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Farrell R, Zaunders J, Poynten IM, Anderson L, Evans L. Concurrent nonavalent human papillomavirus (HPV) vaccination and immune stimulation with imiquimod to treat recalcitrant HPV-associated high grade vaginal intra-epithelial neoplasia. Gynecol Oncol Rep 2024; 52:101350. [PMID: 38445009 PMCID: PMC10912037 DOI: 10.1016/j.gore.2024.101350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 02/13/2024] [Accepted: 02/20/2024] [Indexed: 03/07/2024] Open
Abstract
This is the first report describing detailed T cell responses to viral-like proteins contained in an HPV specific vaccine given in combination with Imiquimod for treatment of persistent VAIN2/3. We postulate that stimulation of the innate immune system with Imiquimod and the specific CD4 and CD8T cell responses following HPV vaccination with Gardasil9@ combined to induce clinical remission in a woman with treatment-refractory disease.
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Affiliation(s)
- R. Farrell
- Chris O'Brien Lifehouse Hospital, Camperdown, Sydney, New South Wales 2050, Australia
- Sydney Medical School, University of Sydney, New South Wales 2006, Australia
| | - J. Zaunders
- NSW State Reference Labaoratory for HIV, Centre for Applied Medical Research, St Vincents Hospital, New South Wales, Australia
- HIV Epidemiology and Prevention Program, The Kirby Institute, University of NSW Kensington, Sydney, New South Wales 2052, Australia
| | - IM. Poynten
- HIV Epidemiology and Prevention Program, The Kirby Institute, University of NSW Kensington, Sydney, New South Wales 2052, Australia
| | - L. Anderson
- Sydney Medical School, University of Sydney, New South Wales 2006, Australia
- NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, Sydney, New South Wales 2050, Australia
| | - L. Evans
- University of NSW Kensington, Sydney, New South Wales 2052, Australia
- Department of Clinical Immunology, Allergy and HIV, Liverpool Hospital, South Western Sydney Local Health District, Liverpool Sydney, New South Wales 2170, Australia
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Veldkamp R, D'hooge M, Sandroff BM, DeLuca J, Kos D, Salter A, Feinstein A, Amato MP, Brichetto G, Chataway J, Farrell R, Chiaravalloti ND, Dalgas U, Filippi M, Freeman J, Motl RW, Meza C, Inglese M, Rocca MA, Cutter G, Feys P. Profiling cognitive-motor interference in a large sample of persons with progressive multiple sclerosis and impaired processing speed: results from the CogEx study. J Neurol 2023; 270:3120-3128. [PMID: 36881147 DOI: 10.1007/s00415-023-11636-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Performing cognitive-motor dual tasks (DTs) may result in reduced walking speed and cognitive performance. The effect in persons with progressive multiple sclerosis (pwPMS) having cognitive dysfunction is unknown. OBJECTIVE To profile DT-performance during walking in cognitively impaired pwPMS and examine DT-performance by disability level. METHODS Secondary analyses were conducted on baseline data from the CogEx-study. Participants, enrolled with Symbol Digit Modalities Test 1.282 standard deviations below normative value, performed a cognitive single task ([ST], alternating alphabet), motor ST (walking) and DT (both). Outcomes were number of correct answers on the alternating alphabet task, walking speed, and DT-cost (DTC: decline in performance relative to the ST). Outcomes were compared between EDSS subgroups (≤ 4, 4.5-5.5, ≥ 6). Spearman correlations were conducted between the DTCmotor with clinical measures. Adjusted significance level was 0.01. RESULTS Overall, participants (n = 307) walked slower and had fewer correct answers on the DT versus ST (both p < 0.001), with a DTCmotor of 15.8% and DTCcognitive of 2.7%. All three subgroups walked slower during the DT versus ST, with DTCmotor different from zero (p's < 0.001). Only the EDSS ≥ 6 group had fewer correct answers on the DT versus ST (p < 0.001), but the DTCcognitive did not differ from zero for any of the groups (p ≥ 0.039). CONCLUSION Dual tasking substantially affects walking performance in cognitively impaired pwPMS, to a similar degree for EDSS subgroups.
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Affiliation(s)
- R Veldkamp
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.
- UMSC, Hasselt-Pelt, Belgium.
| | - M D'hooge
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- UMSC, Hasselt-Pelt, Belgium
- National MS Center Melsbroek, Steenokkerzeel, Belgium
| | - B M Sandroff
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - J DeLuca
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - D Kos
- National MS Center Melsbroek, Steenokkerzeel, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - A Salter
- Department of Neurology, Section on Statistical Planning and Analysis, UT Southwestern Medical Center, Dallas, TX, USA
| | - A Feinstein
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, M5R 3B6, Canada
| | - M P Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - G Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149, Genoa, Italy
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society (AISM), Via Operai 30, 16149, Genoa, Italy
| | - J Chataway
- Queen Square MS Centre, Department of Neuroinflammation, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK
| | - R Farrell
- Queen Square MS Centre, Department of Neuroinflammation, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK
| | - N D Chiaravalloti
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - U Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, 8000, Aarhus, Denmark
| | - M Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, IRCCS, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - J Freeman
- School of Health Professions, Faculty of Health, University of Plymouth, Devon, UK
| | - R W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | - C Meza
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, M5R 3B6, Canada
| | - M Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - M A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, IRCCS, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - G Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, USA
| | - P Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- UMSC, Hasselt-Pelt, Belgium
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Farrell R, Liauw WS, Morris DL. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for ovarian cancer in an Australian institution: lessons from 20 years' experience. BMC Surg 2022; 22:338. [PMID: 36096791 PMCID: PMC9469563 DOI: 10.1186/s12893-022-01786-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/31/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives We report the 20-year experience of the largest Australian unit performing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for ovarian cancer and reflect on learning opportunities. Methods A retrospective review of all cases of CRS for ovarian cancer at St George Peritonectomy Unit from Jan 1998 to Jan 2018 was performed. Prospectively collected data include age, stage, histology, disease extent (PCI), completeness of cytoreduction (CC score), HIPEC regime, 30-day surgical morbidity, disease recurrence, and death. Survival was computed using Kaplan–Meier method and analysed using log-rank tests and Cox-proportional hazards models. Results Forty-one women with advanced ovarian cancer (11 primary stage III/IV, 30 recurrent) underwent CRS, 29 (71%) with HIPEC. Most (68%) had high-volume disease (PCI > 15). In 98%, CC0/CC1 (residual < 2.5 mm) was achieved. Fourteen (34%) had grade 3/4 complications, 1 patient (2%) died within 30 days and 2 patients (5%) died within 90 days. Progression-free and median overall survival was 30.0 and 67.0 months for primary cancer, and 6.7 and 18.1 months for recurrent cancer. Survival was associated with platinum-sensitivity, PCI ≤ 15, and CC score 0, but not HIPEC. Conclusion This study reports outcomes for patients with advanced ovarian cancer patients treated in an Australian centre offering CRS and HIPEC. Whilst survival and morbidity outcomes were good for primary disease, they were poorer than predicted from the literature for cases of recurrent disease. The incorporation of evidence-based predictors of survival and multidisciplinary input are essential to achieve the best survival outcomes.
