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Sun L, Brody R, Candelieri D, Lynch JA, Cohen RB, Li Y, Getz KD, Ky B. Risk of Cardiovascular Events Among Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2023; 149:717-725. [PMID: 37347472 PMCID: PMC10288380 DOI: 10.1001/jamaoto.2023.1342] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/27/2023] [Indexed: 06/23/2023]
Abstract
Importance Cardiovascular (CV) disease is a substantial cause of morbidity and mortality in cancer due to shared risk factors and exposure to potentially cardiotoxic cancer therapy. However, our understanding of CV risk in patients with head and neck squamous cell carcinoma (HNSCC) is limited. Objective To define CV risk profiles, incident stroke, myocardial infarction (MI), and mortality in patients with HNSCC. Design, Setting, and Participants This retrospective, population-based cohort study included 35 897 US veterans with newly diagnosed HNSCC from January 1, 2000, to December 31, 2020. Data were analyzed from May 2022 to January 2023. Exposures Demographic, cancer-specific, and treatment characteristics. Main Outcomes Prevalence of CV risk factors, medication use, and control at HNSCC diagnosis; cumulative incidence of stroke and MI; and all-cause death. Results Of 35 857 US veterans with HNSCC (median [IQR] age, 63 [58-69] years; 176 [0.5%] American Indian or Alaska Native, 57 [0.2%] Asian, 5321 [16.6%] Black, 207 [0.6%] Native Hawaiian or Other Pacific Islander, and 26 277 [82.0%] White individuals), there were high rates of former or current smoking (16 341 [83%]), hypertension (24 023 [67%]), diabetes (7988 [22%]), and hyperlipidemia (18 421 [51%]). Although most patients were taking risk-lowering medications, 15 941 (47%) had at least 1 uncontrolled CV risk factor. Black race was associated with increased risk of having uncontrolled CV risk factor(s) (relative risk, 1.06; 95% CI, 1.03-1.09), and patients with larynx cancer had higher rates of prevalent and uncontrolled risk factors compared with other cancer subsites. Considering death as a competing risk, the 10-year cumulative incidence of stroke and MI was 12.5% and 8.3%, respectively. In cause-specific hazards models, hypertension, diabetes, carotid artery stenosis, coronary artery disease, and presence of uncontrolled CV risk factor(s) were significantly associated with stroke and MI. In extended Cox models, incident stroke and MI were associated with a 47% (95% CI, 41%-54%) and 71% (95% CI, 63%-81%) increased risk of all-cause death, respectively. Conclusion The results of this cohort study suggest that in HNSCC, the burden of suboptimally controlled CV risk factors and incident risk of stroke and MI are substantial. Modifiable CV risk factors are associated with risk of adverse CV events, and these events are associated with a higher risk of death. These findings identify populations at risk and potentially underscore the importance of modifiable CV risk factor control and motivate strategies to reduce CV risk in HNSCC survivorship care.
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Affiliation(s)
- Lova Sun
- Division of Hematology Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Robert Brody
- Division of Otorhinolaryngology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | | | - Julie A. Lynch
- VA Salt Lake City Health Care System, University of Utah, Salt Lake City
| | - Roger B. Cohen
- Division of Hematology Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Yimei Li
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Kelly D. Getz
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Bonnie Ky
- Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Lukens J, Poirier K, Reardon B, Weinstein G, Newman J, Chalian A, Brody R, Rajasekaran K, Cannady S, Basu D, Rassekh C, Shanti R, Montone K, Sun L, Singh A, Cohen R, Lin A. A Phase II Study of Volume and Dose De-Intensification Following Transoral Robotic Surgery (TORS) and Neck Dissection for p16+ Oropharyngeal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Tonnessen R, Samavat H, Rigassio Radler D, Wills J, Brody R. The Relationship between Grit and Growth Mindset and Educational and Professional Characteristics in Clinical Nutrition Graduate Students. J Acad Nutr Diet 2022. [DOI: 10.1016/j.jand.2022.06.168] [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: 10/15/2022]
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Torres-Cruz R, Gassmann C, Sackey J, Touger-Decker R, Brody R. Frequency of Performance of Advanced Practice Tasks Among Alumni from the Rutgers School of Health Professions Department of Clinical and Preventive Nutrition Sciences Graduate Programs. J Acad Nutr Diet 2022. [DOI: 10.1016/j.jand.2022.06.152] [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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Mack P, Gomez J, Rodilla A, Carreño J, Hsu CY, Rolfo C, Meshulami N, Moore A, Brody R, King J, Treatman J, Lee S, Raskin A, Srivastava K, Gleason C, Tcheou J, Bielak D, Acharya R, Gerber D, Rohs N, Henschke C, Yankelevitz D, Simon V, Minna J, Bunn P, García- Sastre A, Krammer F, Shyr Y, Hirsch F. OA06.03 Serological Response to SARS-CoV-2 Vaccination in Patients Lung Cancer: A Mount Sinai-Led Prospective Matched Controlled Study. J Thorac Oncol 2022. [PMCID: PMC9452018 DOI: 10.1016/j.jtho.2022.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sun L, Brody R, Candelieri D, Anglin-Foote T, Lynch JA, Maxwell KN, Damrauer S, Ojerholm E, Lukens JN, Cohen RB, Getz KD, Hubbard RA, Ky B. Association Between Up-front Surgery and Risk of Stroke in US Veterans With Oropharyngeal Carcinoma. JAMA Otolaryngol Head Neck Surg 2022; 148:740-747. [PMID: 35737359 PMCID: PMC9227679 DOI: 10.1001/jamaoto.2022.1327] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Importance Cardiovascular events are an important cause of morbidity in patients with oropharyngeal squamous cell carcinoma (OPSCC). Radiation and chemotherapy have been associated with increased risk of stroke; up-front surgery allows the opportunity for (chemo)radiotherapy de-escalation. Objective To evaluate whether up-front surgery was associated with decreased stroke risk compared to nonsurgical treatment for OPSCC. Design, Setting, and Participants This cohort study was conducted at the US Veterans Health Administration and examined US veterans diagnosed with nonmetastatic OPSCC from 2000 to 2020. Data cutoff was September 17, 2021, and data analysis was performed from October 2021 to February 2022. Exposures Up-front surgical treatment or definitive (chemo)radiotherapy as captured in cancer registry. Main Outcomes and Measures Cumulative incidence of stroke, accounting for death as a competing risk; and association between up-front surgery and stroke risk. After generating propensity scores for the probability of receiving surgical treatment and using inverse probability weighting (IPW) to construct balanced pseudo-populations, Cox regression was used to estimate a cause-specific hazard ratio (csHR) of stroke associated with surgical vs nonsurgical treatment. Results Of 10 436 patients, median (IQR) age was 61 (56-67) years; 10 329 (99%) were male; 1319 (13%) were Black, and 7823 (75%) were White; 2717 received up-front surgery, and 7719 received nonsurgical therapy with definitive (chemo)radiotherapy. The 10-year cumulative incidence of stroke was 12.5% (95% CI, 11.8%-13.3%) and death was 57.3% (95% CI, 56.2%-58.4%). Surgical patients who also received (chemo)radiotherapy had shorter radiation and chemotherapy courses than nonsurgical patients. After propensity score and IPW, the csHR of stroke for surgical treatment was 0.77 (95% CI, 0.66-0.91). This association was consistent across subgroups defined by age and baseline cardiovascular risk factors. Conclusions and Relevance In this cohort study, up-front surgical treatment was associated with a 23% reduced risk of stroke compared with definitive (chemo)radiotherapy. These findings present an important additional risk-benefit consideration to factor into treatment decisions and patient counseling and should motivate future studies to examine cardiovascular events in this high-risk population.
