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Chang PC, Yuan X, Zampieri A, Towns C, Yoo SP, Engstrom C, Tsai S, Robles CR, Zhu Y, Lopez S, Montel-Hagen A, Seet CS, Crooks GM. Generation of antigen-specific mature T cells from RAG1 -/-RAG2 -/-B2M -/- stem cells by engineering their microenvironment. Nat Biomed Eng 2024; 8:461-478. [PMID: 38062131 PMCID: PMC11087257 DOI: 10.1038/s41551-023-01146-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/25/2023] [Indexed: 02/03/2024]
Abstract
Pluripotent stem cells (PSCs) are a promising source of allogeneic T cells for off-the-shelf immunotherapies. However, the process of differentiating genetically engineered PSCs to generate mature T cells requires that the same molecular elements that are crucial for the selection of these cells be removed to prevent alloreactivity. Here we show that antigen-restricted mature T cells can be generated in vitro from PSCs edited via CRISPR to lack endogenous T cell receptors (TCRs) and class I major histocompatibility complexes. Specifically, we used T cell precursors from RAG1-/-RAG2-/-B2M-/- human PSCs expressing a single TCR, and a murine stromal cell line providing the cognate human major histocompatibility complex molecule and other critical signals for T cell maturation. Possibly owing to the absence of TCR mispairing, the generated T cells showed substantially better tumour control in mice than T cells with an intact endogenous TCR. Introducing the T cell selection components into the stromal microenvironment of the PSCs overcomes inherent biological challenges associated with the development of T cell immunotherapies from allogeneic PSCs.
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Affiliation(s)
- Patrick C Chang
- Molecular Biology Interdepartmental Program, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Xuegang Yuan
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Alexandre Zampieri
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Chloe Towns
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Sang Pil Yoo
- Molecular Biology Interdepartmental Program, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Claire Engstrom
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Steven Tsai
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | | | - Yuhua Zhu
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Shawn Lopez
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Amelie Montel-Hagen
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Christopher S Seet
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Molecular Biology Institute, UCLA, Los Angeles, CA, USA
- Broad Stem Cell Research Center, UCLA, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA
| | - Gay M Crooks
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
- Molecular Biology Institute, UCLA, Los Angeles, CA, USA.
- Broad Stem Cell Research Center, UCLA, Los Angeles, CA, USA.
- Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA.
- Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
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2
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Berman E, Shah NP, Deninger M, Altman JK, Amaya M, Begna K, Bhatia R, Chan O, Collins R, Curtin P, DeAngelo DJ, Drazer M, Maness L, Metheny L, Mohan S, Moore J, Oehler V, Pratz K, Pusic I, Rose M, Shomali W, Smith BD, Styler M, Sweet K, Talpaz M, Tanaka T, Tantravahi S, Tsai S, Vaughn J, Welborn J, Yang D, Mauro M, Cortes J, Radich J, Druker B. CML and the WHO: Why? J Clin Oncol 2024; 42:984-986. [PMID: 38086008 DOI: 10.1200/jco.23.01689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/24/2023] [Accepted: 11/16/2023] [Indexed: 03/17/2024] Open
Affiliation(s)
| | - Neil P Shah
- UCSF Helen Diller Family Comprehensive Cancer Center
| | - Michael Deninger
- Versiti Blood Research Institute
- University of Wisconsin Medical Center
| | | | | | | | | | | | | | | | | | | | | | - Leland Metheny
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Center
| | | | | | | | - Keith Pratz
- Abramson Cancer Center at the University Pennsylvania
| | - Iskra Pusic
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - B Douglas Smith
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | | | | | - Jennifer Vaughn
- The Ohio State University Comprehensive Cancer Center-James Cancer Center and Solove Research Institute
| | | | - David Yang
- University of Wisconsin Carbone Cancer Center
| | | | | | | | - Brian Druker
- Knight Cancer Institute, Oregon Health and Science University
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Shah NP, Bhatia R, Altman JK, Amaya M, Begna KH, Berman E, Chan O, Clements J, Collins RH, Curtin PT, DeAngelo DJ, Drazer M, Maness L, Metheny L, Mohan S, Moore JO, Oehler V, Pratz K, Pusic I, Rose MG, Shomali W, Smith BD, Styler M, Talpaz M, Tanaka TN, Tantravahi S, Thompson J, Tsai S, Vaughn J, Welborn J, Yang DT, Sundar H, Gregory K. Chronic Myeloid Leukemia, Version 2.2024, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2024; 22:43-69. [PMID: 38394770 DOI: 10.6004/jnccn.2024.0007] [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] [Indexed: 02/25/2024]
Abstract
Chronic myeloid leukemia (CML) is defined by the presence of Philadelphia chromosome resulting from a reciprocal translocation between chromosomes 9 and 22 [t9;22] that gives rise to a BCR::ABL1 fusion gene. CML occurs in 3 different phases (chronic, accelerated, and blast phase) and is usually diagnosed in the chronic phase in developed countries. Tyrosine kinase inhibitor (TKI) therapy is a highly effective treatment option for patients with chronic phase-CML. The primary goal of TKI therapy in patients with chronic phase-CML is to prevent disease progression to accelerated phase-CML or blast phase-CML. Discontinuation of TKI therapy with careful monitoring is feasible in selected patients. This manuscript discusses the recommendations outlined in the NCCN Guidelines for the diagnosis and management of patients with chronic phase-CML.
