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White EG, Hayes HA, Clark P, Cloran FJ. Subclinical to catastrophic: a range of outcomes in cerebral air embolism. Emerg Radiol 2023; 30:823-827. [PMID: 37953444 DOI: 10.1007/s10140-023-02181-2] [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: 07/18/2023] [Accepted: 10/26/2023] [Indexed: 11/14/2023]
Abstract
Cerebral air embolism (CAE) is a rare, yet potentially devastating condition characterized by entrance of air into cerebral vasculature, that is nearly always iatrogenic. While many findings of CAE are subclinical and incidental at computed tomography (CT), there remain cases of catastrophic and fatal embolisms. Increasing physician awareness of prevention, presentation, and treatment for CAE is crucial for reducing morbidity and mortality. In this case series, we highlight this preventable entity by comparing three cases of CAE that showcase a diverse array of presentations, radiologic findings, and clinical outcomes. We will also explore predisposing factors, prognostic predictors, diagnostic considerations, and available treatments.
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Affiliation(s)
- E G White
- Uniformed Services University of Health Sciences, Bethesda, USA.
| | - H A Hayes
- Department of Radiology, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, USA
| | - P Clark
- Department of Radiology, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, USA
| | - F J Cloran
- Department of Radiology, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, USA
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Guo M, Liu J, Clark P, Ahmad S, Patel R, Varela JC, Mori S. Cryopreserved versus fresh peripheral blood allogeneic stem cell transplantation outcomes in patients receiving post-transplant cyclophosphamide for graft-versus-host prophylaxis during the COVID-19 pandemic: a single center experience. Int J Hematol 2023; 117:428-437. [PMID: 36378406 PMCID: PMC9664429 DOI: 10.1007/s12185-022-03493-8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND/OBJECTIVE Cryopreservation of grafts is not common practice in allogeneic hematopoietic stem cell transplant (HSCT) recipients. However, our center had to use cryopreserved cells for allogeneic HSCT during the COVID-19 pandemic to avoid delays in transplantation due to uncertainty regarding patient and donor exposures. STUDY DESIGN We retrospectively evaluated post-transplant engraftment and survival outcomes of adult patients who received cryopreserved versus fresh allografts during the COVID-19 pandemic. RESULTS Fifty-five patients with hematologic malignancies received either cryopreserved (n = 34) or fresh (n = 21) allogeneic HSCT using peripheral blood stem cells between January 2020 and December 2020. At a median follow-up time of 15 months, cryopreserved allograft recipients had significantly lower overall survival (OS) (p = 0.02). They also experienced significantly delayed neutrophil (p = 0.01) and platelet engraftments (p < 0.0001), as well as higher red blood cell transfusion-dependence after day + 60 (67.6% vs. 28.6%; p = 0.01). Significantly more cryopreserved allograft recipients received donor lymphocyte infusion than fresh allograft recipients (35.3% vs. 4.8%, p = 0.01). Neither relapse-free survival nor non-relapse mortality differed significantly between the two groups. CONCLUSION Cryopreservation of allografts in combination with post-transplant cyclophosphamide may negatively affect engraftment and OS outcomes in HSCT recipients.
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Affiliation(s)
- Mengni Guo
- grid.414935.e0000 0004 0447 7121Department of Internal Medicine AdventHealth, Orlando, FL 32804 USA
| | - Jieying Liu
- grid.414935.e0000 0004 0447 7121Department of Internal Medicine AdventHealth, Orlando, FL 32804 USA
| | - Pamela Clark
- grid.414938.30000 0004 0415 6213Blood and Marrow Transplant Center, AdventHealth Cancer Institute, AHMG2415 N. Orange Ave., Suite 601, Orlando, FL 32804 USA
| | - Sarfraz Ahmad
- grid.414938.30000 0004 0415 6213Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, FL 32804 USA
| | - Rushang Patel
- grid.414938.30000 0004 0415 6213Blood and Marrow Transplant Center, AdventHealth Cancer Institute, AHMG2415 N. Orange Ave., Suite 601, Orlando, FL 32804 USA
| | - Juan Carlos Varela
- grid.414938.30000 0004 0415 6213Blood and Marrow Transplant Center, AdventHealth Cancer Institute, AHMG2415 N. Orange Ave., Suite 601, Orlando, FL 32804 USA
| | - Shahram Mori
- Blood and Marrow Transplant Center, AdventHealth Cancer Institute, AHMG2415 N. Orange Ave., Suite 601, Orlando, FL, 32804, USA.
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Jagodinsky J, Jin W, Bates A, Clark P, Sriramaneni R, Havighurst T, Chakravarthy I, Nystuen E, Kim K, Sondel P, Morris Z. Intratumoral MPL Induces Th1 Polarization and Augments In Situ Vaccination Generated by Radiation and Checkpoint Blockade. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ben Nasr M, D’Addio F, Montefusco L, Usuelli V, Loretelli C, Rossi A, Pastore I, Abdelsalam A, Maestroni A, Dell’Acqua M, Ippolito E, Assi E, Seelam AJ, Fiorina RM, Chebat E, Morpurgo P, Lunati ME, Bolla AM, Abdi R, Bonventre JV, Rusconi S, Riva A, Corradi D, Santus P, Clark P, Nebuloni M, Baldi G, Finzi G, Folli F, Zuccotti GV, Galli M, Herold KC, Fiorina P. Indirect and Direct Effects of SARS-CoV-2 on Human Pancreatic Islets. Diabetes 2022; 71:1579-1590. [PMID: 35499468 PMCID: PMC9490452 DOI: 10.2337/db21-0926] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [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] [Received: 10/15/2021] [Accepted: 04/04/2022] [Indexed: 01/08/2023]
Abstract
Recent studies have shown that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may induce metabolic distress, leading to hyperglycemia in patients affected by coronavirus disease 19 (COVID-19). We investigated the potential indirect and direct effects of SARS-CoV-2 on human pancreatic islets in 10 patients who became hyperglycemic after COVID-19. Although there was no evidence of peripheral anti-islet autoimmunity, the serum of these patients displayed toxicity on human pancreatic islets, which could be abrogated by the use of anti-interleukin-1β (IL-1β), anti-IL-6, and anti-tumor necrosis factor α, cytokines known to be highly upregulated during COVID-19. Interestingly, the receptors of those aforementioned cytokines were highly expressed on human pancreatic islets. An increase in peripheral unmethylated INS DNA, a marker of cell death, was evident in several patients with COVID-19. Pathology of the pancreas from deceased hyperglycemic patients who had COVID-19 revealed mild lymphocytic infiltration of pancreatic islets and pancreatic lymph nodes. Moreover, SARS-CoV-2-specific viral RNA, along with the presence of several immature insulin granules or proinsulin, was detected in postmortem pancreatic tissues, suggestive of β-cell-altered proinsulin processing, as well as β-cell degeneration and hyperstimulation. These data demonstrate that SARS-CoV-2 may negatively affect human pancreatic islet function and survival by creating inflammatory conditions, possibly with a direct tropism, which may in turn lead to metabolic abnormalities observed in patients with COVID-19.
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Affiliation(s)
- Moufida Ben Nasr
- International Center for Type 1 Diabetes, Pediatric Clinical Research Center Romeo and Enrica Invernizzi, Dipartimento di Scienze Biomediche e Cliniche (DIBIC), Università di Milano, Milan, Italy
- Nephrology Division, Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | - Francesca D’Addio
- International Center for Type 1 Diabetes, Pediatric Clinical Research Center Romeo and Enrica Invernizzi, Dipartimento di Scienze Biomediche e Cliniche (DIBIC), Università di Milano, Milan, Italy
- Division of Endocrinology, Azienda Socio-Sanitaria Territoriale (ASST) Fatebenefratelli-Sacco, Milan, Italy
| | - Laura Montefusco
- International Center for Type 1 Diabetes, Pediatric Clinical Research Center Romeo and Enrica Invernizzi, Dipartimento di Scienze Biomediche e Cliniche (DIBIC), Università di Milano, Milan, Italy
| | - Vera Usuelli
- International Center for Type 1 Diabetes, Pediatric Clinical Research Center Romeo and Enrica Invernizzi, Dipartimento di Scienze Biomediche e Cliniche (DIBIC), Università di Milano, Milan, Italy
| | - Cristian Loretelli
- International Center for Type 1 Diabetes, Pediatric Clinical Research Center Romeo and Enrica Invernizzi, Dipartimento di Scienze Biomediche e Cliniche (DIBIC), Università di Milano, Milan, Italy
| | - Antonio Rossi
- Division of Endocrinology, Azienda Socio-Sanitaria Territoriale (ASST) Fatebenefratelli-Sacco, Milan, Italy
| | - Ida Pastore
- Division of Endocrinology, Azienda Socio-Sanitaria Territoriale (ASST) Fatebenefratelli-Sacco, Milan, Italy
| | - Ahmed Abdelsalam
- International Center for Type 1 Diabetes, Pediatric Clinical Research Center Romeo and Enrica Invernizzi, Dipartimento di Scienze Biomediche e Cliniche (DIBIC), Università di Milano, Milan, Italy
| | - Anna Maestroni
- International Center for Type 1 Diabetes, Pediatric Clinical Research Center Romeo and Enrica Invernizzi, Dipartimento di Scienze Biomediche e Cliniche (DIBIC), Università di Milano, Milan, Italy
| | - Marco Dell’Acqua
- International Center for Type 1 Diabetes, Pediatric Clinical Research Center Romeo and Enrica Invernizzi, Dipartimento di Scienze Biomediche e Cliniche (DIBIC), Università di Milano, Milan, Italy
- Division of Endocrinology, Azienda Socio-Sanitaria Territoriale (ASST) Fatebenefratelli-Sacco, Milan, Italy
| | - Elio Ippolito
- International Center for Type 1 Diabetes, Pediatric Clinical Research Center Romeo and Enrica Invernizzi, Dipartimento di Scienze Biomediche e Cliniche (DIBIC), Università di Milano, Milan, Italy
| | - Emma Assi
- International Center for Type 1 Diabetes, Pediatric Clinical Research Center Romeo and Enrica Invernizzi, Dipartimento di Scienze Biomediche e Cliniche (DIBIC), Università di Milano, Milan, Italy
| | - Andy Joe Seelam
- International Center for Type 1 Diabetes, Pediatric Clinical Research Center Romeo and Enrica Invernizzi, Dipartimento di Scienze Biomediche e Cliniche (DIBIC), Università di Milano, Milan, Italy
| | - Roberta Maria Fiorina
- International Center for Type 1 Diabetes, Pediatric Clinical Research Center Romeo and Enrica Invernizzi, Dipartimento di Scienze Biomediche e Cliniche (DIBIC), Università di Milano, Milan, Italy
| | - Enrica Chebat
- Division of Endocrinology, Azienda Socio-Sanitaria Territoriale (ASST) Fatebenefratelli-Sacco, Milan, Italy
| | - Paola Morpurgo
- Division of Endocrinology, Azienda Socio-Sanitaria Territoriale (ASST) Fatebenefratelli-Sacco, Milan, Italy
| | - Maria Elena Lunati
- Division of Endocrinology, Azienda Socio-Sanitaria Territoriale (ASST) Fatebenefratelli-Sacco, Milan, Italy
| | - Andrea Mario Bolla
- Division of Endocrinology, Azienda Socio-Sanitaria Territoriale (ASST) Fatebenefratelli-Sacco, Milan, Italy
| | - Reza Abdi
- Transplantation Research Center and Nephrology Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Joseph V. Bonventre
- Transplantation Research Center and Nephrology Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Stefano Rusconi
- Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Agostino Riva
- Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Domenico Corradi
- Unit of Pathology, Department of Biomedical, Biotechnological and Translational Sciences, University of Parma, Parma, Italy
| | - Pierachille Santus
- Division of Respiratory Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences, DIBIC, Università di Milano, Milan, Italy
| | - Pamela Clark
- Departments of Immunobiology and Internal Medicine, Yale University, New Haven, CT
| | - Manuela Nebuloni
- Department of Biomedical and Clinical Sciences, DIBIC, Università di Milano, Milan, Italy
- Department of Pathology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Gabriella Baldi
- Endocrinology Laboratory, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Giovanna Finzi
- Department of Pathology, University Hospital ASST-Settelaghi, Varese, Italy
| | - Franco Folli
- Endocrinology and Metabolism, Department of Health Science, Università di Milano, ASST Santi Paolo e Carlo, Milan, Italy
| | | | - Massimo Galli
- Infectious Diseases Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Kevan C. Herold
- Departments of Immunobiology and Internal Medicine, Yale University, New Haven, CT
| | - Paolo Fiorina
- International Center for Type 1 Diabetes, Pediatric Clinical Research Center Romeo and Enrica Invernizzi, Dipartimento di Scienze Biomediche e Cliniche (DIBIC), Università di Milano, Milan, Italy
- Nephrology Division, Boston Children’s Hospital, Harvard Medical School, Boston, MA
- Division of Endocrinology, Azienda Socio-Sanitaria Territoriale (ASST) Fatebenefratelli-Sacco, Milan, Italy
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Chotiyarnwong P, McCloskey EV, Harvey NC, Lorentzon M, Prieto-Alhambra D, Abrahamsen B, Adachi JD, Borgström F, Bruyere O, Carey JJ, Clark P, Cooper C, Curtis EM, Dennison E, Diaz-Curiel M, Dimai HP, Grigorie D, Hiligsmann M, Khashayar P, Lewiecki EM, Lips P, Lorenc RS, Ortolani S, Papaioannou A, Silverman S, Sosa M, Szulc P, Ward KA, Yoshimura N, Kanis JA. Is it time to consider population screening for fracture risk in postmenopausal women? A position paper from the International Osteoporosis Foundation Epidemiology/Quality of Life Working Group. Arch Osteoporos 2022; 17:87. [PMID: 35763133 PMCID: PMC9239944 DOI: 10.1007/s11657-022-01117-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 02/03/2023]
Abstract
The IOF Epidemiology and Quality of Life Working Group has reviewed the potential role of population screening for high hip fracture risk against well-established criteria. The report concludes that such an approach should strongly be considered in many health care systems to reduce the burden of hip fractures. INTRODUCTION The burden of long-term osteoporosis management falls on primary care in most healthcare systems. However, a wide and stable treatment gap exists in many such settings; most of which appears to be secondary to a lack of awareness of fracture risk. Screening is a public health measure for the purpose of identifying individuals who are likely to benefit from further investigations and/or treatment to reduce the risk of a disease or its complications. The purpose of this report was to review the evidence for a potential screening programme to identify postmenopausal women at increased risk of hip fracture. METHODS The approach took well-established criteria for the development of a screening program, adapted by the UK National Screening Committee, and sought the opinion of 20 members of the International Osteoporosis Foundation's Working Group on Epidemiology and Quality of Life as to whether each criterion was met (yes, partial or no). For each criterion, the evidence base was then reviewed and summarized. RESULTS AND CONCLUSION The report concludes that evidence supports the proposal that screening for high fracture risk in primary care should strongly be considered for incorporation into many health care systems to reduce the burden of fractures, particularly hip fractures. The key remaining hurdles to overcome are engagement with primary care healthcare professionals, and the implementation of systems that facilitate and maintain the screening program.