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Affiliation(s)
- Lova Sun
- Division of Hematology and Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia,Corporal Michael Crescenz VA Medical Center, Philadelphia
| | - Robert Brody
- Corporal Michael Crescenz VA Medical Center, Philadelphia,Division of Otorhinolaryngology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | | | - Tori Anglin-Foote
- VA Salt Lake City Health Care System, University of Utah, Salt Lake City
| | - Julie A. Lynch
- VA Salt Lake City Health Care System, University of Utah, Salt Lake City
| | - Kara N. Maxwell
- Division of Hematology and Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia,Corporal Michael Crescenz VA Medical Center, Philadelphia,Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Scott Damrauer
- Corporal Michael Crescenz VA Medical Center, Philadelphia,Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia,Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Eric Ojerholm
- Corporal Michael Crescenz VA Medical Center, Philadelphia,Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - John N. Lukens
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Roger B. Cohen
- Division of Hematology and Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Kelly D. Getz
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Rebecca A. Hubbard
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Bonnie Ky
- Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Sannigrahi MK, Rajagopalan P, Lai L, Liu X, Sahu V, Nakagawa H, Brody R, Morgan IM, Windle BE, Wang X, Gimotty PA, Kelly DP, White EA, Basu D. Abstract 2329: Variable HPV E6 levels among oropharyngeal cancers govern therapy response via the PGC1/ERR axis. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-2329] [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: Elevated mitochondrial antioxidant defenses contribute to progression and therapy resistance of some poor prognosis cancer types. By contrast, HPV+ oropharyngeal squamous cell carcinomas (OPSCCs) are generally sensitive to oxidative damage from radiation plus cisplatin, which are often curative. It is unknown whether the subset of HPV+ OPSCCs with poor outcomes exploit antioxidant capacity provided by high mitochondrial mass to evade therapy. It is also unclear whether the wide range of HPV oncoprotein expression among them contributes to diversity in mitochondrial mass and treatment outcomes.
AIMS: (1) evaluate HPV+ OPSCCs for associations between mitochondrial mass and clinical outcome (2) elucidate relationships among HPV oncoprotein levels, mitochondrial mass, and therapy response (3) delineate mechanisms by which variable HPV oncoprotein levels govern therapy response.
METHODS/RESULTS: High expression of genes involved in oxidative metabolism was associated with decreased survival in three patient cohorts. In PDX and cell line models, cisplatin resistance positively correlated with mitochondrial mass (MTCO1/B2M), oxidative metabolism (basal OCR), and antioxidant capacity (NADPH/NADP+). Among the HPV oncoproteins, only full length E6 (fl-E6) was linked to these features, showing negative correlation with mitochondrial mass in the cell lines, PDXs, and patient tumors. Fl-E6 levels also positively correlated with cisplatin response in the PDXs and cell lines. To test whether fl-E6 can mediate such effects, lentiviral fl-E6 expression in HPV+ cancer cell lines with low endogenous fl-E6 was used to increase levels to the high end of the range seen in human tumors. Doing so reduced MTCO1/B2M, basal OCR, and NADPH/NADP+ while sensitizing to radiation and cisplatin in vitro and in vivo. The same effects on mitochondrial biogenesis were maintained in nTERT/E7 keratinocytes. Using luciferase reporter assays, fl-E6 was shown to repress the PGC-1/ERR axis for mitochondrial biogenesis by attenuating p53-dependent PGC1α promoter activity. The prediction of PGC1/ERR axis activation in tumors with low fl-E6 was confirmed in PDXs and patient cohorts, where high ERRα was negatively prognostic.
CONCLUSIONS: These results reveal a novel ability of E6-mediated p53 downregulation to contribute to treatment sensitivity by depleting mitochondrial antioxidant capacity. They also provide evidence that differing fl-E6 levels across HPV+ cancers variably repress the PGC1/ERR pathway, leading to diversity in mitochondrial mass that impacts therapy response. Therapy-refractory features may prove identifiable using expression-based biomarkers in the PGC1/ERR axis and be mitigated through targetable nodes in this pathway. In addition, HPV+ OPSCCs may find competitive advantage in down-regulating fl-E6 upon acquiring alternate drivers to compensate decrease in its oncogenic functions.
Citation Format: Malay K. Sannigrahi, Pavithra Rajagopalan, Ling Lai, Xinyi Liu, Varun Sahu, Hiroshi Nakagawa, Robert Brody, Iain M. Morgan, Bradford E. Windle, Xiaowei Wang, Phyllis A. Gimotty, Daniel P. Kelly, Elizabeth A. White, Devraj Basu. Variable HPV E6 levels among oropharyngeal cancers govern therapy response via the PGC1/ERR axis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2329.
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Affiliation(s)
| | | | - Ling Lai
- 1University of Pennsylvania, Philadelphia, PA
| | - Xinyi Liu
- 2University of Illinois Chicago, Chicago, IL
| | | | | | | | - Iain M. Morgan
- 4Philips Institute for Oral Health Research, Richmond, VA
| | | | | | | | | | | | - Devraj Basu
- 1University of Pennsylvania, Philadelphia, PA
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Sun L, Brody R, Candelieri D, Anglin-Foote T, Lynch JA, Hausler R, Maxwell KN, Damrauer S, Ojerholm E, Lukens JN, Cohen RB, Getz KD, Hubbard RA, Ky B. Association between up-front surgery and risk of stroke in U.S. veterans with oropharyngeal squamous cell carcinoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.6057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6057 Background: Cardiovascular disease and stroke are important causes of long-term morbidity and mortality in patients with oropharyngeal squamous cell carcinoma (OPSCC). Cancer treatments including radiotherapy to the neck and chemotherapy have been associated with increased risk of stroke. In the era of treatment de-intensification for OPSCC, up-front surgical treatment has been proposed as one strategy that allows for de-escalation or avoidance of (chemo)radiotherapy. We sought to quantify the cumulative incidence of stroke in patients treated for non-metastatic OPSCC, and then evaluate whether patients receiving up-front surgery for OPSCC have decreased risk of stroke compared to those undergoing non-surgical treatment. Methods: We identified a cohort of 10,436 United States veterans diagnosed with non-metastatic OPSCC from 2000-2020, of whom 2,717 received up-front surgery (with or without perioperative radiotherapy or chemoradiotherapy) and 7,719 received non-surgical therapy (definitive radiotherapy or chemoradiotherapy). We estimated the cumulative incidence of stroke in this population, accounting for death as a competing risk. To assess the association between up-front surgery and risk of stroke, we generated a propensity score for the probability of receiving surgical treatment and used inverse probability weighting to construct pseudo-populations balanced on all potential confounders. Cox regression models of the inverse probability weighted population were used to estimate the cause-specific hazard ratio of stroke associated with surgical vs non-surgical treatment. Results: The 10-year cumulative incidence of stroke was 12.5% (95% CI 11.8-13.23) and death was 57.3% (95% CI 56.2-58.4). Up-front surgical patients who underwent perioperative (chemo)radiotherapy had shorter radiation and chemotherapy courses compared to non-surgical patients, suggestive of lower treatment intensity. Propensity score generation and inverse probability weighting yielded good overlap and covariate balance between surgical and non-surgical treatment groups. The inverse probability weighted cause-specific hazard ratio of stroke associated with up-front surgical treatment was 0.77 (95% CI 0.66-0.91, p = 0.002). This association was consistent across subgroups defined by age ( > /≤65 years) and baseline cardiovascular risk factors (hypertension, hyperlipidemia, diabetes). Conclusions: In over 10,000 US veterans with OPSCC, cumulative incidence of stroke was 12.5% at 10 years. Up-front surgical treatment was associated with a 23% reduced risk of stroke compared to definitive (chemo)radiotherapy. These findings present an important additional risk-benefit consideration to factor into treatment decisions and patient counseling, and should motivate future studies to examine cardiovascular events in this high-risk population.
