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Wong SN, Li S, Low KH, Chan HW, Zhang X, Chow S, Hui B, Chow PCY, Chow SF. Development of favipiravir dry powders for intranasal delivery: An integrated cocrystal and particle engineering approach via spray freeze drying. Int J Pharm 2024; 653:123896. [PMID: 38346602 DOI: 10.1016/j.ijpharm.2024.123896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/29/2024] [Accepted: 02/07/2024] [Indexed: 02/17/2024]
Abstract
The therapeutic potential of pharmaceutical cocrystals in intranasal applications remains largely unexplored despite progressive advancements in cocrystal research. We present the application of spray freeze drying (SFD) in successful fabrication of a favipiravir-pyridinecarboxamide cocrystal nasal powder formulation for potential treatment of broad-spectrum antiviral infections. Preliminary screening via mechanochemistry revealed that favipiravir (FAV) can cocrystallize with isonicotinamide (INA), but not nicotinamide (NCT) and picolinamide (PIC) notwithstanding their structural similarity. The cocrystal formation was characterized by differential scanning calorimetry, Fourier-transform infrared spectroscopy, and unit cell determination through Rietveld refinement of powder X-ray analysis. FAV-INA crystalized in a monoclinic space group P21/c with a unit cell volume of 1223.54(3) Å3, accommodating one FAV molecule and one INA molecule in the asymmetric unit. The cocrystal was further reproduced as intranasal dry powders by SFD, of which the morphology, particle size, in vitro drug release, and nasal deposition were assessed. The non-porous flake shaped FAV-INA powders exhibited a mean particle size of 19.79 ± 2.61 μm, rendering its suitability for intranasal delivery. Compared with raw FAV, FAV-INA displayed a 3-fold higher cumulative fraction of drug permeated in Franz diffusion cells at 45 min (p = 0.001). Dose fraction of FAV-INA deposited in the nasal fraction of a customized 3D-printed nasal cast reached over 80 %, whereas the fine particle fraction remained below 6 % at a flow rate of 15 L/min, suggesting high nasal deposition whilst minimal lung deposition. FAV-INA was safe in RPMI 2650 nasal and SH-SY5Y neuroblastoma cells without any in vitro cytotoxicity observed. This study demonstrated that combining the merits of cocrystallization and particle engineering via SFD can propel the development of advanced dry powder formulations for intranasal drug delivery.
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Affiliation(s)
- Si Nga Wong
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region; Advanced Biomedical Instrumentation Centre, Hong Kong Science Park, Shatin, Hong Kong Special Administrative Region
| | - Si Li
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region; Advanced Biomedical Instrumentation Centre, Hong Kong Science Park, Shatin, Hong Kong Special Administrative Region
| | - Kam-Hung Low
- Department of Chemistry, Faculty of Science, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region
| | - Ho Wan Chan
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region
| | - Xinyue Zhang
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region
| | - Stephanie Chow
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region
| | - Bo Hui
- Department of Mechanical Engineering, Faculty of Engineering, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region
| | - Philip C Y Chow
- Department of Mechanical Engineering, Faculty of Engineering, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region
| | - Shing Fung Chow
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region; Advanced Biomedical Instrumentation Centre, Hong Kong Science Park, Shatin, Hong Kong Special Administrative Region.
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Chan HW, Zhang X, Chow S, Lam DCL, Chow SF. Inhalable paclitaxel nanoagglomerate dry powders for lung cancer chemotherapy: Design of experiments-guided development, characterization and in vitro evaluation. Int J Pharm 2024; 653:123877. [PMID: 38342326 DOI: 10.1016/j.ijpharm.2024.123877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/12/2024] [Accepted: 02/02/2024] [Indexed: 02/13/2024]
Abstract
Conventional intravenous chemotherapy for lung cancer frequently results in inefficient drug penetration into primary lung tumors and severe systemic toxicities. This study reports the development of inhalable paclitaxel (PTX) nanoagglomerate dry powders (PTX-NADP) for enhanced pulmonary delivery of PTX chemotherapy to lung tumors using full factorial Design of Experiments. PTX nanoparticles were fabricated by flash nanoprecipitation with the aid of N-polyvinylpyrrolidone (PVP) and curcumin (CUR) as stabilizer and co-stabilizer respectively, and subsequently agglomerated into inhalable dry powders via co-spray drying with methylcellulose. The optimized PTX-NADP formulation exhibited acceptable aqueous redispersibility (redispersibility index = 1.17 ± 0.02) into ∼ 150 nm nanoparticles and superb in vitro aerosol performance [mass median aerodynamic diameter (MMAD) = 1.69 ± 0.05 µm and fine particle fraction (FPF) of 70.89 ± 1.72 %] when dispersed from a Breezhaler® at 90 L/min. Notably, adequate aerosolization (MMAD < 3.5 µm and FPF > 40 %) of the optimized formulation was maintained when dispersed at reduced inspiratory flow rates of 30 - 60 L/min. Redispersed PTX nanoparticles from PTX-NADP demonstrated enhanced in vitro antitumor efficacy and cellular uptake in A549 lung adenocarcinoma cells without compromising tolerability of BEAS-2B normal lung epithelial cells towards PTX chemotherapy. These findings highlight the potential of inhaled PTX-NADP therapy to improve therapeutic outcomes for lung cancer patients with varying levels of pulmonary function impairment.
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Affiliation(s)
- Ho Wan Chan
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Xinyue Zhang
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China; Advanced Biomedical Instrumentation Centre, Hong Kong Science Park, Shatin, Hong Kong, China
| | - Stephanie Chow
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - David Chi Leung Lam
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Shing Fung Chow
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China; Advanced Biomedical Instrumentation Centre, Hong Kong Science Park, Shatin, Hong Kong, China.
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Somasegar S, Reddy RA, Chow S, Dorigo O, Renz M, Karam A. Trends in ovarian, fallopian tube, and primary peritoneal cancer incidence, mortality, and survival: A 15-year population-based analysis. Gynecol Oncol 2024; 184:190-197. [PMID: 38330833 DOI: 10.1016/j.ygyno.2024.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/13/2024] [Accepted: 01/22/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To characterize trends in ovarian, fallopian tube, and primary peritoneal cancer incidence and incidence-based mortality based on histology and site of origin. METHODS We obtained age-adjusted incidence and incidence-based mortality for patients with ovarian, fallopian tube, and primary peritoneal cancer from 2000 to 2019 from the US SEER 17 database. Joinpoint 4.9.1.0 was used to characterize log-linear time trends. RESULTS The incidence and incidence-based mortality of all cancers trended down during the study period. The incidence of epithelial cancers decreased from 2004 to 2019 (AAPC -1.2%, p < 0.001), including that of high-grade (2006-2019: APC -1.2%, p < 0.05) and low-grade (2003-2019: APC -2.4%, p < 0.05) epithelial cancers. There was no change in incidence or incidence-based mortality for ovarian stromal and germ cell cancers. CONCLUSION There has been a decrease in the incidence and incidence-based mortality of ovarian, fallopian tube, and primary peritoneal cancer, primarily due to reductions in advanced stage epithelial cancers originating in the ovary, fallopian tube, or peritoneum.
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Affiliation(s)
- Sahana Somasegar
- Stanford University School of Medicine, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Palo Alto, CA, United States of America.
| | - Ravali A Reddy
- Stanford University School of Medicine, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Palo Alto, CA, United States of America
| | - Stephanie Chow
- Stanford University School of Medicine, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Palo Alto, CA, United States of America
| | - Oliver Dorigo
- Stanford University School of Medicine, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Palo Alto, CA, United States of America
| | - Malte Renz
- Stanford University School of Medicine, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Palo Alto, CA, United States of America
| | - Amer Karam
- Stanford University School of Medicine, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Palo Alto, CA, United States of America
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Aryasomayajula C, Stewart C, Eakin C, Reiser H, Chow S, Kapp DS, Chan JK, Liao CI. Impact of limiting reproductive rights of pregnant individuals with cancer in the United States. Gynecol Oncol 2024; 181:183-185. [PMID: 37981547 DOI: 10.1016/j.ygyno.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/30/2023] [Accepted: 11/03/2023] [Indexed: 11/21/2023]
Affiliation(s)
| | - Chelsea Stewart
- Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, USA
| | - Cortney Eakin
- Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, USA
| | - Hannah Reiser
- Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, USA
| | - Stephanie Chow
- Department of Obstetrics and Gynecology-Oncology, Stanford University, Stanford, CA, USA
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - John K Chan
- Division of Gynecologic Oncology, California Pacific Medical Center, San Francisco, CA, USA
| | - Cheng-I Liao
- Department of Obstetrics and Gynecology, Pingtung, Veterans General Hospital, Kaohsiung City, Taiwan
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Chan HW, Lee HW, Chow S, Lam DCL, Chow SF. Integrated continuous manufacturing of inhalable remdesivir nanoagglomerate dry powders: Design, optimization and therapeutic potential for respiratory viral infections. Int J Pharm 2023; 644:123303. [PMID: 37579825 DOI: 10.1016/j.ijpharm.2023.123303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/24/2023] [Accepted: 08/09/2023] [Indexed: 08/16/2023]
Abstract
While inhalable nanoparticle-based dry powders have demonstrated promising potential as next-generation respiratory medicines, erratic particle redispersibility and poor manufacturing reproducibility remain major hurdles hindering their translation from bench to bedside. We developed a one-step continuous process for fabricating inhalable remdesivir (RDV) nanoagglomerate dry powder formulations by integrating flash nanoprecipitation and spray drying. The nanosuspension formulation was optimized using a three-factor Box-Behnken design with a z-average particle size of 233.3 ± 2.3 nm and < 20% size change within six hours. The optimized inhalable nanoagglomerate dry powder formulation produced by spray drying showed adequate aqueous redispersibility (Sf/Si = 1.20 ± 0.01) and in vitro aerosol performance (mass median aerodynamic diameter of 3.80 ± 0.58 µm and fine particle fraction of 39.85 ± 10.16%). In A549 cells, RDV nanoparticles redispersed from the inhalable nanoagglomerate powders displayed enhanced and accelerated RDV cell uptake and negligible cytotoxicity at therapeutic RDV concentrations. No statistically significant differences were observed in the critical quality attributes of the inhalable nanoagglomerate powders produced from the continuous manufacturing and standalone batch modes. This work demonstrates the feasibility of large-scale continuous manufacturing of inhalable nanoagglomerate dry powder formulations, which pave the way for their clinical translation.
