | - M Kheda
- Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA, 30912, USA
- Southwest Georgia Nephrology, Albany, GA, USA
| | - L Young
- College of Nursing at Augusta University, Augusta, GA, USA
| | - A Mohammed
- Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA, 30912, USA
| | - C M Isales
- Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA, 30912, USA
| | - B Siddiqui
- Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA, 30912, USA
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Nickell M, Recko M, Young L, Stoutin J, Davis J, Hammonds K. Outcomes for non-treatment-requiring infants evaluated for retinopathy of prematurity. J AAPOS 2023; 27:269.e1-269.e4. [PMID: 37722621 DOI: 10.1016/j.jaapos.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/28/2023] [Accepted: 07/11/2023] [Indexed: 09/20/2023]
Abstract
PURPOSE To evaluate the rates of visually significant disorders in patients without treatment-requiring retinopathy of prematurity (ROP) at initial follow-up after completion of ROP examinations. METHODS The medical records of all babies evaluated for retinopathy of prematurity between June 2015 and September 2020 were reviewed. Patients with documented gestational age, birth weight, and single versus multiple birth status who did not require ROP treatment and who followed-up with our institution's pediatric ophthalmologist were included. RESULTS A total of 304 patients were included. Of these, 15 (4.9%) had strabismus (12 [4.0%] with esotropia, 3 [0.9%] with exotropia), 30 (9.9%) had myopia, 174 (57.2%) had hyperopia, 54 (18%) had astigmatism, 4 (1.3%) had amblyopia, 5 (1.6%) were labeled amblyopia suspects, 1 (0.3%) had congenital glaucoma, and 1 (0.3%) had congenital cataract. Nineteen (6.3%) had a condition requiring intervention at the first evaluation following completion of ROP examinations, and in 5 (2%), this was a condition that would typically not have been identified without evaluation by a pediatric ophthalmologist. CONCLUSIONS In our population of infants evaluated for retinopathy of prematurity who did not require ROP treatment, the incidence of other ocular disorders requiring intervention at the first non-ROP evaluation was about 6%. This study highlights the need for further research that may aid in the creation of an evidence-based follow-up strategy for premature infants who never undergo ROP treatment.
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Affiliation(s)
| | | | - Lauren Young
- Baylor Scott & White Medical Center - Temple, Texas.
| | | | - James Davis
- Texas A&M University - College Station, Texas
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Young L, Goldsteen D, Nunamaker EA, Prescott MJ, Reynolds P, Thompson-Iritani S, Thurston SE, Martin TL, LaFollette MR. Using refined methods to pick up mice: A survey benchmarking prevalence & beliefs about tunnel and cup handling. PLoS One 2023; 18:e0288010. [PMID: 37676886 PMCID: PMC10484434 DOI: 10.1371/journal.pone.0288010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/16/2023] [Indexed: 09/09/2023] Open
Abstract
Refined handling improves laboratory mouse welfare and research outcomes when compared to traditional tail handling, yet implementation does not seem to be widespread. Refined handling includes picking up a mouse using a tunnel or cupped hands. The aim of this study was to determine the current prevalence of and beliefs towards refined handling using the theory of planned behavior. It was predicted that refined handling prevalence is low compared to traditional handling methods, and its implementation is determined by individual and institutional beliefs. Research personnel were recruited via online convenience sampling through email listservs and social media. A total of 261 participants in diverse roles (e.g. veterinarians, managers, caretakers, researchers, etc.) responded primarily from the USA (79%) and academic institutions (61%) Participants were surveyed about their current use, knowledge, and beliefs about refined handling. Quantitative data were analyzed via descriptive statistics and generalised regression. Qualitative data were analyzed by theme. Research personnel reported low levels of refined handling implementation, with only 10% of participants using it exclusively and a median estimate of only 10% of institutional mice being handled with refined methods. Individually, participants had positive attitudes, neutral norms, and positive control beliefs about refined handling. Participants' intention to provide refined handling in the future was strongly associated with their attitudes, norms, and control beliefs (p<0.01). Participants believed barriers included jumpy mice, perceived incompatibility with restraint, lack of time, and other personnel. However, participants also believed refined handling was advantageous to mouse welfare, handling ease, personnel, and research. Although results from this survey indicate that current refined handling prevalence is low in this sample, personnel believe it has important benefits, and future use is associated with their beliefs about the practice. People who believed refined handling was good, felt pressure to use it, and were confident in their use reported higher implementation. Increased refined handling could be encouraged through education on misconceptions, highlighting advantages, and addressing important barriers.
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Affiliation(s)
- Lauren Young
- Department of Integrative Biology, University of Guelph, Guelph, Ontario, Canada
| | - Donna Goldsteen
- Independent Consultant (Formerly AstraZeneca), Damascus, Maryland, United States of America
| | - Elizabeth A. Nunamaker
- Charles River Laboratories, Global Animal Welfare and Training, Wilmington, Massachusetts, United States of America
| | - Mark J. Prescott
- National Centre for the Replacement, Refinement and Reduction of Animals in Research (NC3Rs), London, United Kingdom
| | - Penny Reynolds
- University of Florida, Gainesville, Florida, United States of America
| | | | - Sarah E. Thurston
- Charles River Laboratories, Global Animal Welfare and Training, Wilmington, Massachusetts, United States of America
| | - Tara L. Martin
- Refinement and Enrichment Advancements Laboratory, University of Michigan, Ann Arbor, Michigan, United States of America
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Rymer JA, Chiswell K, Young L, Chiu A, Liu L, Webb L, Carlisle M, Friedman D, Wang TY. Analysis of Oral Anticoagulant Dosing and Adherence to Therapy Among Patients With Nonvalvular Atrial Fibrillation. JAMA Netw Open 2023; 6:e2317156. [PMID: 37285155 DOI: 10.1001/jamanetworkopen.2023.17156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Importance Although reduced doses of direct oral anticoagulants (DOACs) are approved for patients with nonvalvular atrial fibrillation (NVAF) at high risk of bleeding, little is known about dosing accuracy, particularly in patients with renal dysfunction. Objective To determine whether underdosing of DOACs is associated with longitudinal adherence to anticoagulation. Design, Setting, and Participants This retrospective cohort analysis used data from the Symphony Health claims data set. This national medical and prescription data set comprises 280 million patients and 1.8 million prescribers in the US. Patients included had at least 2 claims for NVAF between January 2015 and December 2017. The dates of analysis for this article were from February 2021 to July 2022. Exposures This study included patients with CHA2DS2-VASc scores of 2 or higher who were treated with a dose of DOACs who did and did not meet label-specified criteria for dose reduction. Main Outcomes and Measures Logistic regression models examined factors associated with off-label dosing (ie, dosing not recommended by US Food and Drug Administration [FDA] labeling), the association of creatinine clearance with recommended DOAC dosing, and the association of DOAC underdosing and excess dosing with 1-year adherence. Results Among the 86 919 patients included (median [IQR] age, 74 [67-80] years; 43 724 men [50.3%]; 82 389 White patients [94.8%]), 7335 (8.4%) received an appropriately reduced dose, and 10 964 (12.6%) received an underdose not consistent with FDA recommendations, meaning that 59.9% (10 964 of 18 299) of those who received a reduced dose received an inappropriate dose. Patients who received off-label doses of DOACs were older (median [IQR] age, 79 [73-85] vs 73 [66-79] years) and had higher CHA2DS2-VASc scores (median [IQR], 5 [4-6] vs 4 [3-6]) compared with patients who received appropriate doses (as recommended by FDA labeling). Renal dysfunction, age, heart failure, and the prescribing clinician being in a surgical specialty were associated with dosing not recommended by FDA labeling. Almost one-third of patients (9792 patients [31.9%]) with creatinine clearance less than 60 mL per minute taking DOACs were either underdosed or excess-dosed not consistent with FDA recommendations. For every 10-unit decrease in creatinine clearance, the odds of the patient receiving an appropriately dosed DOAC was lower by 21%. Treatment with underdosed DOACs was associated with a lower likelihood of adherence (adjusted odds ratio, 0.88; 95% CI, 0.83-0.94) and higher risk of anticoagulation discontinuation (adjusted odds ratio, 1.20; 95% CI, 1.13-1.28) by 1 year. Conclusions and Relevance In this study of oral anticoagulant dosing, DOAC dosing that did not follow FDA label recommendations was observed in a substantial number of patients with NVAF, occurred more frequently in patients with worse renal function, and was associated with less-consistent long-term anticoagulation. These results suggest a need for efforts to improve the quality of DOAC use and dosing.
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Affiliation(s)
- Jennifer A Rymer
- Duke Clinical Research Institute, Durham, North Carolina
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Karen Chiswell
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Andy Chiu
- PRA Health Sciences, Raleigh, North Carolina
| | - Li Liu
- PRA Health Sciences, Raleigh, North Carolina
| | - Laura Webb
- Duke Clinical Research Institute, Durham, North Carolina
| | - Matthew Carlisle
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Daniel Friedman
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Tracy Y Wang
- Duke Clinical Research Institute, Durham, North Carolina
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
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10
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Lam DK, Feliciano PR, Arif A, Bohnuud T, Fernandez TP, Gehrke JM, Grayson P, Lee KD, Ortega MA, Sawyer C, Schwaegerle ND, Peraro L, Young L, Lee SJ, Ciaramella G, Gaudelli NM. Improved cytosine base editors generated from TadA variants. Nat Biotechnol 2023; 41:686-697. [PMID: 36624149 PMCID: PMC10188367 DOI: 10.1038/s41587-022-01611-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/09/2022] [Indexed: 01/11/2023]
Abstract
Cytosine base editors (CBEs) enable programmable genomic C·G-to-T·A transition mutations and typically comprise a modified CRISPR-Cas enzyme, a naturally occurring cytidine deaminase, and an inhibitor of uracil repair. Previous studies have shown that CBEs utilizing naturally occurring cytidine deaminases may cause unguided, genome-wide cytosine deamination. While improved CBEs that decrease stochastic genome-wide off-targets have subsequently been reported, these editors can suffer from suboptimal on-target performance. Here, we report the generation and characterization of CBEs that use engineered variants of TadA (CBE-T) that enable high on-target C·G to T·A across a sequence-diverse set of genomic loci, demonstrate robust activity in primary cells and cause no detectable elevation in genome-wide mutation. Additionally, we report cytosine and adenine base editors (CABEs) catalyzing both A-to-I and C-to-U editing (CABE-Ts). Together with ABEs, CBE-Ts and CABE-Ts enable the programmable installation of all transition mutations using laboratory-evolved TadA variants with improved properties relative to previously reported CBEs.
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Affiliation(s)
| | | | | | | | | | | | | | - Kin D Lee
- Beam Therapeutics, Cambridge, MA, USA
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11
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Bernstein J, Kanarek H, Soteres D, Mutschelknaus D, Cala M, Schultz B, Juethner S, Young L. DIAGNOSTIC PATHWAYS IN LANADELUMAB-TREATED PATIENTS WITH NORMAL C1-INHIBITOR HEREDITARY ANGIOEDEMA (NC1-INH-HAE): A MULTICENTER CHART REVIEW. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.587] [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: 11/11/2022]
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12
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MacLellan A, Nazal B, Young L, Mason G. Waking inactivity as a welfare indicator in laboratory mice: investigating postures, facial expressions and depression-like states. R Soc Open Sci 2022. [PMID: 36340516 DOI: 10.6084/m9.figshare.c.6251130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Animal welfare assessment relies on valid and practical indicators of affect. In mice, the most widely used research vertebrates, lying still with eyes open, inactive-but-awake (IBA) in the home cage, has potential to be one such indicator. IBA is elevated in barren, conventional housing compared with well-resourced, enriched housing, and predicts immobility in Forced Swim Tests, a common measure of 'helplessness' in depression research. In Experiment 1, using females from three strains (C57BL/6, Balb/c and DBA/2), we first replicated past findings, confirming higher levels of IBA in conventional cages and a positive relationship between IBA and helplessness. We then extended this research to three other signs of depression: changes in weight and sleep, and reduced hippocampal volume. Here, IBA positively covaried with body mass index, with sleep in DBA/2s and conventionally housed BALB/cs, and negatively covaried with hippocampal volume in conventionally housed C57BL/6s. In Experiment 2, we sought to refine the phenotype of IBA to improve its accuracy as a welfare indicator. Here, scoring IBA performed in hunched postures appeared to improve its accuracy as an indicator in Balb/c mice. Additional research is now needed to further refine the phenotype of IBA and to confirm whether it reflects states consistent with depression, or instead other underlying poor welfare conditions.
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Affiliation(s)
- Aileen MacLellan
- Department of Integrative Biology, University of Guelph, 50 Stone Road East, Guelph, ON, Canada N1G 2W1
| | - Basma Nazal
- Formerly Department of Animal Biosciences, University of Guelph, 50 Stone Road East, Guelph, ON, Canada N1G 2W1
| | - Lauren Young
- Department of Integrative Biology, University of Guelph, 50 Stone Road East, Guelph, ON, Canada N1G 2W1
| | - Georgia Mason
- Department of Integrative Biology, University of Guelph, 50 Stone Road East, Guelph, ON, Canada N1G 2W1
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13
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MacLellan A, Nazal B, Young L, Mason G. Waking inactivity as a welfare indicator in laboratory mice: investigating postures, facial expressions and depression-like states. R Soc Open Sci 2022; 9:221083. [PMID: 36340516 PMCID: PMC9627452 DOI: 10.1098/rsos.221083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/29/2022] [Indexed: 05/09/2023]
Abstract
Animal welfare assessment relies on valid and practical indicators of affect. In mice, the most widely used research vertebrates, lying still with eyes open, inactive-but-awake (IBA) in the home cage, has potential to be one such indicator. IBA is elevated in barren, conventional housing compared with well-resourced, enriched housing, and predicts immobility in Forced Swim Tests, a common measure of 'helplessness' in depression research. In Experiment 1, using females from three strains (C57BL/6, Balb/c and DBA/2), we first replicated past findings, confirming higher levels of IBA in conventional cages and a positive relationship between IBA and helplessness. We then extended this research to three other signs of depression: changes in weight and sleep, and reduced hippocampal volume. Here, IBA positively covaried with body mass index, with sleep in DBA/2s and conventionally housed BALB/cs, and negatively covaried with hippocampal volume in conventionally housed C57BL/6s. In Experiment 2, we sought to refine the phenotype of IBA to improve its accuracy as a welfare indicator. Here, scoring IBA performed in hunched postures appeared to improve its accuracy as an indicator in Balb/c mice. Additional research is now needed to further refine the phenotype of IBA and to confirm whether it reflects states consistent with depression, or instead other underlying poor welfare conditions.