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Affiliation(s)
- Lova Sun
- University of Pennsylvania, Philadelphia, PA
| | | | | | - Tori Anglin-Foote
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, UT
| | - Julie Ann Lynch
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, UT
| | - Ryan Hausler
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, UT
| | | | | | - Eric Ojerholm
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | | | | | - Kelly D. Getz
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Bonnie Ky
- Hospital of the University of Pennsylvania, Philadelphia, PA
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Basu D, Cao A, Raghav L, Rajagopalan P, Brody R, Gimotty PA. Cataloging targetable dependencies of head and neck cancer cell lines in the DepMap CRISPR screens. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.6056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6056 Background: The DepMap genome-wide loss of function CRISPR screens offer new insight into gene dependencies in HPV(-) head and neck squamous cell carcinoma (HNSCC) cell lines. We aimed to leverage this data to guide preclinical studies by cataloging targetable dependencies and identifying ones predicted to offer a therapeutic window. We also aimed to identify targets representing potential synthetic lethalities by testing for associations between genetic alterations and dependency profile. Methods: DepMap was queried for gene probability and effect scores in cell lines from 77 tumors, including 62 HPV(-) HNSCCs plus 15 ESCCs, which have comparable etiology, genetic features, and tissue of origin. A probability score of ≥ 0.5 was used as the threshold for essentiality. Essential genes were selected for analysis by 3 criteria: (1) presence in ≥10% cell lines, (2) lack of dependency in CRISPR screens of normal human cell lineages, and (3) designation as druggable by the Drug-Gene Interaction Database. Gene set enrichment analysis was performed using the Hallmark Gene Sets. DepMap gene effect scores were used to prioritize targets likely to have a useful therapeutic window based on median scores greater than for EGFR (0.676), a target with established albeit modest utility for HNSCC. The Open Targets platform was used to identify targets with inhibitors used in trials for other cancers and/or nonmalignant diseases. Associations between dependencies and genetic alterations were defined using two-sample t-tests, with filter conditions of p < 0.05 and effect size ≥1. Results: The 231 genes meeting selection criteria had a median gene effect score of 0.56. The criteria captured targets of standard therapeutic agents including TYMS (5-FU), tubulin genes (paclitaxel), EGFR (cetuximab), plus known oncogenes like PIK3CA. GSEA showed enrichment of known oncogenic signaling pathways including PI3K/AKT and JAK/STAT, as well as hallmark cancer processes like DNA repair and apoptosis. 90% were not known oncogenes cataloged in the OncoKB Database. 45 genes had a median gene effect score between that of EGFR and the median for common essential genes, including 7 without known cancer-promoting roles: OTOP1, DHRSX, UTP11, MBTPS1, SLC25A3, PPIAL4G, and RBM10. 17% had inhibitors that reached a non-HNSCC phase II trial, including 10 targets not previously tested in cancer. Novel associations between dependencies and genetic alterations included DDX3X with NOTCH1mut, ITGB1 with CDKN2Amut, and ATP1A1 with HRASmut. Conclusions: We catalog targetable dependencies in cell line models of HNSCC. While well-studied targets were captured, many genes lacked known roles in malignancy. Targets of inhibitors tested in other diseases provide new tools to guide preclinical studies. Association of some dependencies with known molecular subgroups in HNSCC may enhance use of cell line models to personalize therapy.
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Affiliation(s)
- Devraj Basu
- The University of Pennsylvania, Philadelphia, PA
| | - Austin Cao
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Cao A, Rajagopalan P, Gimotty P, Brody R, Basu D. Targetable Vulnerabilities of Head and Neck Cancer Cell Lines Detected by the DepMap CRISPR Screens. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.01.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lee D, Wright C, Shimunov D, Carmona R, Barsky A, Sun L, Cohen R, Bauml J, Brody R, Basu D, Rassekh C, O'Malley B, Chalian A, Newman J, Rajasekaran K, Weinstein G, Lukens J, Lin A, Swisher-McClure S. Definitive Tumor Directed Therapy for Metachronous Oligometastatic HPV-Associated Oropharyngeal Cancer Following Trans-Oral Robotic Surgery. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Maxwell R, Poirier K, Montone K, Swisher-McClure S, Kumar S, Kuperwasser C, Bauml J, Cohen R, Newman J, Brody R, Rajasekaran K, Chalian A, Rassekh C, Weinstein G, Lin A, Lukens J. Detection of Plasma Circulating Tumor-Tissue Modified HPV DNA Following Trans-Oral Robotic Surgery (TORS) and Neck Dissection for p16+ Oropharyngeal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1163] [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: 10/20/2022]
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Chan L, Dobak S, Brody R, Peterson S. Digital Learning: A Survey of RDN Attitudes and Utilization of YouTube for Nutrition Education. J Acad Nutr Diet 2021. [DOI: 10.1016/j.jand.2021.06.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kronisch L, Rigassio-Radler D, Sackey J, Brody R. Food Insecurity and Academic Performance among Students Attending a Large Northeastern U.S. Health Sciences University. J Acad Nutr Diet 2021. [DOI: 10.1016/j.jand.2021.06.241] [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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Basu D, Shimunov D, Cohen RB, Lin A, Swisher-McClure S, Lukens JN, Bauml J, Hartner LP, Aggarwal C, Duvvuri U, Rajasekaran K, Chalian A, Rassekh C, Cannady S, Newman J, O'Malley BW, Weinstein GS, Gimotty PA, Brody R. Outcomes and prediction of lethal recurrence after transoral robotic surgery for HPV+ head and neck cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.6047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6047 Background: Increasing use of transoral robotic surgery (TORS) for human papilloma virus-related (HPV+) head and neck squamous cell carcinomas (HNSCCs) is likely to impact recurrence patterns and outcomes. Profiling HPV+ HNSCC recurrences after TORS and identifying features predictive of lethal outcome would facilitate tailoring adjuvant therapy and guide surveillance post-therapy. This study uses long term follow-up of patients at the first institution to bring TORS into clinical use to describe the recurrence patterns, distinguish outcomes associated with distinct patterns, and create a risk model for lethal recurrence. Methods: This retrospective cohort study at a single academic tertiary center analyzed 634 consecutive, treatment-naïve HPV+ HNSCC patients receiving TORS and neck dissection for clinical features at presentation and pathologic traits identified by surgical resection. The main outcomes were distant metastatic recurrence (DMR) and locoregional recurrence (LRR). Multivariate logistic regression with backward stepwise elimination was used to identify features associated with recurrence. Results: 6.5% of patients developed DMR at a median of 12.4 months after surgery and had a 5-year overall survival (OS) of 52.5% (95% CI, 33.9%-68.2%), whereas the 6.2% patients developing LRR alone had 5-year OS of 83.3% (95% CI, 66.2%-92.2%; P =.01). After recurrence, 5-year progression-free survival was 24.7% (95% CI, 11.4%-40.7%) for DMR cases and 85.7% (95% CI, 65.1-94.6%) for cases with LRR alone (P <.001). Comparing recurrent cases to recurrence-free controls showed DMR to be independently associated with positive surgical margins (AOR 5.7; 95% CI, 2.1-15.7) and advanced clinical stage at presentation (AOR 6.5; 95% CI, 1.9-23.0). Positive margins increased DMR risk by 4.2-fold and reduced 5-year disease-free survival (P <.001) in early-stage cases (Table), which comprised 95% of the cohort. By contrast, isolated LRR was associated with failure to receive indicated adjuvant therapy and was usually controllable by salvage therapy. Conclusions: Based on the largest single institution cohort reported to date, long term oncologic outcomes for HPV+ HNSCCs after TORS are excellent overall. While DMR is often fatal, LRR is salvageable with durable disease control. In addition to standard staging criteria, positive margins indicate substantially higher risk of DMR but not LRR. A risk model for DMR that incorporates margin status after TORS is relevant for guiding clinical trial design and whole-body surveillance.[Table: see text]