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Affiliation(s)
- Ho Wan Chan
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Hok Wai Lee
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Stephanie Chow
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - David Chi Leung Lam
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Shing Fung Chow
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China; Advanced Biomedical Instrumentation Centre, Hong Kong Science Park, Shatin, Hong Kong SAR, China.
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Chan HW, Chow S, Zhang X, Kwok PCL, Chow SF. Role of Particle Size in Translational Research of Nanomedicines for Successful Drug Delivery: Discrepancies and Inadequacies. J Pharm Sci 2023; 112:2371-2384. [PMID: 37453526 DOI: 10.1016/j.xphs.2023.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023]
Abstract
Despite significant research progress in substantiating the therapeutic merits of nanomedicines and the emergence of sophisticated nanotechnologies, the translation of this knowledge into new therapeutic modalities has been sluggish, indicating the need for a more comprehensive understanding of how the unique physicochemical properties of nanoparticles affect their clinical applications. Particle size is a critical quality attribute that impacts the bio-fate of nanoparticles, yet precise knowledge of its effect remains elusive with discrepancies among literature reports. This review aims to address this scientific knowledge gap from a drug development perspective by highlighting potential inadequacies during the evaluation of particle size effects. We begin with a discussion on the major issues in particle size characterization along with the corresponding remedies. The influence of confounding factors on biological effects of particle size, including colloidal stability, polydispersity, and in vitro drug release, are addressed for establishing stronger in vitro-in vivo correlation. Particle size design and tailoring approaches for successful nanoparticulate drug delivery beyond parenteral administration are also illustrated. We believe a holistic understanding of the effect of particle size on bio-fate, combined with consistent nanoparticle manufacturing platforms and tailored characterization techniques, would expedite the translation of nanomedicines into clinical practice.
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Affiliation(s)
- Ho Wan Chan
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong S.A.R., China
| | - Stephanie Chow
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong S.A.R., China
| | - Xinyue Zhang
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong S.A.R., China; Advanced Biomedical Instrumentation Centre, Hong Kong Science Park, Shatin, Hong Kong S.A.R, China
| | - Philip Chi Lip Kwok
- Advanced Drug Delivery Group, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Shing Fung Chow
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong S.A.R., China; Advanced Biomedical Instrumentation Centre, Hong Kong Science Park, Shatin, Hong Kong S.A.R, China.
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Chan HW, Chow S, Zhang X, Zhao Y, Tong HHY, Chow SF. Inhalable Nanoparticle-based Dry Powder Formulations for Respiratory Diseases: Challenges and Strategies for Translational Research. AAPS PharmSciTech 2023; 24:98. [PMID: 37016029 PMCID: PMC10072922 DOI: 10.1208/s12249-023-02559-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/23/2023] [Indexed: 04/06/2023] Open
Abstract
The emergence of novel respiratory infections (e.g., COVID-19) and expeditious development of nanoparticle-based COVID-19 vaccines have recently reignited considerable interest in designing inhalable nanoparticle-based drug delivery systems as next-generation respiratory therapeutics. Among various available devices in aerosol delivery, dry powder inhalers (DPIs) are preferable for delivery of nanoparticles due to their simplicity of use, high portability, and superior long-term stability. Despite research efforts devoted to developing inhaled nanoparticle-based DPI formulations, no such formulations have been approved to date, implying a research gap between bench and bedside. This review aims to address this gap by highlighting important yet often overlooked issues during pre-clinical development. We start with an overview and update on formulation and particle engineering strategies for fabricating inhalable nanoparticle-based dry powder formulations. An important but neglected aspect in in vitro characterization methodologies for linking the powder performance with their bio-fate is then discussed. Finally, the major challenges and strategies in their clinical translation are highlighted. We anticipate that focused research onto the existing knowledge gaps presented in this review would accelerate clinical applications of inhalable nanoparticle-based dry powders from a far-fetched fantasy to a reality.
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Affiliation(s)
- Ho Wan Chan
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 2/F, Laboratory Block 21 Sassoon Road, Hong Kong S.A.R., L2-08B, Pokfulam, China
| | - Stephanie Chow
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 2/F, Laboratory Block 21 Sassoon Road, Hong Kong S.A.R., L2-08B, Pokfulam, China
| | - Xinyue Zhang
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 2/F, Laboratory Block 21 Sassoon Road, Hong Kong S.A.R., L2-08B, Pokfulam, China
| | - Yayi Zhao
- Advanced Biomedical Instrumentation Centre, Hong Kong Science Park, Hong Kong S.A.R, Shatin, China
| | - Henry Hoi Yee Tong
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao S.A.R., China
| | - Shing Fung Chow
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 2/F, Laboratory Block 21 Sassoon Road, Hong Kong S.A.R., L2-08B, Pokfulam, China.
- Advanced Biomedical Instrumentation Centre, Hong Kong Science Park, Hong Kong S.A.R, Shatin, China.
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Chow S, Dorigo O. Monocytes: A Promising New TRAIL in Ovarian Cancer Cell Therapy. Clin Cancer Res 2023; 29:299-301. [PMID: 36383129 DOI: 10.1158/1078-0432.ccr-22-2877] [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] [Received: 10/07/2022] [Revised: 10/23/2022] [Accepted: 11/01/2022] [Indexed: 11/17/2022]
Abstract
Adoptive cell transfer of IFN-activated monocytes administered intraperitoneally to patients with platinum-resistant ovarian cancer demonstrated antitumor effects and acceptable tolerability. The exposure of monocytes to IFNα and IFNγ upregulated TRAIL, which triggered caspase 8 and direct cell-to-cell contact-dependent apoptosis of ovarian cancer cells. See related article by Green et al., p. 349.
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Affiliation(s)
- Stephanie Chow
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, California
| | - Oliver Dorigo
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, California
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Ramaswamy R, Chow S, Javier NM, Leipzig R, Hinrichsen G, Kelley A. ”HOW OLD IS OLD?” ADDRESSING AGEISM AND UNCONSCIOUS BIAS AMONG MEDICAL STUDENTS DURING GERIATRICS CLERKSHIP. Innov Aging 2022. [PMCID: PMC9770303 DOI: 10.1093/geroni/igac059.1268] [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: 12/24/2022] Open
Abstract
Ageism (stereotyping, prejudice and discrimination based on age) has deleterious consequences on older adults’ health. Medical students have variable attitudes and biases toward older people. We hypothesized that an embedded ageism curriculum within the Ambulatory Care-Geriatrics clerkship would increase ageism awareness and commitment to reduce ageism in the clinical environment for third year medical students. The 2021 curriculum included assigned pre-reading, videos, short didactics, expert-facilitated small group discussion of clinical vignettes, reflective journaling, and posting of personal commitments on a virtual messaging board. We surveyed students at the start and end of the clerkship to evaluate baseline awareness, change in UCLA Geriatrics Attitudes Scale, and satisfaction with curricular components. Of the 95 students who thusfar participated in the curriculum, we received 92 pre- and 48 post-curriculum survey responses. Pre-curriculum students reported the median age for “old” was 65 years (range 35-90) and 42% of students expressed preference for younger patients (33% neutral). Proportion of students with self-assessed ability to identify ageist remarks/actions increased from 52%(pre) to 92%(post), and ability to minimize own ageist biases increased from 23%(pre) to 83%(post). 86% of students found the curriculum useful; discussion with experts and viewing an ageism TED Talk were the most favorably scored components. Integrating an ageism curriculum with pre-work, didactic, guided discussion and reflection components in the Geriatrics clerkship increased medical student awareness and confidence in addressing ageism-related behaviors. This curriculum complements students’ clinical interactions with older adults and has the potential to reduce the future impact of ageism in medicine.