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Affiliation(s)
- R Farrell
- Chris O'Brien Lifehouse Hospital, Camperdown, Sydney, NSW, 2050, Australia. .,The University of Sydney, Sydney, NSW, 2006, Australia. .,Department of Surgery, UNSW, Sydney, NSW, 2033, Australia. .,Prince of Wales Private Hospital, Suite 30, Level 7, Randwick Sydney, 2031, Australia.
| | - W S Liauw
- Department of Surgery, UNSW, Sydney, NSW, 2033, Australia.,Cancer Care Centre, St George Hospital, Kogarah, NSW, 2217, Australia
| | - D L Morris
- Department of Surgery, UNSW, Sydney, NSW, 2033, Australia.,Cancer Care Centre, St George Hospital, Kogarah, NSW, 2217, Australia
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Farrell R, Colglazier E, Parker C, Stevens L, Austin ED, Fineman JR. Case Report: Caveolin‐1 Associated with Severe (Pediatric‐onset) Presentation of Pulmonary Arterial Hypertension. Pulm Circ 2022; 12:e12100. [PMID: 35864912 PMCID: PMC9294289 DOI: 10.1002/pul2.12100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
There has been a growing interest in the role that genetic factors influence pediatric pulmonary vascular disease. In fact, data suggests that genetic factors contribute to ~42% of pediatric‐onset pulmonary hypertension. Although animal and human studies suggest that aberrations in Caveolin1 (CAV1) signaling participate in the development of pulmonary vascular disorders, limited reports of CAV1‐associated heritable pulmonary arterial hypertension (HPAH) exist. This is a case report of a 2‐year‐old female with late recognition of HPAH due to a CAV1 pathogenic variant: c.474del, (p.Leu159Serfs*22)(NM_001753.5). The pedigree demonstrates autosomal dominant transmission with reduced penetrance of PAH, suggestive that additional genetic or environmental factors modify PAH development. Genetic testing and the discovery of rare genetic alterations in PAH during infancy and childhood may aid in identifying disease etiologies, guide therapeutic decisions, and ultimately identify novel therapeutic targets. Moreover, CAV1 genetics implicate variable expressivity and incomplete penetrance for HPAH and underscores the utility of predictive genetic testing for unaffected family members no matter their age.
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Affiliation(s)
- R Farrell
- Department of Pediatrics UCSF Benioff Children's Hospital, San Francisco California
| | - E Colglazier
- Department of Pediatrics UCSF Benioff Children's Hospital, San Francisco California
| | - C Parker
- Department of Pediatrics UCSF Benioff Children's Hospital, San Francisco California
| | - L Stevens
- Department of Pediatrics UCSF Benioff Children's Hospital, San Francisco California
| | - ED Austin
- Department of Pediatrics Vanderbilt University Medical Center
| | - JR Fineman
- Department of Pediatrics UCSF Benioff Children's Hospital, San Francisco California
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Farrell R, Summers M, Doogan C, Mulhert N, Keenan E, Buchanan K, Lee H, Padilla H, Stevenson VL. Evaluation of the cognitive benefits of intrathecal baclofen pump implantation in people with intractable multiple sclerosis related spasticity. Mult Scler Relat Disord 2021; 50:102831. [PMID: 33618123 DOI: 10.1016/j.msard.2021.102831] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Spasticity is a common problematic symptom in Multiple Sclerosis with over one third of patients failing first line therapies. Intrathecal baclofen is a safe and efficacious option for treatment resistant spasticity. Anecdotally patients report improved concentration/cognitive performance when switching to intrathecal baclofen (ITB) from systemic medications. AIM To explore whether subjects who proceed with ITB pump implantation for spasticity management and reduce oral anti-spasticity agents will have improved cognitive function. METHODS Subjects were admitted for trial of ITB via lumbar puncture and subsequent pump implantation. Spasticity and cognitive measures before ITB trial and 3 months post implant were recorded. Paired t-test or Wilcoxon Signed Ranks test was used for within subject change and effect sizes (Cohen's dz) were calculated. Subgroup analysis of those on ≥2, or ≤ 1 spasticity medications at baseline was performed. RESULTS 27 subjects with MS completed per protocol. Mean age 46 years [26 - 56], disease duration 15 years [6 - 26], RRMS = 3, SPMS = 17 and PPMS=7. The majority were on multiple spasticity medications. Spasticity scores significantly improved post pump implant. Mean ITB dose at 3 months was 143 mcg / day and 19 discontinued all other treatments for spasticity. There was no deterioration on any cognitive or mood measure. An improvement of moderate effect size was found in Backwards Digit Span (d=0.41, p=0.059) and HADS - anxiety (d=0.37, p=0.097). Fatigue Severity Scale score decreased substantially (d=0.81, p=0.005). Small improvements in Symbol Digit Modalities Test score (d=0.24) and Sustained Attention to Response Task response time (d=0.23) were non-significant. Performance on other measures did not change. Effect sizes were larger in subgroup on ≥2 oral spasticity medications at baseline, compared to the group on ≤1 medication (SDMT, d=0.42 vs d=0.07; Backwards digit span 0.45 vs 0.28; HADS-anxiety 0.39 vs 0.32; HADS-depression d=0.32 vs 0.05 and FSS, d= 1.14 vs 0.42). CONCLUSIONS In a pilot study exploring the impact of ITB on cognition, spasticity scores improved universally and beneficial effects on some measures of fatigue, anxiety, auditory attention and verbal working memory were found. Improvement of speed of processing in those withdrawing higher doses of oral medication was also demonstrated suggesting that switching to ITB has added cognitive and psychological benefits for people with MS.