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Affiliation(s)
- Devraj Basu
- The University of Pennsylvania, Philadelphia, PA
| | | | - Roger B. Cohen
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Alexander Lin
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | | | - Joshua Bauml
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Lee P. Hartner
- Univ of Pennsylvania Abramson Cancer Ctr, Philadelphia, PA
| | | | | | | | - Ara Chalian
- The University of Pennsylvania, Philadelphia, PA
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Morand A, Brody R, Touger-Decker R, Chen S, Chee W, Sackey J, Gomes A, Tomesko J. Changes in Nutrition-Focused Physical Exam Practices of Dietitians in Malaysia who Completed a Hybrid Training Program. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.06.132] [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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Meissner C, Brody R, OSullivan-Maillet J, Rothpletz-Puglia P. Dietetic Interns’ Perceptions: Values of Clinical Rotation Tasks Contributing to Entry-Level Competency. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.06.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Dalton J, Rawal S, Rothpletz -Puglia P, Epstein J, Byham-Gray L, Brody R, Ganzer H, Touger-Decker R. Exploring the Transition of Identity in the Eating Experience in Individuals Post-Treatment for Head and Neck Cancer. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.06.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Tomesko J, Brody R, Chen S, Chee W, Sackey J, Gomes A, Heir G, Touger-Decker R. Use of a Hybrid Training Program to Teach Nutrition Focused Physical Examination to Dietetic Educators and Dietitians in Malaysia. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.06.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Swisher-McClure S, Lukens JN, Aggarwal C, Ahn P, Basu D, Bauml JM, Brody R, Chalian A, Cohen RB, Fotouhi-Ghiam A, Geiger G, Gershowitz J, Livolsi V, Mitra N, Montone K, Newman J, Ojerholm E, O'Malley B, Rajasekaran K, Tan E, Weinstein G, Lin A. A Phase 2 Trial of Alternative Volumes of Oropharyngeal Irradiation for De-intensification (AVOID): Omission of the Resected Primary Tumor Bed After Transoral Robotic Surgery for Human Papilloma Virus-Related Squamous Cell Carcinoma of the Oropharynx. Int J Radiat Oncol Biol Phys 2019; 106:725-732. [PMID: 31785337 DOI: 10.1016/j.ijrobp.2019.11.021] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/29/2019] [Accepted: 11/01/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE This trial tested the safety and efficacy of a novel, deintensified radiation therapy (RT) approach after initial surgical resection for patients with human papilloma virus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC). METHODS AND MATERIALS This single-arm phase 2 prospective clinical trial enrolled 60 patients with stage pT1-pT2 N1-3 HPV-associated OPSCC treated with transoral robotic surgery (TORS) and selective neck dissection at a single institution between May 2014 and September 2017. Patients had favorable features at the primary site (negative surgical margins ≥2 mm, no perineural invasion, and no lymphovascular invasion) but required adjuvant therapy based on lymph node involvement. Surgeries were all performed at a high-volume head and neck cancer center with expertise in TORS. Patients received postoperative RT to at-risk areas in the involved neck (60-66 Gy) and uninvolved neck (54 Gy). The resected primary site was treated as an active avoidance structure in the treatment planning of postoperative RT. Concurrent chemotherapy was administered for patients with extranodal extension. RESULTS Median follow-up of the 60 patients enrolled was 2.4 years (range, 8.5-53.8 months). A single patient recurred at the primary site, for 2-year local control of 98.3%. One patient (1.7%) developed a regional neck recurrence, and 2 patients (3.3%) developed distant metastases. Measured 2-year local recurrence-free survival was 97.9% (95% confidence interval, 86.1%-99.7%). Overall survival was 100% at the time of analysis. The mean radiation dose to the primary site was 36.9 Gy (standard deviation, 10.3 Gy). Two patients (3.3%) experienced late soft tissue necrosis in the primary site surgical bed that resolved within 2 months. Feeding tube dependence rates were 0% during RT, 3.3% temporarily during follow-up, and 0% at last follow-up. CONCLUSIONS Deintensified postoperative RT that avoids the resected primary tumor site and targets only the at-risk neck after TORS for selected patients with HPV-associated OPSCC may be safe and is worthy of further study.
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Affiliation(s)
- Samuel Swisher-McClure
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John N Lukens
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Charu Aggarwal
- Department of Medicine, Division of Hematology/Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter Ahn
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Devraj Basu
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joshua M Bauml
- Department of Medicine, Division of Hematology/Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert Brody
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ara Chalian
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Roger B Cohen
- Department of Medicine, Division of Hematology/Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alireza Fotouhi-Ghiam
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Geoffrey Geiger
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jared Gershowitz
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Virginia Livolsi
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kathleen Montone
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jason Newman
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eric Ojerholm
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bert O'Malley
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Erik Tan
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory Weinstein
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander Lin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
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Schabath MB, Dalvi TB, Dai HA, Crim AL, Midha A, Shire N, Gimbrone NT, Walker J, Greenawalt DM, Lawrence D, Rigas JR, Brody R, Potter D, Kumar NS, Huntsman SA, Gray JE. A Molecular Epidemiological Analysis Of Programmed Cell Death Ligand-1 (PD-L1) Protein Expression, Mutations And Survival In Non-Small Cell Lung Cancer. Cancer Manag Res 2019; 11:9469-9481. [PMID: 31819612 PMCID: PMC6844199 DOI: 10.2147/cmar.s218635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/18/2019] [Indexed: 12/17/2022] Open
Abstract
Purpose To characterize programmed cell death ligand-1 (PD-L1) expression in relation to survival and gene mutation status in patients with advanced NSCLC. The study also explored the influence of tumor mutational burden (TMB) on PD-L1 expression and patient characteristics. Patients and methods Adult patients with histologically or cytologically documented Stage IIIB/Stage IV/recurrent/progressive NSCLC, Eastern Cooperative Oncology Group performance status 0 to 3, and >2 lines of prior systemic treatment regimens were included in this retrospective analysis. Patients were treated from 1997 to 2015 at H. Lee Moffitt Cancer Center and Research Institute, Tampa, or at 7 community centers across the United States. PD-L1 expression level was determined using the VENTANA PD-L1 (SP263) Assay. EGFR and KRAS mutation status and ALK rearrangements were determined by targeted DNA sequencing; these were obtained from clinical records where targeted DNA sequencing was not performed. TMB was calculated as the total number of somatic mutations per sample. Results From a total of 136 patients included in the study, 23.5% had tumors with high PD-L1 expression (≥25%). There were no significant differences in patient characteristics, overall survival (OS), and progression-free survival (PFS) between patients with high PD-L1 expression (median OS: 39.5 months; median PFS: 15.8 months) vs low PD-L1 expression (<25%; median OS: 38.1 months; median PFS: 18.6 months). PD-L1 expression level correlated (P=0.05) with TMB and was consistent with The Cancer Genome Atlas data. Conclusion In this retrospective analysis, survival outcomes of patients with advanced NSCLC were comparable by PD-L1 expression level. EGFR and KRAS mutation status were not found to be significantly associated with PD-L1 expression level, while TMB was weakly associated with PD-L1 expression level. Overall, PD-L1 expression level was not observed to be an independent prognostic biomarker in this cohort of patients with advanced NSCLC treated with chemotherapy.