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Affiliation(s)
- P Chotiyarnwong
- Department of Oncology & Metabolism, Mellanby Centre for Musculoskeletal Research, MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - E V McCloskey
- Department of Oncology & Metabolism, Mellanby Centre for Musculoskeletal Research, MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK.
- Centre for Metabolic Bone Diseases, Northern General Hospital, University of Sheffield, Herries Road, Sheffield, S5 7AU, UK.
| | - N C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - M Lorentzon
- University of Gothenburg, Gothenburg, Sweden
- Australian Catholic University, Melbourne, Australia
| | - D Prieto-Alhambra
- Oxford NIHR Biomedical Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
- GREMPAL (Grup de Recerca en Malalties Prevalents de L'Aparell Locomotor) Research Group, CIBERFes and Idiap Jordi Gol Primary Care Research Institute, Universitat Autònoma de Barcelona and Instituto de Salud Carlos III, Gran Via de Les Corts Catalanes, 591 Atico, 08007, Barcelona, Spain
| | - B Abrahamsen
- Department of Clinical Research, Odense Patient Data Exploratory Network, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
| | - J D Adachi
- Department of Medicine, Michael G DeGroote School of Medicine, St Joseph's Healthcare-McMaster University, Hamilton, ON, Canada
| | - F Borgström
- Quantify Research, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - O Bruyere
- WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - J J Carey
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - P Clark
- Clinical Epidemiology Unit of Hospital Infantil de México Federico Gómez-Faculty of Medicine, Universidad Nacional Autónoma de México, UNAM, Mexico City, Mexico
| | - C Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - E M Curtis
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - E Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - M Diaz-Curiel
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - H P Dimai
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - D Grigorie
- Carol Davila University of Medicine, Bucharest, Romania
- Department of Endocrinology & Bone Metabolism, National Institute of Endocrinology, Bucharest, Romania
| | - M Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - P Khashayar
- Center for Microsystems Technology, Imec and Ghent University, 9050, Ghent, Belgium
| | - E M Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA
| | - P Lips
- Department of Internal Medicine, Endocrine Section & Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - R S Lorenc
- Multidisciplinary Osteoporosis Forum, SOMED, Warsaw, Poland
| | - S Ortolani
- IRCCS Istituto Auxologico, UO Endocrinologia E Malattie del Metabolismo, Milano, Italy
| | - A Papaioannou
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- GERAS Centre for Aging Research, Hamilton, ON, Canada
| | - S Silverman
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - M Sosa
- Bone Metabolic Unit, University of Las Palmas de Gran Canaria, Hospital University Insular, Las Palmas, Gran Canaria, Spain
| | - P Szulc
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | - K A Ward
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - N Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22Nd Century Medical and Research Center, University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - J A Kanis
- Centre for Metabolic Bone Diseases, Northern General Hospital, University of Sheffield, Herries Road, Sheffield, S5 7AU, UK
- Australian Catholic University, Melbourne, Australia
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Edgar CM, Clark P, Patel RD, Varela JC, Mori S. Low-Dose Azacitidine and Venetoclax Maintenance Following Allogeneic Hematopoietic Stem Cell Transplantation in High-Risk AML and MDS Patients: Single Center Retrospective Analysis. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00717-5] [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: 11/25/2022]
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Clark P, Barrueco G, Brown T, Aguayo C, Kelly S, Varela JC, Patel RD, Mori S, Goldstein SC. Use of Novel ‘quarter Point’ Assay for Improving CD34 Yield and Reducing Collection Times for HPC, Apheresis. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00436-5] [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: 11/17/2022]
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Clark P, Holden C, Russell M, Downs H. The Impostor Phenomenon in Mental Health Professionals: Relationships Among Compassion Fatigue, Burnout, and Compassion Satisfaction. Contemp Fam Ther 2021; 44:185-197. [PMID: 33948046 PMCID: PMC8085648 DOI: 10.1007/s10591-021-09580-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 11/23/2022]
Abstract
Imposter phenomenon is defined as a sense of intellectual fraudulence and an inability to internalize success and competency. Although imposter phenomenon has been noted in several populations, literature is sparse that focuses on mental health professionals. In addition, little is known about the relationships between imposter phenomenon, compassion fatigue, and compassion satisfaction for mental health workers. Using a survey design with a convenience sample of 158 mental health workers, this study found that imposter phenomenon was positively associated with compassion fatigue, as well as negatively associated with compassion satisfaction, when controlling for years of work and age. Further, the combination of lower levels of compassion satisfaction and higher levels of burnout predicted higher levels of imposter phenomenon. Implications and preventative measures are discussed.
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Affiliation(s)
- Pamela Clark
- School of Child and Family Sciences, The University of Southern Mississippi, 118 College Drive, #5035, Hattiesburg, MS 39406 USA
| | - Chelsey Holden
- School of Child and Family Sciences, The University of Southern Mississippi, 118 College Drive, #5035, Hattiesburg, MS 39406 USA
| | - Marla Russell
- School of Child and Family Sciences, The University of Southern Mississippi, 118 College Drive, #5035, Hattiesburg, MS 39406 USA
| | - Heather Downs
- School of Child and Family Sciences, The University of Southern Mississippi, 118 College Drive, #5035, Hattiesburg, MS 39406 USA
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Perdigoto AL, Tran T, Patel N, Clark P, Patell K, Stamatouli AM, Reddy V, Clune J, Herold KC, Robert ME, Kluger HM. Elective Colectomy in a Patient with Active Ulcerative Colitis and Metastatic Melanoma Enabling Successful Treatment with Immune Checkpoint Inhibitors. Clin Oncol Case Rep 2020; 3:142. [PMID: 33778814 PMCID: PMC7993656] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Checkpoint inhibitor immunotherapy has significantly advanced treatment of a growing number of advanced malignancies. A consequences of immune system activation that leads to tumor cell destruction by checkpoint inhibitor therapy is the development of immune-related adverse events, some of which can be life threatening. There are limited data on the use of checkpoint inhibitor therapy in patients with preexisting autoimmunity owing to concerns that underlying autoimmune disease may be exacerbated by checkpoint inhibitor treatment. Decisions to treat these patients are made after careful consideration of the risks and benefits of treatment. We describe a patient with active and severe ulcerative colitis with metastatic melanoma who underwent elective colectomy prior to initiation of anti-PD-1 and anti-CTLA-4. The patient had excellent tumor response without flare of his ulcerative colitis suggesting that in select patients with high-risk inflammatory bowel disease, elective colectomy may be an effective treatment option.
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Affiliation(s)
- Ana Luisa Perdigoto
- Section of Endocrinology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Thuy Tran
- Section of Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Natalie Patel
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Pamela Clark
- Department of Immunobiology, Yale University, New Haven, Connecticut, USA
| | - Kanchi Patell
- Section of Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Vikram Reddy
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - James Clune
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Kevan C Herold
- Section of Endocrinology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Immunobiology, Yale University, New Haven, Connecticut, USA
| | - Marie E Robert
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Harriet M Kluger
- Section of Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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10
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Lewiecki EM, Binkley N, Clark P, Kim S, Leslie WD, Morin SN. Core principles for fracture prevention: North American Consensus from the National Osteoporosis Foundation, Osteoporosis Canada, and Academia Nacional de Medicina de Mexico. Osteoporos Int 2020; 31:2073-2076. [PMID: 32676822 DOI: 10.1007/s00198-020-05541-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/07/2020] [Indexed: 01/12/2023]
Abstract
UNLABELLED Core principles for fracture prevention address fundamental concepts for the evaluation and management of patients at risk for fracture. These are intended to form the foundation of clinical practice guidelines and represent a first step toward guideline harmonization. INTRODUCTION The large number of clinical practice guidelines for osteoporosis and discordance of recommendations has led to confusion among clinicians and patients, and likely contributes to the large osteoporosis treatment gap. We propose that stakeholder organizations reach agreement on fundamental principles in the management of osteoporosis and prevention of fracture as a first step toward a goal of guideline harmonization. METHODS The best available evidence, as interpreted by an ad hoc working group of expert representatives from major osteoporosis societies in North America, was considered in the development of core principles for skeletal healthcare. These principles were subsequently endorsed by the USA National Osteoporosis Foundation, Osteoporosis Canada, and Academia Nacional de Medicina de Mexico (National Academy of Medicine of Mexico). RESULTS Core principles are summarized here in bullet format. Categories include evaluation, lifestyle and nutrition, pharmacological therapy, and monitoring. A pathway forward to achieve guideline harmonization, at least in part, is proposed. CONCLUSION Greater concordance of recommendations for the care of patients at risk for fracture are expected to lead to improved patient care across jurisdictions, with a narrowing of the osteoporosis treatment gap and reduced burden of fractures.
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Affiliation(s)
- E M Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA.
| | - N Binkley
- University of Wisconsin Osteoporosis Clinical Research Program, Madison, WI, USA
| | - P Clark
- Clinical Epidemiology Unit, Hospital Infantil Federico Gómez, Mexico, D.F. Mexico, Faculty of Medicine, Universidad Nacional Autonoma de Mexico, Mexico, D.F., Mexico
| | - S Kim
- Department of Medicine, Division of Endocrinology & Metabolism, Women's College Hospital, University of Toronto, Toronto, Canada
| | - W D Leslie
- Departments of Medicine and Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - S N Morin
- Department of Medicine, Division of General Internal Medicine, McGill University, Montreal, Canada
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11
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Abstract
Background The extended and clinically silent progression of Type 1 diabetes (T1D) creates a challenge for clinical interventions and for understanding the mechanisms that underlie its pathogenesis. Over the course of the development of Type 1 diabetes, studies in animal models and of human tissues have identified adaptive changes in β cells that may affect their immunogenicity and susceptibility to killing. Loss of β cells has traditionally been identified by impairment in function but environmental factors may affect these measurements. Scope of Review In this review we will highlight features of β cell responses to cell death, particularly in the setting of inflammation, and focus on methods of detecting β cell death in vivo. Major conclusions We developed an assay to measure β cell death in vivo by detecting cell free DNA with epigenetic modifications of the INS gene that are found in β cells. This assay has robust technical performance and identifies killing in individuals at very high risk for disease, but its ability to identify β cell killing in at-risk relatives is limited by the short half-life of the cell free DNA and the need for repeated sampling over an extended course. We present results from the Diabetes Prevention Trial-1 using this assay. In addition, recent studies have identified cellular adaptations in some β cells that may avoid killing but impair metabolic function. Cells with these characteristics may aggravate the autoimmune response but also may represent a potentially recoverable source of functional β cells.
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Affiliation(s)
| | | | | | | | - Maria Korah
- Department of Immunobiology, New Haven, CT, USA
| | - Jinxiu Rui
- Department of Immunobiology, New Haven, CT, USA
| | | | - Kevan C Herold
- Department of Immunobiology, New Haven, CT, USA; Department of Internal Medicine Yale University, New Haven, CT, USA.
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12
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Harris M, El Hindy M, Usmari-Moraes M, Hudd F, Shafei M, Dong M, Hezwani M, Clark P, House M, Forshaw T, Kehoe P, Conway ME. BCAT-induced autophagy regulates Aβ load through an interdependence of redox state and PKC phosphorylation-implications in Alzheimer's disease. Free Radic Biol Med 2020; 152:755-766. [PMID: 31982508 DOI: 10.1016/j.freeradbiomed.2020.01.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/16/2020] [Accepted: 01/16/2020] [Indexed: 01/09/2023]
Abstract
Leucine, nutrient signal and substrate for the branched chain aminotransferase (BCAT) activates the mechanistic target of rapamycin (mTORC1) and regulates autophagic flux, mechanisms implicated in the pathogenesis of neurodegenerative conditions such as Alzheimer's disease (AD). BCAT is upregulated in AD, where a moonlighting role, imparted through its redox-active CXXC motif, has been suggested. Here we demonstrate that the redox state of BCAT signals differential phosphorylation by protein kinase C (PKC) regulating the trafficking of cellular pools of BCAT. We show inter-dependence of BCAT expression and proteins associated with the P13K/Akt/mTORC1 and autophagy signalling pathways. In response to insulin or an increase in ROS, BCATc is trafficked to the membrane and docks via palmitoylation, which is associated with BCATc-induced autophagy through PKC phosphorylation. In response to increased levels of BCATc, as observed in AD, amyloid β (Aβ) levels accumulate due to a shift in autophagic flux. This effect was diminished when incubated with leucine, indicating that dietary levels of amino acids show promise in regulating Aβ load. Together these findings show that increased BCATc expression, reported in human AD brain, will affect autophagy and Aβ load through the interdependence of its redox-regulated phosphorylation offering a novel target to address AD pathology.