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Affiliation(s)
| | - Stephanie Chow
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | | | - Rosanne Leipzig
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Gregory Hinrichsen
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Amy Kelley
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
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Ghosh J, Schultz BM, Chan J, Wultsch C, Singh R, Shureiqi I, Chow S, Doymaz A, Varriano S, Driscoll M, Muse J, Kleiman FE, Krampis K, Issa JPJ, Sapienza C. Epigenome-Wide Study Identifies Epigenetic Outliers in Normal Mucosa of Patients with Colorectal Cancer. Cancer Prev Res (Phila) 2022; 15:755-766. [PMID: 36219239 PMCID: PMC9623234 DOI: 10.1158/1940-6207.capr-22-0258] [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] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/13/2022] [Accepted: 08/23/2022] [Indexed: 01/31/2023]
Abstract
Nongenetic predisposition to colorectal cancer continues to be difficult to measure precisely, hampering efforts in targeted prevention and screening. Epigenetic changes in the normal mucosa of patients with colorectal cancer can serve as a tool in predicting colorectal cancer outcomes. We identified epigenetic changes affecting the normal mucosa of patients with colorectal cancer. DNA methylation profiling on normal colon mucosa from 77 patients with colorectal cancer and 68 controls identified a distinct subgroup of normally-appearing mucosa with markedly disrupted DNA methylation at a large number of CpGs, termed as "Outlier Methylation Phenotype" (OMP) and are present in 15 of 77 patients with cancer versus 0 of 68 controls (P < 0.001). Similar findings were also seen in publicly available datasets. Comparison of normal colon mucosa transcription profiles of patients with OMP cancer with those of patients with non-OMP cancer indicates genes whose promoters are hypermethylated in the OMP patients are also transcriptionally downregulated, and that many of the genes most affected are involved in interactions between epithelial cells, the mucus layer, and the microbiome. Analysis of 16S rRNA profiles suggests that normal colon mucosa of OMPs are enriched in bacterial genera associated with colorectal cancer risk, advanced tumor stage, chronic intestinal inflammation, malignant transformation, nosocomial infections, and KRAS mutations. In conclusion, our study identifies an epigenetically distinct OMP group in the normal mucosa of patients with colorectal cancer that is characterized by a disrupted methylome, altered gene expression, and microbial dysbiosis. Prospective studies are needed to determine whether OMP could serve as a biomarker for an elevated epigenetic risk for colorectal cancer development. PREVENTION RELEVANCE Our study identifies an epigenetically distinct OMP group in the normal mucosa of patients with colorectal cancer that is characterized by a disrupted methylome, altered gene expression, and microbial dysbiosis. Identification of OMPs in healthy controls and patients with colorectal cancer will lead to prevention and better prognosis, respectively.
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Affiliation(s)
- Jayashri Ghosh
- Fels Cancer Institute for Personalized Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Bryant M. Schultz
- Fels Cancer Institute for Personalized Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Joe Chan
- Fels Cancer Institute for Personalized Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Claudia Wultsch
- Bioinformatics and Computational Genomics Laboratory, Hunter College, City University of New York, New York, New York.,Sackler Institute for Comparative Genomics, American Museum of Natural History, New York, New York
| | - Rajveer Singh
- Bioinformatics and Computational Genomics Laboratory, Hunter College, City University of New York, New York, New York
| | - Imad Shureiqi
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Stephanie Chow
- Nutrition Department, School of Urban Public Health at Hunter College, New York, New York
| | - Ahmet Doymaz
- Department of Chemistry, Hunter College, City University of New York, New York, New York
| | - Sophia Varriano
- The Graduate Center, City University of New York, New York, New York
| | | | - Jennifer Muse
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Frida E. Kleiman
- Department of Chemistry, Hunter College, City University of New York, New York, New York
| | - Konstantinos Krampis
- Bioinformatics and Computational Genomics Laboratory, Hunter College, City University of New York, New York, New York.,Department of Biological Sciences, Hunter College, City University of New York, New York, New York.,Institute of Computational Biomedicine, Weill Cornell Medical College, New York, New York
| | | | - Carmen Sapienza
- Fels Cancer Institute for Personalized Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.,Corresponding Author: Carmen Sapienza, Fels Cancer Institute for Personalized Medicine, Lewis Katz School of Medicine, Temple University, 3307 N. Broad Street, Room 300, Philadelphia, PA 19140. Phone: 215-707-7373; E-mail:
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Freitas C, Hunt BAE, Wong SM, Ristic L, Fragiadakis S, Chow S, Iaboni A, Brian J, Soorya L, Chen JL, Schachar R, Dunkley BT, Taylor MJ, Lerch JP, Anagnostou E. Atypical Functional Connectivity During Unfamiliar Music Listening in Children With Autism. Front Neurosci 2022; 16:829415. [PMID: 35516796 PMCID: PMC9063167 DOI: 10.3389/fnins.2022.829415] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/10/2022] [Indexed: 12/30/2022] Open
Abstract
Background Atypical processing of unfamiliar, but less so familiar, stimuli has been described in Autism Spectrum Disorder (ASD), in particular in relation to face processing. We examined the construct of familiarity in ASD using familiar and unfamiliar songs, to investigate the link between familiarity and autism symptoms, such as repetitive behavior. Methods Forty-eight children, 24 with ASD (21 males, mean age = 9.96 years ± 1.54) and 24 typically developing (TD) controls (21 males, mean age = 10.17 ± 1.90) completed a music familiarity task using individually identified familiar compared to unfamiliar songs, while magnetoencephalography (MEG) was recorded. Each song was presented for 30 s. We used both amplitude envelope correlation (AEC) and the weighted phase lag index (wPLI) to assess functional connectivity between specific regions of interest (ROI) and non-ROI parcels, as well as at the whole brain level, to understand what is preserved and what is impaired in familiar music listening in this population. Results Increased wPLI synchronization for familiar vs. unfamiliar music was found for typically developing children in the gamma frequency. There were no significant differences within the ASD group for this comparison. During the processing of unfamiliar music, we demonstrated left lateralized increased theta and beta band connectivity in children with ASD compared to controls. An interaction effect found greater alpha band connectivity in the TD group compared to ASD to unfamiliar music only, anchored in the left insula. Conclusion Our results revealed atypical processing of unfamiliar songs in children with ASD, consistent with previous studies in other modalities reporting that processing novelty is a challenge for ASD. Relatively typical processing of familiar stimuli may represent a strength and may be of interest to strength-based intervention planning.
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Affiliation(s)
- Carina Freitas
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Benjamin A. E. Hunt
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada
- Neuroscience and Mental Health Program, Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Simeon M. Wong
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada
- Neuroscience and Mental Health Program, Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Leanne Ristic
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Susan Fragiadakis
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Stephanie Chow
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Alana Iaboni
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Jessica Brian
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Latha Soorya
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, United States
| | - Joyce L. Chen
- Faculty of Kinesiology and Physical Education and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Russell Schachar
- Department of Psychiatry Research, Hospital for Sick Children, Toronto, ON, Canada
| | - Benjamin T. Dunkley
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada
- Neuroscience and Mental Health Program, Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Margot J. Taylor
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada
- Neuroscience and Mental Health Program, Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Departments of Psychology and Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Jason P. Lerch
- Neuroscience and Mental Health Program, Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
| | - Evdokia Anagnostou
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Neuroscience and Mental Health Program, Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
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12
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Chow S, Brown K, Sanon M, Perez S, Kelley A, Javier NM. Addressing Systemic Racism by Creating a Diversity, Equity, and Inclusion Department Initiative. Innov Aging 2021. [PMCID: PMC8680484 DOI: 10.1093/geroni/igab046.2095] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The ongoing COVID-19 pandemic has underscored the need to optimize care for one of the most affected sectors: older adults in nursing homes and more specifically highly vulnerable populations such as residents with dementia. Research developed in collaboration with stakeholders can optimize impact, relevance, and trustworthiness of study findings thereby informing advances in care. Yet, evidence on stakeholder driven research for enhancing dementia care is limited. This symposium will provide examples of stakeholder-driven research questions that were addressed with stakeholder engagement. First, we will present current evidence about the perspectives of caregivers, including those from communities of color. The second presentation will discuss the perspective of clinical training stakeholders responsible for supporting system-wide clinical program implementation and their experiences with early and later adopter nursing homes within the context of a clinical trial. The third presentation will address the perspective of policy makers and payers via the effect of state-mandated dementia training on resident outcomes. The fourth and final present the findings from a study that examined how nursing home stakeholders responded to a payor requirements for pharmacy services and the relationship between that response and patient outcomes. We will conclude the session with a discussion of stakeholder-engagement methods and recommendations for future nursing home research, which champions stakeholder collaboration.
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Affiliation(s)
- Stephanie Chow
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Katherine Brown
- Icahn School of Medicine at Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Martine Sanon
- Icahn School of Medicine at Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Sasha Perez
- Icahn School of Medicine at Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Amy Kelley
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Noelle Marie Javier
- Icahn School of Medicine at Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, United States
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13
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Chow S, Yamada Y, Munoz L, Lavayen S, Payne J, Sreevalsan K, Fani S. Characterizing Patients and Themes of SARS-CoV-2 Vaccine Hesitancy in a New York City High-Risk Older Population. Innov Aging 2021. [PMCID: PMC8680836 DOI: 10.1093/geroni/igab046.2700] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background: Vaccines to prevent SARS-CoV-2 infection are deemed one of the most promising measures in controlling the devastating pandemic, yet there is significant vaccine hesitancy in some communities. Historic systemic health, discrimination, and structural inequities in specific racial and ethnic communities contribute to vaccine hesitancy with disproportionately negative impact. It is therefore critical to better understand vaccine hesitancy in this high-risk older population. The ALIGN (Acute Life Interventions, Goals, and Needs) program co-manages a panel of older patients with complex medical and psychosocial needs in an urban academic medical center. Methods: ALIGN enrolled or graduated Patients or designated healthcare proxies were contacted by telephone to discuss SARS-CoV-2 vaccine willingness and hesitancy using a standardized web-based survey. Qualitative data was categorized into themes and subgroups. Demographic data was collected by chart review. Results: Complete results are forthcoming and will include patient reported race and ethnicity baseline, vaccine hesitancy perceptions, with common overarching themes, and clinical team member debriefing. Iterative quality improvement actions taken based on elicited patient themes will also be included and assessed in telephone follow-up for changes in vaccine hesitancy. Conclusions: We are conducting a qualitative and quality improvement study characterizing vaccine perceptions and hesitancy in a high-risk older group with focus on racial and ethnic disparities in this population. This preliminary data informs healthcare providers of potential health literacy, cultural and language, and other potential barriers in order to help further understand how to optimize SARS-CoV-2 vaccine acceptance and delivery in a patient population with elevated risk.