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Affiliation(s)
- Matthew B Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | | | | | - Anita Midha
- Department of Personalised Healthcare and Biomarkers, AstraZeneca, Cambridge, UK
| | - Norah Shire
- Oncology R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Nicholas T Gimbrone
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jill Walker
- Department of Precision Medicine Oncology, AstraZeneca, Cambridge, UK
| | | | - David Lawrence
- Department of Global Medicines Development, AstraZeneca, Cambridge, UK
| | - James R Rigas
- Department of Global Medical Affairs Oncology, AstraZeneca, Gaithersburg, MD, USA
| | - Robert Brody
- Department of Global Medical Affairs Oncology, AstraZeneca, Gaithersburg, MD, USA
| | - Danielle Potter
- Department of Global Medical Affairs Oncology, AstraZeneca, Gaithersburg, MD, USA
| | | | | | - Jhanelle E Gray
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Treacy P, Pavlova I, Falagario U, Brody R, Epstein J, Cordero Bravo J, Barthe F, Wiklund P, Tewari A, Durand M. Mesure du collagène au sein d’un tissu cancéreux prostatique à l’aide du microscope multiphotonique : résultats préliminaires. Prog Urol 2019. [DOI: 10.1016/j.purol.2019.08.218] [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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23
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Baltz J, Brody R, Sackey J, Touger-Decker R. The Perceived Value of the Advanced Practice Certification in Clinical Nutrition by Registered Dietitian Nutritionists Who Hold the Credential and Potentially Eligible Candidates. J Acad Nutr Diet 2018. [DOI: 10.1016/j.jand.2018.06.247] [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: 11/27/2022]
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24
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Roberts S, Byham-Gray L, Brody R, Rawal S. VBEN vs RBEN in the ICU: Impact on Nutrition Delivery and Glycemic Control. J Acad Nutr Diet 2018. [DOI: 10.1016/j.jand.2018.06.262] [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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Rajaram S, Wiecek W, Lawson R, Blak B, Zhao Y, Hackett J, Brody R, Salimi T, Amzal B, Patel V. A retrospective observational analysis of post-pandemic influenza-related outcomes in the United Kingdom, 2010-2014. Hum Vaccin Immunother 2018; 14:368-377. [PMID: 29135336 PMCID: PMC5806636 DOI: 10.1080/21645515.2017.1403696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study set out to evaluate influenza- and respiratory-related illnesses recorded during primary care physician consultations in England following the H1N1 pandemic in 2009 and to enable the development of a dynamic disease model. Data were obtained from the Clinical Practice Research Datalink of primary care records over four influenza seasons (2010–2014). The primary outcome of the study was incidence of influenza- and respiratory-related diagnoses, calculated per practice and by season and age group. Upper respiratory tract infection diagnoses were most frequently recorded (mean seasonal practice level incidence; 3,762 consultations per 100,000 [SD = 1,989]), and influenza-related diagnoses were least frequently recorded across all seasons, except one. Incidence rates for the under 18 population were higher than those for the general population, in particular for upper respiratory tract infection (range of 8,024–9,950 versus 3,228–4,120, respectively) and otitis media diagnoses (2,668–3,652 versus 782–1,057, respectively). For influenza-related diagnoses, the 65+ age group, the 0 to <2 and 2 to <4 groups had a higher risk (risk ratio = 1.33, 1.12 and 1.16, respectively) than other age groups. This study provides valuable insight into the incidence of influenza- and respiratory-related diagnoses in the primary care setting in England, and suggests a higher burden of disease in young children and the elderly. The study also indicates that some influenza illness is likely to be reported under respiratory-related diagnoses, given the low incidence of influenza-related diagnoses in the study.
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Kennedy DW, Brody R. 55 Year-old Patient with Intranasal Mass. Int Forum Allergy Rhinol 2018; 8:77. [PMID: 29314773 DOI: 10.1002/alr.22077] [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: 11/09/2022]
Abstract
The patient is a 55 year old female who presented with a right sided intranasal mass in 2014. Surgery was recommended, but the patient cancelled the surgery. She returned three years later with a significant progression of the lesion. What is this lesion and how would you manage it? Five months after resection of the lesion, the patient returns with pulsatile clear mucus visible on nasal endoscopy in the region of the prior mass excision. What does this represent and how should we proceed at this point? Is the patient developing a meningo-encephalocele?
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Affiliation(s)
- David W Kennedy
- Rhinology Professor, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Robert Brody
- Head and Neck and Microvascular Fellow, Department of Otolaryngology-Head and Neck Surgery, University of South Carolina
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Rajaram S, Wiecek W, Lawson R, Blak BT, Zhao Y, Hackett J, Brody R, Patel V, Amzal B. Impact of increased influenza vaccination in 2-3-year-old children on disease burden within the general population: A Bayesian model-based approach. PLoS One 2017; 12:e0186739. [PMID: 29244811 PMCID: PMC5731690 DOI: 10.1371/journal.pone.0186739] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 10/08/2017] [Indexed: 11/19/2022] Open
Abstract
Introduction During the 2013–2014 influenza season, Public Health England extended routine influenza vaccination to all 2- and 3-year-old children in England. To estimate the impact of this change in policy on influenza-related morbidity and mortality, we developed a disease transmission and surveillance model informed by real-world data. Methods We combined real-world and literature data sources to construct a model of influenza transmission and surveillance in England. Data were obtained for four influenza seasons, starting with the 2010–2011 season. Bayesian inference was used to estimate model parameters on a season-by-season basis to assess the impact of targeting 2- and 3-year-old children for influenza vaccination. This provided the basis for the construction of counterfactual scenarios comparing vaccination rates of ~2% and ~35% in the 2- and 3- year-old population to estimate reductions in general practitioner (GP) influenza-like-illness (ILI) consultations, respiratory hospitalizations and deaths in the overall population. Results Our model was able to replicate the main patterns of influenza across the four seasons as observed through laboratory surveillance data. Targeting 2- and 3-year-old children for influenza vaccination resulted in reductions in the general population of between 6.2–9.9% in influenza-attributable GP ILI consultations, 6.1–10.7% in influenza-attributable respiratory hospitalizations, and 5.7–9.4% in influenza-attributable deaths. The decrease in influenza-attributable ILI consultations represents a reduction of between 4.5% and 7.3% across all ILI consultations. The reduction in influenza-attributable respiratory hospitalizations represents a reduction of between 1.2% and 2.3% across all respiratory hospitalizations. Reductions in influenza-attributable respiratory deaths represent a reduction of between 0.9% and 2.4% in overall respiratory deaths. Conclusion This study has provided evidence that extending routine influenza vaccination to all healthy children aged 2 and 3 years old leads to benefits in terms of reduced utilization of healthcare resources and fewer respiratory health outcomes and deaths.