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Affiliation(s)
- R Farrell
- Department of Rehabilitation, The National Hospital for Neurology & Neurosurgery, University College London Hospitals (UCLH), London; Department of Neuroinflammation, Queen Square, Institute of Neurology, University College London; NIHR University College London Hospitals, Biomedical Research Centre.
| | - M Summers
- Department of Clinical Neuropsychology, National Hospital for Neurology & Neurosurgery, London, United Kingdom
| | - C Doogan
- Department of Rehabilitation, The National Hospital for Neurology & Neurosurgery, University College London Hospitals (UCLH), London
| | - N Mulhert
- Division of Neuroscience and Experimental Psychology, University of Manchester, United Kingdom
| | - E Keenan
- Department of Rehabilitation, The National Hospital for Neurology & Neurosurgery, University College London Hospitals (UCLH), London
| | - K Buchanan
- Department of Rehabilitation, The National Hospital for Neurology & Neurosurgery, University College London Hospitals (UCLH), London
| | - H Lee
- Department of Rehabilitation, The National Hospital for Neurology & Neurosurgery, University College London Hospitals (UCLH), London
| | - H Padilla
- Department of Rehabilitation, The National Hospital for Neurology & Neurosurgery, University College London Hospitals (UCLH), London
| | - V L Stevenson
- Department of Rehabilitation, The National Hospital for Neurology & Neurosurgery, University College London Hospitals (UCLH), London
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Brant A, Batur P, Arrigain S, Lopez R, Farrell R. P55 Demographic and social factors associated with out-of-pocket expenditures for contraceptive prescriptions in the US during medicaid expansion. Contraception 2020. [DOI: 10.1016/j.contraception.2020.07.074] [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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Farrell R, Jain S, Shiels P, Workman G, Crowther K, Mitchell D. EP-2155 Optimising HDR Prostate Implant, Planning and delivery. A new centre experience. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32575-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Donnelly A, Balaratnam M, Murphy M, Bahadur S, Padilla H, Keenan E, Farrell R, Stevenson V. WP1-12 Reducing infection rates in an intrathecal baclofen service; closing the audit cycle. J Neurol Neurosurg Psychiatry 2019. [DOI: 10.1136/jnnp-2019-abn.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
ObjectivesIntrathecal baclofen (ITB) is a recognised treatment strategy for the management of spasticity. We have 30 years of experience, and 160 patients currently receiving treatment.DesignAn audit (Jan 13 – Jul 15) demonstrated complication rates of 4.4% (infection) and 4.92% (catheter). After this we recommended 1 vancomycin wash of the pump pocket, 2 occlusive dressing of pressure sores, 3 timely MRSA pre-screening, and this was introduced June-August 2016. We present a re-audit of the service.SubjectsAll patients admitted for ITB pump surgery between June 2016 and June 2018.MethodsThe database of patients was used, from which the patient notes were reviewed with information relating to each surgical procedure recorded.ResultsThere were 92 surgical procedures and 78 patients (M 30, F 48). 12 patients had complications, requiring 18 surgical procedures. Out of 18 surgical procedures, 10 were catheter- and 7 pump-related). Our infection rate was lower at 1% of all surgeries (compared with 4.4%), or 0.6% of all ITB pump patients per year (compared with 3.4%), and our catheter complication rate was 6.25% of all patients per year. Our annual incidence rate of all complications was 5.6% in both groups.ConclusionsThe infection risk is lower and complication rate remains stable. We will discuss factors which may influence the risk of complication, and consider recommendations for the future.
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Barr M, Farrell R, Singh S, Foley E, He Y, Brady L, Young V, Ryan R, Nicholson S, Leonard N, Cuffe S, Finn S. MA06.09 XRCC6BP1: A DNA Repair Gene in Cisplatin Resistant Lung Cancer Stem Cells That May Predict Survival Outcomes in Patients. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.364] [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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Barr M, Singh S, Farrell R, Foley E, He Y, Nicholson S, Leonard N, Brady L, Cuffe S, Finn S. PO-510 XRCC6BP1: a novel role in the DNA repair of platinum resistant NSCLC cells. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.1011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Baird V, Drake A, Corrigan K, Clarke J, McGivern U, Byrne M, Workman G, Farrell R. Image guided high dose rate brachytherapy in cervical cancer. Clin Oncol (R Coll Radiol) 2017. [DOI: 10.1016/j.clon.2017.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Murphy A, Parihar V, Shahin A, Farrell R. Imitation, The Greatest Form of Flattery? Ir Med J 2016; 109:322. [PMID: 26904782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Komath D, Jabbar S, Farrell R, Gilhooly M, Messiha A, Shorafa M, Visavadia B, McCaul J. Primary and metastatic Merkel cell carcinoma of parotid. Br J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.bjoms.2015.08.191] [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: 10/22/2022]
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Wong G, Awad Z, Wong P, Wood S, Farrell R. Clinical applicability of the Thy3a cytological category in thyroid nodules aspirates. Our experience in one hundred and fifty-seven patients with Thy3 cytology. Clin Otolaryngol 2014; 39:393-6. [DOI: 10.1111/coa.12307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2014] [Indexed: 11/29/2022]
Affiliation(s)
- G. Wong
- Department of Otolaryngology, Head and Neck Surgery; Northwick Park Hospital; Middlesex UK
| | - Z. Awad
- Department of Otolaryngology, Head and Neck Surgery; Northwick Park Hospital; Middlesex UK
| | - P.Y. Wong
- Department of Otolaryngology, Head and Neck Surgery; Northwick Park Hospital; Middlesex UK
| | - S. Wood
- Department of Otolaryngology, Head and Neck Surgery; Wexham Park Hospital; Slough Berkshire UK
| | - R. Farrell
- Department of Otolaryngology, Head and Neck Surgery; Northwick Park Hospital; Middlesex UK
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Gunderson C, Farrell R, Slaughter K, Ding K, Lauer J, Perry L, McMeekin D, Moore K. The influence of obesity on disease characteristics and survival among patients with epithelial ovarian cancer. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.03.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Slaughter K, Gunderson C, Perry L, Thomas E, Farrell R, Lauer J, Ding K, McMeekin D, Moore K. Acquired platinum resistance among women with high-grade serous epithelial ovarian cancer. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.03.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gunderson C, Thomas E, Slaughter K, Farrell R, Ding K, Lauer J, Perry L, McMeekin D, Moore K. Venous thromboembolism carries a particularly grave prognosis with epithelial ovarian cancer. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.03.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Shakil J, Piracha N, Prasad N, Kopacz J, Tarasuk A, Farrell R, Urban C, Mariano N, Wang G, Segal-Maurer S. Use of outpatient parenteral antimicrobial therapy for transrectal ultrasound-guided prostate biopsy prophylaxis in the setting of community-associated multidrug-resistant Escherichia coli rectal colonization. Urology 2014; 83:710-3. [PMID: 24680441 DOI: 10.1016/j.urology.2013.12.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 12/19/2013] [Accepted: 12/20/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To study the use of ertapenem delivered in an outpatient parenteral antimicrobial therapy (OPAT) hospital-based unit setting for targeted transrectal ultrasound-guided prostate biopsy (TRUSPBx) prophylaxis in the setting of multidrug-resistant (MDR) Escherichia coli rectal colonization. E coli is the pathogen most commonly associated with post-TRUSPBx complications, and there is increasing prevalence of community-associated MDR E coli. METHODS Prospective data analysis of all patients admitted to the OPAT unit for administration of intravenous antibiotics for prophylaxis for TRUSPBx over 18-month period was performed. Patients had identification of MDR E coli in rectal swab cultures and/or intolerance to available oral agents. Microbiologic data and tolerability of administered antibiotics and outcome after TRUSPBx were tabulated. RESULTS Nine patients (median age 74 years) were referred because of antibiotic-resistant E coli from rectal swabs (all fluoroquinolone resistant, 7 MDR). All patients received ertapenem 1 g intravenously 1 day before TRUSPBx and the day of the procedure before TRUSPBx. None of the patients experienced infectious complications immediately after TRUSPBx or several weeks or months later, and no patient was lost to urologic follow-up. CONCLUSION Increasing worldwide reports of prostatitis, urinary tract infections, and septicemia after TRUSPBx because of MDR E coli suggest rectal screening before procedure may be useful in decreasing complications. Targeted prophylaxis in these instances is necessary. Although carbapenems are used for treatment, they are not routinely used for prophylaxis. We report successful use of ertapenem delivered in a hospital-based OPAT unit for TRUSPBx prophylaxis.