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Affiliation(s)
- Stephanie Chow
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Yuji Yamada
- Icahn School of Medicine at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Lizette Munoz
- Mount Sinai Health System, New York, New York, United States
| | - Susana Lavayen
- Mount Sinai Hospital, Mount Sinai Hospital, New York, United States
| | - Jodi Payne
- Icahn School of Medicine at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Kavya Sreevalsan
- Icahn School of Medicine at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Shamsi Fani
- Icahn School of Medicine at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, United States
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14
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Eggold JT, Chow S, Melemenidis S, Wang J, Natarajan S, Loo PE, Manjappa R, Viswanathan V, Kidd EA, Engleman E, Dorigo O, Loo BW, Rankin EB. Abdominopelvic FLASH Irradiation Improves PD-1 Immune Checkpoint Inhibition in Preclinical Models of Ovarian Cancer. Mol Cancer Ther 2021; 21:371-381. [PMID: 34866044 DOI: 10.1158/1535-7163.mct-21-0358] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/20/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022]
Abstract
Treatment of advanced ovarian cancer using PD-1/PD-L1 immune checkpoint blockade shows promise, however current clinical trials are limited by modest response rates. Radiation therapy has been shown to synergize with PD-1/PD-L1 blockade in some cancers but has not been utilized in advanced ovarian cancer due to toxicity associated with conventional abdominopelvic irradiation. While ultra-high dose rate (FLASH) irradiation has emerged as a strategy to reduce radiation-induced toxicity, the immunomodulatory properties of FLASH irradiation remain unknown. Here we demonstrate that single high dose abdominopelvic FLASH irradiation promoted intestinal regeneration and maintained tumor control in a preclinical mouse model of ovarian cancer. Reduced tumor burden in conventional and FLASH treated mice was associated with an early decrease in intratumoral regulatory T cells and a late increase in cytolytic CD8+ T cells. Compared to conventional irradiation, FLASH irradiation increased intratumoral T cell infiltration at early timepoints. Moreover, FLASH irradiation maintained the ability to increase intratumoral CD8+ T cell infiltration and enhance the efficacy of αPD-1 therapy in preclinical models of ovarian cancer. These data highlight the potential for FLASH irradiation to improve the therapeutic efficacy of checkpoint inhibition in the treatment of ovarian cancer.
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Affiliation(s)
| | - Stephanie Chow
- Radiation Oncology and Obstetrics & Gynecology, Stanford University
| | | | | | | | | | | | | | | | - Edgar Engleman
- Department of Pathology, Stanford University School of Medicine
| | - Oliver Dorigo
- Obstetrics and Gynecology/Gynecologic Oncology, Stanford University
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University
| | - Erinn B Rankin
- Radiation Oncology and Obstetrics & Gynecology, Stanford University
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15
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Patel M, Chow S, Munoz L. Pilot Study of a Surgical-Oncology Geriatric Co-Management Program. Innov Aging 2020. [PMCID: PMC7740586 DOI: 10.1093/geroni/igaa057.481] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: This study aims to evaluate clinical outcomes of a pilot co-management model for patients 65 years and older that were referred by their surgical oncologist for a comprehensive geriatric assessment prior to surgery. Methods: A retrospective chart review was conducted for 9 patients. Patients’ pre-operative Charlson Comorbidity Index (CCI) and frailty index were measured. Additional measures included advanced care planning (ACP) documentation and whether patients transferred primary care. Post-operative courses and complications were followed, including length of stay (LOS) and discharge outcomes. Results: A total of 9 patient charts were reviewed. The average age was 79 years. The average CCI and frailty indices were 9 and 4, respectively. Every patient had ACP during the initial assessment. Five patients had multiple outpatient geriatrician visits. Of the 9 referrals, 7 proceeded with surgery. LOS ranged from 6 – 22 days, with a median and average of 8 and 11 days, respectively. Of those undergoing surgery, 4 had an inpatient geriatrics consult. Complications included 1 mortality, 2 aborted cases and 4 with other complications. Four patients were discharged to previous living situations and 2 to SAR. Two patients had one ED/UC visit and 2 had multiple readmissions. No patients transferred their primary care. Conclusion: This is a small pilot showing a promising collaboration between geriatrics and surgical oncology. It outlines a supportive framework for initial and peri-operative geriatric assessments with favorable experiences for both providers. More studies are necessary to make clinical associations with this co-management model.
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Affiliation(s)
- Megha Patel
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York, United States
| | - Stephanie Chow
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Lizette Munoz
- Mount Sinai Hospital, New York, New York, United States
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16
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Munoz L, MacKenzie B, Chun A, Fani S, Lavayen S, Chow S. Acute Life Interventions, Goals, and Needs Program: Social Determinants of Health Among the Most Vulnerable. Innov Aging 2020. [PMCID: PMC7742952 DOI: 10.1093/geroni/igaa057.1267] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Acute Life interventions Goals and Needs program(ALIGN) at Mount Sinai Hospital in New York City, is an inter-professional team dedicated to offering temporary intensive ambulatory care services to the most complex older patient population. This allows us to care for the most vulnerable population which often incur multiple hospitalizations, emergency room visits. Mr.C is a 81 yo male with past medical history of Chronic COPD, Depression, Gait instability, Mild Neuro-cognitive disorder, Hearing Loss, Coronary artery disease. Most significantly he had 3 ED visits, 1 admission, where he was found on the floor of his apartment after two days, by a meals on wheels volunteer. Team conducted a comprehensive assessment of Mr.C’s social determinants of health and compiled a care plan. We learned that Mr.C does not like to bother others therefore found it difficult to seek help. Team built intensive rapport and gained his trust to help simplify medications, increase engagement and explore barriers to home care. Mr.C was connected to several community agencies including, meals on wheels for more stable food access, psychiatry to discuss depression and isolation, adult protective services for deep cleaning,financial management, pharmacy for blister packing, home care services and case management to continue encouragement with care plan. Mr.C is now able to reach out to the team as needed and has a navigator to help with managing care. This is one of many cases ALIGN encounters, that often go undetected due to comprehensive inter-professional care needed and minimal time given in traditional primary care.
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Affiliation(s)
- Lizette Munoz
- Mount Sinai Hospital, New York, New York, United States
| | | | - Audrey Chun
- Icahn School of Medicine at Mount Sinai, New york, New York, United States
| | - Shamsi Fani
- Mount Sinai Medical Center, New York, New York, United States
| | | | - Stephanie Chow
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
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17
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Abstract
Background: The Acute Life Interventions Goals & Needs Program (ALIGN) at the Mount Sinai Hospital in New York City aims to work closely with high risk geriatric patients for short term intensive management of acute medical and social issues. Quantitative measures for determining success of the program is comparing emergency room visits and hospitalizations prior to and after enrollment with ALIGN. The Community Paramedicine service allows a paramedic, the ALIGN provider, and an emergency room physician to assess and triage patients in their home via video conference thereby avoiding ED visits for non-urgent services. Method: We reviewed the utilization of the Community Paramedicine service (from July 2017-February 2020) and its impact on ALIGN’s efforts to reduce unnecessary ED visits and hospitalizations. Results: 36 patients were evaluated with the Community Paramedicine service (from July 2017-February 2020). 19 or 52.8% avoided an ED visit and 17 or 47.2% were transported to the ED. 12 or 70.6% were admitted to the hospital of those that were transported to the ED initially. Top reasons for transport to ED included generalized weakness, acute mental status change (AMS), and shortness of breath (SOB). Conclusions: A Community Paramedicine program utilized by a high risk geriatrics team like ALIGN is effective in reducing ED visits and hospitalizations for the elderly population who incur greater expenses to the health care system and traditionally have poorer health outcomes.