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Affiliation(s)
- Aileen MacLellan
- Department of Integrative Biology, University of Guelph, 50 Stone Road East, Guelph, ON, Canada N1G 2W1
| | - Basma Nazal
- Formerly Department of Animal Biosciences, University of Guelph, 50 Stone Road East, Guelph, ON, Canada N1G 2W1
| | - Lauren Young
- Department of Integrative Biology, University of Guelph, 50 Stone Road East, Guelph, ON, Canada N1G 2W1
| | - Georgia Mason
- Department of Integrative Biology, University of Guelph, 50 Stone Road East, Guelph, ON, Canada N1G 2W1
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14
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Young L, Bibi H, Rasheed R. Undetected hypertension in primary care – a public health iceberg? Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.762] [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: 11/14/2022] Open
Abstract
Abstract
Background
Hypertension is largely asymptomatic and contributes to considerable lifetime cardiovascular morbidity and mortality, costing the NHS £2.1 billion annually. The national prevalence of hypertension is 13.7 % and lack of a national screening programme, despite meeting aspects of the Wilson Junger criteria, adds to delays in detection and treatment. Earlier detection could mitigate future cardiovascular risk. We wanted to understand the potential of detection of prehypertension in primary care to see if this fits the Wilson and Junger criteria for a screening programme.
Methods
GP records of adult patients n = 2178 with a known diagnosis of hypertension on the hypertension register from a practice population of 10,000 patients (prevalence is 22%.) were analysed for the prevalence of prehypertension systolic 120-139 mm hg and diastolic bp of 80-89. The average length of prehypertension, the time delay in detection and treatment were assessed, alongside the prevalence of clinical and therapeutic inertia.
Results
A retrospective analysis of a sample size of 1809 patients out of 2178 patients (83.1%) with known hypertension across 3 primary care sites over 20 years was undertaken. Of these 1809 patients, we found that 1095 patients (60.5%) were prehypertensive prior to being diagnosed. The mean time interval between detection of prehypertension to a formal hypertension diagnosis was 10.6 years, with a standard deviation of 7.89 years with no variation with age or sex. However, 588 patients (32.5%) did not have readings within the prehypertensive ranges prior to diagnosis and were opportunistically detected. 51 patients (2.82%) never had readings recorded within the prehypertensive range.
Conclusions
Prehypertension predates hypertension by an average of 10.6 years. Offering annual screening nationally to patients of risk groups e.g., those with a family history, obesity, and alcohol excess, would enable earlier detection, treatment, and considerable cost saving.
Key messages
• Prehypertension predates hypertension; therefore, hypertension meets the Wilson Junger criteria for earlier detection by a screening programme, which is lacking in the UK.
• Offering a national scheme to screen for hypertension to those at a higher risk, can only be considered a benefit to the public and should be implemented.
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Affiliation(s)
- L Young
- Medical Education and Research, Rigg Milner and Corringham Health Centre , East Tilbury, UK
| | - H Bibi
- Medical Education and Research, Rigg Milner and Corringham Health Centre , East Tilbury, UK
| | - R Rasheed
- Medical Education and Research, Rigg Milner and Corringham Health Centre , East Tilbury, UK
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15
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Dreyzin A, Toner K, Wyche E, Young L, Jacobsohn D, Smith S, Wills M, Angiolillo A, Wistinghausen B, Perdahl-Wallace E, Vatsayan A. REFRACTORY B-LYMPHOBLASTIC LYMPHOMA SUCCESSFULLY TREATED WITH TISAGENLECLEUCEL AND CONSOLIDATIVE STEM CELL TRANSPLANT. Leuk Res 2022. [DOI: 10.1016/s0145-2126(22)00311-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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16
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Diorio C, Murray R, Naniong M, Barrera L, Camblin A, Chukinas J, Coholan L, Edwards A, Fuller T, Gonzales C, Grupp SA, Ladd A, Le M, Messana A, Musenge F, Newman H, Poh YC, Poulin H, Ryan T, Shraim R, Tasian SK, Vincent T, Young L, Zhang Y, Ciaramella G, Gehrke J, Teachey DT. Cytosine base editing enables quadruple-edited allogeneic CART cells for T-ALL. Blood 2022; 140:619-629. [PMID: 35560156 PMCID: PMC9373016 DOI: 10.1182/blood.2022015825] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [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: 02/07/2022] [Accepted: 04/25/2022] [Indexed: 11/20/2022] Open
Abstract
Allogeneic chimeric antigen receptor T-cell (CART) therapies require multiple gene edits to be clinically tractable. Most allogeneic CARTs have been created using gene editing techniques that induce DNA double-stranded breaks (DSBs), resulting in unintended on-target editing outcomes with potentially unforeseen consequences. Cytosine base editors (CBEs) install C•G to T•A point mutations in T cells, with between 90% and 99% efficiency to silence gene expression without creating DSBs, greatly reducing or eliminating undesired editing outcomes following multiplexed editing as compared with clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein 9 (Cas9). Using CBE, we developed 7CAR8, a CD7-directed allogeneic CART created using 4 simultaneous base edits. We show that CBE, unlike CRISPR-Cas9, does not impact T-cell proliferation, lead to aberrant DNA damage response pathway activation, or result in karyotypic abnormalities following multiplexed editing. We demonstrate 7CAR8 to be highly efficacious against T-cell acute lymphoblastic leukemia (T-ALL) using multiple in vitro and in vivo models. Thus, CBE is a promising technology for applications requiring multiplexed gene editing and can be used to manufacture quadruple-edited 7CAR8 cells, with high potential for clinical translation for relapsed and refractory T-ALL.
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Affiliation(s)
- Caroline Diorio
- Division of Oncology, Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; and
| | | | | | | | | | - John Chukinas
- Division of Oncology, Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | - Tori Fuller
- Division of Oncology, Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Stephan A Grupp
- Division of Oncology, Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; and
| | | | | | | | | | - Haley Newman
- Division of Oncology, Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; and
| | | | | | - Theresa Ryan
- Division of Oncology, Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Rawan Shraim
- Division of Oncology, Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Sarah K Tasian
- Division of Oncology, Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; and
| | - Tiffaney Vincent
- Division of Oncology, Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | | | | | - David T Teachey
- Division of Oncology, Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; and
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17
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Zuckerman AD, Whelchel K, Kozlicki M, Simonyan AR, Donovan JL, Gazda NP, Mourani J, Smith AM, Young L, Ortega M, Kelley TN. Health-system specialty pharmacy role and outcomes: A review of current literature. Am J Health Syst Pharm 2022; 79:1906-1918. [PMID: 35916907 DOI: 10.1093/ajhp/zxac212] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE Specialty medications can have life-altering outcomes for patients with complex diseases. However, their benefit relies on appropriate treatment selection, patients' ability to afford and initiate treatment, and ongoing treatment optimization based on patient response to therapy. Mounting research demonstrates the benefits of the health-system specialty pharmacy (HSSP) in improving specialty medication access, affordability, and outcomes. The purpose of this rapid review is to describe the currently reported role and function of HSSP pharmacists and outcomes reported with use of the HSSP model, and to identify gaps in the literature where more information is needed to better understand the HSSP model and outcomes. SUMMARY Current literature describes the role of HSSP pharmacists in facilitating patient access, affordability, and initiation and maintenance of specialty medications. Though it is clear HSSP pharmacists are involved in treatment monitoring, often through utilizing the electronic health record, more information is needed to elucidate the frequency, method, and extent of monitoring. Despite several valuable continuity of care services reported to be provided by HSSPs, the breadth and degree of standardization of these services remains unclear. There is minimal literature describing HSSP education and research involvement. HSSPs have reported significant benefits of this patient care model, as demonstrated by higher adherence and persistence; better clinical outcomes; financial benefits to patients, payers and the health system; better quality of care; higher patient and provider satisfaction with services, and highly efficient specialty pharmacy services. More literature comparing clinical and diagnosis-related outcomes in HSSP versus non-HSSP patients is needed. CONCLUSION HSSPs provide comprehensive, patient-centered specialty medication management that result in improved care across the continuum of the specialty patient journey and act as a valuable resource for specialty clinics and patients beyond medication management. Future research should build on the current description of HSSP services, how services affect patient outcomes, and the impact HSSP network restrictions.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lauren Young
- University of Tennessee Medical Center, Knoxville, TN, USA
| | | | - Tara N Kelley
- Vanderbilt University Medical Center, Nashville, TN, USA
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18
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Sharples K, Vear NK, Porter-Steele J, Anderson DJ, Moeke-Maxwell TH, Laing BB, Young L, Bailey TG, Benge S, Huang Y, Crowley E, Day R, Cartwright R, Findlay M, Porter D, Kuper M, Campbell I, McCarthy AL. Protocol of trans-Tasman feasibility randomised controlled trial of the Younger Women's Wellness After Breast Cancer (YWWACP) lifestyle intervention. Pilot Feasibility Stud 2022; 8:165. [PMID: 35918737 PMCID: PMC9343821 DOI: 10.1186/s40814-022-01114-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Younger women (defined as those < 50 years who are likely pre-menopausal at time of diagnosis) with breast cancer often experience persistent treatment-related side effects that adversely affect their physical and psychological wellbeing. The Women's Wellness After Cancer Program (WWACP) was adapted and piloted in Australia to address these outcomes in younger women. The aims of this feasibility study are to determine (1) the potential to translate the Younger WWACP (YWWACP) intervention to a broader population base in Aotearoa/New Zealand and Australia, and (2) the potential for success of a larger, international, phase ΙΙΙ, randomised controlled trial. METHODS This bi-national, randomised, single-blinded controlled trial involves two main study sites in Aotearoa/New Zealand (Kōwhai study) and Australia (EMERALD study). Young women aged 18 to 50 years who completed intensive treatment (surgery, chemotherapy, and/or radiotherapy) for breast cancer in the previous 24 months are eligible. The potential to translate the YWWACP to women in these two populations will be assessed according to several feasibility outcomes. These include examining intervention accessibility, acceptability and uptake; intervention sustainability and adherence; the prevalence components of the intervention in the control group; intervention efficacy; participants' perception of measurement burden; the effectiveness of planned recruitment strategies; and trial methods and procedures. The studies collectively aim to enrol 60 participants in the intervention group and 60 participants in the control group (total = 120 participants). DISCUSSION Ethical approval has been received from the Southern Health and Disability Ethics Committee (Kōwhai ref: 19/STH/215), and UnitingCare Human Research Ethics Committee (EMERALD ref: 202103). This study will provide important data on the feasibility of the refined YWWACP in the trans-Tasman context. This study will account for and harmonise cross-country differences to ensure the success of a proposed international grant application for a phase ΙΙΙ randomised controlled trial of this program to improve outcomes in younger women living with breast cancer. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR): Kōwhai ACTRN12620000260921 , registered on 27 February 2020. EMERALD ACTRN12621000447853 , registered on 19 April 2021.