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Affiliation(s)
- J Shakil
- The Dr. James J. Rahal Jr. Division of Infectious Diseases, Department of Medicine, New York Hospital Queens, Flushing, NY
| | - N Piracha
- The Dr. James J. Rahal Jr. Division of Infectious Diseases, Department of Medicine, New York Hospital Queens, Flushing, NY
| | - N Prasad
- The Dr. James J. Rahal Jr. Division of Infectious Diseases, Department of Medicine, New York Hospital Queens, Flushing, NY
| | - J Kopacz
- The Dr. James J. Rahal Jr. Division of Infectious Diseases, Department of Medicine, New York Hospital Queens, Flushing, NY
| | - A Tarasuk
- Urology Division, Department of Surgery, New York Hospital Queens, Flushing, NY
| | - R Farrell
- Urology Division, Department of Surgery, New York Hospital Queens, Flushing, NY
| | - C Urban
- The Dr. James J. Rahal Jr. Division of Infectious Diseases, Department of Medicine, New York Hospital Queens, Flushing, NY; Department of Medicine, Weill Cornell Medical College, New York, NY
| | - N Mariano
- The Dr. James J. Rahal Jr. Division of Infectious Diseases, Department of Medicine, New York Hospital Queens, Flushing, NY; Department of Patient Care Services, New York Hospital Queens, Flushing, NY
| | - G Wang
- Urology Division, Department of Surgery, New York Hospital Queens, Flushing, NY
| | - S Segal-Maurer
- The Dr. James J. Rahal Jr. Division of Infectious Diseases, Department of Medicine, New York Hospital Queens, Flushing, NY; Department of Medicine, Weill Cornell Medical College, New York, NY.
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Thomas E, Slaughter K, Gunderson C, Perry L, Lauer J, Farrell R, Ding K, McMeekin D, Moore K. The use of biologic agents and clinical trials may prolong survival for women with primary platinum resistant ovarian carcinoma. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gunderson C, Slaughter K, Thomas E, Farrell R, Ding K, Lauer J, Perry L, McMeekin D, Moore K. Timing of venous thromboembolism: Does it impact survival with serous carcinoma of the ovary? Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.07.041] [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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Gunderson C, Slaughter K, Thomas E, Farrell R, Ding K, Lauer J, Perry L, McMeekin D, Moore K. Is leukocytosis a harbinger of poor prognosis in ovarian cancer akin to thrombocytosis? Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gunderson C, Dinh B, Farrell R, Thomas E, Vesely S, Chopra S, McMeekin D, Moore K. Inpatient versus outpatient management of neutropenic fever in gynecologic oncology patients: Does cost really matter? Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Dooraghi AA, Vu NT, Silverman RW, Farrell R, Shah KS, Wang J, Heath JR, Chatziioannou AF. Betabox: a beta particle imaging system based on a position sensitive avalanche photodiode. Phys Med Biol 2013; 58:3739-53. [PMID: 23656911 PMCID: PMC3706465 DOI: 10.1088/0031-9155/58/11/3739] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A beta camera has been developed that allows planar imaging of the spatial and temporal distribution of beta particles using a 14 × 14 mm(2) position sensitive avalanche photodiode (PSAPD). This camera system, which we call Betabox, can be directly coupled to microfluidic chips designed for cell incubation or other biological applications. Betabox allows for imaging the cellular uptake of molecular imaging probes labeled with charged particle emitters such as (18)F inside these chips. In this work, we investigate the quantitative imaging capabilities of Betabox for (18)F beta particles, in terms of background rate, efficiency, spatial resolution, and count rate. Measurements of background and spatial resolution are considered both at room temperature (21 °C ± 1 °C) and at an elevated operating temperature (37 °C ± 1 °C), as is often required for biological assays. The background rate measured with a 4 keV energy cutoff is below 2 cph mm(-2) at both 21 and 37 °C. The absolute efficiency of Betabox for the detection of (18)F positron sources in contact with a PSAPD with the surface passivated from ambient light and damage is 46% ± 1%. The lower detection limit is estimated using the Rose Criterion to be 0.2 cps mm(-2) for 1 min acquisitions and a 62 × 62 µm(2) pixel size. The upper detection limit is approximately 21 000 cps. The spatial resolution at both 21 and 37 °C ranges from 0.4 mm FWHM at the center of the field of view (FOV), and degrades to 1 mm at a distance of 5 mm away from center yielding a useful FOV of approximately 10 × 10 mm(2). We also investigate the effects on spatial resolution and sensitivity that result from the use of a polymer based microfluidic chip. For these studies we place varying layers of low-density polyethylene (LDPE) between the detector and the source and find that the spatial resolution degrades by ∼180 µm for every 100 µm of LDPE film. Sensitivity is reduced by half with the inclusion of ∼200 µm of additional LDPE film. Lastly, we demonstrate the practical utilization of Betabox, with an imaging test of its linearity, when coupled to a polydimethylsiloxane microfluidic chip designed for cell based assays.