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Affiliation(s)
| | | | - Richard Lawson
- AstraZeneca, Gaithersburg, Maryland, United States of America
| | | | - Yanli Zhao
- MedImmune, Gaithersburg, Maryland, United States of America
| | - Judith Hackett
- AstraZeneca, Gaithersburg, Maryland, United States of America
| | - Robert Brody
- AstraZeneca, Gaithersburg, Maryland, United States of America
| | - Vishal Patel
- Formerly of LASER Analytica, London, United Kingdom
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Brody R, Zhang Y, Ballas M, Siddiqui MK, Gupta P, Barker C, Midha A, Walker J. PD-L1 expression in advanced NSCLC: Insights into risk stratification and treatment selection from a systematic literature review. Lung Cancer 2017; 112:200-215. [DOI: 10.1016/j.lungcan.2017.08.005] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 05/19/2017] [Accepted: 08/03/2017] [Indexed: 12/16/2022]
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Romano M, Brody R, Marcus A, Touger-Decker R. Comparison of Performance of Advanced Clinical Nutrition Practice Tasks of Registered Dietitian Nutritionists with Graduate Degrees. J Acad Nutr Diet 2017. [DOI: 10.1016/j.jand.2017.06.356] [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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Workman A, Brody R, Parasher A, Glicksman J, Brooks S, Newman J, Rassekh C, Chalian A, Chiu A, Weinstein G, Adappa N, O'Malley B, Palmer J. Sinonasal Undifferentiated Carcinoma: A 15-Year Single-Institution Experience. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Alan Workman
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Robert Brody
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Arjun Parasher
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Jordan Glicksman
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Steven Brooks
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Jason Newman
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | | | - Ara Chalian
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | | | - Gregory Weinstein
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Nithin Adappa
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Bert O'Malley
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - James Palmer
- University of Pennsylvania, Philadelphia, Pennsylvania, United States
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Schabath M, Dalvi T, Dai H, Crim A, Midha A, Shire N, Walker J, Greenawalt D, Lawrence D, Rigas J, Brody R, Potter D, Kumar N, Huntsman S, Gray J. P1.01-042 Molecular Epidemiology of Programmed Cell Death 1-Ligand 1 (PD-L1) Protein Expression in Non-Small Cell Lung Cancer. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.566] [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: 10/20/2022]
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Cronin-Fenton D, Dalvi T, Hedgeman E, Norgaard M, Pedersen L, Mortensen K, Midta A, Shire N, Brody R, Fryzek J, Lawrence D, Rigas J, Potter D, Walker J, Mellemgaard A, Rasmussen T, Hamilton-Dutoit S, Sørensen H. An interim assessment of key biomarkers (programmed cell death receptor ligand 1 (PD-L1) expression and epidermal growth factor receptor (EGFR) in third-line therapy non-small cell lung cancer (NSCLC) patients: A Danish cohort study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw383.26] [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: 11/14/2022] Open
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Gallo S, Brody R, Marcus A, Touger-Decker R. Exploring Practice Activities of Advanced Clinical Practice Registered Dietitian Nutritionists. J Acad Nutr Diet 2016. [DOI: 10.1016/j.jand.2016.06.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Desjardins S, Brody R, Marcus A, Touger-Decker R. Nutrition Focused Physical Examination Practices of Registered Dietitian Nutritionists That Have Completed an In-Person Nutrition Focused Physical Examination Course. J Acad Nutr Diet 2016. [DOI: 10.1016/j.jand.2016.06.314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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35
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Tomesko J, Redgate J, Brody R, Allison G, Touger-Decker R. The Use of Computer Assisted Instruction to Teach Nutrition Focused Physical Examination to Students Enrolled In An Online Nutrition Assessment Course. J Acad Nutr Diet 2016. [DOI: 10.1016/j.jand.2016.06.235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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36
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Gall S, Brody R, Marcus A, Byham-Gray L. Determining Current Level of Research Involvement among Clinical Practice Dietitians in Colorado and New Mexico. J Acad Nutr Diet 2016. [DOI: 10.1016/j.jand.2016.06.155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Singh B, Deng FM, Kane Y, Zhan Y, Qi Y, Liu X, Zhang H, Dong Y, Brody R, Wieczorek R, Lee P. Abstract P3-05-08: High prevalence of splicing variant AR-V7 in triple negative breast carcinoma. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-05-08] [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
The androgen receptor (AR) and its pathway have been implicated in tumorigenesis and progression of breast cancer. Anti-androgen therapy has shown efficacy in the metastatic breast cancer and numerous clinical trials are underway to study efficacy in various clinical settings. 15 splicing variants of AR (AR-Vs) have been described in prostate cancer. Structurally, AR-Vs have insertions of cryptic exons downstream of the exons that encode the DNA-binding domain or deletions of the exons encoding the ligand-binding domain, resulting in a disrupted AR open reading frame and expression of ligand-binding-domain-truncated AR proteins. In prostate cancer, some of the AR-Vs especially AR-V7 are associated with aggressive disease and resistance to anti-AR therapy. The AR-V prevalence in human breast cancer specimens has hitherto not been studied. We aimed at studying the expression of AR-Vs in breast cancer specimens and present the data on AR-V1, AR-V7, AR8, and ARV567, in AR-positive triple negative (TNBC) and ER+/Her2- breast cancer.
Design: 98 cases of TNBC, 40 cases of ER+/Her2 breast cancer and 17 cases with reduction mammoplasty were abstracted from NYULMC pathology database and screened for AR expression by immunohistochemistry (IHC). IHC for AR was performed using antibody clone N-20 (Santa Cruz) at 1:100 dilution. Normal breast tissue was used as internal control and 10% nuclear staining was used for categorizing a tumor as AR positive. A subset of cases which over-expressed AR were macrodissected from formalin fixed paraffin embedded sections with total RNA extracted by using the PureLink® FFPE RNA Isolation Kit (Invitrogen). Reverse-transcription was performed by using the SuperScript® III Reverse Transcriptase Kit (Invitrogen). AR-V expression was presented as cycle number difference to housekeeping gene (delta CT) for real-time PCR or as absolute copy number for digital PCR.
Results: AR+ TNBC and AR+/ER+ cases ranged from stage 1A to IIIA. IHC for AR showed > 10% staining in 27 of 98 TNBC cases and in 39 of 40 ER+/Her2- cases.
AR Positive Prevalence in TNBC and ER+ Breast Carcinoma AR+AR-TNBC2771ER+/Her2-391
AR-V7 was expressed in 11 of 13 AR+/TNBC cases (p < 0.05); AR-V1 and AR-V4 were expressed in 4; ARV8 and ARv567es were expressed in 3 and 2 cases respectively. In 25 AR+/ER+/Her2- cases AR-V7 was expressed in 14; AR-V4 in 9; ARV567 in 5, AR-V1 in 3 cases.
AR Spliced Variant Incidence in TNBC, ER+ and Benign breast tissue Benign (N=17)ER+/AR+ (N=25)TNBC+/AR+(N=13)P ValueAR-V113(12%)4(25%)0.145AR-V419(36%)4(25%)0.35AR-V78(47%)14(56%)11(85%)0.021AR-V801(4%)3(19%)0.474AR-V56715(20%)2(12.5%)0.092
Conclusion: We report expression of various spliced variants in TNBC, ER+/Her2- breast cancer. A statistically significant expression of AR-V7 is seen in TNBC. Since AR-V7 predicts for poor prognosis and lack of response to anti-AR therapy in prostate cancer, AR-V7 expression maybe a useful biomarker to analyze response data in on going breast cancer clinical trials.