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Affiliation(s)
- K Sharples
- Cancer Trials New Zealand, Auckland, New Zealand.,University of Otago, Dunedin, New Zealand
| | - N K Vear
- University of Queensland, Brisbane, Australia.
| | | | | | | | - B B Laing
- University of Auckland, Auckland, New Zealand
| | - L Young
- Wesley Choices Cancer Support Centre, Brisbane, Australia
| | - T G Bailey
- University of Queensland, Brisbane, Australia
| | - S Benge
- Cancer Trials New Zealand, Auckland, New Zealand
| | - Y Huang
- Cancer Trials New Zealand, Auckland, New Zealand
| | - E Crowley
- Cancer Trials New Zealand, Auckland, New Zealand
| | - R Day
- Cancer Trials New Zealand, Auckland, New Zealand
| | - R Cartwright
- Cancer Trials New Zealand, Auckland, New Zealand
| | - M Findlay
- Cancer Trials New Zealand, Auckland, New Zealand
| | - D Porter
- Department of Oncology, Auckland Hospital, Auckland, New Zealand
| | - M Kuper
- Department of Oncology, Waikato Hospital, Hamilton, New Zealand
| | - I Campbell
- Department of Surgery, Waikato Hospital, Hamilton, New Zealand
| | - A L McCarthy
- University of Queensland, Brisbane, Australia.,Mater Research Institute, Brisbane, Australia
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19
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Kouli O, Murray V, Bhatia S, Cambridge WA, Kawka M, Shafi S, Knight SR, Kamarajah SK, McLean KA, Glasbey JC, Khaw RA, Ahmed W, Akhbari M, Baker D, Borakati A, Mills E, Thavayogan R, Yasin I, Raubenheimer K, Ridley W, Sarrami M, Zhang G, Egoroff N, Pockney P, Richards T, Bhangu A, Creagh-Brown B, Edwards M, Harrison EM, Lee M, Nepogodiev D, Pinkney T, Pearse R, Smart N, Vohra R, Sohrabi C, Jamieson A, Nguyen M, Rahman A, English C, Tincknell L, Kakodkar P, Kwek I, Punjabi N, Burns J, Varghese S, Erotocritou M, McGuckin S, Vayalapra S, Dominguez E, Moneim J, Salehi M, Tan HL, Yoong A, Zhu L, Seale B, Nowinka Z, Patel N, Chrisp B, Harris J, Maleyko I, Muneeb F, Gough M, James CE, Skan O, Chowdhury A, Rebuffa N, Khan H, Down B, Fatimah Hussain Q, Adams M, Bailey A, Cullen G, Fu YXJ, McClement B, Taylor A, Aitken S, Bachelet B, Brousse de Gersigny J, Chang C, Khehra B, Lahoud N, Lee Solano M, Louca M, Rozenbroek P, Rozitis E, Agbinya N, Anderson E, Arwi G, Barry I, Batchelor C, Chong T, Choo LY, Clark L, Daniels M, Goh J, Handa A, Hanna J, Huynh L, Jeon A, Kanbour A, Lee A, Lee J, Lee T, Leigh J, Ly D, McGregor F, Moss J, Nejatian M, O'Loughlin E, Ramos I, Sanchez B, Shrivathsa A, Sincari A, Sobhi S, Swart R, Trimboli J, Wignall P, Bourke E, Chong A, Clayton S, Dawson A, Hardy E, Iqbal R, Le L, Mao S, Marinelli I, Metcalfe H, Panicker D, R HH, Ridgway S, Tan HH, Thong S, Van M, Woon S, Woon-Shoo-Tong XS, Yu S, Ali K, Chee J, Chiu C, Chow YW, Duller A, Nagappan P, Ng S, Selvanathan M, Sheridan C, Temple M, Do JE, Dudi-Venkata NN, Humphries E, Li L, Mansour LT, Massy-Westropp C, Fang B, Farbood K, Hong H, Huang Y, Joan M, Koh C, Liu YHA, Mahajan T, Muller E, Park R, Tanudisastro M, Wu JJG, Chopra P, Giang S, Radcliffe S, Thach P, Wallace D, Wilkes A, Chinta SH, Li J, Phan J, Rahman F, Segaran A, Shannon J, Zhang M, Adams N, Bonte A, Choudhry A, Colterjohn N, Croyle JA, Donohue J, Feighery A, Keane A, McNamara D, Munir K, Roche D, Sabnani R, Seligman D, Sharma S, 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Wyn-Griffiths F, Brew A, Kaur G, Soni D, Tickle A, Akbar Z, Appleyard T, Figg K, Jayawardena P, Johnson A, Kamran Siddiqui Z, Lacy-Colson J, Oatham R, Rowlands B, Sludden E, Turnbull C, Allin D, Ansar Z, Azeez Z, Dale VH, Garg J, Horner A, Jones S, Knight S, McGregor C, McKenna J, McLelland T, Packham-Smith A, Rowsell K, Spector-Hill I, Adeniken E, Baker J, Bartlett M, Chikomba L, Connell B, Deekonda P, Dhar M, Elmansouri A, Gamage K, Goodhew R, Hanna P, Knight J, Luca A, Maasoumi N, Mahamoud F, Manji S, Marwaha PK, Mason F, Oluboyede A, Pigott L, Razaq AM, Richardson M, Saddaoui I, Wijeyendram P, Yau S, Atkins W, Liang K, Miles N, Praveen B, Ashai S, Braganza J, Common J, Cundy A, Davies R, Guthrie J, Handa I, Iqbal M, Ismail R, Jones C, Jones I, Lee KS, Levene A, Okocha M, Olivier J, Smith A, Subramaniam E, Tandle S, Wang A, Watson A, Wilson C, Chan XHF, Khoo E, Montgomery C, Norris M, Pugalenthi PP, Common T, Cook E, Mistry H, Shinmar HS, Agarwal G, Bandyopadhyay S, Brazier B, Carroll L, Goede A, Harbourne A, Lakhani A, Lami M, Larwood J, Martin J, Merchant J, Pattenden S, Pradhan A, Raafat N, Rothwell E, Shammoon Y, Sudarshan R, Vickers E, Wingfield L, Ashworth I, Azizi S, Bhate R, Chowdhury T, Christou A, Davies L, Dwaraknath M, Farah Y, Garner J, Gureviciute E, Hart E, Jain A, Javid S, Kankam HK, Kaur Toor P, Kaz R, Kermali M, Khan I, Mattson A, McManus A, Murphy M, Nair K, Ngemoh D, Norton E, Olabiran A, Parry L, Payne T, Pillai K, Price S, Punjabi K, Raghunathan A, Ramwell A, Raza M, Ritehnia J, Simpson G, Smith W, Sodeinde S, Studd L, Subramaniam M, Thomas J, Towey S, Tsang E, Tuteja D, Vasani J, Vio M, Badran A, Adams J, Anthony Wilkinson J, Asvandi S, Austin T, Bald A, Bix E, Carrick M, Chander B, Chowdhury S, Cooper Drake B, Crosbie S, D Portela S, Francis D, Gallagher C, Gillespie R, Gravett H, Gupta P, Ilyas C, James G, Johny J, Jones A, Kinder F, MacLeod C, Macrow C, Maqsood-Shah A, Mather J, McCann L, McMahon R, Mitham E, Mohamed M, Munton E, Nightingale K, O'Neill K, Onyemuchara I, Senior R, Shanahan A, Sherlock J, Spyridoulias A, Stavrou C, Stokes D, Tamang R, Taylor E, Trafford C, Uden C, Waddington C, Yassin D, Zaman M, Bangi S, Cheng T, Chew D, Hussain N, Imani-Masouleh S, Mahasivam G, McKnight G, Ng HL, Ota HC, Pasha T, Ravindran W, Shah K, Vishnu K S, Zaman S, Carr W, Cope S, Eagles EJ, Howarth-Maddison M, Li CY, Reed J, Ridge A, Stubbs T, Teasdaled D, Umar R, Worthington J, Dhebri A, Kalenderov R, Alattas A, Arain Z, Bhudia R, Chia D, Daniel S, Dar T, Garland H, Girish M, Hampson A, Kyriacou H, Lehovsky K, Mullins W, Omorphos N, Vasdev N, Venkatesh A, Waldock W, Bhandari A, Brown G, Choa G, Eichenauer CE, Ezennia K, Kidwai Z, Lloyd-Thomas A, Macaskill Stewart A, Massardi C, Sinclair E, Skajaa N, Smith M, Tan I, Afsheen N, Anuar A, Azam Z, Bhatia P, Davies-kelly N, Dickinson S, Elkawafi M, Ganapathy M, Gupta S, Khoury EG, Licudi D, Mehta V, Neequaye S, Nita G, Tay VL, Zhao S, Botsa E, Cuthbert H, Elliott J, Furlepa M, Lehmann J, Mangtani A, Narayan A, Nazarian S, Parmar C, Shah D, Shaw C, Zhao Z, Beck C, Caldwell S, Clements JM, French B, Kenny R, Kirk S, Lindsay J, McClung A, McLaughlin N, Watson S, Whiteside E, Alyacoubi S, Arumugam V, Beg R, Dawas K, Garg S, Lloyd ER, Mahfouz Y, Manobharath N, Moonesinghe R, Morka N, Patel K, Prashar J, Yip S, Adeeko ES, Ajekigbe F, Bhat A, Evans C, Farrugia A, Gurung C, Long T, Malik B, Manirajan S, Newport D, Rayer J, Ridha A, Ross E, Saran T, Sinker A, Waruingi D, Allen R, Al Sadek Y, Alves do Canto Brum H, Asharaf H, Ashman M, Balakumar V, Barrington J, Baskaran R, Berry A, Bhachoo H, Bilal A, Boaden L, Chia WL, Covell G, Crook D, Dadnam F, Davis L, De Berker H, Doyle C, Fox C, Gruffydd-Davies M, Hafouda Y, Hill A, Hubbard E, Hunter A, Inpadhas V, Jamshaid M, Jandu G, Jeyanthi M, Jones T, Kantor C, Kwak SY, Malik N, Matt R, McNulty P, Miles C, Mohomed A, Myat P, Niharika J, Nixon A, O'Reilly D, Parmar K, Pengelly S, Price L, Ramsden M, Turnor R, Wales E, Waring H, Wu M, Yang T, Ye TTS, Zander A, Zeicu C, Bellam S, Francombe J, Kawamoto N, Rahman MR, Sathyanarayana A, Tang HT, Cheung J, Hollingshead J, Page V, Sugarman J, Wong E, Chiong J, Fung E, Kan SY, Kiang J, Kok J, Krahelski O, Liew MY, Lyell B, Sharif Z, Speake D, Alim L, Amakye NY, Chandrasekaran J, Chandratreya N, Drake J, Owoso T, Thu YM, Abou El Ela Bourquin B, Alberts J, Chapman D, Rehnnuma N, Ainsworth K, Carpenter H, Emmanuel T, Fisher T, Gabrel M, Guan Z, Hollows S, Hotouras A, Ip Fung Chun N, Jaffer S, Kallikas G, Kennedy N, Lewinsohn B, Liu FY, Mohammed S, Rutherfurd A, Situ T, Stammer A, Taylor F, Thin N, Urgesi E, Zhang N, Ahmad MA, Bishop A, Bowes A, Dixit A, Glasson R, Hatta S, Hatt K, Larcombe S, Preece J, Riordan E, Fegredo D, Haq MZ, Li C, McCann G, Stewart D, Baraza W, Bhullar D, Burt G, Coyle J, Deans J, Devine A, Hird R, Ikotun O, Manchip G, Ross C, Storey L, Tan WWL, Tse C, Warner C, Whitehead M, Wu F, Court EL, Crisp E, Huttman M, Mayes F, Robertson H, Rosen H, Sandberg C, Smith H, Al Bakry M, Ashwell W, Bajaj S, Bandyopadhyay D, Browlee O, Burway S, Chand CP, Elsayeh K, Elsharkawi A, Evans E, Ferrin S, Fort-Schaale A, Iacob M, I K, Impelliziere Licastro G, Mankoo AS, Olaniyan T, Otun J, Pereira R, Reddy R, Saeed D, Simmonds O, Singhal G, Tron K, Wickstone C, Williams R, Bradshaw E, De Kock Jewell V, Houlden C, Knight C, Metezai H, Mirza-Davies A, Seymour Z, Spink D, Wischhusen S. Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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Giannoudis A, Vareslija D, Sharma V, Zakaria R, Platt-Higgins A, Rudland P, Jenkinson M, Young L, Palmieri C. 20P The importance of ARG2 expression in the immune-depleted microenvironment of primary breast cancer and brain metastasis. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.035] [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: 11/15/2022] Open
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21
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MacLellan A, Resasco A, Young L, Mason G. Assessment of Mouse Judgment Bias through an Olfactory Digging Task. J Vis Exp 2022. [DOI: 10.3791/63426] [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: 10/31/2022] Open
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22
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Chen Y, Spillane S, Shiels MS, Young L, Quach D, Berrington de González A, Freedman ND. Trends in Opioid Use Among Cancer Patients in the United States: 2013-2018. JNCI Cancer Spectr 2022; 6:pkab095. [PMID: 35098020 PMCID: PMC8793171 DOI: 10.1093/jncics/pkab095] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/20/2021] [Accepted: 10/27/2021] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND In response to the US opioid epidemic, the Centers for Disease Control and Prevention updated their guideline on prescription opioids for chronic pain management in March 2016. The aim of this study was to provide detailed analysis of trends in opioid claims among cancer patients in the United States during 2013-2018. METHODS We analyzed pharmaceutical dispensing data from Symphony Health's Integrated Dataverse database, which covers approximately 80% of the US population. We examined annual trends in dispensed opioids in cancer patients during 2013-2018. We examined quarterly trends of the prevalence, mean number of days, and dose (stated as morphine milligram equivalents) of opioid dispensing in cancer patients. RESULTS Dispensing records of an average of over 3.7 million cancer patients contributed to the study annually in 2013-2018. The annual prevalence of opioid dispensing claims declined from 40.2% in 2013 to 34.5% in 2018. Annual declines occurred across cancer sites, and particularly among patients with metastatic cancer (decline of 19.8%), breast cancer (18.2%), and lung cancer (13.8%). By quarter, the prevalence of opioid claims declined statistically significantly from 26.6% in Q1 2013 to 21.2% in Q4 2018; this decline was more pronounced after Q3 2016 (2-sided P = .004). Both quarterly trends in mean days and morphine milligram equivalents of opioids supplied showed a gradual decline from 2013 to 2018, with a slightly larger decline after 2016. CONCLUSIONS We observed a decline in opioid use among cancer patients, particularly after 2016, coinciding with the publication of the Centers for Disease Control and Prevention's guideline on prescription opioids for chronic pain management.