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Affiliation(s)
- A A Dooraghi
- Crump Institute for Molecular Imaging, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
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Abstract
INTRODUCTION Floseal® (Baxter, Hayward, CA, US) can be of value in reducing blood loss and haematoma rates. The manufacturer’s warnings include allergic reaction, poor wound healing and intravascular thrombosis. We aimed to determine whether Floseal® is safe to use in various head and neck surgery (HNS) procedures. METHODS A prospective trial was conducted using Floseal® in 42 various consecutive head and neck surgery procedures. Adverse incidents were used as the main outcome measure, including allergic reaction, wound breakdown, wound infection and thrombosis. Secondary outcome measures included haematoma formation, hospital stay, drain times and output. RESULTS No adverse incidents were recorded in the trial period. Two patients developed haematomas and required surgical exploration where a bleeding vessel was identified and dealt with. CONCLUSIONS Floseal® is safe to be used in head and neck surgery with no adverse effects. A larger number and a control group are required to ascertain its value in reducing blood loss, haematoma formation, drain usage and hospital stay.
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Affiliation(s)
- A Ujam
- North West London Hospitals NHS Trust, UK.
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Bishop E, Nugent E, Mathews C, Farrell R, Landrum L, McMeekin D. Prognostic factors in stage 2B–3B cervical cancer in an era of chemoradiation. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Farrell R, Nugent E, Mathews C, Bishop E, Perry L, Landrum L, Lee S, Kim Y, Nam J, Kim Y, McMeekin D. Outcomes and disease progression after cervical excisional procedures (EPS), loop electroexcisional procedure (LEEP) or cone biopsy specimens (CKC), and radical hysterectomy (RH) for early stage invasive cervical cancer. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.07.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Nugent E, Bishop E, Mathews C, Perry L, Farrell R, Landrum L, Moxley K. The prognostic impact of isolated pelvic lymph node metastasis in a contemporary population of early stage and loco-regionally advanced carcinoma of the uterine cervix. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.07.078] [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: 11/12/2022]
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Perry L, Mathews C, Nugent E, Farrell R, Moore K. Para-aortic nodal metastases in the modern era: still a dismal prognosis. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2012.07.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gentile TR, Bales M, Arp U, Dong B, Farrell R. Response of large area avalanche photodiodes to low energy x rays. Rev Sci Instrum 2012; 83:053105. [PMID: 22667600 DOI: 10.1063/1.4714348] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
For an experiment to study neutron radiative beta-decay, we operated large area avalanche photodiodes (APDs) near liquid nitrogen temperature to detect x rays with energies between 0.2 keV and 20 keV. Whereas there are numerous reports of x ray spectrometry using APDs at energies above 1 keV, operation near liquid nitrogen temperature allowed us to reach a nominal threshold of 0.1 keV. However, due to the short penetration depth of x rays below 1 keV, the pulse height spectrum of the APD become complex. We studied the response using monochromatic x ray beams and employed phenomenological fits of the pulse height spectrum to model the measurement of a continuum spectrum from a synchrotron. In addition, the measured pulse height spectrum was modelled using a profile for the variation in efficiency of collection of photoelectrons with depth into the APD. The best results are obtained with the collection efficiency model.
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Affiliation(s)
- T R Gentile
- Stop 8461, National Institute of Standards and Technology, Gaithersburg, Maryland 20899, USA
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Backes F, Farrell R, Brudie L, Ahmad S, Salani R, Eisenhauer E, Cohn D, Holloway R, Fowler J, O'Malley D. Endometrial cancer staging in the elderly: Robotic or open? Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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31
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Wong WL, Sonoda LI, Gharpurhy A, Gollub F, Wellsted D, Goodchild K, Lemon C, Farrell R, Saunders M. 18F-fluorodeoxyglucose positron emission tomography/computed tomography in the assessment of occult primary head and neck cancers--an audit and review of published studies. Clin Oncol (R Coll Radiol) 2011; 24:190-5. [PMID: 22183080 DOI: 10.1016/j.clon.2011.11.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 10/05/2011] [Accepted: 11/04/2011] [Indexed: 02/07/2023]
Abstract
AIMS To assess the value of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with squamous cell and undifferentiated cancer neck nodes and no primary site on conventional assessment. MATERIALS AND METHODS Seventy-eight patients with neck nodal metastases from an unknown primary cancer were studied. PET/CT was carried out in all patients, 1h after FDG injection. RESULTS Uptake suspicious of an occult primary cancer was found in 46/78 (59.0%) patients. Subsequent investigations confirmed a primary site in the base of the tongue in 14, pharyngeal palatine tonsil in 14, post cricoid in one, lung in one. PET/CT diagnosed primary cancers in 30/78 patients (38.5%); sensitivity, specificity, positive predictive value, negative predictive value: 30/30 (100.0%), 32/48 (66.7%), 30/46 (65.2%), 32/32 (100.0%), respectively. PET/CT detected additional disease in four patients: contralateral nodal disease in two, mediastinal nodal disease in one and liver metastases in one. CONCLUSIONS FDG PET/CT is of value in the assessment of patients with occult head and neck primary cancers. However, false-positive results remain a limitation of the investigation.
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Affiliation(s)
- W L Wong
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, UK.
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Beattie MS, Ganschow P, Gabram-Mendola S, Wilson A, Joseph G, Lee R, Loranger K, Stanislaw C, Seelaus C, Farrell R, Trim L, DelPozo S, Luce J. P2-13-03: Comparative Assessment of 636 Women at Risk for Hereditary Breast Cancer within 3 Public Hospitals: The Consortium of Underserved BRCA Testers. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p2-13-03] [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: Underserved women at risk for Hereditary Breast and Ovarian Cancer (HBOC) are confronted with many unique challenges, such as barriers to accessing appropriate genetic testing and counseling services and decreased resources, that place them at increased cancer risk. It is unclear whether these high-risk women are appropriately referred for genetic counseling and what their genetic test results demonstrate due to minimal practice-based evidence. To study this population, and to establish an infrastructure to further explore long-term outcomes, we formed the Consortium of Underserved BRCA testers in October 2010 from: San Francisco General Hospital (SF), Stroger Hospital of Cook County (Chicago), and Grady Memorial Hospital (Atlanta).
Methods: Using common clinical and research protocols and mixed methods analysis, we examined and compared referral patterns, demographics, and BRCA test results between sites. We used chart reviews and common data collection instruments to gather and pool data. Using descriptive and comparative statistics, we examined similarities and differences between Consortium sites.