Citation Format: Singh B, Deng F-M, Kane Y, Zhan Y, Qi Y, Liu X, Zhang H, Dong Y, Brody R, Wieczorek R, Lee P. High prevalence of splicing variant AR-V7 in triple negative breast carcinoma. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-05-08.
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Affiliation(s)
- B Singh
- New York University Langone Medical Center, NY, NY; Tulane University, New Orleans, MI
| | - F-M Deng
- New York University Langone Medical Center, NY, NY; Tulane University, New Orleans, MI
| | - Y Kane
- New York University Langone Medical Center, NY, NY; Tulane University, New Orleans, MI
| | - Y Zhan
- New York University Langone Medical Center, NY, NY; Tulane University, New Orleans, MI
| | - Y Qi
- New York University Langone Medical Center, NY, NY; Tulane University, New Orleans, MI
| | - X Liu
- New York University Langone Medical Center, NY, NY; Tulane University, New Orleans, MI
| | - H Zhang
- New York University Langone Medical Center, NY, NY; Tulane University, New Orleans, MI
| | - Y Dong
- New York University Langone Medical Center, NY, NY; Tulane University, New Orleans, MI
| | - R Brody
- New York University Langone Medical Center, NY, NY; Tulane University, New Orleans, MI
| | - R Wieczorek
- New York University Langone Medical Center, NY, NY; Tulane University, New Orleans, MI
| | - P Lee
- New York University Langone Medical Center, NY, NY; Tulane University, New Orleans, MI
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Willcutts K, Brody R, Stankorb S. Preoperative Fasting Practices at a U.S. Teaching Hospital: A Retrospective Descriptive Study. J Acad Nutr Diet 2014. [DOI: 10.1016/j.jand.2014.06.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Gaylor C, Brody R, Parrott J, Touger-Decker R. Usage Patterns of the Standards of Practice and Standards of Professional Performance in Nutrition Support by Registered Dietitian Members of the American Society for Parenteral and Enteral Nutrition and Dietitians in Nutrition Support. J Acad Nutr Diet 2012. [DOI: 10.1016/j.jand.2012.06.262] [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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40
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Sudore RL, Landefeld CS, Barnes DE, Lindquist K, Williams BA, Brody R, Schillinger D. An advance directive redesigned to meet the literacy level of most adults: a randomized trial. Patient Educ Couns 2007; 69:165-95. [PMID: 17942272 PMCID: PMC2257986 DOI: 10.1016/j.pec.2007.08.015] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.4] [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: 03/10/2007] [Revised: 07/25/2007] [Accepted: 08/09/2007] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To determine whether an advance directive redesigned to meet most adults' literacy needs (fifth grade reading level with graphics) was more useful for advance care planning than a standard form (>12th grade level). METHODS We enrolled 205 English and Spanish-speaking patients, aged >/=50 years from an urban, general medicine clinic. We randomized participants to review either form. Main outcomes included acceptability and usefulness in advance care planning. Participants then reviewed the alternate form; we assessed form preference and six-month completion rates. RESULTS Forty percent of enrolled participants had limited literacy. Compared to the standard form, the redesigned form was rated higher for acceptability and usefulness in care planning, P</=0.03, particularly for limited literacy participants (P for interaction </=0.07). The redesigned form was preferred by 73% of participants. More participants randomized to the redesigned form completed an advance directive at six months (19% vs. 8%, P=0.03); of these, 95% completed the redesigned form. CONCLUSIONS The redesigned advance directive was rated more acceptable and useful for advance care planning and was preferred over a standard form. It also resulted in higher six-month completion rates. PRACTICE IMPLICATIONS An advance directive redesigned to meet most adults' literacy needs may better enable patients to engage in advance care planning.
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Affiliation(s)
- Rebecca L Sudore
- Division of Geriatrics, University of California San Francisco and the San Francisco Veterans Affairs Medical Center, CA 94121, USA, United States.
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41
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Lee N, Wuu CS, Brody R, Laguna JL, Katz AE, Bagiella E, Ennis RD. Factors predicting for postimplantation urinary retention after permanent prostate brachytherapy. Int J Radiat Oncol Biol Phys 2000; 48:1457-60. [PMID: 11121648 DOI: 10.1016/s0360-3016(00)00784-7] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE Urinary retention requiring catheterization is a known complication among prostate cancer patients treated with permanent interstitial radioactive seed implantation. However, the factors associated with this complication are not well known. This study was conducted to determine these factors. METHODS AND MATERIALS Ninety-one consecutive prostate cancer patients treated with permanent interstitial implantation at our institution from 1996 to 1999 were evaluated. All patients underwent pre-implant ultrasound and postimplant CT volume studies. Isotopes used were (125)I (54 patients) or (103)Pd (37 patients). Twenty-three patients were treated with a combination of 45 Gy of external beam radiation therapy as well as seed implantation, of which only 3 patients were treated with (125)I. Mean pretreatment prostate ultrasound volume was 35.4 cc (range, 10.0-70.2 cc). The mean planning ultrasound target volume (PUTV) was 39.6 cc (range, 16.1-74.5 cc), whereas the mean posttreatment CT target volume was 55.0 cc (range, 20.2-116 cc). Patient records were reviewed to determine which patients required urinary catheterization for relief of urinary obstruction. The following factors were analyzed as predictors for urinary retention: clinical stage; Gleason score; prostate-specific antigen; external beam radiation therapy; hormone therapy; pre-implant urinary symptoms (asymptomatic/nocturia x 1 vs. more significant urinary symptoms); pretreatment ultrasound prostate volume; PUTV; PUTV within the 125%, 150%, 200%, 250%, 300% isodose lines; postimplant CT volume within the 125%, 150%, 200%, 250%, 300% isodose lines; D90; D80; D50; ratio of post-CT volume to the PUTV; the absolute change in volume between the CT volume and PUTV; number of needles used; activity per seed; and the total activity of the implant. Statistical analyses using logistic regression and chi2 were performed. RESULTS Eleven of 91 (12%) became obstructed. Significant factors predicting for urinary retention were the total number of needles used (p < 0.038); the pretreatment ultrasound prostate volume (p < 0.048); the PUTV (p < 0.02); and the posttreatment CT volume (p < 0.021). Two of 51 patients (3.9%) requiring 33 or fewer needles (median) experienced obstruction vs. 9 of 40 (22.5%) requiring more than 33 (p < 0.007). If the pretreatment ultrasound prostate volume was 35 cc or less (median), 3 of 43 (7%) vs. 8 of 36 (22%) with a volume greater than 35 cc experienced obstruction (p < 0.051). CONCLUSION The number of needles required (perhaps related to trauma to the prostate) and the prostate volumes were significant factors predicting for urinary retention after permanent prostate seed implantation.