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Affiliation(s)
- Yingxi Chen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Susan Spillane
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | | | | | | | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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Abstract
BACKGROUND Enteral feeding for very preterm or very low birth weight (VLBW) infants is often delayed for several days after birth due to concern that early introduction of feeding may not be tolerated and may increase the risk of necrotising enterocolitis. Concerns exist, however, that delaying enteral feeding may diminish the functional adaptation of the gastrointestinal tract and prolong the need for parenteral nutrition with its attendant infectious and metabolic risks. OBJECTIVES To determine the effects of delayed introduction of progressive enteral feeds on the risk of necrotising enterocolitis, mortality and other morbidities in very preterm or VLBW infants. SEARCH METHODS Search strategies were developed by an information specialist in consultation with the review authors. The following databases were searched in October 2021 without date or language restrictions: CENTRAL (2021, Issue 10), MEDLINE via OVID (1946 to October 2021), Embase via OVID (1974 to October 2021), Maternity and Infant Care via OVID (1971 to October 2021), CINAHL (1982 to October 2021). We also searched for eligible trials in clinical trials databases, conference proceedings, previous reviews, and reference lists of retrieved articles. SELECTION CRITERIA Randomised controlled trials that assessed the effects of delayed (four or more days after birth) versus earlier introduction of progressive enteral feeds on necrotising enterocolitis, mortality and other morbidities in very preterm or VLBW infants. DATA COLLECTION AND ANALYSIS Two review authors separately evaluated trial risk of bias, extracted data, and synthesised effect estimates using risk ratio (RR), risk difference (RD), and mean difference. We used the GRADE approach to assess the certainty of evidence for effects on necrotising enterocolitis, mortality, feed intolerance, and invasive infection. MAIN RESULTS We included 14 trials in which a total of 1551 infants participated. Potential sources of bias were lack of clarity on methods to generate random sequences and conceal allocation in half of the trials, and lack of masking of caregivers or investigators in all of the trials. Trials typically defined delayed introduction of progressive enteral feeds as later than four to seven days after birth and early introduction as four days or fewer after birth. Infants in six trials (accounting for about half of all of the participants) had intrauterine growth restriction or circulatory redistribution demonstrated by absent or reversed end-diastolic flow velocities in the fetal aorta or umbilical artery. Meta-analyses showed that delayed introduction of progressive enteral feeds may not reduce the risk of necrotising enterocolitis (RR 0.81, 95% confidence interval (CI) 0.58 to 1.14; RD -0.02, 95% CI -0.04 to 0.01; 13 trials, 1507 infants; low-certainty evidence due risk of bias and imprecision) nor all-cause mortality before hospital discharge (RR 0.97, 95% CI 0.70 to 1.36; RD -0.00, 95% CI -0.03 to 0.03; 12 trials, 1399 infants; low-certainty evidence due risk of bias and imprecision). Delayed introduction of progressive enteral feeds may slightly reduce the risk of feed intolerance (RR 0.81, 95% CI 0.68 to 0.97; RD -0.09, 95% CI -0.17 to -0.02; number needed to treat for an additional beneficial outcome = 11, 95% CI 6 to 50; 6 trials, 581 infants; low-certainty evidence due to risk of bias and imprecision) and probably increases the risk of invasive infection (RR 1.44, 95% CI 1.15 to 1.80; RD 0.10, 95% CI 0.04 to 0.15; number needed to treat for a harmful outcome = 10, 95% CI 7 to 25; 7 trials, 872 infants; moderate-certainty evidence due to risk of bias). AUTHORS' CONCLUSIONS: Delaying the introduction of progressive enteral feeds beyond four days after birth (compared with earlier introduction) may not reduce the risk of necrotising enterocolitis or death in very preterm or VLBW infants. Delayed introduction may slightly reduce feed intolerance, and probably increases the risk of invasive infection.
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Affiliation(s)
- Lauren Young
- Department of Neonatal Medicine, Trevor Mann Baby Unit, Royal Alexandra Children's Hospital, Brighton, UK
| | - Sam J Oddie
- Bradford Neonatology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - William McGuire
- Centre for Reviews and Dissemination, University of York, York, UK
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Young L. Counselling students' responses to conducting role‐play activities online: An evaluation of MSc university students. Couns Psychother Res 2021. [DOI: 10.1002/capr.12487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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25
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Yang Y(A, Murray R, Camblin A, Musenge F, Coholan L, Naniong M, Sweezy D, Haskett S, Young L, Zhang Y, Costa A, Wu H, Ladd A, Barrera L, Schlehuber L, Smith S, Poh YC, Ciaramella G, Gehrke J. 155 CD5 knockout enhances the potency of multiplex base-edited allogeneic anti-CD5 CAR T-cell therapy for the treatment of T-cell malignancies. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BackgroundT-cell lymphomas and leukemias are a class of diseases lacking durable effective therapies, where median survival for patients suffering from relapsed/refractory disease is often measured in months. Translation of B-cell targeting CAR-T therapeutic success to T-cell malignancies comes with significant challenges. Notably, the shared expression of target antigens on malignant T-cells and in the T-cell product itself results in CAR-T activation and fratricide during manufacturing. To overcome the challenges associated with creating CD5-targeting CAR-Ts, we developed a process to simultaneously base edit five target genes, including CD5 and PD1, to produce potency-enhanced allogeneic anti-CD5 CAR T-cells for use as an off-the-shelf treatment for T-cell malignancies.MethodsAnti-CD5 CAR-Ts were produced in a GMP-compatible process using T-cells isolated from healthy human donors. T-cells were modified using base editing technology to simultaneously knock-out five target genes in a single electroporation step. Edited T-cells were transduced with a lentivirus encoding a second-generation anti-CD5 CAR. Knockout frequencies were evaluated by flow cytometry and next-generation sequencing. Anti-CD5 CAR-Ts were then characterized for their specificity in vitro and potency in in vivo xenograft tumor models.ResultsSimultaneous base editing at five genomic loci resulted in anti-CD5 CAR-Ts edited with 94–98% efficiency at each target gene, greatly diminishing the likelihood of GvHD, CAR-T rejection, fratricide, and checkpoint inhibitor activation. In addition, CD5 has an established role as a negative regulator of TCR signaling, and T cells lacking CD5 have enhanced proliferative capacity.1 Anti-CD5 CAR T-cells with or without CD5 KO demonstrated equally potent cytotoxicity and cytokine production in vitro against CD5 expressing tumor lines. However, CD5 KO greatly improved in vivo efficacy of anti-CD5 CAR-Ts in a murine model of T-ALL against established tumor xenografts. Mice previously cleared of tumor underwent a second tumor challenge to assess the persistence of anti-CD5 CAR-T cells and were cleared of tumor a second time, indicating extended persistence of functional anti-CD5 CAR-T cells in vivo.ConclusionsOur approach addresses current technological limitations in developing and applying CAR-Ts that target T-cell malignancies and demonstrates that simultaneous multiplex base editing of up to five targets can create universally compatible, fratricide-resistant, therapeutically active anti-CD5 CAR-Ts. We further demonstrate that CD5 knockout produces CAR-T cells with enhanced potency capable of clearing multiple tumor challenges in vivo. We are progressing this CD5-targeting CAR-T cell product towards potential clinical development for the treatment of T cell malignancies and other CD5+ hematological tumors.ReferenceGuillaume V, Peredo G, Romain R. CD5, an Undercover Regulator of TCR Signaling. Frontiers in Immunology 2018;9:2900.Ethics ApprovalAll animal studies were performed according to the guidelines and approval of the Institutional Animal Care and Use Committee.
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Miarka L, Monteiro C, Dalmasso C, Yebra N, Fustero-Torre C, Hegarty A, Keelan S, Goy Y, Mohme M, Caleiras E, Vareslija D, Young L, Soffietti R, Fernández-Alén J, Blasco G, Alcázar L, Sepúlveda J, Pérez A, Lain A, Siegfried A, Wikman H, Cohen-Jonathan Moyal E, Valiente M. P02.01 A strategy to personalize the use of radiation in patients with brain metastasis based on S100A9-mediated resistance. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.054] [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: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Finding effective treatment options for patients with brain metastasis remains an unmet need. Given the limitations imposed by the blood-brain-barrier for systemic approaches, radiotherapy offers a superior ability to access the brain. While clinical practice recently adapted the use of stereotactic radiosurgery (SRS), Whole-Brain-Radiotherapy (WBRT) continuous to be an important treatment option, since many patients present with multifocal lesions or bad performance scores, rendering them ineligible for SRS. Unfortunately, overall survival of patients remains unaffected by radiotherapy. Despite this clinical data, the molecular mechanisms that allow metastatic cells to resist radiotherapy in the brain is unknown.
MATERIAL AND METHODS
We have applied WBRT to experimental brain metastasis from lung and breast adenocarcinoma and validated their resistance in vivo.
RESULTS
An unbiased search to identify potential mediators of resistance identified the S100A9-RAGE-NFκB-JunB pathway. Targeting this pathway genetically reverts the resistance to radiotherapy and increases therapeutic benefits in vivo. In two independent cohorts of brain metastasis from lung and breast adenocarcinoma patients, levels of S100A9 correlate with the response to radiotherapy, offering a novel approach to stratify patients according to their expected benefit. In order to make this biomarker also available for brain metastasis patients receiving palliative WBRT without preceding surgery, we complemented our tumor-specimen based approach with the less invasive detection of S100A9 from liquid biopsies. Here, serum S100A9 also correlated with a worse response to WBRT in brain metastasis patients. Furthermore, we have validated the use of a blood-brain-barrier permeable RAGE inhibitor to restore radio-sensitivity in experimental brain metastasis models in vivo and in patient-derived organotypic cultures of radio-resistant brain metastasis ex vivo.
CONCLUSION
We identified S100A9 as a major mediator of radio-resistance in brain metastasis and offer the molecular framework to personalize radiotherapy by exploiting it as a biomarker and as a therapeutic target, thus maximizing the benefits for the patient.
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Affiliation(s)
- L Miarka
- Brain Metastasis Group, CNIO, Madrid, Spain
| | - C Monteiro
- Brain Metastasis Group, CNIO, Madrid, Spain
| | - C Dalmasso
- Radiation Oncology Department, Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | - N Yebra
- Brain Metastasis Group, CNIO, Madrid, Spain
| | | | - A Hegarty
- Endocrine Oncology Research Group, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - S Keelan
- Endocrine Oncology Research Group, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Y Goy
- Radiation Oncology Department, UKE, Hamburg, Germany
| | - M Mohme
- Neurosurgery Department, UKE, Hamburg, Germany
| | - E Caleiras
- Histopathology Unit, CNIO, Madrid, Spain
| | - D Vareslija
- Endocrine Oncology Research Group, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - L Young
- Endocrine Oncology Research Group, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - R Soffietti
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | | | - G Blasco
- Department of Neurosurgery, Hospital La Princesa, Madrid, Spain
| | - L Alcázar
- Department of Neurosurgery, Hospital La Princesa, Madrid, Spain
| | - J Sepúlveda
- Neuro-Oncology Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Pérez
- Neurosurgery Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Lain
- Neuropathology Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Siegfried
- Anatomopathology Department, CHU, Toulouse, France
| | - H Wikman
- Department of Tumor Biology, UKE, Hamburg, Germany
| | - E Cohen-Jonathan Moyal
- Radiation Oncology Department, Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | - M Valiente
- Brain Metastasis Group, CNIO, Madrid, Spain
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Li X, Inhester L, Robatjazi SJ, Erk B, Boll R, Hanasaki K, Toyota K, Hao Y, Bomme C, Rudek B, Foucar L, Southworth SH, Lehmann CS, Kraessig B, Marchenko T, Simon M, Ueda K, Ferguson KR, Bucher M, Gorkhover T, Carron S, Alonso-Mori R, Koglin JE, Correa J, Williams GJ, Boutet S, Young L, Bostedt C, Son SK, Santra R, Rolles D, Rudenko A. Pulse Energy and Pulse Duration Effects in the Ionization and Fragmentation of Iodomethane by Ultraintense Hard X Rays. Phys Rev Lett 2021; 127:093202. [PMID: 34506178 DOI: 10.1103/physrevlett.127.093202] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 01/24/2021] [Accepted: 07/02/2021] [Indexed: 06/13/2023]
Abstract
The interaction of intense femtosecond x-ray pulses with molecules sensitively depends on the interplay between multiple photoabsorptions, Auger decay, charge rearrangement, and nuclear motion. Here, we report on a combined experimental and theoretical study of the ionization and fragmentation of iodomethane (CH_{3}I) by ultraintense (∼10^{19} W/cm^{2}) x-ray pulses at 8.3 keV, demonstrating how these dynamics depend on the x-ray pulse energy and duration. We show that the timing of multiple ionization steps leading to a particular reaction product and, thus, the product's final kinetic energy, is determined by the pulse duration rather than the pulse energy or intensity. While the overall degree of ionization is mainly defined by the pulse energy, our measurement reveals that the yield of the fragments with the highest charge states is enhanced for short pulse durations, in contrast to earlier observations for atoms and small molecules in the soft x-ray domain. We attribute this effect to a decreased charge transfer efficiency at larger internuclear separations, which are reached during longer pulses.