Results: SF's program began 9 years ago, Chicago's began 6 years ago, and Atlanta's began 3 years ago. Medicaid funding for BRCA testing has been available in SF since 2011, in Chicago since 2009, and is not yet available in Atlanta. P values were all <0.05 for comparing referral sources between sites. Each site uses unique referral tools and systems. For example, in SF, a family history screening questionnaire is administered during mammography; in Chicago, an extensive primary care network has been educated to provide appropriate referrals; in Atlanta, a pedigree assessment tool is employed by referring clinics.
Conclusions: Despite differences in referral patterns and Medicaid funding, underserved women at all 3 public hospital sites had similar BRCA positive rates, which are in line with positive rates from University Cancer Centers. We believe this relates to the availability of genetic counseling services and a similar testing threshold at each site. The large and ethnically diverse population of this Consortium can serve as a valuable resource for researchers and clinicians. We plan to follow this cohort prospectively to study clinical outcomes and medical decisions after BRCA testing in underserved families at risk of HBOC.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-13-03.
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Affiliation(s)
- MS Beattie
- 1University of California, San Francisco, CA; San Francisco General Hospital, San Francisco, CA; Stroger Hospital of Cook County, Chicago, IL; Rush University Medical Center, Chicago, IL; Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - P Ganschow
- 1University of California, San Francisco, CA; San Francisco General Hospital, San Francisco, CA; Stroger Hospital of Cook County, Chicago, IL; Rush University Medical Center, Chicago, IL; Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - S Gabram-Mendola
- 1University of California, San Francisco, CA; San Francisco General Hospital, San Francisco, CA; Stroger Hospital of Cook County, Chicago, IL; Rush University Medical Center, Chicago, IL; Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - A Wilson
- 1University of California, San Francisco, CA; San Francisco General Hospital, San Francisco, CA; Stroger Hospital of Cook County, Chicago, IL; Rush University Medical Center, Chicago, IL; Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - G Joseph
- 1University of California, San Francisco, CA; San Francisco General Hospital, San Francisco, CA; Stroger Hospital of Cook County, Chicago, IL; Rush University Medical Center, Chicago, IL; Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - R Lee
- 1University of California, San Francisco, CA; San Francisco General Hospital, San Francisco, CA; Stroger Hospital of Cook County, Chicago, IL; Rush University Medical Center, Chicago, IL; Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - K Loranger
- 1University of California, San Francisco, CA; San Francisco General Hospital, San Francisco, CA; Stroger Hospital of Cook County, Chicago, IL; Rush University Medical Center, Chicago, IL; Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - C Stanislaw
- 1University of California, San Francisco, CA; San Francisco General Hospital, San Francisco, CA; Stroger Hospital of Cook County, Chicago, IL; Rush University Medical Center, Chicago, IL; Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - C Seelaus
- 1University of California, San Francisco, CA; San Francisco General Hospital, San Francisco, CA; Stroger Hospital of Cook County, Chicago, IL; Rush University Medical Center, Chicago, IL; Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - R Farrell
- 1University of California, San Francisco, CA; San Francisco General Hospital, San Francisco, CA; Stroger Hospital of Cook County, Chicago, IL; Rush University Medical Center, Chicago, IL; Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - L Trim
- 1University of California, San Francisco, CA; San Francisco General Hospital, San Francisco, CA; Stroger Hospital of Cook County, Chicago, IL; Rush University Medical Center, Chicago, IL; Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - S DelPozo
- 1University of California, San Francisco, CA; San Francisco General Hospital, San Francisco, CA; Stroger Hospital of Cook County, Chicago, IL; Rush University Medical Center, Chicago, IL; Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
| | - J Luce
- 1University of California, San Francisco, CA; San Francisco General Hospital, San Francisco, CA; Stroger Hospital of Cook County, Chicago, IL; Rush University Medical Center, Chicago, IL; Emory University, Atlanta, GA; Grady Memorial Hospital, Atlanta, GA
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Farrell R, Mathews C, Walker J, Landrum L. Cervical adenocarcinoma in the elderly. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2011.07.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Mathews C, Goodrich S, Farrell R, DeSimone C, Seamon L, Landrum L. Adenocarcinoma as an independent risk factor for early-stage intermediate-risk cervical carcinoma. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.249] [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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Abstract
Carotid body tumours cause characteristic splaying of the internal and external carotid arteries, known as ‘Lyre Sign’. Vagal paragangliomas are rare tumours that arise from glomus cells along the length of the vagus nerve. We present a case in which a vagal paraganglioma has arisen from the vagus nerve at the carotid bifurcation, and has mimicked the ‘Lyre Sign’ of a carotid body tumour.
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Affiliation(s)
- R Nash
- Northwick Park Hospital, London, UK
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Hamzaoglu H, Cooper J, Alsahli M, Falchuk KR, Peppercorn MA, Farrell RJ. Safety of infliximab in Crohn's disease: a large single-center experience. Inflamm Bowel Dis 2010; 16:2109-16. [PMID: 20848473 DOI: 10.1002/ibd.21290] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [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: 01/21/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the short- and long-term safety experience of infliximab treatment in patients with Crohn's disease (CD) in clinical practice. METHODS The medical records of 297 consecutive patients with CD treated with infliximab at the Beth Israel Deaconess Medical Center were reviewed for demographic features and adverse events. RESULTS The 297 patients received a total of 1794 infusions. Patients received a median of four infusions and had a median follow-up of 14.3 months. Forty-four patients (15%) experienced a serious adverse event, requiring the infusion to be stopped in 33 patients (11%). Acute infusion reactions occurred in 18 patients (6%) including respiratory problems in 10 patients (3%) and an anaphylactoid reaction in 1 patient (0.3%). Serum sickness-like disease occurred in one patient (0.3%) and three patients (1%) developed drug-induced lupus. One patient developed a probable new demyelination disorder. Eight patients (2.7%), all of whom were on concurrent immunosuppressants, developed a serious infection, one resulting in fatal sepsis. Six patients (2%) developed malignancies including two lymphomas and two skin cancers. A total of four (1.3%) deaths were observed (median age 72.5 years); two due to gastrointestinal bleeding, one due to sepsis, and one due to malignancy. CONCLUSIONS While short- and long-term infliximab therapy was generally well tolerated, serious adverse events occurred in 15% of patients including drug-induced lupus, fatal sepsis, and malignancy. Concomitant immunosuppressants were significantly associated with infections and deaths, particularly among elderly patients.