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Affiliation(s)
- N Lee
- Department of Radiation Oncology and Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
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42
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Brody R, Rosenfeld RM, Goldsmith AJ, Madell JR. Parents cannot detect mild hearing loss in children. First place--Resident Clinical Science Award 1998. Otolaryngol Head Neck Surg 1999; 121:681-6. [PMID: 10580220 DOI: 10.1053/hn.1999.v121.a101041] [Citation(s) in RCA: 16] [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] [Indexed: 11/11/2022]
Abstract
Otitis media with effusion is among the most common illnesses of childhood and is often associated with chronic or persistent middle ear effusion (MEE). Our goal was to develop and validate a self-administered parent survey that would identify children at high risk for mild hearing loss caused by MEE. We evaluated 115 children. Parents rated their child's hearing using the HL-7, a 7-item self-administered survey, and a global visual-analog scale. Static admittance and gradient were recorded. Test-retest reliability, internal consistency, and validity of the HL-7 were compared with the 4-frequency pure-tone average (PTA) hearing level (HL) for the better hearing ear. The HL-7 had good test-retest reliability and internal consistency. Survey scores correlated well with the global hearing rating (R = 0.67, P < 0.001) but did not correlate with PTA (R = 0.10, P = 0.29). Tympanometric gradient was unrelated to ear-specific PTA, but not abnormal static admittance (<0.2 cc), which produced a mean 7-dB HL decrease in hearing (ANOVA, P = 0.02). The HL-7 is a reliable and internally consistent measure of parent perception of child hearing, but unfortunately these perceptions are inaccurate for mild hearing loss. Abnormal static admittance is a risk factor for hearing loss.
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Affiliation(s)
- R Brody
- Department of Otolaryngology, State University of New York Health Science Center at Brooklyn College Hospital, Brooklyn, NY 11201, USA
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Ennis R, Zhao G, Gerstein A, Brody R, Rubin M, Papaopoulos N. 2153 Length of the CAG repeat polymorphism within the androgen receptor gene predicts biochemical (PSA) complete response to neo-adjuvant androgen deprivation in a prospective clinical trial. Int J Radiat Oncol Biol Phys 1999. [DOI: 10.1016/s0360-3016(99)90422-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Interventions to enhance young people's communication are rarely based on research into adolescent communication, but take a more general, analytic, skills-based approach. This paper argues that evidence of young people's communication experiences is an important resource to inform the targeting and content of interventions, which has hitherto been overlooked. An exploratory, hypothesis-generating study of teenagers' accounts of their communication experiences was carried out. Four thousand and forty-eight adolescents aged 13-19 described a recent communication experience with (i) a family member, (ii) a friend or (iii) a non-family adult (professional or official). Self-reported bad communication experiences outweighted good ones only in adolescents' communications with adults outside the family, and there were significant variations across contexts in terms of the purposes, explanations and attributions for perceived bad communication. Implications of the research for future interventions are discussed.
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Affiliation(s)
- J Drury
- Trust for the Study of Adolescence, Brighton, U.K
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Abstract
Most of the studies of frontal sinus anatomy were completed 50 to 70 years ago. The information they provide is not necessarily relevant or helpful to the modern rhinologic surgeon who approaches the frontal sinus transnasally and endoscopically. We performed anatomical dissections of the outflow tract of 82 frontal sinuses in 41 cadaver heads to illustrate the various drainage patterns from the frontal sinus to the nose and to correlate these drainage sites with the distance and angle from the pyriform aperture. We found that the frontal sinus drained anterior to the uncinate process in 24 specimens (29.3%) with an average distance of 3.65 cm from the pyriform aperture and 58 degrees from the nasal floor. The frontal sinus drained posterior to the uncinate process in 56 specimens (68.3%) with an average distance of 4.10 cm and 65 degrees from the nasal floor. In this latter group, most of the sinuses (51 specimens) drained into the ethmoid infundibulum. Two of the specimens had a hypoplastic frontal sinus with no outflow tract at all. These findings are different from those described in the early 20th century.
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Affiliation(s)
- D Lee
- Department of Otolaryngology, State University of New York Health Science Center, Brooklyn, USA
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Heilig S, Brody R, Marcus FS, Shavelson L, Sussman PC. Physician-hastened death. Advisory guidelines for the San Francisco Bay area from the Bay Area Network of Ethics Committees. West J Med 1997; 166:370-8. [PMID: 9217447 PMCID: PMC1304310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Recent high court opinions and pending Supreme Court rulings on the legality of physician-hastened death necessitate a pragmatic response from the medical profession. Adopting a "harm reduction" perspective on this contentious topic, the Bay Area Network of Ethics Committees developed practice guidelines for responding to a patient request for hastened death. The guidelines will be offered to the local medical community for use by individuals and health care institutions if the practice of physician-hastened death becomes legal. A multidisciplinary consensus process was used in developing the guidelines, which address clinical, ethical, and procedural concerns.
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Affiliation(s)
- S Heilig
- San Francisco Medical Society, CA 94108, USA
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Affiliation(s)
- L Soohoo
- University Hospitals of Cleveland, Ohio
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Miaskowski C, Nichols R, Brody R, Synold T. Assessment of patient satisfaction utilizing the American Pain Society's Quality Assurance Standards on acute and cancer-related pain. J Pain Symptom Manage 1994; 9:5-11. [PMID: 8169462 DOI: 10.1016/0885-3924(94)90140-6] [Citation(s) in RCA: 169] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
An evaluation of patient satisfaction with pain management is one component of a total quality assurance program on pain management recommended by the American Pain Society. This study utilized the patient satisfaction survey recommended by the Quality Assurance Committee of the American Pain Society and was conducted in an acute care, municipal hospital. Seventy-two medical-surgical patients were interviewed about their pain management. Data from the survey suggest that while patients experienced moderate-to-severe pain and had to wait relatively long periods of time for pain medications, in most cases they were satisfied with their overall pain management. Recommendations for conducting patient satisfaction surveys of pain management in acute care settings are reviewed, and methods for interpreting data from these types of surveys are discussed.
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Affiliation(s)
- C Miaskowski
- Department of Physiological Nursing, University of California, San Francisco 94143
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Epstein EH, McNutt NS, Beallo R, Thyberg W, Brody R, Hirsch A, LaBraico JM. Severe vasculitis during isotretinoin therapy. Arch Dermatol 1987; 123:1123-5. [PMID: 3477128] [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: 01/06/2023]
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50
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Vinciguerra V, Degnan TJ, Sciortino A, O'Connell M, Moore T, Brody R, Budman D, Eng M, Carlton D. A comparative assessment of home versus hospital comprehensive treatment for advanced cancer patients. J Clin Oncol 1986; 4:1521-8. [PMID: 3760919 DOI: 10.1200/jco.1986.4.10.1521] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
A prospective comparative analysis of home and hospital comprehensive treatment for advanced non-ambulatory cancer patients was conducted. Patients were assigned to hospital (group A) and home (group B) treatment groups based on geographic location. Home treatment was provided by the Don Monti Home Oncology Medical Extension (HOME) program. A multidisciplinary health team, including an oncologist, oncology nurse, social worker, dietitian, and medical technologist, was transported to the home in a medically equipped van. Services included physical examinations, pain control, psychosocial interventions, chemotherapy and blood transfusions, nutrition consultation, and bereavement counseling. One hundred seventy-four patients were treated at home and 44 in the hospital. Pretreatment characteristics were similar for both groups, with the exception that age under 50 years was more frequent in the hospital group, and home patients were more likely to have gastrointestinal (GI) cancer. Medical benefits for home treatment included decreased narcotic analgesic requirements, decreased hospitalization and length of stay, and improved measurements of fat stores for female patients. Improved survival for home patients was related to Karnofsky performance status, since there was no difference in survival for sicker patients with lower performance status whether they received home or hospital treatment. Patient and family acceptance of home treatment was excellent. Comprehensive home treatment provided by a multispecialty oncology team is an effective alternative to hospitalization for terminal cancer patients.
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