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Affiliation(s)
- Shamsi Fani
- Mount Sinai Medical Center, New York, New York, United States
| | - Lizette Munoz
- Mount Sinai Hospital, New York, New York, United States
| | | | - Blair McKenzie
- The Mount Sinai Hospital, New York, New York, United States
| | - Audrey Chun
- Icahn School of Medicine at Mount Sinai, New york, New York, United States
| | - Jeff Cao
- The Mount Sinai Hospital, New York, New York, United States
| | - Stephanie Chow
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
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18
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Chow S, Chun A, Munoz L, Fani S, Morrison RS, MacKenzie B, Lavayen S, Hung W. Building a Framework for Care of Older Patients in an Academic Setting: High Risk Geriatrics Ambulatory Care Program. Innov Aging 2020. [PMCID: PMC7742621 DOI: 10.1093/geroni/igaa057.1684] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND: Traditional models of geriatric medicine and health system reimbursement structure often force ambulatory care teams to function as high-volume delivery programs, thereby dis-servicing our most vulnerable and frail older patients. This “high cost and high needs” labeled demographic requires uniquely adapted plans from medical and social work providers. METHODS: To better examine opportunities for improved framework for geriatric ambulatory care, the Acute Life Interventions, Goals & Needs (ALIGN) Program has launched several inter-professional pilot programs, each with intention to explore components of health care service to older patients, and feasibility of implementation in other health care systems. Three current models include the ALIGN Program itself, a telemedicine community paramedicine program, and a geriatric surgery co-management program. RESULTS: Preliminary results are forthcoming, with initial promising findings. For the first 126 patients enrolled, mean emergency room (ED) visits 6 months prior to ALIGN enrollment were 1.7 visits per person, reduced to 0.7 ED visits/person 6 months post-graduation from the program, and 126 fewer ED visits. Mean hospitalization 6 months prior to enrollment was 0.32 per person, whereas 6 months post-graduation was 0.2 hospitalizations/person, totaling 40.32 hospitalizations saved. Mean length of stay in the hospital 6 months prior to ALIGN enrollment for the 22 patients admitted was 7.7 days, reduced to 7.3 days post-graduation, and 32 fewer hospital days in the small subset of patients requiring hospitalization despite program interventions. CONCLUSION: The ALIGN Program’s multi-professional and flexible modularity highlights promising innovative frameworks for ambulatory geriatrics care, warranting further exploration and collaboration.
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Affiliation(s)
- Stephanie Chow
- Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Audrey Chun
- Icahn School of Medicine at Mount Sinai, New york, New York, United States
| | - Lizette Munoz
- Mount Sinai Hospital, New York, New York, United States
| | - Shamsi Fani
- Mount Sinai Medical Center, New York, New York, United States
| | | | | | | | - William Hung
- Icahn School of Medicine at Mount Sinai; James J Peters VA Medical Center, Bronx, New York, United States
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Chow S, Raine-Bennett T, Samant ND, Postlethwaite DA, Holzapfel M. Breast cancer risk after hysterectomy with and without salpingo-oophorectomy for benign indications. Am J Obstet Gynecol 2020; 223:900.e1-900.e7. [PMID: 32585221 DOI: 10.1016/j.ajog.2020.06.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/30/2020] [Accepted: 06/18/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Breast cancer risk has been extensively studied in women with genetic predisposition, that is, mutations in breast cancer genes 1 and 2. Although there are guidelines for performing bilateral salpingo-oophorectomies in individuals with specific genetic risks, oophorectomies are also performed in many women considered to be at average risk of developing breast cancer. The risk of breast cancer in women with average risk who undergo hysterectomy with bilateral salpingo-oophorectomy for benign indications is less clear. OBJECTIVE This study aimed to estimate breast cancer risk after hysterectomy with and without concomitant bilateral salpingo-oophorectomy for benign indications. STUDY DESIGN From 2001 to 2015, women aged 18 years and older from Kaiser Permanente Northern California who underwent hysterectomy alone and hysterectomy with bilateral salpingo-oophorectomy were identified using the International Classification of Diseases, Ninth Revision, procedure and Current Procedural Terminology codes. Women with a breast cancer gene mutation and previous history of breast cancer or gynecologic cancer were excluded. Descriptive and bivariate analyses were used to describe and compare demographic and clinical characteristics. Breast cancer incidence rates were calculated per 100,000 person-years. Survival analysis and Cox proportional hazard models were conducted to compare the risk of developing breast cancer. RESULTS Of 49,215 women who underwent hysterectomy, 19,826 had hysterectomy with bilateral salpingo-oophorectomy. Whites, Hispanics, blacks, Asians, and other or unknown comprised 51.2%, 20.3%, 12.7%, 10.4%, and 5.3% of the study population, respectively. The average age of women with hysterectomy alone was 45.5 years compared with 50.8 years for those who had hysterectomy with bilateral salpingo-oophorectomy. During the study period, 915 women received a diagnosis of breast cancer. Age-specific breast cancer incidence rates were higher in women older than 60 years with oophorectomy than hysterectomy alone (471.2 [95% confidence interval, 386.2-556.2] vs 463.0 [95% confidence interval, 349.6-576.5], respectively). After controlling for age, race, income, and Charlson Comorbidity Index, women with bilateral salpingo-oophorectomy had a 14% lower risk of breast cancer than women with hysterectomy alone (hazard ratio, 0.86; 95% confidence interval, 0.75-0.98). All-cause mortality was higher with oophorectomy than hysterectomy alone (64.4% vs 35.6%, P<.0001, respectively). CONCLUSION Women with concurrent bilateral salpingo-oophorectomy for benign indications had a lower risk of breast cancer than those who had hysterectomy alone. However, all-cause mortality was higher in women with oophorectomy. Perimenopausal patients undergoing hysterectomy for benign indications should be counseled on the risks and benefits of oophorectomy at the time of surgery.
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Affiliation(s)
- Stephanie Chow
- Department of Obstetrics and Gynecology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA.
| | - Tina Raine-Bennett
- Department of Obstetrics and Gynecology, The Permanente Medical Group, Inc, Oakland, CA
| | - Navendu D Samant
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | | | - Marie Holzapfel
- Department of Obstetrics and Gynecology, The Permanente Medical Group, Inc, Santa Clara, CA
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20
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Chow S, Wong D, Liao CI, Mann A, Tian C, Darcy KM, Chan JK. Uterine clear cell carcinoma risk in White versus non-White US subpopulations: does race matter? J Gynecol Oncol 2020; 31:e81. [PMID: 33078591 PMCID: PMC7593224 DOI: 10.3802/jgo.2020.31.e81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/18/2020] [Accepted: 06/21/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To determine incidence rates of uterine clear cell carcinoma among non-White US subpopulations. METHODS Data from the United States Cancer Statistics and National Cancer Database from 2004 to 2016 were analyzed using descriptive statistics. RESULTS A total of 488,811 women were diagnosed with uterine cancer from 2004-2016. Of these, 73.3% were endometrioid, 6.6% were serous, 5.3% were carcinosarcoma, 1.4% were clear cell, and 13.4% were other. Blacks had the highest incidence rate of uterine clear cell compared with Whites, Asian/Pacific Islanders, and American Indian/Alaska Natives (0.59 vs. 0.31, 0.29, and 0.24, respectively). Overall mean age at diagnosis was 68.6 years, with the youngest age in Asian/Pacific Islanders compared to Whites, Blacks, and American Indian/Alaska Natives (65.9 vs. 68.7, 68.6, and 66.3 years, respectively). Analysis of the Asian subpopulation revealed significantly younger age at diagnosis in Vietnamese women (55.8 years) compared with 72.4 years in Japanese, 68.6 years in Pacific Islander, 66.6 years in Indian/Pakistani, 65.9 years in Filipino, 65.8 years in Chinese, 65.2 years in Korean, and 63.7 years in other Asians. CONCLUSIONS Black women are two times more likely to be diagnosed with uterine clear cell carcinoma compared with other races. Asians present at younger ages, with Vietnamese women most likely to be diagnosed at the youngest age.
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Affiliation(s)
- Stephanie Chow
- Division of Gynecologic Oncology, Stanford University Medical Center, Stanford, CA, USA.
| | - Deanna Wong
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Cheng I Liao
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Amandeep Mann
- Division of Gynecologic Oncology, Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - Chunqiao Tian
- Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA.,The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Kathleen M Darcy
- Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA.,The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.,John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - John K Chan
- Division of Gynecologic Oncology, Palo Alto Medical Foundation, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA
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21
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Chow S, Eggold J, Levy K, Wang J, Manjappa R, Dorigo O, Loo B, Rankin E. Combination total abdominal ultra-rapid flash irradiation and PD-1 inhibition provides enhanced tumor burden control in a preclinical ovarian cancer model. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.102] [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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22
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Chow S, Liao C, Mann A, Dorigo O, Litkouhi B, Lai K, Kapp D, Chan J. Uterine clear cell carcinoma risk in Asian subpopulations. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.606] [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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Natarajan S, Levy K, Wang J, Chow S, Eggold J, Loo P, Manjappa R, Lartey FM, Schüler E, Skinner L, Rafat M, Ko R, Kim A, Rawi DA, von Eyben R, Dorigo O, Casey KM, Graves EE, Bush K, Yu AS, Koong AC, Maxim PG, Loo BW, Rankin EB. Abstract 5351: FLASH irradiation enhances the therapeutic index of abdominal radiotherapy in mice. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-5351] [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: 11/16/2022]
Abstract
Abstract
Radiation therapy is the most effective cytotoxic cancer therapy available for the treatment of localized tumors. However, radiation-induced toxicity to normal tissues limits the radiation dose and therefore the curative potential of radiotherapy. In particular, the highly radiosensitive intestine greatly limits the use of radiation for patients with intra-abdominal tumor diseases including women with ovarian cancer. Here we sought to investigate the safety and efficacy of FLASH radiation therapy in the treatment of widespread ovarian cancer peritoneal metastases. We performed abdominal irradiation on healthy and ovarian tumor-bearing mice at conventional (CONV, (0.07 Gy/sec)) or FLASH (200 Gy/sec) dose rates and examined gut function by stool counts, DNA damage in crypt cells by γ-H2AX staining, cell death and proliferation by TUNEL/ caspase-3 staining and BrdU immunohistochemistry respectively. We report that ultrahigh dose rate FLASH irradiation causes significantly less radiation-induced intestinal injury in both healthy and tumor-bearing mice compared to CONV dose rate irradiation. Abdominal FLASH reduced the mortality from gastrointestinal syndrome, preserved gut function and epithelial integrity as reflected by their stool counts and FITC-Dextran analysis. In addition, we found decreased cell death and enhanced proliferation of crypt base columnar cells (CBCs) following FLASH irradiation in comparison to CONV irradiation. We also detected reduced number of γ-H2AX foci in crypt cells indicating less DNA damage and/or increased DNA repair after FLASH compared to CONV irradiation. Importantly, FLASH and CONV irradiation have similar efficacy in the reduction of ovarian cancer peritoneal metastases. These findings suggest that FLASH irradiation has biological advantages compared to conventional dose rate irradiation in reducing radiation-induced intestinal injury within the irradiation field and therefore may be an effective strategy to enhance the therapeutic index of radiotherapy for the treatment of abdominal and pelvic tumor disease.