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Affiliation(s)
- H Hamzaoglu
- Department of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
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Naik R, Galaal K, Godfrey K, Edmondson R, Kucukmetin A, Fisher A, Katory M, Mercer-Jones M, Farrell R. Surgical training in gastrointestinal procedures within a UK gynaecological oncology subspecialty programme. BJOG 2010. [DOI: 10.1111/j.1471-0528.2010.02658.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chua TC, Robertson G, Farrell R, Liauw W, Yan TD, Morris DL. Systematic review of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for ovarian peritoneal carcinomatosis: A more efficacious way of delivering intraperitoneal chemotherapy. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5524] [Citation(s) in RCA: 3] [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: 11/20/2022] Open
Abstract
5524 Background: Advanced and recurrent ovarian cancer results in extensive dissemination of tumor within the peritoneal cavity. The current evidence suggests that cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) may be a feasible option with potential benefits compared to the current standard of care in the treatment of peritoneal carcinomatosis from ovarian cancer. Methods: A systematic review of relevant studies before August 2008 was undertaken to document and report its efficacy. Each study was appraised using a predetermined protocol. The quality of studies was assessed. The patient characteristics, protocol of treatment, perioperative morbidity and mortality, and treatment outcomes were synthesized through a narrative review with full tabulation of results of all included studies. Results: In total, 15 non-randomized, observational studies were reviewed, comprising of 512 patients. All patients received HIPEC as part of the combined treatment with cytoreductive surgery. Cisplatin was the most common chemoperfusate. The mortality associated with the treatment ranged from 0 to 10%. The rates of severe morbidity ranged from 0 to 40%. The median time of follow up ranged from 14 to 64 months, the median disease-free survival ranged from 10 to 57 months and the overall median survival ranged from 22 to 64 months. In patients who had an optimal cytoreduction, the median survival ranged from 29 to 66 months, with a 3- and 5-year survival rate that ranged from 35 to 63% and 12 to 66%, respectively. Conclusions: The future for cytoreductive surgery and HIPEC in ovarian cancer is promising. More studies are called for to validate the efficacy of this treatment. For it to become generally accepted, the oncology community must commit to a randomized trial. Before this, the current treatment of cytoreductive surgery combined with adjuvant intraperitoneal and intravenous chemotherapy should remain the mainstay of treatment. No significant financial relationships to disclose.
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Affiliation(s)
| | | | | | - W. Liauw
- St George Hospital, Sydney, Australia
| | - T. D. Yan
- St George Hospital, Sydney, Australia
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Farrell R, Kapoor R, Leary S, Rudge P, Thompson A, Miller D, Giovannoni G. Neutralizing anti-interferon beta antibodies are associated with reduced side effects and delayed impact on efficacy of Interferon-beta. Mult Scler 2007; 14:212-8. [PMID: 17986510 DOI: 10.1177/1352458507082066] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED Interferon-beta (IFNbeta) is a biological therapy which is immunogenic, inducing anti-IFN-beta neutralizing antibodies (Nabs) in some subjects. The frequency of Nabs varies depending on IFN-beta product and the Nab assay used. OBJECTIVE Assess frequency of Nabs using novel Luciferase assay, evaluate association with relapses, frequency of side effects and to compare results with published data. METHODS Serum samples at 12 and 24 months and a follow up sample were tested for binding and Nabs. Titre >20 NU was considered positive. Charts were reviewed retrospectively for clinical data. RESULTS Out of 327 subjects included, 130 subjects (40%) were binding antibody positive, 89 (27%) were Nab +ve at anytime. Risk at 12 months for being Nab +ve: Avonex 8%, Betaferon 39%, Rebif 33%, P < 10(-5); at 24 months 8, 31 and 27% respectively, P = 0.002. Nab titres were highest in Rebif Nab +ve subjects - 50% >320 NU. Annualized relapse rate was 1.53 pre-treatment, after treatment relapse rate was higher in Nab +ve group 0.67 (95% CI 0.38-0.97) versus 0.5 (0.38-0.61) Nab -ve P = 0.04. Nab status at 12 and 24 months was significantly associated with risk of subsequent relapse, risk being greatest in those with highest titres. Side effects were also significantly associated with Nab -ve status.
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Affiliation(s)
- R Farrell
- National Hospital for Neurology and Neurosurgery, Institute of Neurology, Queen Square, London, UK.
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Hughes JP, Tatla T, Farrell R. How we do it: Changes in thyroid and salivary gland surgery since 1989: who's doing it and what are they doing? Clin Otolaryngol 2006; 31:443-6. [PMID: 17014459 DOI: 10.1111/j.1749-4486.2006.01244.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Keypoints * The aim of this study was to identify changes in the provision of parotid, submandibular and thyroid gland surgery between surgical specialties since 1989, as well as changes in surgical practice. * Data from the Department of Health's Hospital Episode Statistics (HES) was extracted from 1989/1990 and 2003/2004 records by operation and surgical specialty in England. * The data reveals a considerable decline in the amount of parotid and submandibular surgery performed by General surgeons; with the majority of this surgery currently being performed by ENT surgeons, and to a lesser extent, Oral and Maxillo-Facial surgeons. * Thyroid surgery has undergone less radical change, with General surgeons continuing to perform the majority of cases; however, an increasing proportion is now provided by ENT surgeons. * There also seems to be changes in the types of thyroid operation being performed; with large increases in total thyroidectomy and reductions in subtotal thyroidectomies.
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Affiliation(s)
- R J Farrell
- Department of Medicine and Gastroenterology, Connolly Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland.
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Ang YS, Farrell RJ. Risk of lymphoma: inflammatory bowel disease and immunomodulators. Gut 2006; 55:580-1. [PMID: 16531538 PMCID: PMC1856179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Liyanage SH, Khemani S, Lloyd S, Farrell R. Simple keel fixation technique for endoscopic repair of anterior glottic stenosis. J Laryngol Otol 2006; 120:322-4. [PMID: 16623977 DOI: 10.1017/s0022215106000247] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/29/2005] [Indexed: 11/05/2022]
Abstract
The use of keels in the treatment of anterior glottic stenosis is well established. A variety of methods for keel fixation have previously been documented. We describe a simple technique of securing a Silastic keel, placed endoscopically, with a simple percutaneous suture, after laser vaporization of an anterior commissure web.