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Affiliation(s)
- X Li
- J. R. Macdonald Laboratory, Department of Physics, Kansas State University, Manhattan, Kansas, USA
| | - L Inhester
- Center for Free-Electron Laser Science, DESY, Hamburg, Germany
- The Hamburg Centre for Ultrafast Imaging, Hamburg, Germany
| | - S J Robatjazi
- J. R. Macdonald Laboratory, Department of Physics, Kansas State University, Manhattan, Kansas, USA
| | - B Erk
- Deutsches Elektronen-Synchrotron (DESY), Hamburg, Germany
| | - R Boll
- Max Planck Institute for Nuclear Physics, Heidelberg, Germany
- European XFEL, Schenefeld, Germany
| | - K Hanasaki
- Center for Free-Electron Laser Science, DESY, Hamburg, Germany
- The Hamburg Centre for Ultrafast Imaging, Hamburg, Germany
| | - K Toyota
- Center for Free-Electron Laser Science, DESY, Hamburg, Germany
- The Hamburg Centre for Ultrafast Imaging, Hamburg, Germany
| | - Y Hao
- Center for Free-Electron Laser Science, DESY, Hamburg, Germany
- The Hamburg Centre for Ultrafast Imaging, Hamburg, Germany
- Institute of Theoretical Physics and Department of Physics, University of Science and Technology Beijing, Beijing, People's Republic of China
| | - C Bomme
- Deutsches Elektronen-Synchrotron (DESY), Hamburg, Germany
| | - B Rudek
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig, Germany
| | - L Foucar
- Max Planck Institute for Medical Research, Heidelberg, Germany
| | - S H Southworth
- Chemical Sciences and Engineering Division, Argonne National Laboratory, Lemont, Illinois, USA
| | - C S Lehmann
- Chemical Sciences and Engineering Division, Argonne National Laboratory, Lemont, Illinois, USA
- Fachbereich Chemie, Philipps-Universität Marburg, Marburg, Germany
| | - B Kraessig
- Chemical Sciences and Engineering Division, Argonne National Laboratory, Lemont, Illinois, USA
| | - T Marchenko
- Sorbonne Université, CNRS, Laboratoire de Chimie Physique-Matière et Rayonnement, LCPMR, Paris, France
| | - M Simon
- Sorbonne Université, CNRS, Laboratoire de Chimie Physique-Matière et Rayonnement, LCPMR, Paris, France
| | - K Ueda
- Institute of Multidisciplinary Research for Advanced Materials, Tohoku University, Sendai, Japan
| | - K R Ferguson
- LCLS, SLAC National Accelerator Laboratory, Menlo Park, California, USA
| | - M Bucher
- Chemical Sciences and Engineering Division, Argonne National Laboratory, Lemont, Illinois, USA
- LCLS, SLAC National Accelerator Laboratory, Menlo Park, California, USA
| | - T Gorkhover
- LCLS, SLAC National Accelerator Laboratory, Menlo Park, California, USA
- Institut für Optik und Atomare Physik, Technische Universität Berlin, Berlin, Germany
| | - S Carron
- LCLS, SLAC National Accelerator Laboratory, Menlo Park, California, USA
| | - R Alonso-Mori
- LCLS, SLAC National Accelerator Laboratory, Menlo Park, California, USA
| | - J E Koglin
- LCLS, SLAC National Accelerator Laboratory, Menlo Park, California, USA
| | - J Correa
- Center for Free-Electron Laser Science, DESY, Hamburg, Germany
- Deutsches Elektronen-Synchrotron (DESY), Hamburg, Germany
| | - G J Williams
- LCLS, SLAC National Accelerator Laboratory, Menlo Park, California, USA
- NSLS-II, Brookhaven National Laboratory, Upton New York, USA
| | - S Boutet
- LCLS, SLAC National Accelerator Laboratory, Menlo Park, California, USA
| | - L Young
- Chemical Sciences and Engineering Division, Argonne National Laboratory, Lemont, Illinois, USA
- Department of Physics and James Franck Institute, The University of Chicago, Chicago, Illinois, USA
| | - C Bostedt
- Chemical Sciences and Engineering Division, Argonne National Laboratory, Lemont, Illinois, USA
- Paul Scherrer Institut, Villigen-PSI, Villigen, Switzerland
- Institute of Chemical Sciences and Engineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - S-K Son
- Center for Free-Electron Laser Science, DESY, Hamburg, Germany
- The Hamburg Centre for Ultrafast Imaging, Hamburg, Germany
| | - R Santra
- Center for Free-Electron Laser Science, DESY, Hamburg, Germany
- The Hamburg Centre for Ultrafast Imaging, Hamburg, Germany
- Department of Physics, Universität Hamburg, Hamburg, Germany
| | - D Rolles
- J. R. Macdonald Laboratory, Department of Physics, Kansas State University, Manhattan, Kansas, USA
- Deutsches Elektronen-Synchrotron (DESY), Hamburg, Germany
| | - A Rudenko
- J. R. Macdonald Laboratory, Department of Physics, Kansas State University, Manhattan, Kansas, USA
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Abstract
BACKGROUND Early enteral feeding practices are potentially modifiable risk factors for necrotising enterocolitis (NEC) in very preterm or very low birth weight (VLBW) infants. Observational studies suggest that conservative feeding regimens, including slowly advancing enteral feed volumes, reduce the risk of NEC. However, it is unclear whether slow feed advancement may delay establishment of full enteral feeding, and if it could be associated with infectious morbidities secondary to prolonged exposure to parenteral nutrition. OBJECTIVES To determine the effects of slow rates of enteral feed advancement on the risk of NEC, mortality, and other morbidities in very preterm or VLBW infants. SEARCH METHODS We searched CENTRAL (2020, Issue 10), Ovid MEDLINE (1946 to October 2020), Embase via Ovid (1974 to October 2020), Maternity and Infant Care database (MIDIRS) (1971 to October 2020), CINAHL (1982 to October 2020), and clinical trials databases and reference lists of retrieved articles for eligible trials. SELECTION CRITERIA We included randomised or quasi-randomised controlled trials that assessed effects of slow (up to 24 mL/kg/d) versus faster rates of advancement of enteral feed volumes on the risk of NEC in very preterm or VLBW infants. DATA COLLECTION AND ANALYSIS Two review authors separately evaluated trial risk of bias, extracted data, and synthesised effect estimates using risk ratio (RR), risk difference (RD), and mean difference. We used the GRADE approach to assess the certainty of evidence. Outcomes of interest were NEC, all-cause mortality, feed intolerance, and invasive infection. MAIN RESULTS We included 14 trials involving a total of 4033 infants (2804 infants participated in one large trial). None of the trials masked parents, caregivers, or investigators. Risk of bias was otherwise low. Most infants were stable very preterm or VLBW infants of birth weight appropriate for gestation. About one-third of all infants were extremely preterm or extremely low birth weight (ELBW), and about one-fifth were small for gestational age, growth-restricted, or compromised as indicated by absent or reversed end-diastolic flow velocity in the foetal umbilical artery. Trials typically defined slow advancement as daily increments of 15 to 24 mL/kg, and faster advancement as daily increments of 30 to 40 mL/kg. Meta-analyses showed that slow advancement of enteral feed volumes probably has little or no effect on the risk of NEC (RR 1.06, 95% confidence interval (CI) 0.83 to 1.37; RD 0.00, 95% CI -0.01 to 0.02; 14 trials, 4026 infants; moderate-certainty evidence) or all-cause mortality prior to hospital discharge (RR 1.13, 95% CI 0.91 to 1.39; RD 0.01, 95% CI -0.01 to 0.02; 13 trials, 3860 infants; moderate-certainty evidence). Meta-analyses suggested that slow advancement may slightly increase feed intolerance (RR 1.18, 95% CI 0.95 to 1.46; RD 0.05, 95% CI -0.02 to 0.12; 9 trials, 719 infants; low-certainty evidence) and may slightly increase the risk of invasive infection (RR 1.14, 95% CI 0.99 to 1.31; RD 0.02, 95% CI -0.00 to 0.05; 11 trials, 3583 infants; low-certainty evidence). AUTHORS' CONCLUSIONS The available trial data indicate that advancing enteral feed volumes slowly (daily increments up to 24 mL/kg) compared with faster rates probably does not reduce the risk of NEC, death, or feed intolerance in very preterm or VLBW infants. Advancing the volume of enteral feeds at a slow rate may slightly increase the risk of invasive infection.
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Affiliation(s)
- Sam J Oddie
- Bradford Neonatology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Lauren Young
- Department of Neonatal Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - William McGuire
- Centre for Reviews and Dissemination, University of York, York, UK
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Oh Y, Hennessey A, Young L, Yates D, Barrett C. OP0274-PARE EVALUATION OF PATIENT SATISFACTION FOR TELEHEALTH (PHONE AND VIDEO) IN RHEUMATOLOGY OUTPATIENTS DURING COVID-19 PANDEMIC. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Telehealth via phone (TPhone) or video conference (TVideo) in rheumatology has been a topic of interest for many years. Its use was rapidly expanded due to the international public health emergency of coronavirus disease-19 (COVID-19) outbreak in 2020. Australian Medicare Benefits Schedule (MBS) swiftly enabled temporary MBS telehealth items on 13 March 2020, currently extended until 31 March 20211. In the early phase of the COVID-19 pandemic, Antony et al. conducted a single-centre public survey to assess patient perception of rheumatology telehealth. Their results showed that 98.4% of patients consider telehealth acceptable during the pandemic2. It is unclear, however, whether this positive perception persists after patients experience a telehealth. In addition, a survey data in 2019 suggested more than half of Australian rheumatologists work in private practice3. Therefore, inclusion of private patients will better represent patient perception of telehealth.Objectives:The aim of this study was to evaluate patient satisfaction with telehealth during the COVID-19 pandemic. This would determine its feasibility to be integrated in future rheumatology outpatient model.Methods:A questionnaire containing 30 questions was sent to rheumatology patients who attended telehealth appointments at a level 2 public hospital and a local private clinic between April and May 2020. The questionnaires aimed to obtain information on baseline demographics (sex, age, public or private patient, employment status, visual or auditory impairment), appointment details (TPhone or TVideo, usual arrangement for face-to-face (F2F) appointment, cost effectiveness) and appointment satisfaction using a 5-point Likert scale. Descriptive statistical analysis was conducted.Results:The questionnaire was sent to 1452 patients, of which 494 patients responded (34%). Female predominance (77.1%) and a higher proportion of TPhone (79.1%) was seen in the respondents. A majority of patients were existing patients known to the services (90.9%). More than 70% of responses indicated overall satisfaction in specialist care via telehealth, and 88.7% perceived this suitable during a pandemic. Of all respondents, 21.7% were prescribed new medication, and the majority of these patients were confident in taking the new medication after the telehealth appointment. Future acceptability for TPhone was significantly lower in private patients compared to public patients (p= 0.01). Subgroup analysis revealed that higher telehealth satisfaction was associated with needing to take time off work to attend face-to-face appointment (p= 0.02), perception of cost effectiveness (p<0.001) and TVideo (p=0.03).Conclusion:This is the first study which included both public and private rheumatology patients to evaluate patient satisfaction for telehealth during the COVID-19 pandemic. Overall high level of satisfaction was seen in telehealth most notably associated with its cost effectiveness. A higher percentage of patients who had TVideo compared to TPhone were receptive to future telehealth via TVideo, supportive of the importance of visual cues. This in turn will have significant administrative and technological burdens to coordinate in comparison to a F2F or TPhone review. This qualitative study provides valuable insight of patient perception of telehealth, which has the potential to compliment the traditional rheumatology outpatient model of care following the pandemic.References:[1]COVID-19 Temporary MBS Telehealth Services 2020 [Available from: http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-TempBB.[2]Antony A, Connelly K, De Silva T, Eades L, Tillett W, Ayoub S, et al. Perspectives of Patients With Rheumatic Diseases in the Early Phase of COVID-19. Arthritis Care & Research. 2020;72(9):1189-95.[3]Association AR. Workforce Survey Exective Summary 2019 2019 [Available from: https://rheumatology.org.au/members/documents/WorkforceSurveyExecutiveSummary-websiteMay2019.pdf.Acknowledgements:University of QueenslandNursing staff at Redcliffe Hospital and Administration officers at Redcliffe & Northside RheumatologyDisclosure of Interests:None declared
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Wong DM, Young L, Dembek KA. Blood thiamine (vitamin B 1 ), ascorbic acid (vitamin C), and cortisol concentrations in healthy and ill neonatal foals. J Vet Intern Med 2021; 35:1988-1994. [PMID: 34056771 PMCID: PMC8295700 DOI: 10.1111/jvim.16188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/05/2021] [Accepted: 05/17/2021] [Indexed: 12/20/2022] Open
Abstract
Background Sepsis is common in foals and several treatments are used to facilitate recovery. Evidence in people suggests an association between low blood concentrations of thiamine, ascorbic acid, and cortisol and sepsis, with further evidence suggesting that administration of hydrocortisone, thiamine, and ascorbic acid may improve outcome. No information is available with regard to these treatments in foals. Hypothesis/Objectives To compare blood concentrations of thiamine, ascorbic acid, and cortisol in healthy and ill foals. Animals Fifteen healthy and 27 ill (septic and sick‐nonseptic [SNS]) foals were evaluated at admission. Fewer healthy and ill foals were available for sampling at 72 and 120 hours. Methods Prospective study. Blood was collected from healthy foals at 12 (n = 15), 72 (n = 11), and 120 (n = 9) hours of age and from ill foals <48 hours old at admission (n = 27), 72 (n = 8), and 120 (n = 8) hours after presentation. Thiamine, ascorbic acid, and cortisol concentrations were measured in blood samples and compared between groups of foals. Results Blood concentrations of thiamine were significantly lower in septic compared to healthy foals at 72 (median, 1.72 ng/mL; P = .02) and 120 (median, 2.0 ng/mL; P = .04) hours after admission; blood concentrations of ascorbic acid also were significantly lower in septic compared to healthy foals at 72 (median, 4.4 μg/mL; P = .02) and 120 hours (median, 4.8 μg/mL; P = .03). Blood concentrations of ascorbic acid were lower in SNS compared to healthy foals at 72 (median, 6.9 μg/mL; P = .03) and 120 (median, 6.4 μg/mL; P = .04) hours after admission. Serum cortisol concentrations were significantly higher at admission in septic (median, 4.23 μg/dL) compared to SNS (median, 1.8 μg/dL; P = .01) and healthy (median, 2.2 μg/dL; P = .002) foals. Conclusions and Clinical Importance A potential association exists between illness in foals and lower blood concentrations of thiamine and ascorbic acid during hospitalization. Additional studies are needed to examine a larger population of foals and determine the clinical impact of low vitamin concentrations, if any, on morbidity and mortality.