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Affiliation(s)
- M Harris
- Faculty of Health and Applied Sciences, University of the West of England, Coldharbor Lane, Bristol, BS16 1QY, UK
| | - M El Hindy
- Faculty of Health and Applied Sciences, University of the West of England, Coldharbor Lane, Bristol, BS16 1QY, UK
| | - M Usmari-Moraes
- Faculty of Health and Applied Sciences, University of the West of England, Coldharbor Lane, Bristol, BS16 1QY, UK
| | - F Hudd
- Faculty of Health and Applied Sciences, University of the West of England, Coldharbor Lane, Bristol, BS16 1QY, UK
| | - M Shafei
- Faculty of Health and Applied Sciences, University of the West of England, Coldharbor Lane, Bristol, BS16 1QY, UK
| | - M Dong
- Department of Chemistry, North Carolina Agricultural and Technical State University, Market Street, Greensboro, NC, 27411, USA
| | - M Hezwani
- Faculty of Health and Applied Sciences, University of the West of England, Coldharbor Lane, Bristol, BS16 1QY, UK
| | - P Clark
- Faculty of Health and Applied Sciences, University of the West of England, Coldharbor Lane, Bristol, BS16 1QY, UK
| | - M House
- Faculty of Health and Applied Sciences, University of the West of England, Coldharbor Lane, Bristol, BS16 1QY, UK
| | - T Forshaw
- Faculty of Health and Applied Sciences, University of the West of England, Coldharbor Lane, Bristol, BS16 1QY, UK
| | - P Kehoe
- Institute of Clinical Neurosciences, Learning and Research Building, Southmead Hospital, Bristol, United Kingdom
| | - M E Conway
- Faculty of Health and Applied Sciences, University of the West of England, Coldharbor Lane, Bristol, BS16 1QY, UK.
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13
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Speake C, Ylescupidez A, Neiman D, Shemer R, Glaser B, Tersey SA, Usmani-Brown S, Clark P, Wilhelm JJ, Bellin MD, Herold KC, Mirmira RG, Dor Y, Evans-Molina C. Circulating Unmethylated Insulin DNA As a Biomarker of Human Beta Cell Death: A Multi-laboratory Assay Comparison. J Clin Endocrinol Metab 2020; 105:5698251. [PMID: 31913467 PMCID: PMC7015459 DOI: 10.1210/clinem/dgaa008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/06/2020] [Indexed: 02/06/2023]
Abstract
CONTEXT There is an unmet need for biomarkers of pancreatic beta-cell death to improve early diagnosis of type 1 diabetes, enroll subjects into clinical trials, and assess treatment response. To address this need, several groups developed assays measuring insulin deoxyribonucleic acid (DNA) with unmethylated CpG sites in cell-free DNA. Unmethylated insulin DNA should be derived predominantly from beta-cells and indicate ongoing beta-cell death. OBJECTIVE To assess the performance of three unmethylated insulin DNA assays. DESIGN AND PARTICIPANTS Plasma or serum samples from 13 subjects undergoing total pancreatectomy and islet autotransplantation were coded and provided to investigators to measure unmethylated insulin DNA. Samples included a negative control taken post-pancreatectomy but pretransplant, and a positive control taken immediately following islet infusion. We assessed technical reproducibility, linearity, and persistence of detection of unmethylated insulin DNA for each assay. RESULTS All assays discriminated between the negative sample and samples taken directly from the islet transplant bag; 2 of 3 discriminated negative samples from those taken immediately after islet infusion. When high levels of unmethylated insulin DNA were present, technical reproducibility was generally good for all assays. CONCLUSIONS The measurement of beta cell cell-free DNA, including insulin, is a promising approach, warranting further testing and development in those with or at-risk for type 1 diabetes, as well as in other settings where understanding the frequency or kinetics of beta cell death could be useful.
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Affiliation(s)
- Cate Speake
- Diabetes Clinical Research Program, Benaroya Research Institute at Virginia Mason, Seattle, WA, US
- Correspondence and Reprint Requests: Cate Speake, PhD, Diabetes Clinical Research Program, Benaroya Research Institute, 1201 9th Avenue, Seattle, WA 98101. E-mail:
| | - Alyssa Ylescupidez
- Diabetes Clinical Research Program, Benaroya Research Institute at Virginia Mason, Seattle, WA, US
| | - Daniel Neiman
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Ruth Shemer
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Benjamin Glaser
- Endocrinology and Metabolism Service, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Sarah A Tersey
- Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, US
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, US
| | | | - Pamela Clark
- Departments of Immunobiology and Internal Medicine, Yale University School of Medicine, New Haven, CT, US
| | - Joshua J Wilhelm
- Department of Surgery, Schulze Diabetes Institute, University of Minnesota, Minneapolis, MN, US
| | - Melena D Bellin
- Departments of Pediatrics and Surgery, University of Minnesota, Minneapolis, MN, US
| | - Kevan C Herold
- Departments of Immunobiology and Internal Medicine, Yale University School of Medicine, New Haven, CT, US
| | - Raghavendra G Mirmira
- Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, US
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, US
| | - Yuval Dor
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Carmella Evans-Molina
- Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, US
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, US
- The Richard L. Roudebush VA Medical Center, Indianapolis, IN, US
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14
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Bagley LA, Kimberly C, Marino A, Clark P, Pomeroy C. Beliefs About Premarital Cohabitation: Do Individuals Believe Living Together Helps Divorce-Proof Marriage? Contemp Fam Ther 2019. [DOI: 10.1007/s10591-019-09524-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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15
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Wang H, Gou W, Strange C, Wang J, Nietert PJ, Cloud C, Owzarski S, Shuford B, Duke T, Luttrell L, Lesher A, Papas KK, Herold KC, Clark P, Usmani-Brown S, Kitzmann J, Crosson C, Adams DB, Morgan KA. Islet Harvest in Carbon Monoxide-Saturated Medium for Chronic Pancreatitis Patients Undergoing Islet Autotransplantation. Cell Transplant 2019; 28:25S-36S. [PMID: 31885286 PMCID: PMC7016471 DOI: 10.1177/0963689719890596] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/21/2019] [Accepted: 10/31/2019] [Indexed: 12/13/2022] Open
Abstract
Stresses encountered during human islet isolation lead to unavoidable β-cell death after transplantation. This reduces the chance of insulin independence in chronic pancreatitis patients undergoing total pancreatectomy and islet autotransplantation. We tested whether harvesting islets in carbon monoxide-saturated solutions is safe and can enhance islet survival and insulin independence after total pancreatectomy and islet autotransplantation. Chronic pancreatitis patients who consented to the study were randomized into carbon monoxide (islets harvested in a carbon monoxide-saturated medium) or control (islets harvested in a normal medium) groups. Islet yield, viability, oxygen consumption rate, β-cell death (measured by unmethylated insulin DNA), and serum cytokine levels were measured during the peri-transplantation period. Adverse events, metabolic phenotypes, and islet function were measured prior and at 6 months post-transplantation. No adverse events directly related to the infusion of carbon monoxide islets were observed. Carbon monoxide islets showed significantly higher viability before transplantation. Subjects receiving carbon monoxide islets had less β-cell death, decreased CCL23, and increased CXCL12 levels at 1 or 3 days post transplantation compared with controls. Three in 10 (30%) of the carbon monoxide subjects and none of the control subjects were insulin independent. This pilot trial showed for the first time that harvesting human islets in carbon monoxide-saturated solutions is safe for total pancreatectomy and islet autotransplantation patients.
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Affiliation(s)
- Hongjun Wang
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Wenyu Gou
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Charlie Strange
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Jingjing Wang
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Paul J. Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Colleen Cloud
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Stefanie Owzarski
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Betsy Shuford
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Tara Duke
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Louis Luttrell
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Aaron Lesher
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | | | - Kevan C. Herold
- Department of Immunology, Yale University, New Haven, CT, USA
| | - Pamela Clark
- Department of Immunology, Yale University, New Haven, CT, USA
| | | | | | - Craig Crosson
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - David B. Adams
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Katherine A. Morgan
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
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16
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Abstract
Electronic nicotine delivery systems (ENDS) are devices that contain a power source, a heating element, and a tank or cartridge containing an “e-liquid,” which is a mixture of nicotine and flavoring in a glycerol–propylene glycol vehicle. Their increasing popularity among adolescents might be attributed to aggressive marketing in physical venues, social media outlets, as well as irreversible changes caused by nicotine in the developing brains of youth and young adults, predisposing them to addictive behaviors. Adolescent ENDS users were 4 times more likely to initiate cigarette smoking, and the odds of quitting smoking were lower and, in many instances, delayed for those using ENDS. ENDS also renormalize cigarette-like behaviors, such as inhaling/exhaling smoke. The oral cavity is the initial point of contact of ENDS and the first affected system in humans. Oral health depends on an intricate balance in the interactions between oral bacteria and the human immune system, and dysbiosis of oral microbial communities underlies the etiology of periodontitis, caries, and oral cancer. Emerging evidence from subjects with periodontitis as well as periodontally healthy subjects demonstrates that e-cigarette use is associated with a compositional and functional shift in the oral microbiome, with an increase in opportunistic pathogens and virulence traits.
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Affiliation(s)
- P.S. Kumar
- College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - P. Clark
- School of Public Health, University of Maryland, Baltimore, MD, USA
| | - M.C. Brinkman
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - D. Saxena
- College of Dentistry, New York University, New York, NY, USA
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17
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Simmons KM, Fouts A, Pyle L, Clark P, Dong F, Yu L, Usmani-Brown S, Gottlieb P, Herold KC, Steck AK. Unmethylated Insulin as an Adjunctive Marker of Beta Cell Death and Progression to Type 1 Diabetes in Participants at Risk for Diabetes. Int J Mol Sci 2019; 20:ijms20163857. [PMID: 31398795 PMCID: PMC6719233 DOI: 10.3390/ijms20163857] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/01/2019] [Accepted: 08/02/2019] [Indexed: 12/12/2022] Open
Abstract
Islet autoantibody (iAb)-positive individuals have a high risk of progression to type 1 diabetes (T1D), although the rate of progression is highly variable and factors involved in the rate of progression are largely unknown. The ratio of unmethylated/methylated insulin DNA levels (unmethylated INS ratio) has been shown to be higher in participants at high risk of T1D compared to healthy controls. We aimed to evaluate whether an unmethylated INS ratio may be a useful biomarker of beta cell death and rate of progression to T1D. In TrialNet participants who were followed in the Pathway to Prevention Study and progressed to diabetes (n = 57, median age of onset 15.3 years), we measured unmethylated INS ratio and autoantibodies by electrochemiluminescence (ECL) assays (ECL-IAA, ECL-GADA, and ECL-IA2) and radioimmunoassays (RIA) (mIAA, GADA, IA2A, and ZnT8A) longitudinally for 24 months prior to diagnosis. Linear models were used to test the association between unmethylated INS ratio and the age at T1D diagnosis and unmethylated INS ratio and iAb over time. Close to diabetes onset, the unmethylated INS ratio was associated with mIAA (p = 0.003), ECL-IAA (p = 0.002), and IA2A (p = 0.01) levels, but not with GADA, ECL-GADA, ECL-IA2, or ZnT8A levels. No significant associations were found at baseline (24 months prior to T1D diagnosis). Only mIAA levels were significantly associated with an unmethylated INS ratio over time, with a 0.24 change in the ratio for each 0.1 change in mIAA z-score (p = 0.02). Adjusting for a baseline unmethylated INS ratio, an increased rate of change in unmethylated INS ratio from baseline to diabetes onset was associated with a five-year decrease in age at T1D diagnosis (p = 0.04).
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Grants
- 5RA-2017 Juvenile Diabetes Research Foundation United States of America
- U01 DK061010 NIDDK NIH HHS
- U01 DK103153 NIDDK NIH HHS
- P30 DK045735 NIDDK NIH HHS
- K12 DK094712 NIDDK NIH HHS
- UL1 TR001863 NCATS NIH HHS
- 1-14-CD-17 American Diabetes Association
- U01 DK061010, U01 DK061034, U01 DK061042, U01 DK061058, U01 DK085465, U01 DK085453, U01 DK085461, U01 DK085463, U01 DK085466, U01 DK085499, U01 DK085504, U01 DK085505, U01 DK085509, U01 DK103180, U01-DK103153, U01-DK085476, U01-DK103266 NIH HHS
- DK094712-08 NIDDK NIH HHS
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Affiliation(s)
- Kimber M Simmons
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, 1775 Aurora Ct, MSA140, Bldg 20, Aurora, CO 80045, USA.
| | - Alexandra Fouts
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, 1775 Aurora Ct, MSA140, Bldg 20, Aurora, CO 80045, USA
| | - Laura Pyle
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | | | - Fran Dong
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, 1775 Aurora Ct, MSA140, Bldg 20, Aurora, CO 80045, USA
| | - Liping Yu
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, 1775 Aurora Ct, MSA140, Bldg 20, Aurora, CO 80045, USA
| | | | - Peter Gottlieb
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, 1775 Aurora Ct, MSA140, Bldg 20, Aurora, CO 80045, USA
| | | | - Andrea K Steck
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, 1775 Aurora Ct, MSA140, Bldg 20, Aurora, CO 80045, USA
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18
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Hyndman TH, Marschang RE, Bruce M, Clark P, Vitali SD. Reptarenaviruses in apparently healthy snakes in an Australian zoological collection. Aust Vet J 2019; 97:93-102. [PMID: 30919443 DOI: 10.1111/avj.12792] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 12/02/2018] [Accepted: 01/22/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Inclusion body disease (IBD) is a disease of snakes with a global distribution and has recently been shown to be caused by reptarenaviruses. Testing for this group of viruses in asymptomatic snakes allows the association between infection and disease to be further elucidated. METHODS A reptarenavirus was detected by RT-PCR in a reticulated python (Malayopython reticulatus) from an Australian zoological collection that was open-mouth breathing and had erythematous oral mucosa. Another 27 pythons, 4 elapids, 2 colubrids and 2 boas from this collection were then screened. From these animals, swabs, whole blood and/or tissue were tested for reptarenaviruses by RT-PCR. Additionally, blood films from 10 snakes were examined by light microscopy for the presence of inclusion bodies. The majority of samples were collected over a 484-day period. RESULTS A total of 8 animals were RT-PCR-positive (8/36 = 22.2%): 6 were pythons, 1 was a corn snake (Pantherophis guttatus) and 1 was a Madagascar tree boa (Sanzinia madagascariensis). From them, 57 samples were collected, but only one from each animal was RT-PCR-positive (8/57 = 14.0%). From all 36 animals in this study, 8/182 samples were RT-PCR-positive (4.4%). Inclusion bodies were not recognised in any of the blood films. Only the reticulated python showed signs of illness, which improved without any further intervention. All other RT-PCR-positive snakes were apparently healthy throughout the duration of the study. CONCLUSION This study showed a weak association between the presence of reptarenaviruses and disease. Testing serially collected swab and whole-blood samples increased the number of animals in which reptarenaviruses were detected.