Citation Format: Suchitra Natarajan, Karen Levy, Jinghui Wang, Stephanie Chow, Joshua Eggold, Phoebe Loo, Rakesh Manjappa, Frederick M. Lartey, Emil Schüler, Lawrie Skinner, Marjan Rafat, Ryan Ko, Anna Kim, Duaa Al Rawi, Rie von Eyben, Oliver Dorigo, Kerriann M. Casey, Edward E. Graves, Karl Bush, Amy S. Yu, Albert C. Koong, Peter G. Maxim, Billy W. Loo, Erinn B. Rankin. FLASH irradiation enhances the therapeutic index of abdominal radiotherapy in mice [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5351.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Marjan Rafat
- 2Department of Vanderbilt University School of Engineering, Nashville, TN
| | - Ryan Ko
- 1Stanford University, Stanford, CA
| | - Anna Kim
- 1Stanford University, Stanford, CA
| | | | | | | | | | | | | | | | | | - Peter G. Maxim
- 4Indiana University School of Medicine, Indianapolis, IN
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Abel MK, Chan JK, Chow S, Darcy K, Tian C, Kapp DS, Mann AK, Liao CI. Trends and survival outcomes of robotic, laparoscopic, and open surgery for stage II uterine cancer. Int J Gynecol Cancer 2020; 30:1347-1355. [PMID: 32753561 DOI: 10.1136/ijgc-2020-001646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION A recent randomized clinical trial showed that minimally invasive surgery led to poorer survival compared with open surgery in early stage cervical cancer. We determined the trends in adoption of minimally invasive surgery and 5-year overall survival outcomes after open, laparoscopic-assisted, and robotic-assisted hysterectomy for stage II uterine cancer with cervical stromal involvement. METHODS Data for patients with stage II uterine cancer were acquired from the National Cancer Database from 2010 to 2015. χ2 testing, Kaplan-Meier methods, and Cox models were used for statistical analyses. RESULTS Of 2949 patients, 44.3% underwent open hysterectomy, 13.9% underwent laparoscopic hysterectomy, and 41.8% underwent robotic hysterectomy. The proportion of robotic cases increased from 26.8% in 2010 to 48.3% in 2015 (annual percent change 10.1%), with a decrease in open hysterectomy from 63.3% to 34.3% (annual percent change -12.5%). The overall 5-year survival was 77.6% in robotic, 76.8% in laparoscopic, and 72.5% in open hysterectomy (p=0.045); however, after adjusting for known prognostic factors, robotic (HR 1.00, 95% CI 0.82 to 1.21; p=0.97) and laparoscopic hysterectomy (HR 1.09, 95% CI 0.83 to 1.44; p=0.54) did not portend for improved survival compared with open hysterectomy. Black women (HR 1.59, 95% CI 1.25 to 2.02; p<0.001) and individuals with co-morbidities (HR 1.45, 95% CI 1.21 to 1.75, p<0.001) had worse adjusted survival and the highest rates of open hysterectomy. CONCLUSION The use of minimally invasive surgery for stage II uterine cancer has increased over time, with comparable adjusted 5-year survival after robotic or laparoscopic hysterectomy compared with open hysterectomy. Black women and those with co-morbidities had lowest rates of minimally invasive surgery and the poorest adjusted survival.
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Affiliation(s)
- Mary Kathryn Abel
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - John K Chan
- Division of Gynecologic Oncology, Palo Alto Medical Foundation, California Pacific Medical Center, Sutter Health, San Francisco, California, USA
| | - Stephanie Chow
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
| | - Kathleen Darcy
- Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Chunqiao Tian
- Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Amandeep K Mann
- Division of Gynecologic Oncology, Palo Alto Medical Foundation Research Institute, Palo Alto, California, USA
| | - Cheng-I Liao
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Affiliation(s)
- William W Hung
- Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA; Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, USA.
| | - Stephanie Chow
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
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Olsson-Brown A, Guinan T, McKay M, Thurston K, Chow S, Lord R, Sacco J. Implementation of a dedicated immuno-oncology toxicity service reduces the acute impact of immune-related adverse events. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz253.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Chow S, Gunnison K, Tucker L, Pruett K. Topical vaginal estrogen use and risk of endometrial hyperplasia or cancer. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.03.234] [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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Chow S, Chan J, Kapp D, Mann A, Liao C. Racial and regional disparities and outcomes of stage II endometrial cancer patients after robotic surgery. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.281] [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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Chow S, Chan J, Delic L, Kapp D, Mann A, Liao C. Adjuvant chemotherapy and radiation improve survival of surgical stage I uterine clear cell carcinoma patients. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.475] [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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Olsson-Brown A, Guinan T, McKay M, Chow S, Lord R, Pirmohamed M, Sacco J. The unexpected challenges of immunotherapy. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy486.010] [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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31
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Chow S, Lee KL, Lee J, Liu CM. Massive Transfusion Protocol: Provider Education to Improve Patient Outcomes [1M]. Obstet Gynecol 2018. [DOI: 10.1097/aog.0000000000002561] [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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Anderson H, Daheron L, Savvidis G, Negre H, Nag A, Thorner A, Liu X, Gu S, Hu X, Kelley M, Chow S, Daley H, Manduke R, Hwa A, Pagliuca F, Ritz J. Safety considerations in the generation of clinical grade autologous ips cell lines. Cytotherapy 2018. [DOI: 10.1016/j.jcyt.2018.02.044] [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: 10/17/2022]
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Negre H, Pinte L, Manduke R, Cunningham A, Anderson H, Richard S, Khelladi R, Mai J, Chow S, Kelley M, Daley H, Sturtevant O, Nikiforow S, Ritz J. Personnel environmental monitoring during manufacture of manipulated cell therapy products. Cytotherapy 2018. [DOI: 10.1016/j.jcyt.2018.02.192] [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: 10/17/2022]
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Abstract
The first conception outside of the human body that led to the birth of Louise Brown was a tremendous accomplishment, which opened the door to the utilization of assisted reproductive techniques globally. This brought the understanding that accomplishing life in a dish required several steps, the most obvious being the timing and characteristics of fertilization. It soon became obvious in the 1980s that the most disappointing phenomenon was unexpected and complete fertilization failure. Among the approaches that were attempted to treat male factor infertility, ICSI surfaced as the technique that brought the ratio of the gametes to 1:1 and was also able to grant consistent fertilization and a higher pregnancy rate. ICSI has now been implemented for a quarter of a century, proving itself as the ultimate technique utilizing ejaculated spermatozoa independent of the semen parameters and is the sole insemination method to be used with surgically retrieved spermatozoa. There are currently various indications for ICSI that are widely adopted, rendering it the most popular insemination method worldwide. The reliability of ICSI ensures its employment in upcoming techniques involving in vitro spermatogenesis and neogametogenesis.
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Affiliation(s)
- C L O'Neill
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive MedicineWeill Cornell Medicine, New York, New York, USA
| | - S Chow
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive MedicineWeill Cornell Medicine, New York, New York, USA
| | - Z Rosenwaks
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive MedicineWeill Cornell Medicine, New York, New York, USA
| | - G D Palermo
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive MedicineWeill Cornell Medicine, New York, New York, USA
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Palermo GD, O'Neill CL, Chow S, Cheung S, Parrella A, Pereira N, Rosenwaks Z. Intracytoplasmic sperm injection: state of the art in humans. Reproduction 2017; 154:F93-F110. [PMID: 29158352 PMCID: PMC5719728 DOI: 10.1530/rep-17-0374] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 11/09/2017] [Accepted: 11/20/2017] [Indexed: 12/31/2022]
Abstract
Among infertile couples, 25% involve both male and female factors, while male factor alone accounts for another 25% due to oligo-, astheno-, teratozoospermia, a combination of the three, or even a complete absence of sperm cells in the ejaculate and can lead to a poor prognosis even with the help of assisted reproductive technology (ART). Intracytoplasmic sperm injection (ICSI) has been with us now for a quarter of a century and in spite of the controversy generated since its inception, it remains in the forefront of the techniques utilized in ART. The development of ICSI in 1992 has drastically decreased the impact of male factor, resulting in millions of pregnancies worldwide for couples who, without ICSI, would have had little chance of having their own biological child. This review focuses on the state of the art of ICSI regarding utility of bioassays that evaluate male factor infertility beyond the standard semen analysis and describes the current application and advances in regard to ICSI, particularly the genetic and epigenetic characteristics of spermatozoa and their impact on reproductive outcome.