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Affiliation(s)
- David M Wong
- Lloyd Veterinary Medical Center, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | | | - Katarzyna A Dembek
- North Carolina State University, College of Veterinary Medicine, Raleigh, NC, USA
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Young L, Odzer J, Fenton MAA, Lopresti ML, Duffy CM, Higel-Mcgovern C, Begnoche MH, Dizon DS. Survey of caregiver needs after their loved ones completed cancer treatment. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e24048] [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
e24048 Background: Many people with cancer have medical and psycho-social-sexual sequelae following completion of treatment, which can extend well in to the future and impact both caregivers and families. In response to the unmet needs of people with cancer, the Survivorship Care Plan (SCP) was proposed as a roadmap for patients starting from diagnosis and treatment and preparing them for future care, both inside and beyond oncology-specific issues. However, the SCP does not address needs of families or caregivers, nor was it meant to. We sought to identify the needs of caregivers to determine whether a tailored SCP for the caregiver (SCP-C) should be considered. Methods: People who were at least 6 months out from the end of treatment were invited to participate, along with their designated caregiver. Volunteers with cancer completed the National Comprehensive Cancer Network Survivorship Assessment Survey at the time of consent. Caregivers participated in a semi-structured interview using an adaptation of the Veterans Affairs Caregiver Self-Assessment worksheet, supplemented by open-ended questions. Descriptive statistics were used; categorical variables were compared using chi-square or Fisher’s Exact Test. Results: 24 dyads (patient and caregiver pairs) were enrolled. Median age for patients was 70 (60.7 to 73) and caregivers was 66 (52.2-72). Time since end of treatment was 32 months (9.7 to 69.6) for patients and 32.8 months (8.3 to 51.3) for caregivers. The majority of patient respondents were female (87.5%) and caregiver respondents were male (70.8%); the majority had early-stage disease (63%). About 65% of caregivers were spouses and 74% of them lived with the person with cancer. 75% of caregivers spent 6 months to 3 years as a caregiver. They reported multiple types of support to patients, including help with ADLs, transportation, medical management and emotional support, regardless of time elapsed since their loved one’s diagnosis. Intimate support was significantly less among married couples less than 3 years out from diagnosis (23 vs 73%, respectively, p < .05). 100% of caregivers reported that they understood the diagnosis and follow up plan. However, almost 20% felt they did not fully understand potential side effects of treatment. Caregivers coped well in all domains with the exception of maintaining mental and physical health; compared to those out 3 years or less, those out for longer were more likely to report doing well (90% vs 45%, p < 0.5). Conclusions: Although caregivers reported high satisfaction with cancer-specific information, a large minority reported issues related to the side effects of treatment. In addition, while caregivers did well after completing treatment, those still within the first 3 years of the index diagnosis reported more issues with physical and mental health. These data point toward targeted resources that could be provided specific in an SCP-C.
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Affiliation(s)
- Lauren Young
- Brown University Internal Medicine Residency, Providence, RI
| | - Jamie Odzer
- Warren Alpert Medical School of Brown University, Providence, RI
| | | | | | | | | | | | - Don S. Dizon
- Lifespan Cancer Institute and Brown University, Providence, RI
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Jung J, Bollag W, Waller J, Tran S, Baer S, Kheda M, Mohammed A, Padala S, Young L, Siddiqui B. 239 Cutaneous squamous cell carcinoma and mortality in end stage renal disease. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.261] [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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Siddiquee N, Waller J, Baer S, Kheda M, Mohammed A, Padala S, Siddiqui B, Young L, Tran S, Bollag W. 235 Association of stroke with psoriasis in end-stage renal disease patients. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.257] [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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Keelan S, Charmsaz S, Purcell S, Varešlija D, Cocchiglia S, Bane F, Hill A, Young L. O28: M6A DEMETHYLASE FTO A POTENTIAL TARGET IN BRAIN METASTATIC BREAST CANCER. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.028] [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: 11/14/2022]
Abstract
Abstract
Introduction
Brain metastasis (BrM) occurs in 10-30% of patients with advanced breast cancer (BC). BrM is increasing in incidence and confers a poor prognosis. We aimed to investigate the contribution of global epi-transcriptomic alterations in N6-methyladenosine (m6A) RNA-methylation as a therapeutic target in brain metastatic breast cancer.
Method
In preliminary studies we have demonstrated m6A demethylase – FTO as the main contributor to the progression of ER+ breast cancer. Furthermore an association between FTO and reduced disease-free-survival (n=870, p=0.018) was observed. Here we conducted an epigenetic inhibitor screen using two therapeutic agents, ethyl-ester-meclofenamic acid (MA2) and FB23-2 on matched 2D cell line, 3D organoid cultures and patient-derived xenografts (PDX) explant models of brain metastasis.
Result
Upon integration of mapped global RNA methylation landscape with matched proteomic analysis, we observed genome-wide RNA hypo-methylation of key pluripotency genes, including SOX2 and KLF4, as key players underlying tumour progression to the brain. Genetic and pharmacological inhibition of FTO in novel ex vivo models of BrM significantly reduced protein expression levels of KLF4 and SOX2. Moreover, pharmacological inhibition of FTO with MA2 and FB23-2, inhibited cell proliferation in endocrine-resistant BC and patient BrM cells. We translate our findings to the clinic by demonstrating the efficacy of anti-FTO therapies in several unique PDX and 3D organoid BrM models.
Conclusion
Our results reveal epi-transcriptional remodelling events as a key mechanism in BrM. This study establishes an early role for targeting RNA methylation in the management of disease progression and presents FTO as a potential therapeutic target in BrM.
Take-home message
This study establishes an early role for targeting RNA methylation in the management of disease progression and presents FTO as a potential therapeutic target in brain metastatic breast cancer.
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Affiliation(s)
- S Keelan
- Department of Surgery, The Royal College of Surgeons in Ireland
| | - S Charmsaz
- Department of Surgery, The Royal College of Surgeons in Ireland
| | - S Purcell
- Department of Surgery, The Royal College of Surgeons in Ireland
| | - D Varešlija
- Department of Surgery, The Royal College of Surgeons in Ireland
| | - S Cocchiglia
- Department of Surgery, The Royal College of Surgeons in Ireland
| | - F Bane
- Department of Surgery, The Royal College of Surgeons in Ireland
| | - A Hill
- Department of Surgery, The Royal College of Surgeons in Ireland
| | - L Young
- Department of Surgery, The Royal College of Surgeons in Ireland
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Jagust P, Varešlija D, Cocchiglia S, O'Haloran PJ, Dablouk MO, Brett FM, Cryan J, Beausang A, Hudson L, Hill ADK, Young L. O50: DEVELOPMENT OF A PATIENT-DERIVED TUMOUR ORGANOIDS FROM METASTATIC BREAST CANCER FOR ASSESSMENT OF NOVEL CLINICALLY ACTIONABLE TARGETS. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.050] [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: 11/14/2022]
Abstract
Abstract
Introduction
Metastatic breast cancer (MBC) is the main source of mortality in breast cancer patients largely due to lack of effective treatments. Our previous results suggest that tumour transcriptional heterogeneity drives therapy resistance and cancer relapse. While traditional in vitro human cancer cell line models have been widely used for disease modelling, they do not faithfully recapitulate the pathophysiology of MBC.
Method
In this study we developed patient-derived tumour organoid cultures from frozen patient-derived (PDX) models of MBC. Using those models we performed preclinical drug screening of investigational and FDA approved therapeutics previously uncovered by us as potentially clinically actionable in MBC.
Result
Our results reveal high heterogeneity in the responses to various targeted therapies among tested MBC organoids, which makes them a valuable tool for studying intra-tumor heterogeneity and drug response. Moreover, drug screening identified a divergent set of the breast to brain metastatic MBC organoids that showed high sensitivity to a new class of tyrosine kinase receptors, RET.
Conclusion
Taken together, our novel MBC models and methodology applied here provides an important modelling tool to assess the contribution of intra-tumour heterogeneity and microenvironment to drug response as they recapitulate the cellular, structural and biochemical complexity previously observed in our genomic characterisation of MBCs. Application of this type of translational research will enhance the development of new targeted precision medicine strategies and prelude stratification for clinical trials. Abbreviations MBC- Metastatic Breast Cancer; PDX- Patient-Derived Xenografts; FDA- Food and Drug Administration; RET- Receptor Tyrosine Kinase
Take-home message
Patient-derived tumour organoid cultures provide an important modelling tool to assess the contribution of intra-tumour heterogeneity and microenvironment to drug response as they recapitulate the cellular, structural and biochemical complexity previously observed in genomic characterisation of metastatic breast cancer.
SURGICAL EDUCATION AND TRAINING
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Affiliation(s)
- P Jagust
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland,
| | - D Varešlija
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland,
| | - S Cocchiglia
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland,
| | - PJ O'Haloran
- Department of Neurosurgery, National Neurosurgical Center, Beaumont Hospital, Dublin, Ireland,
| | - MO Dablouk
- Department of Neurosurgery, National Neurosurgical Center, Beaumont Hospital, Dublin, Ireland,
| | - FM Brett
- Department of Neuropathology, National Neurosurgical Center, Beaumont Hospital, Dublin, Ireland
| | - J Cryan
- Department of Neuropathology, National Neurosurgical Center, Beaumont Hospital, Dublin, Ireland
| | - A Beausang
- Department of Neuropathology, National Neurosurgical Center, Beaumont Hospital, Dublin, Ireland
| | - L Hudson
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland,
| | - ADK Hill
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland,
| | - L Young
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland,
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Casco N, Jorge AL, Palmero D, Alffenaar JW, Fox G, Ezz W, Cho JG, Skrahina A, Solodovnikova V, Bachez P, Arbex MA, Galvão T, Rabahi M, Pereira GR, Sales R, Silva DR, Saffie MM, Miranda RC, Cancino V, Carbonell M, Cisterna C, Concha C, Cruz A, Salinas NE, Revillot ME, Farias J, Fernandez I, Flores X, Gallegos P, Garavagno A, Guajardo C, Bahamondes MH, Merino LM, Muñoz E, Muñoz C, Navarro I, Navarro J, Ortega C, Palma S, Pardenas AM, Pereira G, Castillo PP, Pinto M, Pizarro R, Rivas F, Rodriguez P, Sánchez C, Serrano A, Soto A, Taiba C, Venegas M, Vergara MS, Vilca E, Villalon C, Yucra E, Li Y, Cruz A, Guelvez B, Plaza R, Tello K, Andréjak C, Blanc FX, Dourmane S, Froissart A, Izadifar A, Rivière F, Schlemmer F, Gupta N, Ish P, Mishra G, Sharma S, Singla R, Udwadia ZF, Manika K, Diallo BD, Hassane-Harouna S, Artiles N, Mejia LA, Alladio F, Calcagno A, Centis R, Codecasa LR, D Ambrosio L, Formenti B, Gaviraghi A, Giacomet V, Goletti D, Gualano G, Kuksa L, Danila E, Diktanas S, Miliauskas S, Ridaura RL, López F, Torrico MM, Rendon A, Akkerman OW, Piubello A, Souleymane MB, Aizpurua E, Gonzales R, Jurado J, Loban A, Aguirre S, de Egea V, Irala S, Medina A, Sequera G, Sosa N, Vázquez F, Manga S, Villanueva R, Araujo D, Duarte R, Marques TS, Grecu VI, Socaci A, Barkanova O, Bogorodskaya M, Borisov S, Mariandyshev A, Kaluzhenina A, Stosic M, Beh D, Ng D, Ong C, Solovic I, Dheda D, Gina P, Caminero JA, Cardoso-Landivar J, de Souza Galvão ML, Dominguez-Castellano A, García-García JM, Pinargote IM, Fernandez SQ, Sánchez-Montalvá A, Huguet ET, Murguiondo MZ, Bruchfeld J, Bart PA, Mazza-Stalder J, Tiberi S, Arrieta F, Heysell S, Logsdon J, Young L. TB and COVID-19 co-infection: rationale and aims of a global study. Int J Tuberc Lung Dis 2021; 25:78-80. [PMID: 33384052 DOI: 10.5588/ijtld.20.0786] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
| | | | | | | | - G Fox
- New South Wales, Australia
| | - W Ezz
- New South Wales, Australia
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Kartolo A, Holstead R, Hopman W, Young L, Baetz T. Safety and efficacy analysis of pembrolizumab dosing patterns in patients with advanced melanoma and non-small cell lung cancer. J Oncol Pharm Pract 2021; 28:87-95. [PMID: 33509058 DOI: 10.1177/1078155220984252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To evaluate the impact of discrepancy between prescribed and recommended fixed 200 mg dose (P-F discrepancy) on immune-related adverse events (irAEs) and treatment efficacy in patients with advanced melanoma and NSCLC. METHODS This retrospective study included 177 patients with advanced melanoma or non-small cell lung cancer (NSCLC) who received at least one cycle of single-agent pembrolizumab. We defined P-F discrepancy as the differences between prescribed pembrolizumab dose and 200 mg recommended dose, expressed in percentages. Our primary outcome was immune-related adverse events (irAEs), and our secondary outcomes included overall survival (OS) and progression free survival (PFS). RESULTS The median P-F discrepancy was -21.5%, with the 25th and 75th percentile at -32% and -5.0% respectively. ROC curve analyses did not show any optimal cutoffs to prognosticate irAEs (AUC = 0.558 for all patients) or cancer mortality (AUC = 0.583 for melanoma; AUC = 0.539 for NSCLC) in either cancer type. Separate multivariable Cox analyses suggested no statistically significant association between P-F discrepancy and overall survival in patients with melanoma (HR 1.012, 95%CI 0.987-1.038, P = 0.362) or NSCLC (HR 0.998, 95%CI 0.978-1.019, P = 0.876). CONCLUSION There was no optimal pembrolizumab cut-off point to predict irAEs or treatment efficacy. We supported the use of weight-based pembrolizumab dosing, given the potential cost-saving and no differences in terms of irAEs or treatment efficacy in patients with advanced melanoma or NSCLC. Future studies on province- or national-level would be important to validate our findings.