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Affiliation(s)
- T H Hyndman
- School of Veterinary Medicine, Murdoch University, Murdoch, Western Australia, Australia
| | | | - M Bruce
- School of Veterinary Medicine, Murdoch University, Murdoch, Western Australia, Australia
| | - P Clark
- School of Biomedical Sciences, Curtin University, Bentley, WA, Australia
| | - S D Vitali
- Perth Zoo, Department of Biodiversity, Conservation and Attractions, South Perth, WA, Australia
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19
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Baschnagel A, Kaushik S, Abel L, Clark P, Buehler D, Kimple R. The development and characterization of patient derived xenografts from non-small cell lung cancer brain metastases. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.01.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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20
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Perdigoto AL, Preston-Hurlburt P, Clark P, Long SA, Linsley PS, Harris KM, Gitelman SE, Greenbaum CJ, Gottlieb PA, Hagopian W, Woodwyk A, Dziura J, Herold KC. Treatment of type 1 diabetes with teplizumab: clinical and immunological follow-up after 7 years from diagnosis. Diabetologia 2019; 62:655-664. [PMID: 30569273 PMCID: PMC6402971 DOI: 10.1007/s00125-018-4786-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [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: 08/13/2018] [Accepted: 10/26/2018] [Indexed: 12/19/2022]
Abstract
AIMS/HYPOTHESIS The long-term effects of successful immune therapies for treatment of type 1 diabetes have not been well studied. The Autoimmunity-Blocking Antibody for Tolerance (AbATE) trial evaluated teplizumab, an Fc receptor non-binding humanised anti-CD3 monoclonal antibody in individuals with new-onset type 1 diabetes, and ended in 2011. Clinical drug-treated responders showed an increased frequency of 'partially exhausted' CD8+ T cells. We studied the clinical, immunological and metabolic status of participants after an average follow-up of 7 years. METHODS Participants with detectable C-peptide at year 2 of AbATE returned for follow-up. C-peptide responses were assessed by 4 h mixed-meal tolerance test. Autoantibodies and HbA1c levels were measured and average daily insulin use was obtained from patient logs. Peripheral blood mononuclear cells were analysed by flow cytometry and cytokine release. RESULTS Fifty-six per cent of the original participants returned. Three of the original control group who did not return had lost all detectable C-peptide by the end of the 2 year trial. The C-peptide responses to a mixed-meal tolerance test were similar overall in the drug vs control group of participants but were significantly improved, with less loss of C-peptide, in drug-treated responders identified at 1 year. However, the improvements in C-peptide response were not associated with lower HbA1c levels or insulin use. Drug-treated responders showed a significantly increased frequency of programmed cell death protein 1-positive central memory and anergic CD8+ T cells at follow-up. CONCLUSIONS/INTERPRETATION These findings suggest there is reduced decline in C-peptide and persistent immunological responses up to 7 years after diagnosis of diabetes in individuals who respond to teplizumab. TRIAL REGISTRATION ClinicalTrials.gov NCT02067923; the protocol is available at www.immunetolerance.org (ITN027AI).
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Affiliation(s)
- Ana Luisa Perdigoto
- Division of Endocrinology, Department of Internal Medicine, Yale University, New Haven, CT, USA
| | - Paula Preston-Hurlburt
- Department of Immunobiology, Yale University, 300 George St, 353E, New Haven, CT, 06520, USA
| | - Pamela Clark
- Department of Immunobiology, Yale University, 300 George St, 353E, New Haven, CT, 06520, USA
| | - S Alice Long
- Benaroya Research Institute at Virginia Mason, Seattle, WA, USA
| | - Peter S Linsley
- Benaroya Research Institute at Virginia Mason, Seattle, WA, USA
| | - Kristina M Harris
- Immune Tolerance Network, Biomarker & Discovery Research, Bethesda, MD, USA
| | - Steven E Gitelman
- Division of Pediatric Endocrinology and Diabetes Center, University of California San Francisco, San Francisco, CA, USA
| | | | - Peter A Gottlieb
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Alyssa Woodwyk
- Division of Epidemiology or Biostatistics, Western Michigan University, Kalamazoo, MI, USA
| | - James Dziura
- Department of Emergency Medicine, Yale University, New Haven, CT, USA
| | - Kevan C Herold
- Department of Immunobiology, Yale University, 300 George St, 353E, New Haven, CT, 06520, USA.
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21
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Barton D, Brooks T, Cieslak A, Elkins G, Clark P, Baydoun M, Smith A, VanPoznak C. Abstract P1-12-04: Preliminary evaluation of a mind-body intervention to improve body and/or self-image: A phase II randomized trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-12-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The number of cancer survivors is growing and expected to be 18.9 million by 2024. Addressing survivorship issues, such as sexual health, are a critical part of health promotion. Women diagnosed with breast or gynecologic cancer can experience distressing changes in their self and/or body image, which affects their sexual health. This study evaluates hypnosis compared to progressive muscle relaxation (PMR) to improve self/body image in order to improve sexuality.
Methods: Women with a history of breast or gynecologic cancer, who also report negative body image changes, were randomized in a 2:1 fashion to a 6-week intervention of hypnotic relaxation or PMR. Both intervention arms consisted of three 30-minute sessions delivered face-to-face by a trained therapist, one every two weeks, along with home practice using a CD. The primary outcome was impact of treatment on body image using the Impact of Treatment Scale (ITS). Secondary outcomes included mood (Positive/Negative Affect Scale-PANAS), sexual satisfaction (PROMIS satisfaction), and perceived change (Global Impression of Change Scale -GCIS). Outcomes were measured at baseline and 6 weeks except for the GCIS measured only at 6 weeks. A series of independent samples t-tests were used to compare changes in outcome measures between arms. The intention-to-treat principle was applied.
Results: The final randomized sample consisted of 87 women. There was no statistically significant difference (p=.15) in the change in ITS between groups at 6 weeks, with both groups significantly improving (within group effect size Cohen's d .49 - .75). There were non-significant differences between groups on secondary outcomes. Change from baseline for positive affect (PANAS) was 1.7 in the hypnosis group and 3.8 in the PMR group while negative affect change was very similar being about 2.8 in both groups. Change from baseline for the PROMIS general sexual satisfaction scale was 1.5 in the hypnosis group and 1.3 in the PMR group. On the GCIS at 6 weeks, 42% of the hypnosis group reported moderate to very much improvement on self/body image (GCIS) while only 32% of the PMR group reported this level of improvement; and 36% of the hypnosis group versus 11% of the PMR group reported moderate to very much improvement in their sexuality.
Implications: The stress relieving strategies applied in this study may contribute substantially to decreasing the distress of the cancer experience related to altered self/body image and sexuality. The variable improvement across domains suggests that hypnosis and PMR may work in different ways, mechanistically. Further mechanistic studies of interventions to optimally promote survivorship health are warranted.
Citation Format: Barton D, Brooks T, Cieslak A, Elkins G, Clark P, Baydoun M, Smith A, VanPoznak C. Preliminary evaluation of a mind-body intervention to improve body and/or self-image: A phase II randomized trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-12-04.
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Affiliation(s)
- D Barton
- University of Michigan, Ann Arbor, MI; Baylor University, Waco, TX
| | - T Brooks
- University of Michigan, Ann Arbor, MI; Baylor University, Waco, TX
| | - A Cieslak
- University of Michigan, Ann Arbor, MI; Baylor University, Waco, TX
| | - G Elkins
- University of Michigan, Ann Arbor, MI; Baylor University, Waco, TX
| | - P Clark
- University of Michigan, Ann Arbor, MI; Baylor University, Waco, TX
| | - M Baydoun
- University of Michigan, Ann Arbor, MI; Baylor University, Waco, TX
| | - A Smith
- University of Michigan, Ann Arbor, MI; Baylor University, Waco, TX
| | - C VanPoznak
- University of Michigan, Ann Arbor, MI; Baylor University, Waco, TX
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Beitsch P, Whitworth P, Baron P, Rosen B, Compagnoni G, Simmons R, Smith LA, Holmes D, Brown E, Gold L, Clark P, Coomer C, Grady I, Barbosa K, Riley L, Kinney M, Lyons S, MacDonald H, Kahn S, Ruiz A, Patel R, Curcio L, Esplin E, Yang S. Abstract P5-09-06: Underdiagnosis of HBOC in breast cancer patients: Are genetic testing guidelines a tool or an obstacle? Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-09-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Pathogenic genetic variants are estimated to occur in 10-15% of all breast cancer patients, with BRCA 1/2 accounting for 40-50% of pathogenic/likely pathogenic (P/LP) variants. However, it is estimated that <30% of breast cancer patients harboring a BRCA 1/2 variant have been identified, with the percentage being much less for ˜20 other breast cancer associated genes. Reasons for this are multifactorial and include complicated and restrictive testing guidelines developed at a time when the cost of testing was high and guidelines for management were limited. Today, cost has plummeted and there are definitive management guidelines for a broader range of genes. We created a community based Registry to determine the incidence of P/LP variants in breast cancer patients who meet and who do not meet the NCCN 2017 genetic testing criteria.
Methods: An IRB-approved multicenter prospective registry was initiated with 20 community and academic sites experienced incancer genetic testing and counseling.
Eligibility criteria included patients with a breast cancer diagnosis who had not been previously tested. Consecutive patients aged 18-90 were consented and underwent an 80 gene panel test (Invitae –Multi-Cancer Panel). The non-inferiority study was powered to detect a difference in P/LP variant rate of 4 percentage points with statistical significance (p<0.05, Fisher's exact test).
HIPAA compliant electronic case report forms collected information on patient diagnosis, test results, and physician recommendations made after test results were received.
Results: Over 1000 patients were enrolled and data from 910 subjects analyzed to date. 50.4% met NCCN criteria and 49.5% did not. Median age for the enrolled patients is 60.5 and ranged from 22-93. 56.0% of patients were recently diagnosed with breast cancer. 10.9% of patients had a history of a prior non breast cancer. Overall, 8.9% of patients had a pathogenicvariant. 9.6% of patients who met NCCN criteria with test results had a P/LP variant. 8.2% of patients who did not meet criteria had a P/LP variant. The difference of positive cases among the two groups is not statistically significant (P = 0.49)
4.9% of patients had pathogenic variants if only an 11 gene standard breast cancer panel was considered.
The spectrum of mutated genes varied between the two groups, with some overlap.
Conclusions:
There was no statistically significant difference in the number of pathogenic/likely pathogenic variants between those patients who met and those who did not meet NCCN guidelines. Expanded panel testing yields more medically actionable P/LP variants than testing BRCA 1/2 alone or breast cancer panels with 11 genes. This study demonstrates that there will be a significant number of patients with P/LP variants are missed if NCCN guidelines are required for genetic testing. Current NCCN guidelines for the genetic testing of breast cancer patients are an obstacle to identifying patients with P/LP variants and should be removed.
Universal BC Genetic Testing RegistryNCCN Criteria (910 patients analyzed)#/% who have P/LP variants#/% who do not have P/LP variantsPatients who meet guidelines44/459 (9.6%)415/459 (90.4%)Patients who do not meet guidelines37/451 (8.2%)414/451 (91.8%)
Citation Format: Beitsch P, Whitworth P, Baron P, Rosen B, Compagnoni G, Simmons R, Smith LA, Holmes D, Brown E, Gold L, Clark P, Coomer C, Grady I, Barbosa K, Riley L, Kinney M, Lyons S, MacDonald H, Kahn S, Ruiz A, Patel R, Curcio L, Esplin E, Yang S. Underdiagnosis of HBOC in breast cancer patients: Are genetic testing guidelines a tool or an obstacle? [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-09-06.
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Affiliation(s)
- P Beitsch
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - P Whitworth
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - P Baron
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - B Rosen
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - G Compagnoni
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - R Simmons
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - LA Smith
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - D Holmes
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - E Brown
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - L Gold
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - P Clark
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - C Coomer
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - I Grady
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - K Barbosa
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - L Riley
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - M Kinney
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - S Lyons
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - H MacDonald
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - S Kahn
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - A Ruiz
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - R Patel
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - L Curcio
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - E Esplin
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
| | - S Yang
- TME Dallas, Dallas, TX; TME Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical Care, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albuquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St. Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, VA; Good Samaritin, Los Gatos, CA; Breast Link, Laguna Hills, CA; Invitae, San Francisco, CA
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Beitsch P, Whitworth P, Baron P, Rosen B, Compagnoni G, Simmons R, Smith LA, Holmes D, Brown E, Gold L, Clark P, Coomer C, Grady I, Barbosa K, Riley L, Kinney M, Lyons S, MacDonald H, Kahn S, Ruiz A, Patel R, Curcio L, Esplin E, Yang S, Michalski S. Abstract P5-09-03: Expanded panel testing superior to BRCA1/2 and breast cancer panel in patients with breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-09-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The testing of hereditary breast and ovarian cancer (HBOC) patients for BRCA1/2 only was established years ago to identify patients with clinically actionable variants and limit the economic burden. However, the cost of genetic testing has plummeted, and the number of breast cancer-risk genes with management guidelines has expanded. We created a community-based registry to test all breast cancer patients. A primary objective of this registry included accruing and comparing patients who did and did not meet NCCN guidelines and determining if providing all breast cancer patients with comprehensive multi-gene panel testing yields additional clinical value than testing BRCA1/2 alone.
Methods: An IRB-approved multicenter prospective registry was initiated with 20 community-based and academic breast sites, selected to insure geographic and ethnic diversity. Consecutive patients ages 18-90 with current or prior breast cancer were offered testing with an 80-gene panel (Invitae, San Francisco, CA). HIPAA-compliant case report forms collected patient diagnosis, test results, and physician recommendations made after test results.
Results: Over 1,000 patients were enrolled and data on 911 have been analyzed to date. Median age of patients is 60.5 (range 22 to 93). 56.0% were recently diagnosed with breast cancer. Of these patients, 50.54% met NCCN criteria, and 49.5% did not. 10.9% had history of a prior non-breast cancer. The pathogenic/likely pathogenic (P/LP) variant rate for patients on a comprehensive 80-gene panel was 8.9%. When restricted to a guidelines-based 11-gene breast cancer panel (BRCA1/2, ATM, CDH1, CHEK2, NBN, NF1, PTEN, STK11, TP53, PALB2), 4.9% had P/LP variants; when limited to BRCA1/2, 1.6% had P/LP variants. Of all patients with P/LP findings, 93% had variants in cancer-risk genes with established management recommendations (Table 1) and 80% had germline variants conferring eligibility for precision medicine-based cancer treatments, such as PARP inhibitors, through actively enrolling clinical trials.