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Affiliation(s)
- S H Liyanage
- Department of Otolaryngology-- Head and Neck Surgery, Northwick Park and St Mark's Hospitals, Harrow, UK
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Farrell R, Scurry J, Otton G, Hacker NF. Clinicopathologic review of malignant polyps in stage 1A carcinoma of the endometrium. Gynecol Oncol 2005; 98:254-62. [PMID: 15936803 DOI: 10.1016/j.ygyno.2005.03.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2005] [Revised: 03/21/2005] [Accepted: 03/31/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aims of this study were to determine the incidence of malignant polyps in stage 1A endometrial cancer, to define the pathological features of such cancers, and to assess whether clinical outcome differs from similar cancers without a malignant polyp. METHODS We performed a retrospective pathological review of 107 cases of stage 1A endometrial cancer treated at two centers in New South Wales between January 1988 and July 2003. The presence of a malignant polyp was determined and a pathological description made of the tumor. Clinical data were collected, including prior tamoxifen usage, tumor recurrence and survival. The outcome of the malignant polyp group was compared to the same histological subtype not involving a malignant polyp. RESULTS The incidence of malignant polyps in our series was 32%. Malignant polyps occurred in all 8 cases involving a serous subtype. Precursor lesions of endometrial cancer were identified within malignant polyps. Three out of the four recurrences occurred in high-grade tumor subtypes and all four had a large primary tumor (size > or = 4 cm). When comparing the same subtype of tumor with and without a malignant polyp, there was no significant difference in clinical outcome. CONCLUSIONS Approximately one-third of stage 1A endometrial cancers are associated with a malignant polyp. Serous carcinoma commonly arises within an otherwise benign endometrial polyp. Malignant polyps offer an opportunity to identify precursors of endometrial carcinoma. Clinical outcome of stage 1A endometrial carcinoma was related to the histological subtype and the size of the tumor rather than the presence of a malignant polyp.
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Affiliation(s)
- R Farrell
- Gynaecological Cancer Centre, Royal Hospital for Women, Sydney, Australia
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Mcdonald E, Clarke F, Dale C, Davidson C, Farrell R, Hand L, Mcardle T, Smith O, Steinberg M, Watpool I, Ward R, Heels-ansdell D, Cook D. Crit Care 2005; 9:P267. [DOI: 10.1186/cc3330] [Citation(s) in RCA: 3] [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: 11/10/2022] Open
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Dokhale PA, Silverman RW, Shah KS, Grazioso R, Farrell R, Glodo J, McClish MA, Entine G, Tran VH, Cherry SR. Performance measurements of a depth-encoding PET detector module based on position-sensitive avalanche photodiode read-out. Phys Med Biol 2004; 49:4293-304. [PMID: 15509066 DOI: 10.1088/0031-9155/49/18/007] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We are developing a high-resolution, high-efficiency positron emission tomography (PET) detector module with depth of interaction (DOI) capability based on a lutetium oxyorthosilicate (LSO) scintillator array coupled at both ends to position-sensitive avalanche photodiodes (PSAPDs). In this paper we present the DOI resolution, energy resolution and timing resolution results for complete detector modules. The detector module consists of a 7 x 7 matrix of LSO scintillator crystals (1 x 1 x 20 mm3 in dimension) coupled to 8 x 8 mm2 PSAPDs at both ends. Flood histograms were acquired and used to generate crystal look-up tables. The DOI resolution was measured for individual crystals within the array by using the ratio of the signal amplitudes from the two PSAPDs on an event-by-event basis. A measure of the total scintillation light produced was obtained by summing the signal amplitudes from the two PSAPDs. This summed signal was used to measure the energy resolution. The DOI resolution was measured to be 3-4 mm FWHM irrespective of the position of the crystal within the array, or the interaction location along the length of the crystal. The total light signal and energy resolution was almost independent of the depth of interaction. The measured energy resolution averaged 14% FWHM. The coincidence timing resolution measured using a pair of identical detector modules was 4.5 ns FWHM. These results are consistent with the design goals and the performance required of a compact, high-resolution and high-efficiency PET detector module for small animal and breast imaging applications.
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Affiliation(s)
- P A Dokhale
- Department of Biomedical Engineering, University of California-Davis, One Shields Avenue, Davis, CA 95616, USA
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Abstract
Glucocorticoids are potent inhibitors of T cell activation and proinflammatory cytokines and are highly effective treatment for active inflammatory bowel disease (IBD). However, failure to respond, acutely or chronically, to glucocorticoid therapy is a common indication for surgery in IBD, with as many as 50% of patients with Crohn's disease (CD) and approximately 20% of patients with ulcerative colitis (UC) requiring surgery in their lifetime as a result of poor response to glucocorticoids. Studies report that approximately one-third of patients with CD are steroid dependent and one-fifth are steroid resistant while approximately one-quarter of patients with UC are steroid dependent and one-sixth are steroid resistant. While the molecular basis of glucocorticoid resistance has been widely assessed in other inflammatory conditions, the pathophysiology of the glucocorticoid resistance in IBD is poorly understood. Research in IBD suggests that the phenomenon of glucocorticoid resistance is compartmentalised to T-lymphocytes and possibly other target inflammatory cells. This review focuses on three key molecular mechanisms of glucocorticoid resistance in IBD: (i) decreased cytoplasmic glucocorticoid concentration secondary to increased P-glycoprotein-mediated efflux of glucocorticoid from target cells due to overexpression of the multidrug resistance gene (MDR1); (ii) impaired glucocorticoid signaling because of dysfunction at the level of the glucocorticoid receptor; and (iii) constitutive epithelial activation of proinflammatory mediators, including nuclear factor kappa B, resulting in inhibition of glucocorticoid receptor transcriptional activity. In addition, the impact of disease heterogeneity on glucocorticoid responsiveness and recent advances in IBD pharmacogenetics are discussed.
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily B, Member 1/metabolism
- Anti-Inflammatory Agents/metabolism
- Anti-Inflammatory Agents/therapeutic use
- Carrier Proteins/genetics
- Colitis, Ulcerative/drug therapy
- Colitis, Ulcerative/immunology
- Colitis, Ulcerative/metabolism
- Crohn Disease/drug therapy
- Crohn Disease/immunology
- Crohn Disease/metabolism
- Cytokines/immunology
- Drug Resistance, Multiple/immunology
- Gene Expression
- Genes, MDR
- Humans
- Inflammatory Bowel Diseases/drug therapy
- Inflammatory Bowel Diseases/immunology
- Inflammatory Bowel Diseases/metabolism
- Intracellular Signaling Peptides and Proteins
- NF-kappa B/metabolism
- Nod2 Signaling Adaptor Protein
- Polymorphism, Genetic
- Receptors, Glucocorticoid/genetics
- Receptors, Glucocorticoid/metabolism
- T-Lymphocytes/immunology
- Treatment Failure
- Tumor Necrosis Factor-alpha/immunology
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Affiliation(s)
- R J Farrell
- Department of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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Farrell R, Gray D, Gindlesperger V, Arredondo F, Liu J, Loret de Mola J. Treatment of αVβ3 integrin abnormalities increases pregnancy success rates after failed IVF cycles. Fertil Steril 2003. [DOI: 10.1016/s0015-0282(03)01960-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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