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Affiliation(s)
- A Kartolo
- Cancer Centre of Southeastern Ontario, Kingston, ON, Canada.,Queen's University, Kingston, ON, Canada
| | - R Holstead
- Cancer Centre of Southeastern Ontario, Kingston, ON, Canada.,Queen's University, Kingston, ON, Canada
| | - W Hopman
- Queen's University, Kingston, ON, Canada
| | - L Young
- Cancer Centre of Southeastern Ontario, Kingston, ON, Canada
| | - T Baetz
- Cancer Centre of Southeastern Ontario, Kingston, ON, Canada.,Queen's University, Kingston, ON, Canada
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Young L, McGuire W, Fowlie PW. Commentary on "Enteral Lactoferrin Supplementation for Prevention of Sepsis and Necrotizing Enterocolitis in Preterm Infants". Neonatology 2021; 118:139-142. [PMID: 33561861 DOI: 10.1159/000512988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Lauren Young
- Department of Neonatal Medicine, Evelina London Children's Hospital, St Thomas' Hospital, London, United Kingdom
| | - William McGuire
- Centre for Reviews and Dissemination, University of York, York, United Kingdom,
| | - Peter W Fowlie
- Department of Paediatrics, Ninewells Hospital and Medical School, Dundee, United Kingdom
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Abstract
Human milk contains various bioactive substances including hormones, immunoglobulins, enzymes, and growth factors in addition to its macro- and micronutrients. It has been suggested that human milk is a vehicle of communication between the maternal and infant immune systems, providing passive protection as well as direct active immunomodulation. Human milk protects newborns against pathogens by acting directly on multiple physiologic systems. Bioactive and immunologic factors regulate the infant's immune, metabolic, and microbiome systems. Breastfeeding protects infants in all socioeconomic groups, showing a pattern of protective dose/duration-response effects. This review summarizes the immune components and immunologic properties of human milk and provides an update of their potential implications in the neonatal population.
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Affiliation(s)
- Lauren Young
- Neonatal Medicine, Trevor Mann Baby Unit, Brighton and Sussex University Hospitals, Brighton, UK
| | - William McGuire
- Centre for Reviews and Dissemination and Hull York Medical School, University of York, York, UK
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Kjellsson L, Nanda KD, Rubensson JE, Doumy G, Southworth SH, Ho PJ, March AM, Al Haddad A, Kumagai Y, Tu MF, Schaller RD, Debnath T, Bin Mohd Yusof MS, Arnold C, Schlotter WF, Moeller S, Coslovich G, Koralek JD, Minitti MP, Vidal ML, Simon M, Santra R, Loh ZH, Coriani S, Krylov AI, Young L. Resonant Inelastic X-Ray Scattering Reveals Hidden Local Transitions of the Aqueous OH Radical. Phys Rev Lett 2020; 124:236001. [PMID: 32603165 DOI: 10.1103/physrevlett.124.236001] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 05/01/2020] [Accepted: 05/22/2020] [Indexed: 05/06/2023]
Abstract
Resonant inelastic x-ray scattering (RIXS) provides remarkable opportunities to interrogate ultrafast dynamics in liquids. Here we use RIXS to study the fundamentally and practically important hydroxyl radical in liquid water, OH(aq). Impulsive ionization of pure liquid water produced a short-lived population of OH(aq), which was probed using femtosecond x-rays from an x-ray free-electron laser. We find that RIXS reveals localized electronic transitions that are masked in the ultraviolet absorption spectrum by strong charge-transfer transitions-thus providing a means to investigate the evolving electronic structure and reactivity of the hydroxyl radical in aqueous and heterogeneous environments. First-principles calculations provide interpretation of the main spectral features.
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Affiliation(s)
- L Kjellsson
- Department of Physics and Astronomy, Uppsala University, Box 516, S-751 20 Uppsala, Sweden
| | - K D Nanda
- Department of Chemistry, University of Southern California, Los Angeles, California 90007, USA
| | - J-E Rubensson
- Department of Physics and Astronomy, Uppsala University, Box 516, S-751 20 Uppsala, Sweden
| | - G Doumy
- Chemical Sciences and Engineering Division, Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - S H Southworth
- Chemical Sciences and Engineering Division, Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - P J Ho
- Chemical Sciences and Engineering Division, Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - A M March
- Chemical Sciences and Engineering Division, Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - A Al Haddad
- Chemical Sciences and Engineering Division, Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - Y Kumagai
- Chemical Sciences and Engineering Division, Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - M-F Tu
- Chemical Sciences and Engineering Division, Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - R D Schaller
- Center for Nanoscale Materials, Argonne National Laboratory, Lemont, Illinois 60439, USA
- Department of Chemistry, Northwestern University, Evanston, Illinois 60208, USA
| | - T Debnath
- Division of Chemistry and Biological Chemistry, Nanyang Technological University, Singapore 639798
| | - M S Bin Mohd Yusof
- Division of Chemistry and Biological Chemistry, Nanyang Technological University, Singapore 639798
| | - C Arnold
- Center for Free-Electron Laser Science, DESY, 22607 Hamburg, Germany
- Department of Physics, Universität Hamburg, 20146 Hamburg, Germany
- Hamburg Centre for Ultrafast Imaging, 22607 Hamburg, Germany
| | - W F Schlotter
- LCLS, SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - S Moeller
- LCLS, SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - G Coslovich
- LCLS, SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - J D Koralek
- LCLS, SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - M P Minitti
- LCLS, SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - M L Vidal
- DTU Chemistry-Department of Chemistry, Technical University of Denmark, DK-2800 Kongens Lyngby, Denmark
| | - M Simon
- Sorbonne Université and CNRS, Laboratoire de Chimie Physique-Matière et Rayonnement, 75252 Paris Cedex 05, France
| | - R Santra
- Center for Free-Electron Laser Science, DESY, 22607 Hamburg, Germany
- Department of Physics, Universität Hamburg, 20146 Hamburg, Germany
- Hamburg Centre for Ultrafast Imaging, 22607 Hamburg, Germany
| | - Z-H Loh
- Division of Chemistry and Biological Chemistry, Nanyang Technological University, Singapore 639798
| | - S Coriani
- DTU Chemistry-Department of Chemistry, Technical University of Denmark, DK-2800 Kongens Lyngby, Denmark
| | - A I Krylov
- Department of Chemistry, University of Southern California, Los Angeles, California 90007, USA
| | - L Young
- Chemical Sciences and Engineering Division, Argonne National Laboratory, Lemont, Illinois 60439, USA
- Department of Physics and James Franck Institute, The University of Chicago, Chicago, Illinois 60637, USA
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Areia C, Vollam S, Ede J, Young L, Piper P, King E, Watkinson P. Regulatory challenges of designing and testing continuous ambulatory vital signs monitoring in ward environments: lessons learned from the vHDU project. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Berman Z, Fischman A, Young L, Flanagan S, Katz M, Diiulio M, Kuban J, Golzarian J, Rose S. Abstract No. 390 Feasibility, safety, and efficacy of in-line balloon occlusion assisted delivery of ethylene-vinyl alcohol copolymer (Onyx) for peripheral arterial applications: a multicenter case series. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.451] [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: 11/16/2022] Open
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Yang F, Simpson G, Young L, Ford J, Dogan N, Wang L. Impact of contouring variability on oncological PET radiomics features in the lung. Sci Rep 2020; 10:369. [PMID: 31941949 PMCID: PMC6962150 DOI: 10.1038/s41598-019-57171-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 12/24/2019] [Indexed: 12/24/2022] Open
Abstract
Radiomics features extracted from oncological PET images are currently under intense scrutiny within the context of risk stratification for a variety of cancers. However, the lack of robustness assessment poses problems for their application across institutions and for broader patient populations. The objective of the current study was to examine the extent to which radiomics parameters from oncological PET vary in response to manual contouring variability in lung cancer. Imaging data employed in the study consisted of 26 PET scans with lesions in the lung being created through the use of an anthropomorphic phantom in conjunction with Monte Carlo simulations. From each of the simulated lesions, 25 radiomics features related to the gray-level co-occurrence matrices (GLCOM), gray-level size zone matrices (GLSZM), and gray-level neighborhood difference matrices (GLNDM) were extracted from ground truth contour and from manual contours provided by 10 raters in regard to four intensity discretization schemes with number of gray levels of 32, 64, 128, and 256, respectively. The impact of interrater variability in tumor delineation upon the agreement between raters on radiomics features was examined via interclass correlation and leave-p-out assessment. Only weak and moderate correlations were found between segmentation accuracy as measured by the Dice coefficient and percent feature error from ground truth for the vast majority of the features being examined. GLNDM-based texture parameters emerged as the top performing category of radiomcs features in terms of robustness against contouring variability for discretization schemes engaging number of gray levels of 32, 64, and 128 while GLCOM-based parameters stood out for discretization scheme engaging 256 gray levels. How and to what extent interrater reliability of radiomics features vary in response to the number of raters were largely feature-dependent. It was concluded that impact of contouring variability on PET-based radiomics features is present to varying degrees and could be experienced as a barrier to convey PET-based radiomics research to clinical relevance.
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Affiliation(s)
- F Yang
- Department of Radiation Oncology, University of Miami, Miami, FL, USA.
| | - G Simpson
- Department of Biomedical Engineering, University of Miami, Miami, FL, USA
| | - L Young
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - J Ford
- Department of Radiation Oncology, University of Miami, Miami, FL, USA
| | - N Dogan
- Department of Radiation Oncology, University of Miami, Miami, FL, USA
| | - L Wang
- Department of Radiation Oncology, University of Miami, Miami, FL, USA
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44
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Loh ZH, Doumy G, Arnold C, Kjellsson L, Southworth SH, Al Haddad A, Kumagai Y, Tu MF, Ho PJ, March AM, Schaller RD, Bin Mohd Yusof MS, Debnath T, Simon M, Welsch R, Inhester L, Khalili K, Nanda K, Krylov AI, Moeller S, Coslovich G, Koralek J, Minitti MP, Schlotter WF, Rubensson JE, Santra R, Young L. Observation of the fastest chemical processes in the radiolysis of water. Science 2020; 367:179-182. [DOI: 10.1126/science.aaz4740] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 11/15/2019] [Indexed: 01/01/2023]
Abstract
Elementary processes associated with ionization of liquid water provide a framework for understanding radiation-matter interactions in chemistry and biology. Although numerous studies have been conducted on the dynamics of the hydrated electron, its partner arising from ionization of liquid water, H2O+, remains elusive. We used tunable femtosecond soft x-ray pulses from an x-ray free electron laser to reveal the dynamics of the valence hole created by strong-field ionization and to track the primary proton transfer reaction giving rise to the formation of OH. The isolated resonance associated with the valence hole (H2O+/OH) enabled straightforward detection. Molecular dynamics simulations revealed that the x-ray spectra are sensitive to structural dynamics at the ionization site. We found signatures of hydrated-electron dynamics in the x-ray spectrum.