Conclusions: This study demonstrates that comprehensive panel testing of breast cancer patients provides a higher yield of clinically actionable P/LP variants than BRCA1/2 testing alone. Limited panels may miss clinically relevant P/LP variants, leaving risk for preventable cancers undiscovered and unnecessarily restricting patients' treatment options. These results also suggest that variants in tumor suppressor genes, not previously thought related to breast cancer, may contribute to its etiology. A comprehensive panel strategy reveals untapped clinical utility and can impact breast cancer patient care by informing implementation of precision medicine treatment interventions and guiding long-term medical management and surveillance for patients and their family members.
PatientsVariantsWith breast cancer management guidelines (including variants ATM*, BRCA1*, BRCA2*, CHEK2*, NBN*, NF1, PALB2*, TP53*)45 (56%)46 (55%)With cancer guidelines and clinical management implications (including variants BARD1*, FH, MITF, MSH6*, MUTYH*, PTCH1, RAD50*, RAD51C*, RAD51D*, RB1, RET, VHL)31 (38%)33 (39%)Evidence of actionability accruing (including variants BLM, DIS3L2, RECQL4)5 (6%)5 (6%)Totals8184*P/LP variants in these genes confer potential clinical trial eligibility, e.g. NCT02401347.
Citation Format: Beitsch P, Whitworth P, Baron P, Rosen B, Compagnoni G, Simmons R, Smith LA, Holmes D, Brown E, Gold L, Clark P, Coomer C, Grady I, Barbosa K, Riley L, Kinney M, Lyons S, MacDonald H, Kahn S, Ruiz A, Patel R, Curcio L, Esplin E, Yang S, Michalski S. Expanded panel testing superior to BRCA1/2 and breast cancer panel in patients with breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-09-03.
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Affiliation(s)
- P Beitsch
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - P Whitworth
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - P Baron
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - B Rosen
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - G Compagnoni
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - R Simmons
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - LA Smith
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - D Holmes
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - E Brown
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - L Gold
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - P Clark
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - C Coomer
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - I Grady
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - K Barbosa
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - L Riley
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - M Kinney
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - S Lyons
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - H MacDonald
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - S Kahn
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - A Ruiz
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - R Patel
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - L Curcio
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - E Esplin
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - S Yang
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
| | - S Michalski
- TME-Dallas, Dallas, TX; TM- Nashville, Nashville, TN; Roper St. Francis, Charleston, SC; Advocate Health, Barrington, IL; Advanced Surgical, Barrington, IL; Weill Cornell, New York, NY; Linda Ann Smith MD, Albaquerque, NM; Dennis Holmes MD, Los Angeles, CA; Comprehensive Breast Care, Troy, MI; Ironwood Cancer Centers, Phoenix, AZ; Staten Island University, Staten Island, NY; North Valley Breast Clinic, Redding, CA; Alaska Breast Care Specialists, Anchorage, AK; St Lukes, Allentown, PA; Center for Advanced Breast Care, Arlington Heights, IL; Lyons Care Associates, Wailuku, HI; Hoag Memorial Hospital, Newport Beach, CA; The Breast Center at Chesapeake Regional, Chesapeake, Va; Good Samaritan-Los Gatos, Los Gatos, CA; Breastlink, Laguna Hills, CA; Invitae, San Francisco, CA
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Abstract
A number of European studies have documented the ability of procalcitonin (PCT), a novel inflammatory marker, to discriminate patients with sepsis from those with other causes of systemic inflammatory response syndrome (SIRS). The aim of this study was to assess procalcitonin's performance in an Australian intensive care unit (ICU) setting to examine whether it could discriminate between these two conditions. One hundred and twenty-three consecutive adult ICU patients fulfilling criteria for SIRS were enlisted in the study. Over a period of five days, daily serum PCT and C-reactive protein (CRP) levels were measured. At least two sets of cultures were taken of blood, sputum/broncho-alveolar lavage (BAL) and urine. Other cultures were taken as clinically indicated. Questionnaires to ascertain clinical suspicion of sepsis were prospectively answered by the ICU senior registrars. PCT values were ten times higher in patients with positive blood cultures; CRP values were also significantly higher in the bacteraemic patients. Both PCT and CRP had a good ability to discriminate bacteraemia from non-infectious SIRS, with the area under receiver operating characteristics (ROC) curves for PCT being 0.8 and for CRP being 0.82. However neither PCT or CRP was able to discriminate patients with localized sepsis from those without. Utilizing both tests resulted in a more sensitive screen than either one alone, while PCT was a more accurate diagnostic test for bacteraemia than CRP. The PCT value also differed between those who died in hospital and those who survived. Measurement of PCT alone or in combination with CRP can aid discrimination of septicaemia/bacteraemia with associated SIRS from non-infectious SIRS in an Australian ICU setting.
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Affiliation(s)
- K Bell
- Departments of Intensive Care and Immunopathology, Westmead Hospital, New South Wales
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Maguire R, Arber A, Klepacz N, Connaghan J, Mcphelim J, Blythe K, Murray P, Rupani H, Mcnaughton L, Moylan A, Clark P. Determining the feasibility and acceptability of a mobile health application to remotely monitor the symptoms of people with mesothelioma at home. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30254-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Clark P, Denova-Gutiérrez E, Razo C, Rios-Blancas MJ, Lozano R. The burden of musculoskeletal disorders in Mexico at national and state level, 1990-2016: estimates from the global burden of disease study 2016. Osteoporos Int 2018; 29:2745-2760. [PMID: 30242448 DOI: 10.1007/s00198-018-4698-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
Abstract
UNLABELLED Worldwide, musculoskeletal (MSK) disorders are the second cause of living with disability. According to our data, in Mexico, MSK conditions are an important cause of disability, at national and state level. Preventive actions promoted by health systems to reduce the burden of MSK disorders are essential. INTRODUCTION We describe premature mortality and disability due to musculoskeletal (MSK) disorders in Mexico at national and state level from 1990 to 2016. METHODS Using data from the global burden of disease study 2016 (GBD 2016), we present rates and trends in years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) caused by MSK disorders in Mexico by state from 1990 to 2016. The burden of MSK disorders was computed using standard GBD methodology. To compare the burden of MSK disorders across the country, states were grouped by sociodemographic index (SDI). RESULTS In Mexico, MSK disorders were the 3rd and 17th greatest cause of YLDs and YLLs in 2016, respectively, accounting for 1.95 million (95% UI 1.4-2.5) DALYs. Among all MSK disorders, low back and neck pain had the highest all-ages DALYs rate and represented 3.6% of total DALYs. All-ages YLLs and YLDs rates of MSK disorders were 234 and 37% higher in females (YLLs 102.2, 95% UI 79.9-110.7; YLDs 1677.9, 95% UI 1213.5-2209.4) than in males (YLLs 30.6, 95% UI 28.3-34.0; YLDs 1224.7, 95% UI 887.2-1608.3), respectively. Northern and high SDI states had higher rates of MSK disorders in comparison with southern and low SDI states. Only 16% of YLDs caused by all MSK disorders could be attributed to risk factors currently assessed in GBD. CONCLUSION MSK conditions are an important cause of premature mortality and disability. Researcher engagement and cross-sectorial actions to address the burden of MSK disorders are essential.
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Affiliation(s)
- P Clark
- Clinical Epidemiology Research Unit, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
- School of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - E Denova-Gutiérrez
- Nutrition and Health Research Center, National Institute of Public Health, 655 Colonia Santa María Ahuacatitlán, C.P, 62100, Cuernavaca, Mexico.
| | - C Razo
- National Institute of Public Health, Cuernavaca, Mexico
| | | | - R Lozano
- National Institute of Public Health, Cuernavaca, Mexico
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Ogura H, Preston-Hurlburt P, Perdigoto AL, Amodio M, Krishnaswamy S, Clark P, Yu H, Egli D, Fouts A, Steck AK, Herold KC. Identification and Analysis of Islet Antigen-Specific CD8 + T Cells with T Cell Libraries. J Immunol 2018; 201:1662-1670. [PMID: 30082321 PMCID: PMC6449153 DOI: 10.4049/jimmunol.1800267] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/06/2018] [Indexed: 11/19/2022]
Abstract
Type 1 diabetes (T1D) is most likely caused by killing of β cells by autoreactive CD8+ T cells. Methods to isolate and identify these cells are limited by their low frequency in the peripheral blood. We analyzed CD8+ T cells, reactive with diabetes Ags, with T cell libraries and further characterized their phenotype by CyTOF using class I MHC tetramers. In the libraries, the frequency of islet Ag-specific CD45RO+IFN-γ+CD8+ T cells was higher in patients with T1D compared with healthy control subjects. Ag-specific cells from the libraries of patients with T1D were reactive with ZnT8186-194, whereas those from healthy control recognized ZnT8186-194 and other Ags. ZnT8186-194-reactive CD8+ cells expressed an activation phenotype in T1D patients. We found TCR sequences that were used in multiple library wells from patients with T1D, but these sequences were private and not shared between individuals. These sequences could identify the Ag-specific T cells on a repeated draw, ex vivo in the IFN-γ+ CD8+ T cell subset. We conclude that CD8+ T cell libraries can identify Ag-specific T cells in patients with T1D. The T cell clonotypes can be tracked in vivo with identification of the TCR gene sequences.
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Affiliation(s)
- Hideki Ogura
- Department of Immunobiology, Yale University, New Haven, CT 06520
| | | | | | - Matthew Amodio
- Department of Genetics and of Computer Science, Yale University, New Haven, CT 06520
| | - Smita Krishnaswamy
- Department of Genetics and of Computer Science, Yale University, New Haven, CT 06520
| | - Pamela Clark
- Department of Immunobiology, Yale University, New Haven, CT 06520
| | - Hua Yu
- Department of Immunobiology, Yale University, New Haven, CT 06520
| | - Dieter Egli
- Naomi Berrie Diabetes Center, Division of Molecular Genetics, Columbia University, New York, NY 10032
| | - Alexandra Fouts
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO 80045
| | - Andrea K Steck
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO 80045
| | - Kevan C Herold
- Department of Immunobiology, Yale University, New Haven, CT 06520;
- Department of Internal Medicine, Yale University, New Haven, CT 06520
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A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk. Diabetes Care 2018; 41:1887-1894. [PMID: 30002199 PMCID: PMC6105323 DOI: 10.2337/dc18-0087] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/06/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals. RESEARCH DESIGN AND METHODS We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables. RESULTS Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002). CONCLUSIONS The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.
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Affiliation(s)
- Maria J. Redondo
- Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | | | - Andrea K. Steck
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Seth Sharp
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | - John M. Wentworth
- Walter and Eliza Hall Institute of Medical Research and Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Michael N. Weedon
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | | | | | | | | | - Richard A. Oram
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
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Guirant L, Carlos F, Curiel D, Kanis JA, Borgström F, Svedbom A, Clark P. Health-related quality of life during the first year after a hip fracture: results of the Mexican arm of the International Cost and Utility Related to Osteoporotic Fractures Study (MexICUROS). Osteoporos Int 2018; 29:1147-1154. [PMID: 29464277 DOI: 10.1007/s00198-018-4389-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 10/25/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
UNLABELLED We investigated changes in health-related quality of life (HRQoL) due to hip fracture in Mexican adults aged ≥ 50 years during the first year post-fracture. Mean accumulated loss was 0.27 quality-adjusted life years (QALYs). HRQoL before fracture was the main contributor to explain the loss of QALYs. INTRODUCTION We aimed to estimate the health-related quality of life (HRQoL) loss over 1 year in patients sustaining a hip fracture in Mexico. METHODS Individuals aged ≥ 50 years old with diagnosis of a low-energy-induced hip fracture enrolled in the International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS) composed the study population. After a recall of their own pre-fracture status, HRQoL was prospectively collected in three phases over 12 months of follow-up using EQ-5D-3L. The UK preference weight set was applied to calculate the utility values. The accumulated quality-adjusted life years (QALYs) loss in the first year post-fracture was estimated using the trapezoid method. Multivariate regression analysis allowed identifying determinants of QALYs loss. RESULTS One hundred ninety-three patients (mean ± SD age 77.2 ± 9.9 years; 80% women; 15.5% with prior fracture in the last 5 years; 78% in low-income category) were evaluated. Mean (95% CI) utility value before fracture was 0.64 (0.59-0.68). It dropped to 0.01 (0.01-0.02) immediately after fracture and then improved to 0.46 (0.42-0.51) and 0.60 (0.55-0.64) at 4 and 12 months post-fracture, respectively. Disregarding fracture-related mortality, accumulated QALYs loss over the first year was 0.27 (0.24-0.30) QALYs. Mobility, self-care, and usual activities were the most affected domains throughout the whole year. HRQoL before fracture was the main contributor to explain the loss of QALYs. CONCLUSIONS Hip fractures reduce dramatically the HRQoL, with the loss sustained at least over the first year post-fracture in Mexico. The utility values derived from this study can be used in future economic evaluations.
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Affiliation(s)
- L Guirant
- Instituto Tecnológico Autónomo de México, Mexico City, Mexico
| | - F Carlos
- R A C Salud Consultores, S.A. de C.V., Mexico City, Mexico
| | - D Curiel
- Faculty of Medicine UNAM, Mexico City, Mexico
- SSPDF C.S. TII Hortencia, Mexico City, Mexico
| | - J A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
- Institute for Health and Ageing, Catholic University of Australia, Melbourne, 3000, Australia
| | - F Borgström
- LIME/MMC, Karolinska Institutet, Stockholm, Sweden
| | | | - P Clark
- Faculty of Medicine UNAM, Mexico City, Mexico.
- Clinical Epidemiology Unit, Facultad de Medicina UNAM, Hospital Infantil Federico Gómez, Mexico City, Mexico.