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Affiliation(s)
- G D Palermo
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive MedicineWeill Cornell Medicine, New York, New York, USA
| | - C L O'Neill
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive MedicineWeill Cornell Medicine, New York, New York, USA
| | - S Chow
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive MedicineWeill Cornell Medicine, New York, New York, USA
| | - S Cheung
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive MedicineWeill Cornell Medicine, New York, New York, USA
| | - A Parrella
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive MedicineWeill Cornell Medicine, New York, New York, USA
| | - N Pereira
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive MedicineWeill Cornell Medicine, New York, New York, USA
| | - Z Rosenwaks
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive MedicineWeill Cornell Medicine, New York, New York, USA
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Chow S, Kurogi H, Yamamoto T, Tomoda T, Mochioka N, Shirotori F, Yoshinaga T, Ambe D, Okazaki M, Nagai S, Yanagimoto T. Reproductive isolation between sympatric Anguilla japonica and Anguilla marmorata. J Fish Biol 2017; 91:1517-1525. [PMID: 28990671 DOI: 10.1111/jfb.13483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 09/11/2017] [Indexed: 06/07/2023]
Abstract
Species-specific restriction fragment length polymorphism in the intron of the androgen receptor gene (ar5) was found in glass to silver-stage individuals of Anguilla japonica (n = 51) and A. marmorata (n = 21). The sequence analysis of 16S rDNA from 328 anguillid leptocephali collected in the North Equatorial Current of the western North Pacific Ocean revealed the specimens to be A. japonica (n = 194), A. marmorata (n = 128), A. bicolor pacifica (n = 5) and A. luzonensis (n = 1). All leptocephali of A. japonica and A. marmorata were monomorphic and did not share an allele at the ar5 locus, indicating that the two species are reproductively isolated.
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Affiliation(s)
- S Chow
- National Research Institute of Fisheries Science, Japan Fisheries Research and Education Agency, 2-12-4 Fukuura, Yokohama, Kanagawa, 236-8648, Japan
| | - H Kurogi
- Yokosuka Laboratory, National Research Institute of Fisheries Science, Japan Fisheries Research and Education Agency, 6-3-1, Nagai, Kanagawa, 238-0316, Japan
| | - T Yamamoto
- Yokosuka Laboratory, National Research Institute of Fisheries Science, Japan Fisheries Research and Education Agency, 6-3-1, Nagai, Kanagawa, 238-0316, Japan
| | - T Tomoda
- National Research Institute of Aquaculture, Japan Fisheries Research and Education Agency, 205 Natsui, Shibushi, Kagoshima, 899-7101, Japan
| | - N Mochioka
- Kyushu University, 6-10-1 Hakozaki, Fukuoka, 812-8581, Japan
| | - F Shirotori
- School of Marine Biosciences, Kitasato University, 1-15-1 Kitasato, Sagamihara, Kanagawa, 252-0373, Japan
| | - T Yoshinaga
- School of Marine Biosciences, Kitasato University, 1-15-1 Kitasato, Sagamihara, Kanagawa, 252-0373, Japan
| | - D Ambe
- National Research Institute of Fisheries Science, Japan Fisheries Research and Education Agency, 2-12-4 Fukuura, Yokohama, Kanagawa, 236-8648, Japan
| | - M Okazaki
- National Research Institute of Fisheries Science, Japan Fisheries Research and Education Agency, 2-12-4 Fukuura, Yokohama, Kanagawa, 236-8648, Japan
| | - S Nagai
- National Research Institute of Fisheries Science, Japan Fisheries Research and Education Agency, 2-12-4 Fukuura, Yokohama, Kanagawa, 236-8648, Japan
| | - T Yanagimoto
- National Research Institute of Fisheries Science, Japan Fisheries Research and Education Agency, 2-12-4 Fukuura, Yokohama, Kanagawa, 236-8648, Japan
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Chow S, Leach R, Mitchell C. Non-elective admissions in cancer care - A review of acute oncology services (AOS) implementation in a north-west region of England. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx375.020] [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] Open
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38
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Parrella A, O'Neill C, Chow S, Goldstein M, Rosenwaks Z, Palermo G. Sperm source influences the extent of DNA fragmentation and shapes reproductive outcome. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.914] [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: 11/28/2022]
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Parrella A, Chow S, Cheung S, O'Neill C, Rosenwaks Z, Palermo G. Proportional oocyte nuclear maturation in relation to ICSI outcome. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.441] [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: 10/18/2022]
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40
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Taylor GT, Suter EA, Li ZQ, Chow S, Stinton D, Zaliznyak T, Beaupré SR. Single-Cell Growth Rates in Photoautotrophic Populations Measured by Stable Isotope Probing and Resonance Raman Microspectrometry. Front Microbiol 2017; 8:1449. [PMID: 28824580 PMCID: PMC5541042 DOI: 10.3389/fmicb.2017.01449] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 01/17/2017] [Accepted: 07/17/2017] [Indexed: 12/17/2022] Open
Abstract
A new method to measure growth rates of individual photoautotrophic cells by combining stable isotope probing (SIP) and single-cell resonance Raman microspectrometry is introduced. This report explores optimal experimental design and the theoretical underpinnings for quantitative responses of Raman spectra to cellular isotopic composition. Resonance Raman spectra of isogenic cultures of the cyanobacterium, Synechococcus sp., grown in 13C-bicarbonate revealed linear covariance between wavenumber (cm−1) shifts in dominant carotenoid Raman peaks and a broad range of cellular 13C fractional isotopic abundance. Single-cell growth rates were calculated from spectra-derived isotopic content and empirical relationships. Growth rates among any 25 cells in a sample varied considerably; mean coefficient of variation, CV, was 29 ± 3% (σ/x¯), of which only ~2% was propagated analytical error. Instantaneous population growth rates measured independently by in vivo fluorescence also varied daily (CV ≈ 53%) and were statistically indistinguishable from single-cell growth rates at all but the lowest levels of cell labeling. SCRR censuses of mixtures prepared from Synechococcus sp. and T. pseudonana (a diatom) populations with varying 13C-content and growth rates closely approximated predicted spectral responses and fractional labeling of cells added to the sample. This approach enables direct microspectrometric interrogation of isotopically- and phylogenetically-labeled cells and detects as little as 3% changes in cellular fractional labeling. This is the first description of a non-destructive technique to measure single-cell photoautotrophic growth rates based on Raman spectroscopy and well-constrained assumptions, while requiring few ancillary measurements.