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Affiliation(s)
- Z.-H. Loh
- Division of Chemistry and Biological Chemistry, School of Physical and Mathematical Sciences, Nanyang Technological University, Singapore
| | - G. Doumy
- Chemical Sciences and Engineering Division, Argonne National Laboratory, Lemont, IL, USA
| | - C. Arnold
- Center for Free-Electron Laser Science, DESY, Hamburg, Germany
- Department of Physics, Universität Hamburg, Hamburg, Germany
- Hamburg Centre for Ultrafast Imaging, Hamburg, Germany
| | - L. Kjellsson
- Department of Physics and Astronomy, Uppsala University, Uppsala, Sweden
- European XFEL GmbH, Schenefeld, Germany
| | - S. H. Southworth
- Chemical Sciences and Engineering Division, Argonne National Laboratory, Lemont, IL, USA
| | - A. Al Haddad
- Chemical Sciences and Engineering Division, Argonne National Laboratory, Lemont, IL, USA
| | - Y. Kumagai
- Chemical Sciences and Engineering Division, Argonne National Laboratory, Lemont, IL, USA
| | - M.-F. Tu
- Chemical Sciences and Engineering Division, Argonne National Laboratory, Lemont, IL, USA
| | - P. J. Ho
- Chemical Sciences and Engineering Division, Argonne National Laboratory, Lemont, IL, USA
| | - A. M. March
- Chemical Sciences and Engineering Division, Argonne National Laboratory, Lemont, IL, USA
| | - R. D. Schaller
- Center for Nanoscale Materials, Argonne National Laboratory, Lemont, IL, USA
- Department of Chemistry, Northwestern University, Evanston, IL, USA
| | - M. S. Bin Mohd Yusof
- Division of Chemistry and Biological Chemistry, School of Physical and Mathematical Sciences, Nanyang Technological University, Singapore
| | - T. Debnath
- Division of Chemistry and Biological Chemistry, School of Physical and Mathematical Sciences, Nanyang Technological University, Singapore
| | - M. Simon
- Sorbonne Université and CNRS, Laboratoire de Chemie Physique-Matière et Rayonnement, LCPMR, F-750005 Paris, France
| | - R. Welsch
- Center for Free-Electron Laser Science, DESY, Hamburg, Germany
- Hamburg Centre for Ultrafast Imaging, Hamburg, Germany
| | - L. Inhester
- Center for Free-Electron Laser Science, DESY, Hamburg, Germany
| | - K. Khalili
- Department of Energy Conversion and Storage, Technical University of Denmark, Roskilde, Denmark
| | - K. Nanda
- Department of Chemistry, University of Southern California, Los Angeles, CA, USA
| | - A. I. Krylov
- Center for Free-Electron Laser Science, DESY, Hamburg, Germany
- Department of Chemistry, University of Southern California, Los Angeles, CA, USA
| | - S. Moeller
- Linac Coherent Light Source, SLAC National Accelerator Laboratory, Menlo Park, CA, USA
| | - G. Coslovich
- Linac Coherent Light Source, SLAC National Accelerator Laboratory, Menlo Park, CA, USA
| | - J. Koralek
- Linac Coherent Light Source, SLAC National Accelerator Laboratory, Menlo Park, CA, USA
| | - M. P. Minitti
- Linac Coherent Light Source, SLAC National Accelerator Laboratory, Menlo Park, CA, USA
| | - W. F. Schlotter
- Linac Coherent Light Source, SLAC National Accelerator Laboratory, Menlo Park, CA, USA
| | - J.-E. Rubensson
- Department of Physics and Astronomy, Uppsala University, Uppsala, Sweden
| | - R. Santra
- Center for Free-Electron Laser Science, DESY, Hamburg, Germany
- Department of Physics, Universität Hamburg, Hamburg, Germany
- Hamburg Centre for Ultrafast Imaging, Hamburg, Germany
| | - L. Young
- Chemical Sciences and Engineering Division, Argonne National Laboratory, Lemont, IL, USA
- Department of Physics and James Franck Institute, University of Chicago, Chicago, IL, USA
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McMahon M, Tumelty K, Walls G, Eakin R, O’Hare J, Young L, Mcaleese J. Oligometastatic relapse after radical radiotherapy for NSCLC. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30126-4] [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: 11/16/2022]
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46
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Young L, Lou K, Kasper KM. Transversus Abdominis Plane (Tap) Block With Liposomal Bupivacaine for Laparoscopic Hysterectomy With Umbilical Contained Tissue Extraction: A Retrospective Study. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.716] [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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Kim A, Kalet AM, Cao N, Hippe DS, Fang LC, Young L, Meyer J, Lang EV, Mayr NA. Effects of Preparatory Coaching and Home Practice for Deep Inspiration Breath Hold on Cardiac Dose for Left Breast Radiation Therapy. Clin Oncol (R Coll Radiol) 2019; 30:571-577. [PMID: 29773446 DOI: 10.1016/j.clon.2018.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/23/2018] [Accepted: 04/05/2018] [Indexed: 11/19/2022]
Abstract
AIMS Deep inspiration breath hold (DIBH) reduces cardiac radiation exposure by creating cardiac-chest wall separation in breast cancer radiotherapy. DIBH requires sustaining chest wall expansion for up to 40 s and involves complex co-ordination of thoraco-abdominal muscles, which may not be intuitive to patients. We investigated the effect of in-advance preparatory DIBH coaching and home practice on cardiac doses. MATERIALS AND METHODS Successive patients from 1 February 2015 to 31 December 2016 with left-sided breast cancer who underwent tangential field radiotherapy utilising the DIBH technique were included. The study cohort consisted of patients treated by a physician who routinely provided DIBH coaching and home practice instructions at least 5 days before simulation. The control group included non-coached patients under another physician's care. Minimum, maximum and mean cardiac doses and V5, V10 and V30 from DIBH and free breathing simulation computed tomography scans were obtained from the planning system. DIBH and free breathing cardiac doses and volume exposures were compared between the coached and non-coached groups using the two-sample t-test, Fisher's exact test and the Mann-Whitney U-test. RESULTS Twenty-seven coached and 42 non-coached patients were identified. The DIBH maximum cardiac dose was lower in coached patients at 13.1 Gy compared with 19.4 Gy without coaching (P = 0.004). The percentage cardiac volume exposure in DIBH was lower in coached patients; the DIBH V10 was 0.5% without coaching and 0.1% with coaching (P = 0.005). There was also a trend towards lower DIBH V5 in the coached group compared with the non-coached group (1.2% versus 1.9%, P = 0.071). No significant differences in patient cardiopulmonary comorbidity factors that might influence cardiac doses were found between the groups. CONCLUSIONS Our results suggest that cardiac dose sparing can potentially be further improved with a 5 day regimen of preparatory DIBH coaching and in-advance home practice before simulation. These hypothesis-generating findings should be confirmed in a larger study.
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Affiliation(s)
- A Kim
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - A M Kalet
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - N Cao
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - D S Hippe
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - L C Fang
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - L Young
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - J Meyer
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - E V Lang
- Hypnalgesics, LLC, Brookline, MA, USA
| | - N A Mayr
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA.
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Danhauer SC, Brenes GA, Levine BJ, Young L, Tindle HA, Addington EL, Wallace RB, Naughton MJ, Garcia L, Safford M, Kim MM, LeBlanc ES, Snively BM, Snetselaar LG, Shumaker S. Variability in sleep disturbance, physical activity and quality of life by level of depressive symptoms in women with Type 2 diabetes. Diabet Med 2019; 36:1149-1157. [PMID: 30552780 PMCID: PMC6571069 DOI: 10.1111/dme.13878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2018] [Indexed: 12/20/2022]
Abstract
AIMS To examine (1) the prevalence of depressive symptoms in women with Type 2 diabetes, (2) the associations between depressive symptoms and the following dependent variables: sleep disturbance; physical activity; physical health-related; and global quality of life, and (3) the potential moderating effects of antidepressants and optimism on the relationship between depressive symptoms and dependent variables. METHODS Participants in the Women's Health Initiative who had Type 2 diabetes and data on depressive symptoms (N=8895) were included in the analyses. In multivariable linear regression models controlling for sociodemographic, medical and psychosocial covariates, we examined the main effect of depressive symptoms, as well as the interactions between depressive symptoms and antidepressant use, and between depressive symptoms and optimism, on sleep disturbance, physical activity, physical health-related quality of life; and global quality of life. RESULTS In all, 16% of women with Type 2 diabetes reported elevated depressive symptoms. In multivariable analyses, women with depressive symptoms had greater sleep disturbance (P<0.0001) and lower global quality of life (P<.0001). We found evidence of significant statistical interaction in the models for quality-of-life outcomes: the increased risk of poor physical health-related quality of life associated with antidepressant use was stronger in women without vs with depressive symptoms, and the association between greater optimism and higher global quality of life was stronger in women with vs without depressive symptoms. CONCLUSIONS To improve health behaviours and quality of life in women with Type 2 diabetes, sociodemographic and medical characteristics may identify at-risk populations, while psychosocial factors including depression and optimism may be important targets for non-pharmacological intervention.
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Affiliation(s)
- S C Danhauer
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, NC
| | - G A Brenes
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston Salem, NC
| | - B J Levine
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, NC
| | - L Young
- Department of Medicine, Division of Endocrinology and Metabolism, Section on Gerontology and Geriatric Medicine, UNC School of Medicine, Chapel Hill, NC
| | - H A Tindle
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - E L Addington
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - R B Wallace
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA
| | - M J Naughton
- Division of Cancer Prevention and Control, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - L Garcia
- Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA
| | - M Safford
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - M M Kim
- Center for Biobehavioral Health Disparities Research, Department of Community and Family Medicine, Duke University, Durham, NC
| | - E S LeBlanc
- Kaiser Permanente Center for Health Research NW, Portland, OR, USA
| | - B M Snively
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, WinstonSalem, NC, USA
| | - L G Snetselaar
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA
| | - S Shumaker
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, NC
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Hernandez ND, Daley EM, Young L, Kolar SK, Wheldon C, Vamos CA, Cooper D. HPV Vaccine recommendations: does a health care provider's gender and ethnicity matter to Unvaccinated Latina college women? Ethn Health 2019; 24:645-661. [PMID: 28826257 DOI: 10.1080/13557858.2017.1367761] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 08/09/2017] [Indexed: 06/07/2023]
Abstract
Objectives: There are disparities in the uptake of HPV vaccine among racial/ethnic minority women. The strongest predictor of HPV vaccine uptake among adult women is health care provider (HCP) recommendation; however, it is unclear how issues relating to race/ethnicity may mitigate these recommendations. Research shows that racial/ethnic and gender concordance between a patient and HCP can improve patient satisfaction, access and quality of care. If concordance contributes to improved patient-provider interactions, then it may be a factor in patient decisions regarding HPV vaccination. The objectives of this study were to (1) explore gender and ethnicity HCP preference regarding HPV vaccination among unvaccinated; and (2) understand factors associated with those preferences. Design: Unvaccinated Latina college students (n = 187) completed a survey that assessed HCP preferences, medical mistrust, cultural assimilation and HPV vaccine recommendation. Logistic regression models evaluated associations between above variables with HPV knowledge and preference for a female and/or Latina HCP. Results: Most respondents had health insurance (71%), a regular HCP (64%), were US-born (67%), with foreign-born parents (74%). Thirty-four percent and 18% agreed that they would be more likely to get the HPV vaccine if the recommending HCP was female and Latino, respectively. Latina women reporting higher medical mistrust preferred a HPV vaccine recommendation from a Latino/a provider. Conclusions: Latinas' preferences regarding gender and ethnicity of their HCPs may affect patient-provider interactions. Increasing diversity and cultural awareness among HCPs, and providing linguistically and culturally-appropriate information may decrease patient-provider mistrust, increase uptake of the HPV vaccine, and decrease persistent cervical cancer disparities.
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Affiliation(s)
- Natalie D Hernandez
- a Department of Community Health and Preventive Medicine , Prevention Research Center, Morehouse School of Medicine , Atlanta , GA , USA
| | - Ellen M Daley
- b Department of Community and Family Health , College of Public Health, University of South Florida , Tampa , FL , USA
| | - Lauren Young
- c Arizona Department of Health Services , STD Control Program , Phoenix , AZ , USA
| | - Stephanie K Kolar
- b Department of Community and Family Health , College of Public Health, University of South Florida , Tampa , FL , USA
| | - Christopher Wheldon
- b Department of Community and Family Health , College of Public Health, University of South Florida , Tampa , FL , USA
| | - Cheryl A Vamos
- b Department of Community and Family Health , College of Public Health, University of South Florida , Tampa , FL , USA
| | - Dexter Cooper
- a Department of Community Health and Preventive Medicine , Prevention Research Center, Morehouse School of Medicine , Atlanta , GA , USA
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Palmer CD, Bulik B, Yang A, Hart M, Davis M, Francis J, Duke F, Zhou R, Busby J, Murphy T, Clark A, Young L, Zhong M, Caldwell K, Abhyankar J, Cook A, Boucher T, Rousseau R, Voong C, Rizvi N, Frattini M, Yelensky R, Jooss K, Skoberne M. Abstract 4059: Identification of pre-existing neoantigen-specific T cells in patients receiving checkpoint inhibitor therapy using a deep learning antigen prediction model. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-4059] [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
Immune Checkpoint Blockade (ICB) has revolutionized the treatment of patients with cancer but provides durable clinical benefit to only a minority of patients. Neoantigens, antigens derived from tumor mutations, are emerging as key targets of T cells in patients with clinical responses to ICB whose tumors exhibit high mutational burden. T cells specific to some neoantigens appear to be naturally generated in these patients and can be further expanded upon ICB. Accurate neoantigen identification may fuel therapeutic advances by driving potent anti-neoantigen immune responses through therapeutic immunization or adoptive cell therapy. However, identification of neoantigens and neoantigen-reactive T cells remains a significant challenge. Current methods are time consuming and labor intensive and require non-routine clinical specimen collections. Here, we apply deep learning to a large HLA peptide and genomic dataset from NSCLC patients to create a computational model of minimal epitope presentation for neoantigen prediction. We demonstrate that our model allows rapid identification of neoantigens and neoantigen reactive T cells using routine clinical biopsies and blood specimens. This methodology does not require HLA-specific reagents and enables identification of T cell responses for every patient. To identify neoantigen-specific T cells, selected peptides, prioritized by our prediction model, were synthesized as minimal epitopes and added to short-term in vitro stimulation (IVS) cultures to expand neoantigen-reactive T cells. The presence of antigen-specific T cells was assessed two weeks later using IFN-gamma (IFN-g) ELISpot against pools of the prioritized neoantigens. Patient-specific peptide pools and IFN-g ELISpot enabled identification of neoantigen-reactive T cells in 5/9 (56%) patients on ICB. Deconvolution yielded an average of 2 recognized neoantigens per patient, with increased responses over time observed in one patient where multiple time points were available. Neoantigen responses were confirmed in repeat IVS cultures where additional samples were available. Importantly, expansion of HLA-matched healthy controls in the presence of patient peptide pools did not result in any responses by IFN-g ELISpot. In addition, antigen-reactive T cells were sorted for single cell sequencing on the 10x platform using CD137 as an HLA-independent T-cell activation marker. In summary, pre-existing neoantigen specific T cells and TCR clones can be rapidly identified utilizing routine clinical specimens, through (i) a powerful neoantigen prediction model, (ii) short-term in vitro T-cell expansion followed by IFN-gamma ELISpot, and (iii) HLA-independent selection and single cell sequencing. This methodology may allow rapid design of neoantigen-targeting vaccines or selection of TCRs for cell therapeutic approaches.
Citation Format: Christine D. Palmer, Brendan Bulik, Aaron Yang, Meghan Hart, Matthew Davis, Joshua Francis, Fujiko Duke, Rita Zhou, Jennifer Busby, Tyler Murphy, Andrew Clark, Lauren Young, Mike Zhong, Kamilah Caldwell, Jesse Abhyankar, Alison Cook, Tommy Boucher, Raphaël Rousseau, Cynthia Voong, Naiyer Rizvi, Mark Frattini, Roman Yelensky, Karin Jooss, Mojca Skoberne. Identification of pre-existing neoantigen-specific T cells in patients receiving checkpoint inhibitor therapy using a deep learning antigen prediction model [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4059.
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