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Balk EM, Adam GP, Langberg VN, Earley A, Clark P, Ebeling PR, Mithal A, Rizzoli R, Zerbini CAF, Pierroz DD, Dawson-Hughes B. Correction to: Global dietary calcium intake among adults: a systematic review. Osteoporos Int 2018; 29:1223. [PMID: 29480343 PMCID: PMC6828480 DOI: 10.1007/s00198-018-4447-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The original Electronic Supplementary Material file 3 contained an erroneous reference for Mali. A link to the corrected file is provided here.
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Affiliation(s)
- E M Balk
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA.
| | - G P Adam
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA
| | - V N Langberg
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA
| | - A Earley
- Evidera, 500 Totten Pond Rd, Waltham, MA, USA
| | - P Clark
- Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - P R Ebeling
- School of Clinical Sciences, Monash University, Clayton, Australia
| | - A Mithal
- Medanta Medicity, Sector 38, Gurgaon, India
| | - R Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - C A F Zerbini
- Centro Paulista de Investigação Clínica, Sao Paulo, Brazil
| | - D D Pierroz
- International Osteoporosis Foundation, Nyon, Switzerland
| | - B Dawson-Hughes
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
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Svedbom A, Borgstöm F, Hernlund E, Ström O, Alekna V, Bianchi ML, Clark P, Curiel MD, Dimai HP, Jürisson M, Kallikorm R, Lember M, Lesnyak O, McCloskey E, Sanders KM, Silverman S, Solodovnikov A, Tamulaitiene M, Thomas T, Toroptsova N, Uusküla A, Tosteson ANA, Jönsson B, Kanis JA. Quality of life for up to 18 months after low-energy hip, vertebral, and distal forearm fractures-results from the ICUROS. Osteoporos Int 2018; 29:557-566. [PMID: 29230511 DOI: 10.1007/s00198-017-4317-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [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: 06/08/2017] [Accepted: 11/13/2017] [Indexed: 11/25/2022]
Abstract
UNLABELLED This study used data from the International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) to estimate the quality of life (QoL) impact of fracture. Hip, vertebral, and distal forearm fractures incur substantial QoL losses. Hip and vertebral fracture results in markedly impaired QoL for at least 18 months. INTRODUCTION The International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) is a multinational observational study that aims to describe costs and quality of life (QoL) consequences of osteoporotic fractures. To date, 11 countries have participated in the study: Australia, Austria, Estonia, France, Italy, Lithuania, Mexico, Russia, Spain, the UK, and the USA. The objective of this paper is to describe the QoL impact of hip, vertebral, and distal forearm fracture. METHODS Data were collected at four time-points for five QoL point estimates: within 2 weeks after fracture (including pre-fracture recall) and at 4, 12, and 18 months after fracture. Quality of life was measured as health state utility values (HSUVs) derived from the EQ-5D-3L. Complete case analysis was conducted as the base case with available case and multiple imputation performed as sensitivity analyses. Multivariate analysis was performed to explore predictors of QoL impact of fracture. RESULTS Among 5456 patients enrolled using convenience sampling, 3021 patients were eligible for the base case analysis (1415 hip, 1047 distal forearm, and 559 vertebral fractures). The mean (SD) difference between HSUV before and after fracture for hip, vertebral, and distal forearm fracture was estimated at 0.89 (0.40), 0.67 (0.45), and 0.48 (0.34), respectively (p < 0.001 for all fracture types). Eighteen months after fracture, mean HSUVs were lower than before the fracture in patients with hip fracture (0.66 vs. 0.77 p < 0.001) and vertebral fracture (0.70 vs. 0.83 p < 0.001). Hospitalization and higher recalled pre-fracture QoL were associated with increased QoL impact for all fracture types. CONCLUSIONS Hip, vertebral, and distal forearm fractures incur substantial loss in QoL and for patients with hip or vertebral fracture, QoL is markedly impaired for at least 18 months.
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Affiliation(s)
| | - F Borgstöm
- LIME/MMC, Karolinska Institutet, Stockholm, Sweden
| | | | - O Ström
- LIME/MMC, Karolinska Institutet, Stockholm, Sweden
| | - V Alekna
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - M L Bianchi
- Bone Metabolism Unit, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - P Clark
- Clinical Epidemiology Unit, Hospital Infantil Federico Gómez and Faculty of Medicine UNAM, Mexico City, Mexico
| | - M D Curiel
- Servicio de Medicina Interna/Enfermedades Metabolicas Oseas, Fundacion Jimenez Diaz, Madrid, Spain
- Catedra de Enfermedades Metabolicas Óseas, Universidad Autonoma, Madrid, Spain
| | - H P Dimai
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - M Jürisson
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - R Kallikorm
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - M Lember
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - O Lesnyak
- Ural State Medical University, Yekaterinburg, Russia
- North West Mechnikov State Medical University, St. Petersburg, Russia
| | - E McCloskey
- Academic Unit of Bone Metabolism, Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - K M Sanders
- Institute for Health and Ageing, Australian Catholic University, Melbourne, 3000, Australia
| | - S Silverman
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - M Tamulaitiene
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - T Thomas
- INSERM U1059, Lab Biologie Intégrée du Tissu Osseux, Service de Rhumatologie, CHU de Saint-Etienne, Université de Lyon, Saint-Etienne, France
| | - N Toroptsova
- FSBSI "Scientific Research Institute of Rheumatology named after V.A.Nasonova, Moscow, Russia
| | - A Uusküla
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - A N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, PA, USA
| | - B Jönsson
- Stockholm School of Economics, Stockholm, Sweden
| | - J A Kanis
- Institute for Health and Ageing, Australian Catholic University, Melbourne, 3000, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
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Clark P, Denova-Gutiérrez E, Zerbini C, Sanchez A, Messina O, Jaller JJ, Campusano C, Orces CH, Riera G, Johansson H, Kanis JA. FRAX-based intervention and assessment thresholds in seven Latin American countries. Osteoporos Int 2018; 29:707-715. [PMID: 29273826 DOI: 10.1007/s00198-017-4341-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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: 10/24/2017] [Accepted: 12/04/2017] [Indexed: 10/18/2022]
Abstract
UNLABELLED Age-specific intervention and assessment thresholds were developed for seven Latin American countries. The intervention threshold ranged from 1.2% (Ecuador) to 27.5% (Argentina) at the age of 50 and 90 years, respectively. In the Latin American countries, FRAX offers a substantial advance for the detection of subjects at high fracture risk. INTRODUCTION Intervention thresholds are proposed using the Fracture Risk Assessment (FRAX) tool. We recommended their use to calculate the ten-year probability of fragility fracture (FF) in both, men and women with or without the inclusion of bone mineral density (BMD). The purpose of this study is to compute FRAX-based intervention and BMD assessment thresholds for seven Latin American countries in men and women ≥ 40 years. METHODS The intervention threshold (IT) was set at a 10-year probability of a major osteoporotic fracture (MOF) equivalent to a woman with a prior FF and a body mass index (BMI) equal to 25.0 kg/m2 without BMD or other clinical risk factors. The lower assessment threshold was set at a 10-year probability of a MOF in women with BMI equal to 25.0 kg/m2, no previous fracture and no clinical risk factors. The upper assessment threshold was set at 1.2 times the IT. RESULTS For the seven LA countries, the age-specific IT varied from 1.5 to 27.5% in Argentina, 3.8 to 25.2% in Brazil, 1.6 up to 20.0% in Chile, 0.6 to 10.2% in Colombia, 0.9 up to 13.6% in Ecuador, 2.6 to 20.0% in Mexico, and 0.7 up to 22.0% in Venezuela at the age of 40 and 90 years, respectively. CONCLUSIONS In the LA countries, FRAX-based IT offers a substantial advance for the detection of men and women at high fracture risk, particularly in the elderly. The heterogeneity of IT between the LA countries indicates that country-specific FRAX models are appropriate rather than a global LA model.
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Affiliation(s)
- P Clark
- Clinical Epidemiology Research Unit, Hospital Infantil de México Federico Gomez, Dr. Márquez #164, Col. Doctores, Mexico City, Mexico
- School of Medicine, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - E Denova-Gutiérrez
- Clinical Epidemiology Research Unit, Hospital Infantil de México Federico Gomez, Dr. Márquez #164, Col. Doctores, Mexico City, Mexico.
- School of Medicine, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico.
| | - C Zerbini
- Centro Paulista de Investigação Clinica, São Paulo, Brazil
| | - A Sanchez
- Centro de Endocrinología, Rosario, Argentina
| | - O Messina
- Servicio de Reumatología, Hospital Argerich, Buenos Aires, Argentina
- Unidad de Postgrado en Reumatología, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - J J Jaller
- Centro de Reumatología y Ortopedia, Barranquilla, Colombia
| | - C Campusano
- Clínica de la Universidad de los Andes, Santiago, Chile
| | - C H Orces
- Department of Medicine, Laredo Medical Center, Laredo, TX, USA
| | - G Riera
- Unidad Metabolica, Universidad de Carabobo, Valencia, Venezuela
| | - H Johansson
- Institute for Health and Ageing, Catholic University of Australia, Melbourne, Australia
| | - J A Kanis
- Institute for Health and Ageing, Catholic University of Australia, Melbourne, Australia
- Medical School, Sheffield, UK Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, England
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Brennand J, Conkie JA, McCall F, Greer IA, Walker I, Clark P. Activated Protein C Sensitivity, Protein C, Protein S and Coagulation in Normal Pregnancy. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1615035] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryA prospective study of activated protein C sensitivity, protein C, protein S, and other coagulation factors in 239 women during normal pregnancy was carried out. Protein C activity appeared unaffected by gestation, although an elevation of protein C activity was observed in the early puerperium. A fall in total and free protein S with increasing gestation was observed. Activated protein C sensitivity ratio (APC:SR) showed a progressive fall through pregnancy. This fall correlated with changes in factor VIIIc, factor Vc and protein S. 38% of subjects, with no evidence of Factor V Leiden or anticardiolipin antibodies, showed a low APC:SR (APC:SR <2.6) in the third trimester of pregnancy. Aside from a significant reduction in birth weight, no difference in pregnancy outcome was observed between these subjects and those with a normal APC:SR. Activated protein C sensitivity ratio, modified by pre-dilution of patient samples with factor V depleted plasma, showed no consistent trend with gestation.
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Balk EM, Adam GP, Langberg VN, Earley A, Clark P, Ebeling PR, Mithal A, Rizzoli R, Zerbini CAF, Pierroz DD, Dawson-Hughes B. Global dietary calcium intake among adults: a systematic review. Osteoporos Int 2017; 28:3315-3324. [PMID: 29026938 PMCID: PMC5684325 DOI: 10.1007/s00198-017-4230-x] [Citation(s) in RCA: 193] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 09/17/2017] [Indexed: 11/06/2022]
Abstract
Low calcium intake may adversely affect bone health in adults. Recognizing the presence of low calcium intake is necessary to develop national strategies to optimize intake. To highlight regions where calcium intake should be improved, we systematically searched for the most representative national dietary calcium intake data in adults from the general population in all countries. We searched 13 electronic databases and requested data from domain experts. Studies were double-screened for eligibility. Data were extracted into a standard form. We developed an interactive global map, categorizing countries based on average calcium intake and summarized differences in intake based on sex, age, and socioeconomic status. Searches yielded 9780 abstracts. Across the 74 countries with data, average national dietary calcium intake ranges from 175 to 1233 mg/day. Many countries in Asia have average dietary calcium intake less than 500 mg/day. Countries in Africa and South America mostly have low calcium intake between about 400 and 700 mg/day. Only Northern European countries have national calcium intake greater than 1000 mg/day. Survey data for three quarters of available countries were not nationally representative. Average calcium intake is generally lower in women than men, but there are no clear patterns across countries regarding relative calcium intake by age, sex, or socioeconomic status. The global calcium map reveals that many countries have low average calcium intake. But recent, nationally representative data are mostly lacking. This review draws attention to regions where measures to increase calcium intake are likely to have skeletal benefits.
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Affiliation(s)
- E M Balk
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA.
| | - G P Adam
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA
| | - V N Langberg
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA
| | - A Earley
- Evidera, 500 Totten Pond Rd, Waltham, MA, USA
| | - P Clark
- Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - P R Ebeling
- School of Clinical Sciences, Monash University, Clayton, Australia
| | - A Mithal
- Medanta Medicity, Sector 38, Gurgaon, India
| | - R Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - C A F Zerbini
- Centro Paulista de Investigação Clínica, Sao Paulo, Brazil
| | - D D Pierroz
- International Osteoporosis Foundation, Nyon, Switzerland
| | - B Dawson-Hughes
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
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Clark P, Chitnis N, Kamoun M, Johnson B, Margolis D, Monos D. 492 SNPs within the MHC associated with atopic dermatitis are located within miRNA sequences. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Watson CV, Richter P, de Castro BR, Sosnoff C, Potts J, Clark P, McCraw J, Yan X, Chambers D, Watson C. Smoking Behavior and Exposure: Results of a Menthol Cigarette Cross-over Study. Am J Health Behav 2017; 41:309-319. [PMID: 28376975 DOI: 10.5993/ajhb.41.3.10] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Our objective was to improve understanding of the differences in use behavior and exposure when smoking menthol and non-menthol cigarettes using a 2-part cross-over design. METHODS Adult daily smokers were assigned randomly to alternate between 2 weeks of exclusively smoking a menthol test cigarette or a non-menthol test cigarette. Urine and saliva were collected for biomarker measurements; carbon monoxide (CO) was measured, and participants smoked test cigarettes through a CreSS® smoking topography device during 3 clinic visits. Participants turned in their cigarette butts from the test periods for determination of mouth level nicotine and completed subjective questionnaires related to the test cigarettes. RESULTS Regardless of cigarette preference, participants had higher salivary cotinine when smoking the non-menthol test cigarette, but there were no significant differences detected in urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol between the 2 test cigarettes. Mouth level nicotine, puff volume, and puff duration were significantly higher when smoking the menthol brand. Both menthol and non-menthol smokers reported significantly lower enjoyment and satisfaction scores for test cigarettes compared with their brand of choice. CONCLUSIONS Our results suggest that mentholation has an effect on measures of smoking behavior and that mouth level nicotine is a useful indicator of between-brand smoke exposure.