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Affiliation(s)
- Gordon T Taylor
- School of Marine and Atmospheric Sciences, Stony Brook UniversityStony Brook, NY, United States
| | - Elizabeth A Suter
- School of Marine and Atmospheric Sciences, Stony Brook UniversityStony Brook, NY, United States
| | - Zhuo Q Li
- School of Marine and Atmospheric Sciences, Stony Brook UniversityStony Brook, NY, United States
| | - Stephanie Chow
- School of Marine and Atmospheric Sciences, Stony Brook UniversityStony Brook, NY, United States
| | - Dallyce Stinton
- School of Marine and Atmospheric Sciences, Stony Brook UniversityStony Brook, NY, United States
| | - Tatiana Zaliznyak
- School of Marine and Atmospheric Sciences, Stony Brook UniversityStony Brook, NY, United States
| | - Steven R Beaupré
- School of Marine and Atmospheric Sciences, Stony Brook UniversityStony Brook, NY, United States
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Kinsella BG, Chow S, Kushki A. Evaluating the Usability of a Wearable Social Skills Training Technology for Children with Autism Spectrum Disorder. Front Robot AI 2017. [DOI: 10.3389/frobt.2017.00031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chow S, Galvis V, Pillai M, Leach R, Keene E, Spencer-Shaw A, Shablak A, Shanks J, Liptrot T, Thistlethwaite F, Hawkins RE. High-dose interleukin2 - a 10-year single-site experience in the treatment of metastatic renal cell carcinoma: careful selection of patients gives an excellent outcome. J Immunother Cancer 2016; 4:67. [PMID: 27777776 PMCID: PMC5067981 DOI: 10.1186/s40425-016-0174-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 10/07/2016] [Indexed: 01/05/2023] Open
Abstract
Background VEGF-targeted therapy has become the mainstay of treatment for majority of mRCC patients. For most patients, benefit is short-lived and therefore treatment remains palliative in intent. HD IL2 is an effective immunotherapy treatment capable of durable remission in some patients but its unselected use has been difficult due to its modest response rate and considerable adverse effects. Using set pathology criteria as a selection tool in clinical practice, we have been able to show improved outcomes in our previous report. Here, we present an updated and extended report of this treatment and seek to explore any pathological, clinical and treatment variables likely to predict better outcomes. Methods This is an extension of a previously reported clinical audit, which includes mRCC cases treated with HD IL2 between 2003 and 2013. Since 2006, tumour specimens of potential candidates were routinely reviewed prospectively and stratified into Favourable or Other categories based on constitution of histological growth pattern, namely alveolar or solid versus papillary and/or sarcomatoid architecture; clear cell versus granular cell cytoplasmic morphology. HD IL2 was preferentially offered to patients with Favourable pathology. Outcome evaluation includes response rates, survival, and treatment tolerance. Multivariate analysis was performed to explore potential prognostic and predictive factors. Results Among prospectively selected patients with Favourable pathology (n = 106), overall response rate was 48.1 % (51/106) with CR rate of 21.6 % (23/106). Median OS was 58.1 months. Factors associated with significantly better response and/or survival includes favourable pathology pattern, higher cycle 1 tolerance and lower number of metastatic organ sites (<3). CAIX (Carbonic anhydrase 9) has prognostic value but is not predictive of response. Toxicities were those expected of IL2 but were manageable on general medical wards, with no treatment-related death. Importantly most complete responses were durable with 76 % (23/30) cases remained relapse-free (median 39 months follow up) and 2 of the seven who relapsed had had long-term disease free survival after resection of oligometastatic relapse. Conclusions Our experience shows that HD IL2 remains an effective and safe treatment in well-selected cases of mRCC. The result in this single-institution patient series confirms similar outcomes to our previously reported retrospective series. Given the prospect of long-term remission, fit patients with Favourable histology and low disease burden should be considered for HD IL2 in an experienced centre. Better understanding has been gained from this in-depth analysis especially the examination of possible response predictors and strategies that can improve treatment outcome. Electronic supplementary material The online version of this article (doi:10.1186/s40425-016-0174-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Chow
- The Christie NHS Foundation Trust, Manchester, UK
| | - V Galvis
- The Christie NHS Foundation Trust, Manchester, UK
| | - M Pillai
- The Christie NHS Foundation Trust, Manchester, UK
| | - R Leach
- The Christie NHS Foundation Trust, Manchester, UK
| | - E Keene
- The Christie NHS Foundation Trust, Manchester, UK ; The University of Manchester, Manchester, UK
| | | | - A Shablak
- The Christie NHS Foundation Trust, Manchester, UK
| | - J Shanks
- The Christie NHS Foundation Trust, Manchester, UK
| | - T Liptrot
- The Christie NHS Foundation Trust, Manchester, UK
| | | | - R E Hawkins
- The Christie NHS Foundation Trust, Manchester, UK ; The University of Manchester, Manchester, UK ; The Christie Clinic, Manchester, UK
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Chow S, Yanagimoto T, Kurogi H, Appleyard SA, Pogonoski JJ. A giant anguilliform leptocephalus Thalassenchelys foliaceus Castle & Raju is a junior synonym of Congriscus maldivensis (Norman 1939). J Fish Biol 2016; 89:2203-2211. [PMID: 27511812 DOI: 10.1111/jfb.13111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 07/12/2016] [Indexed: 06/06/2023]
Abstract
A single specimen of giant leptocephalus Thalassenchelys foliaceus Castle & Raju 1975 was caught in subtropical waters of the western North Pacific Ocean. Mitochondrial coI gene sequence divergence between T. foliaceus and Congriscus maldivensis (Norman 1939) was 0·64 ± 0·27% (mean ± s.e.), and the myomere and vertebral counts of these species were similar, indicating T. foliaceus is a junior synonym of C. maldivensis.
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Affiliation(s)
- S Chow
- National Research Institute of Fisheries Science, 2-12-4 Fukuura, Kanagawa 236-8648, Japan.
| | - T Yanagimoto
- National Research Institute of Fisheries Science, 2-12-4 Fukuura, Kanagawa 236-8648, Japan
| | - H Kurogi
- National Research Institute of Fisheries Science, 6-3-1 Nagai, Kanagawa 238-0316, Japan
| | - S A Appleyard
- Australian National Fish Collection, National Research Collections Australia, Commonwealth Scientific and Industrial Research Organisation (CSIRO), GPO Box 1538, Hobart, Tasmania, 7001, Australia
| | - J J Pogonoski
- Australian National Fish Collection, National Research Collections Australia, Commonwealth Scientific and Industrial Research Organisation (CSIRO), GPO Box 1538, Hobart, Tasmania, 7001, Australia
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Duerden EG, Lee M, Chow S, Sato J, Mak-Fan K, Taylor MJ. Neural Correlates of Reward Processing in Typical and Atypical Development. Child Neurol Open 2016; 3:2329048X16667350. [PMID: 28503615 PMCID: PMC5417348 DOI: 10.1177/2329048x16667350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/25/2016] [Revised: 06/19/2016] [Accepted: 07/29/2016] [Indexed: 12/22/2022] Open
Abstract
Atypically developing children including those born preterm or who have autism spectrum disorder can display difficulties with evaluating rewarding stimuli, which may result from impaired maturation of reward and cognitive control brain regions. During functional magnetic resonance imaging, 58 typically and atypically developing children (6-12 years) participated in a set-shifting task that included the presentation of monetary reward stimuli. In typically developing children, reward stimuli were associated with age-related increases in activation in cognitive control centers, with weaker changes in reward regions. In atypically developing children, no age-related changes were evident. Maturational disturbances in the frontostriatal regions during atypical development may underlie task-based differences in activation.
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Affiliation(s)
- Emma G Duerden
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Neurology, University of Toronto, Toronto, Ontario, Canada.,Neurosciences & Mental Health, Research Institute, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Minha Lee
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Chow
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Julie Sato
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Kathleen Mak-Fan
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Margot J Taylor
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Neurology, University of Toronto, Toronto, Ontario, Canada.,Neurosciences & Mental Health, Research Institute, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada
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Artz AS, Chow S. Hematopoietic cell transplantation in older adults: deciding or decision-making? Bone Marrow Transplant 2016; 51:643-4. [PMID: 27042839 DOI: 10.1038/bmt.2016.86] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 02/25/2016] [Accepted: 02/26/2016] [Indexed: 11/09/2022]
Affiliation(s)
- A S Artz
- Department of Medicine, University of Chicago, Section of Hematology/Oncology, Chicago, IL, USA
| | - S Chow
- Department of Medicine, University of Chicago, Section of Geriatrics and Palliative Medicine, Chicago, IL, USA
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Okazaki S, Manabe H, Omatsu T, Tsuchiaka S, Yamamoto T, Chow S, Shibuno T, Watanabe K, Ono S, Kuwada H, Mizutani T. Detection of Japanese eel endothelial cells-infecting virus (JEECV) in the Japanese eel Anguilla japonica (Temminck & Schlegel), living in natural habitats. J Fish Dis 2015; 38:849-852. [PMID: 25117695 DOI: 10.1111/jfd.12294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/23/2014] [Accepted: 06/30/2014] [Indexed: 06/03/2023]
Affiliation(s)
- S Okazaki
- The United Graduate School of Veterinary Sciences, Gifu University, Gifu, Japan
- Research and Education Center for Prevention of Global Infectious Diseases of Animals, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - H Manabe
- National Research Institute of Aquaculture, Fisheries Research Agency, Kanagawa, Japan
| | - T Omatsu
- The United Graduate School of Veterinary Sciences, Gifu University, Gifu, Japan
- Research and Education Center for Prevention of Global Infectious Diseases of Animals, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - S Tsuchiaka
- The United Graduate School of Veterinary Sciences, Gifu University, Gifu, Japan
- Research and Education Center for Prevention of Global Infectious Diseases of Animals, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - T Yamamoto
- National Research Institute of Aquaculture, Fisheries Research Agency, Kanagawa, Japan
| | - S Chow
- National Research Institute of Fisheries Science, Fisheries Research Agency, Kanagawa, Japan
| | - T Shibuno
- National Research Institute of Aquaculture, Fisheries Research Agency, Kanagawa, Japan
| | - K Watanabe
- National Research Institute of Aquaculture, Fisheries Research Agency, Kanagawa, Japan
| | - S Ono
- School of Marine Science and Technology, Tokai University, Shizuoka, Japan
| | - H Kuwada
- National Research Institute of Aquaculture, Fisheries Research Agency, Kanagawa, Japan
| | - T Mizutani
- The United Graduate School of Veterinary Sciences, Gifu University, Gifu, Japan
- Research and Education Center for Prevention of Global Infectious Diseases of Animals, Tokyo University of Agriculture and Technology, Tokyo, Japan
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Burt T, Wu H, Layton A, Rouse D, Chin B, Hawk T, Weitzel D, Cohen-Wolkowiez M, Chow S, Noveck R. Intra-Arterial Microdosing (IAM), a novel Drug development approach, proof of concept in Rats. Clin Ther 2015. [DOI: 10.1016/j.clinthera.2015.05.122] [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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Evans M, Chow S, Galvis V, Leach R, Keene E, Spencer-Shaw A, Shablak A, Shanks J, Thistlethwaite F, Hawkins R. Evaluating the Place of Interleukin-2 in the Management of Metastatic Renal Cell Cancer (MRCC) in the Era of Targeted Therapy. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu466.4] [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: 11/13/2022] Open
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Chow S, Dale W, Buesing K, Reynolds V, Paloma M, Bishop M, Artz A. Initial experience of a comprehensive geriatric assessment (CGA) before allogeneic hematopoietic cell transplantation (HCT) for patients 60years and older. J Geriatr Oncol 2014. [DOI: 10.1016/j.jgo.2014.09.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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