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Affiliation(s)
| | | | | | | | | | | | - Joan McCraw
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Xizheng Yan
- Centers for Disease Control and Prevention, Atlanta, GA
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Bellin MD, Clark P, Usmani-Brown S, Dunn TB, Beilman GJ, Chinnakotla S, Pruett TL, Ptacek P, Hering BJ, Wang Z, Gilmore T, Wilhelm J, Hodges JS, Moran A, Herold KC. Unmethylated Insulin DNA Is Elevated After Total Pancreatectomy With Islet Autotransplantation: Assessment of a Novel Beta Cell Marker. Am J Transplant 2017; 17:1112-1118. [PMID: 27643615 PMCID: PMC5357596 DOI: 10.1111/ajt.14054] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 08/16/2016] [Accepted: 09/07/2016] [Indexed: 01/25/2023]
Abstract
Beta cell death may occur both after islet isolation and during infusion back into recipients undergoing total pancreatectomy with islet autotransplantation (TPIAT) for chronic pancreatitis. We measured the novel beta cell death marker unmethylated insulin (INS) DNA in TPIAT recipients before and immediately after islet infusion (n = 21) and again 90 days after TPIAT, concurrent with metabolic functional assessments (n = 25). As expected, INS DNA decreased after pancreatectomy (p = 0.0002). All TPIAT recipients had an elevated unmethylated INS DNA ratio in the first hours following islet infusion. In four samples (three patients), INS DNA was also assessed immediately after islet isolation and again before islet infusion to assess the impact of the isolation process: Unmethylated and methylated INS DNA fractions both increased over this interval, suggesting death of beta cells and exocrine tissue before islet infusion. Higher glucose excursion with mixed-meal tolerance testing was associated with persistently elevated INS DNA at day 90. In conclusion, we observed universal early elevations in the beta cell death marker INS DNA after TPIAT, with pronounced elevations in the islet supernatant before infusion, likely reflecting beta cell death induced by islet isolation. Persistent posttransplant elevation of INS DNA predicted greater hyperglycemia at 90 days.
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Affiliation(s)
- Melena D. Bellin
- Department of Pediatrics, University of Minnesota, Minneapolis, MN,Department of Surgery, University of Minnesota, Minneapolis, MN
| | - Pamela Clark
- Departments of Immunobiology and Internal Medicine, Yale University School of Medicine, New Haven, CT
| | | | - Ty B. Dunn
- Department of Surgery, University of Minnesota, Minneapolis, MN
| | | | | | | | - Peggy Ptacek
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | | | - Zuoheng Wang
- School of Public Health, Yale University, New Haven, CT
| | - Thomas Gilmore
- Department of Surgery, University of Minnesota, Minneapolis, MN
| | - Joshua Wilhelm
- Department of Surgery, University of Minnesota, Minneapolis, MN
| | - James S. Hodges
- Department of Biostatistics, University of Minnesota, Minneapolis, MN
| | - Antoinette Moran
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Kevan C. Herold
- Departments of Immunobiology and Internal Medicine, Yale University School of Medicine, New Haven, CT
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Zerbini CAF, Clark P, Mendez-Sanchez L, Pereira RMR, Messina OD, Uña CR, Adachi JD, Lems WF, Cooper C, Lane NE. Biologic therapies and bone loss in rheumatoid arthritis. Osteoporos Int 2017; 28:429-446. [PMID: 27796445 DOI: 10.1007/s00198-016-3769-2] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [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: 08/02/2016] [Accepted: 09/07/2016] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a common systemic autoimmune disease of unknown cause, characterized by a chronic, symmetric, and progressive inflammatory polyarthritis. One of the most deleterious effects induced by the chronic inflammation of RA is bone loss. During the last 15 years, the better knowledge of the cytokine network involved in RA allowed the development of potent inhibitors of the inflammatory process classified as biological DMARDs. These new drugs are very effective in the inhibition of inflammation, but there are only few studies regarding their role in bone protection. The principal aim of this review was to show the evidence of the principal biologic therapies and bone loss in RA, focusing on their effects on bone mineral density, bone turnover markers, and fragility fractures. METHODS Using the PICOST methodology, two coauthors (PC, LM-S) conducted the search using the following MESH terms: rheumatoid arthritis, osteoporosis, clinical trials, TNF- antagonists, infliximab, adalimumab, etanercept, certolizumab, golimumab, IL-6 antagonists, IL-1 antagonists, abatacept, tocilizumab, rituximab, bone mineral density, bone markers, and fractures. The search was conducted electronically and manually from the following databases: Medline and Science Direct. The search period included articles from 2003 to 2015. The selection included only original adult human research written in English. Titles were retrieved and the same two authors independently selected the relevant studies for a full text. The retrieved selected studies were also reviewed completing the search for relevant articles. The first search included 904 titles from which 253 titles were selected. The agreement on the selection among researchers resulted in a Kappa statistic of 0.95 (p < 0.000). Only 248 abstracts evaluated were included in the acronym PICOST. The final selection included only 28 studies, derived from the systematic search. Additionally, a manual search in the bibliography of the selected articles was made and included into the text and into the section of "small molecules of new agents." CONCLUSION Treatment with biologic drugs is associated with the decrease in bone loss. Studies with anti-TNF blocking agents show preservation or increase in spine and hip BMD and also a better profile of bone markers. Most of these studies were performed with infliximab. Only three epidemiological studies analyzed the effect on fractures after anti-TNF blocking agent's treatment. IL-6 blocking agents also showed improvement in localized bone loss not seen with anti-TNF agents. There are a few studies with rituximab and abatacept. Although several studies reported favorable actions of biologic therapies on bone protection, there are still unmet needs for studies regarding their actions on the risk of bone fractures.
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Affiliation(s)
- C A F Zerbini
- Centro Paulista de Investigação Clínica, Rua Moreira e Costa, 342-Ipiranga, São Paulo, SP, 04266-010, Brazil.
| | - P Clark
- Hospital Infantil Federico Gómez-Faculty of Medicine UNAM, Ciudad de México D.F, Mexico
| | - L Mendez-Sanchez
- Hospital Infantil Federico Gómez-Faculty of Medicine UNAM, Ciudad de México D.F, Mexico
| | - R M R Pereira
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - O D Messina
- IRO Clinical Research Center Buenos Aires, Buenos Aires, Argentina
| | - C R Uña
- IRO Clinical Research Center Buenos Aires, Buenos Aires, Argentina
| | - J D Adachi
- Actavis Chair for Better Bone Health in Rheumatology, Hamilton, ON, Canada
| | - W F Lems
- Amsterdam Rheumatology and Immunology Centre, VU University Medical Centre, Amsterdam, The Netherlands
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
- University of Oxford, Oxford, UK
| | - N E Lane
- Center for Musculoskeletal Health, Sacramento, CA, USA
- UC Davis Health System, University of California, Sacramento, CA, USA
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Affiliation(s)
| | - Pamela Clark
- Occupational Therapy Helper, Lancaster Moor Hospital
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Abstract
This article shows howa Social Worker andan 0. T. Helper together organised a weekly group for elderly confused patients which succeeded inimproving interpersonal relationships among the patients, helped to alleviate anxiety and was enjoyedby those who took part.
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Affiliation(s)
- Glenys M. Jones
- O. T. Dept., Standen Hall, Lancaster Moor Hospital, Lancaster
| | - Pamela Clark
- O. T. Dept., Standen Hall, Lancaster Moor Hospital, Lancaster
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Denova-Gutiérrez E, Clark P, Tucker KL, Muñoz-Aguirre P, Salmerón J. Dietary patterns are associated with bone mineral density in an urban Mexican adult population. Osteoporos Int 2016; 27:3033-40. [PMID: 27198234 DOI: 10.1007/s00198-016-3633-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 02/22/2016] [Accepted: 05/06/2016] [Indexed: 11/29/2022]
Abstract
UNLABELLED Several types of nutrients and foods affect bone mineral density (BMD). However, these nutrients occur together in food groups and dietary patterns, and the overall effects of dietary patterns are not yet well known. INTRODUCTION We evaluated the associations between dietary patterns and BMD among adults participating in the Health Workers Cohort Study. METHODS In a cross-sectional analysis, we examined 6915 Mexican adults aged 20-80 years. All participants completed a validated self-administered food frequency questionnaire (FFQ) and had total, hip, and spine BMD measurements assessed by dual-energy X-ray absorptiometry (DXA). The FFQ included 116 foods, which were grouped into 22 categories and entered into a factor analysis to derive dietary patterns. RESULTS Three dietary patterns emerged-a Prudent, a Refined foods, and a Dairy and fish pattern. After adjustment for potential confounders, those in the highest quintile of the Prudent pattern had lower odds (OR) of low spine BMD (OR = 0.80; 95 % CI 0.68, 0.94; P for trend = 0.031) compared to those in the lowest quintile. In contrast, participants in the highest quintile of the Refined foods pattern had greater odds of low total BMD (OR = 1.74; 95 % CI 1.10, 2.76; P for trend = 0.016) than those in the lowest quintile. Finally, participants in the highest quintile of the Dairy and fish dietary pattern had significantly lower likelihood of having low BMD. CONCLUSION This study identified specific dietary patterns associated with BMD among a Mexican adult population and highlights the importance of promoting food-based prevention strategies for maintaining bone health.
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Affiliation(s)
| | - P Clark
- Hospital Infantil de Mexico Federico Gomez, Ciudad de México, Mexico.
- Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico.
| | - K L Tucker
- Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - P Muñoz-Aguirre
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Cuernavaca, México
| | - J Salmerón
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Cuernavaca, México
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
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Qin L, Li G, Kirkiles-Smith N, Clark P, Fang C, Wang Y, Yu ZX, Devore D, Tellides G, Pober JS, Jane-wit D. Complement C5 Inhibition Reduces T Cell-Mediated Allograft Vasculopathy Caused by Both Alloantibody and Ischemia Reperfusion Injury in Humanized Mice. Am J Transplant 2016; 16:2865-2876. [PMID: 27104811 PMCID: PMC5075274 DOI: 10.1111/ajt.13834] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 04/10/2016] [Accepted: 04/14/2016] [Indexed: 01/25/2023]
Abstract
Allograft vasculopathy (AV) is characterized by diffuse stenoses in the vasculature of solid organ transplants. Previously, we developed two humanized models showing that alloantibody and ischemia reperfusion injury (IRI) exacerbated T cell-mediated AV in human arterial xenografts in vivo. Herein we examined a causal role for terminal complement activation in both settings. IRI, in contrast to alloantibody, elicited widespread membrane attack complex (MAC) assembly throughout the vessel wall. Both alloantibody and IRI caused early (24 h) and robust endothelial cell (EC) activation localized to regions of intimal MAC deposition, indicated by increases in nuclear factor kappa B (NF-κB)-inducing kinase, an MAC-dependent activator of noncanonical NF-kB, VCAM-1 expression and Gr-1+ neutrophil infiltration. Endothelial cell activation by alloantibody was inhibited by antimouse C5 mAb, but not by anti-C5a mAb or by control mAb, implicating MAC as the primary target of anti-C5 mAb. Antimouse C5 mAb significantly reduced alloantibody- and IRI-enhanced T cell infiltration and AV-like changes, including neointimal hyperplasia as well as intraluminal thrombosis in a subset of IRI-treated arterial grafts. These results indicate that increased AV lesion formation in response to either alloantibody or IRI is dependent on complement C5 activation and, accordingly, inhibition of this pathway may attenuate AV.
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Affiliation(s)
- Lingfeng Qin
- Department of Surgery, Yale School of Medicine, New Haven, CT 06519
| | - Guangxin Li
- Department of Surgery, Yale School of Medicine, New Haven, CT 06519
| | | | - Pamela Clark
- Immunobiology, Yale School of Medicine, New Haven, CT 06519
| | - Caodi Fang
- Immunobiology, Yale School of Medicine, New Haven, CT 06519
| | - Yi Wang
- Alexion Pharmaceuticals Inc., 100 College St, New Haven, CT 06511
| | - Zhao-Xue Yu
- Alexion Pharmaceuticals Inc., 100 College St, New Haven, CT 06511
| | - Denise Devore
- Alexion Pharmaceuticals Inc., 100 College St, New Haven, CT 06511
| | - George Tellides
- Department of Surgery, Yale School of Medicine, New Haven, CT 06519
| | - Jordan S Pober
- Immunobiology, Yale School of Medicine, New Haven, CT 06519
| | - Dan Jane-wit
- Cardiovascular Medicine, Yale School of Medicine, New Haven, CT 06519
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Hughes J, Jagoe R, Clark P, Klenerman L. Pattern Recognition of Images of the Pressure Distribution under the Foot from the Pedobarograph. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/00223638.1989.11737030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rivas-Ruiz R, Méndez-Sánchez L, Castelán-Martínez OD, Clark P, Tamayo J, Talavera JO, Huitrón G, Salmerón-Castro J. Comparison of International Reference Values for Bone Speed of Sound in Pediatric Populations: Meta-analysis. J Clin Densitom 2016; 19:316-25. [PMID: 26088387 DOI: 10.1016/j.jocd.2015.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 01/11/2015] [Revised: 04/07/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
Abstract
The aim of this study was to compare international reference values (RV) for tibial and radial speed of sound (SoS) assessed by quantitative ultrasound (QUS) in pediatric populations. These values were compared by age and country of origin in a systematic review with meta-analysis from studies published on QUS (Sunlight Omnisense). A search was carried out in electronic databases. Nine studies with 6963 patients were included in the meta-analysis. For the newborn populations, 3 studies (from Italy, Portugal, and Israel) were used. These studies included subjects with 27-42 wk gestational age. The mean difference (Portugal-Israel) was found to be 23.62 m/s [95% confidence interval [CI] 6.29, 40.95]. Additionally, no difference was found between Italy-Portugal (p = 0.69), or Italy-Israel (p = 0.28). In pediatric populations, we compared 8 studies from Canada, Mexico, Israel, Greece, Portugal, and Turkey. No significant differences found for SoS RV between Israel-Turkey, Israel-Greece, or Israel-Canada (p > 0.05). Significant differences were found in Mexico-Israel -105.29 m/s (95% CI -140.05, -70.54) (p < 0.001); Mexico-Portugal -115.14 m/s (95% CI -164.86, -65.42) (p < 0.001); Mexico-Greece: -239.14 m/s (95% CI -267.67, -210.62) (p < 0.001); Mexico-Turkey: -115.14 m/s (95% CI -164.86, -65.42) (p < 0.001); Mexico-Canada: -113.51 m/s (95% CI -140.25, -86.77) (p < 0.001).This study demonstrates that there are differences in SoS-RV obtained by tibial and radial QUS in pediatric populations between Mexico and other countries (Israel, Portugal, Greece, Turkey, and Canada).
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Affiliation(s)
- R Rivas-Ruiz
- Centro de Adiestramiento en Investigación Clínica, Coordinación de Investigación en Salud, Centro Médico Nacional S. XXI, IMSS, México, D.F.; Facultad de Medicina, Universidad Nacional Autónoma de México, México, D.F
| | - L Méndez-Sánchez
- Unidad de Epidemiología Clínica, Hospital Infantil de México Federico Gómez, México, D.F.; Facultad de Medicina, Universidad Nacional Autónoma de México, México, D.F..
| | - O D Castelán-Martínez
- Unidad de Epidemiología Clínica, Hospital Infantil de México Federico Gómez, México, D.F
| | - P Clark
- Unidad de Epidemiología Clínica, Hospital Infantil de México Federico Gómez, México, D.F.; Facultad de Medicina, Universidad Nacional Autónoma de México, México, D.F
| | - J Tamayo
- Comité Mexicano para la Prevención de la Osteoporosis, México, D.F
| | - J O Talavera
- Centro de Adiestramiento en Investigación Clínica, Coordinación de Investigación en Salud, Centro Médico Nacional S. XXI, IMSS, México, D.F.; Centro de Investigación en Ciencias Médicas, Universidad Autónoma del Estado de México, Toluca, México
| | - G Huitrón
- Centro de Investigación en Ciencias Médicas, Universidad Autónoma del Estado de México, Toluca, México
| | - J Salmerón-Castro
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Cuernavaca, México; Centro de Investigación de Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, México
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Jones M, Welch J, Turvey J, Cannon J, Clark P, Szram J, Cullinan P. Prevalence of sensitization to 'improver' enzymes in UK supermarket bakers. Allergy 2016; 71:997-1000. [PMID: 26836630 DOI: 10.1111/all.12854] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Supermarket bakers are exposed not only to flour and alpha-amylase but also to other 'improver' enzymes, the nature of which is usually shrouded by commercial sensitivity. We aimed to determine the prevalence of sensitization to 'improver' enzymes in UK supermarket bakers. METHODS We examined the prevalence of sensitization to enzymes in 300 bakers, employed by one of two large supermarket bakeries, who had declared work-related respiratory symptoms during routine health surveillance. Sensitization was determined using radioallergosorbent assay to eight individual enzymes contained in the specific 'improver' mix used by each supermarket. RESULTS The prevalence of sensitization to 'improver' enzymes ranged from 5% to 15%. Sensitization was far more likely if the baker was sensitized also to either flour or alpha-amylase. The prevalence of sensitization to an 'improver' enzyme did not appear to be related to the concentration of that enzyme in the mix. CONCLUSIONS We report substantial rates of sensitization to enzymes other than alpha-amylase in UK supermarket bakers; in only a small proportion of bakers was there evidence of sensitization to 'improver mix' enzymes without sensitization to either alpha-amylase or flour. The clinical significance of these findings needs further investigation, but our findings indicate that specific sensitization in symptomatic bakers may not be identified without consideration of a wide range of workplace antigens.
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Affiliation(s)
- M. Jones
- Department of Occupational and Environmental Medicine; Imperial College and Royal Brompton; London UK
| | - J. Welch
- Department of Occupational and Environmental Medicine; Imperial College and Royal Brompton; London UK
| | - J Turvey
- Department of Occupational and Environmental Medicine; Imperial College and Royal Brompton; London UK
| | - J. Cannon
- Department of Occupational and Environmental Medicine; Harefield NHS Trust; London UK
| | - P. Clark
- Department of Occupational and Environmental Medicine; Imperial College and Royal Brompton; London UK
| | - J. Szram
- Department of Occupational and Environmental Medicine; Imperial College and Royal Brompton; London UK
| | - P. Cullinan
- Department of Occupational and Environmental Medicine; Imperial College and Royal Brompton; London UK
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Hromi-Fiedler A, Chapman D, Segura-Pérez S, Damio G, Clark P, Martinez J, Pérez-Escamilla R. Barriers and Facilitators to Improve Fruit and Vegetable Intake Among WIC-Eligible Pregnant Latinas: An Application of the Health Action Process Approach Framework. J Nutr Educ Behav 2016; 48:468-477.e1. [PMID: 27373861 PMCID: PMC4934128 DOI: 10.1016/j.jneb.2016.04.398] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 04/04/2016] [Accepted: 04/24/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Identify barriers and facilitators to improve prenatal fruit and vegetable (F&V) intake among Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)-eligible Latinas using the Health Action Process Approach framework. DESIGN Qualitative data were collected via audiotaped in-depth interviews as part of a larger study to design an intervention to increase prenatal F&V intake. SETTING Hartford, Connecticut. PARTICIPANTS Forty-five WIC-eligible Latinas completed the study. Included women were: ≥ 18 years old; in 2nd or 3rd trimester; having a singleton pregnancy; overweight or obese (ie, pregravid body mass index ≥ 25); not on a restricted diet; nonsmokers. PHENOMENON OF INTEREST Prenatal factors that promote and hinder F&V intake. ANALYSIS Transcripts were independently read and coded, and a consensus was reached about emerging themes. RESULTS Ten factors influenced prenatal F&V intake: social support, family structure, F&V access, F&V preferences, F&V knowledge, F&V health outcome expectations, self-efficacy, intentions, F&V action/coping planning strategies, and maternal health status. CONCLUSIONS AND IMPLICATIONS Social support from family/friends emerged as the primary distal factor driving prenatal F&V intake. Interventions designed to empower pregnant Latinas to gain the access, confidence, knowledge, and strategies necessary to consume more F&Vs must consider strengthening support to achieve the desired outcome.
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Affiliation(s)
- Amber Hromi-Fiedler
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT.
| | - Donna Chapman
- Exercise Science and Sports Studies Department, Springfield College, Springfield, MA
| | | | | | - Pamela Clark
- Women's Ambulatory Health Services, Hartford Hospital, Hartford, CT
| | - Josefa Martinez
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT
| | - Rafael Pérez-Escamilla
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT
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Butterworth DM, Rose SS, Clark P, Rowland P, Knight S, Haboubi NY. Light Microscopy, Immunohistochemistry and Electron Microscopy of the Valves of the Lower Limb Veins and Jugular Veins. Phlebology 2016. [DOI: 10.1177/026835559200700107] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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
Objectives: To demonstrate the light, electron microscopy and immunohistochemistry appearances of the valves of lower limb veins and jugular veins of subject with evidence of venous disease. Design: A prospective study of saphenous veins obtained at post mortem examination and jugular vein obtained at time of surgery. Setting: Health Service district general hospital. Patients: Patients with no evidence of venous disease being treated in the hospital for unrelated conditions, or examined at autopsy in the Department of Pathology. Interventions: Sections of saphenous vein from the lower limb and jugular vein were examined using conventional histology, immunohistochemical staining and electron microscopy. Main outcome measures: Microscopic and electron microscopic appearances of histological sections of venous valves. Results: The valve agger contains an increased amount of fibrous tissue compared with the vein wall and saphenous and jugular veins. However, in saphenous veins the muscle layer of the wall could be traced across the base of the agger, but this was deficient in jugular valves. Electron microscopic examination showed that most of the valve cusp was composed of collagen fibrils, aggregated in irregularly arranged bundles. Elastic fibre material was present in the subendothelial zones. Nerve and muscle fibres were not present in the cusp. Conclusions: Valve cusps in both high and low pressure systems are similar, and the authors suggest that cusp/agger/vein wall complex is important for valve function.
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Affiliation(s)
- D. M. Butterworth
- Department of Histopathology, The University Hospital of South Manchester, Nell Lane, West Didsbury, Manchester, UK
| | - S. S. Rose
- Department of Vascular Surgery, The University Hospital of South Manchester, Nell Lane, West Didsbury, Manchester, UK
| | - P. Clark
- Department of Histopathology, The University Hospital of South Manchester, Nell Lane, West Didsbury, Manchester, UK
| | - P. Rowland
- Department of Histopathology, The University Hospital of South Manchester, Nell Lane, West Didsbury, Manchester, UK
| | - S. Knight
- Department of Plastic, The University Hospital of South Manchester, Nell Lane, West Didsbury, Manchester, UK
| | - N. Y. Haboubi
- Department of Histopathology, The University Hospital of South Manchester, Nell Lane, West Didsbury, Manchester, UK
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Jane-wit D, Surovtseva YV, Qin L, Li G, Liu R, Clark P, Manes TD, Wang C, Kashgarian M, Kirkiles-Smith NC, Tellides G, Pober JS. Complement membrane attack complexes activate noncanonical NF-κB by forming an Akt+ NIK+ signalosome on Rab5+ endosomes. Proc Natl Acad Sci U S A 2015; 112:9686-91. [PMID: 26195760 PMCID: PMC4534258 DOI: 10.1073/pnas.1503535112] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Complement membrane attack complexes (MACs) promote inflammatory functions in endothelial cells (ECs) by stabilizing NF-κB-inducing kinase (NIK) and activating noncanonical NF-κB signaling. Here we report a novel endosome-based signaling complex induced by MACs to stabilize NIK. We found that, in contrast to cytokine-mediated activation, NIK stabilization by MACs did not involve cIAP2 or TRAF3. Informed by a genome-wide siRNA screen, instead this response required internalization of MACs in a clathrin-, AP2-, and dynamin-dependent manner into Rab5(+)endosomes, which recruited activated Akt, stabilized NIK, and led to phosphorylation of IκB kinase (IKK)-α. Active Rab5 was required for recruitment of activated Akt to MAC(+) endosomes, but not for MAC internalization or for Akt activation. Consistent with these in vitro observations, MAC internalization occurred in human coronary ECs in vivo and was similarly required for NIK stabilization and EC activation. We conclude that MACs activate noncanonical NF-κB by forming a novel Akt(+)NIK(+) signalosome on Rab5(+) endosomes.
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Affiliation(s)
- Dan Jane-wit
- Division of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT 06520
| | - Yulia V Surovtseva
- Yale Center for Molecular Discovery, Yale University, New Haven, CT 06516
| | - Lingfeng Qin
- Department of Surgery, Yale University School of Medicine, New Haven, CT 06520
| | - Guangxin Li
- Department of Surgery, Yale University School of Medicine, New Haven, CT 06520
| | - Rebecca Liu
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06520
| | - Pamela Clark
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06520
| | - Thomas D Manes
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06520
| | - Chen Wang
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06520
| | - Michael Kashgarian
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06520
| | | | - George Tellides
- Department of Surgery, Yale University School of Medicine, New Haven, CT 06520
| | - Jordan S Pober
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06520; Department of Pathology, Yale University School of Medicine, New Haven, CT 06520
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Naik BI, Pajewski TN, Bogdonoff DI, Zuo Z, Clark P, Terkawi AS, Durieux ME, Shaffrey CI, Nemergut EC. Rotational thromboelastometry–guided blood product management in major spine surgery. J Neurosurg Spine 2015; 23:239-49. [DOI: 10.3171/2014.12.spine14620] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Major spinal surgery in adult patients is often associated with significant intraoperative blood loss. Rotational thromboelastometry (ROTEM) is a functional viscoelastometric method for real-time hemostasis testing. In this study, the authors sought to characterize the coagulation abnormalities encountered in spine surgery and determine whether a ROTEM-guided, protocol-based approach to transfusion reduced blood loss and blood product use and cost.
METHODS
A hospital database was used to identify patients who had undergone adult deformity correction spine surgery with ROTEM-guided therapy. All patients who received ROTEM-guided therapy (ROTEM group) were matched with historical cohorts whose coagulation status had not been evaluated with ROTEM but who were treated using a conventional clinical and point-of-care laboratory approach to transfusion (Conventional group). Both groups were subdivided into 2 groups based on whether they had received intraoperative tranexamic acid (TXA), the only coagulation-modifying medication administered intraoperatively during the study period. In the ROTEM group, 26 patients received TXA (ROTEM-TXA group) and 24 did not (ROTEM-nonTXA group). Demographic, surgical, laboratory, and perioperative transfusion data were recorded. Data were analyzed by rank permutation test, adapted for the 1:2 ROTEM-to-Conventional matching structure, with p < 0.05 considered significant.
RESULTS
Comparison of the 2 groups in which TXA was used showed significantly less fresh-frozen plasma (FFP) use in the ROTEM-TXA group than in the Conventional-TXA group (median 0 units [range 0–4 units] vs 2.5 units [range 0–13 units], p < 0.0002) but significantly more cryoprecipitate use (median 1 unit [range 0–4 units] in the ROTEM-TXA group vs 0 units [range 0–2 units] in the Conventional-TXA group, p < 0.05), with a nonsignificant reduction in blood loss (median 2.6 L [range 0.9–5.4 L] in the ROTEM-TXA group vs 2.9 L [0.7–7.0 L] in the Conventional-TXA group, p = 0.21). In the 2 groups in which TXA was not used, the ROTEM-nonTXA group showed significantly less blood loss than the Conventional-nonTXA group (median 1 L [range 0.2–6.0 L] vs 1.5 L [range 1.0–4.5 L], p = 0.0005), with a trend toward less transfusion of packed red blood cells (pRBC) (median 0 units [range 0–4 units] vs 1 unit [range 0–9 units], p = 0.09]. Cryoprecipitate use was increased and FFP use decreased in response to ROTEM analysis identifying hypofibrinogenemia as a major contributor to ongoing coagulopathy.
CONCLUSIONS
In major spine surgery, ROTEM-guided transfusion allows for standardization of transfusion practices and early identification and treatment of hypofibrinogenemia. Hypofibrinogenemia is an important cause of the coagulopathy encountered during these procedures and aggressive management of this complication is associated with less intraoperative blood loss, reduced transfusion requirements, and decreased transfusion-related cost.
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Affiliation(s)
| | | | | | - Zhiyi Zuo
- Departments of 1Anesthesiology,
- 2Neurosurgery, and
| | - Pamela Clark
- 3Pathology, University of Virginia, Charlottesville, Virginia
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