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MESH Headings
- Humans
- Blast Crisis/chemically induced
- Blast Crisis/drug therapy
- Blast Crisis/genetics
- Protein Kinase Inhibitors/adverse effects
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Philadelphia Chromosome
- Leukemia, Myeloid, Chronic-Phase/drug therapy
- Fusion Proteins, bcr-abl/genetics
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Affiliation(s)
- Neil P Shah
- 1UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Jessica K Altman
- 3Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | | | | | | | | | | | | | - Leland Metheny
- 14Case Comprehensive Cancer Center University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | - Keith Pratz
- 18Abramson Cancer Center at the University of Pennsylvania
| | - Iskra Pusic
- 19Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - B Douglas Smith
- 22The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | | | | | - Jennifer Vaughn
- 29The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
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Ponce SEB, Small CJ, Ahmad T, Patel K, Tsai S, Kamgar M, George B, Kharofa JR, Saeed H, Dua KS, Clarke C, Aldakkak M, Evans DB, Christians K, Paulson ES, de Choudens SO, Erickson BA, Hall WA. Patterns of Locoregional Pancreatic Cancer Recurrence after Total Neoadjuvant Therapy and Implications on Optimal Neoadjuvant Radiation Treatment Volumes. Int J Radiat Oncol Biol Phys 2023; 117:e284-e285. [PMID: 37785058 DOI: 10.1016/j.ijrobp.2023.06.1270] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Neoadjuvant treatment for patients with localized pancreatic adenocarcinoma (PDAC) has improved survival duration. As survival increases, local disease control becomes even more important. We sought to understand the patterns of locoregional recurrence following total neoadjuvant therapy (TNT) and determine the impact of treatment volumes on recurrence. MATERIALS/METHODS Patients with PDAC managed with neoadjuvant chemotherapy and chemoradiation (TNT) followed by surgery who developed an isolated locoregional or simultaneously locoregional and distant recurrence were identified. Locoregional recurrences were individually contoured utilizing commercially available software. When available, original neoadjuvant dose distributions were registered to the scans on which the locoregional recurrences were contoured. Recurrences where then classified as in-field (> 95% of prescription dose), marginal (50-95% of prescription dose), or out of field (< 50% of prescription dose). Target volumes were created using four commonly utilized PDAC contouring guidelines to characterize the relationship of the local recurrence to the RT dose distribution. RESULTS Of 474 patients treated with TNT and surgery, 80 (17%) patients developed a locoregional recurrence with or without distant recurrence, visible on diagnostic imaging. Of the 80 patients, 56 (70%) had tumors in the pancreatic head; 46 (57.5%) were borderline resectable, 23 (28.8%) locally advanced, and 11 (13.6%) resectable. The most common initial neoadjuvant therapies were FOLFIRINOX (57.5%) and gemcitabine/nab-paclitaxel (18.8%). Chemoradiation included concurrent gemcitabine (47.5%) or 5-fluorouracil (26.3%). RT dose distributions were available for 38 patients; 22 (57.9%) had in-field failures, 9 (23.7%) marginal failures, and 7 (18.4%) out of field failures. Each published contouring atlas covered a relatively low percentage of recurrences, which are summarized in Table 1. Regions at particularly high likelihood of recurrence that were under covered on existing atlases included: aortic-diaphragmic junction, retro-pancreatic duodenal nodal basin, and the region to the right of the superior mesenteric artery (SMA). CONCLUSION We present the largest series (to our knowledge) of mapped locoregional recurrences for patients being treated with TNT in PDAC. These recurrences differ substantially from established atlases and highlight anatomical regions of highest priority for RT coverage. A novel visual contouring volume highlighting these regions will be presented which will strive to advance the use of RT in the TNT setting.
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Affiliation(s)
- S E Beltran Ponce
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - C J Small
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - T Ahmad
- Medical College of Wisconsin, Milwaukee, WI
| | - K Patel
- Medical College of Wisconsin, Milwaukee, WI
| | - S Tsai
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - M Kamgar
- Department of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - B George
- Department of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - J R Kharofa
- University of Cincinnati, Department of Radiation Oncology, University of Cincinnati Cancer Center, Cincinnati, OH
| | - H Saeed
- Lynn Cancer Institute, Boca Raton Regional Hospital, Baptist Health South Florida, Boca Raton, FL
| | - K S Dua
- Department of Gastroenterology, Medical College of Wisconsin, Milwaukee, WI
| | - C Clarke
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - M Aldakkak
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - D B Evans
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - K Christians
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - E S Paulson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - S Ortiz de Choudens
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI; Department of Radiation Oncology, Froedtert & the Medical College of Wisconsin, Milwaukee, WI
| | - B A Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - W A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
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5
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Li S, Wang CS, Montel-Hagen A, Chen HC, Lopez S, Zhou O, Dai K, Tsai S, Satyadi W, Botero C, Wong C, Casero D, Crooks GM, Seet CS. Strength of CAR signaling determines T cell versus ILC differentiation from pluripotent stem cells. Cell Rep 2023; 42:112241. [PMID: 36906850 PMCID: PMC10315155 DOI: 10.1016/j.celrep.2023.112241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 01/04/2023] [Accepted: 02/23/2023] [Indexed: 03/13/2023] Open
Abstract
Generation of chimeric antigen receptor (CAR) T cells from pluripotent stem cells (PSCs) will enable advances in cancer immunotherapy. Understanding how CARs affect T cell differentiation from PSCs is important for this effort. The recently described artificial thymic organoid (ATO) system supports in vitro differentiation of PSCs to T cells. Unexpectedly, PSCs transduced with a CD19-targeted CAR resulted in diversion of T cell differentiation to the innate lymphoid cell 2 (ILC2) lineage in ATOs. T cells and ILC2s are closely related lymphoid lineages with shared developmental and transcriptional programs. Mechanistically, we show that antigen-independent CAR signaling during lymphoid development enriched for ILC2-primed precursors at the expense of T cell precursors. We applied this understanding to modulate CAR signaling strength through expression level, structure, and presentation of cognate antigen to demonstrate that the T cell-versus-ILC lineage decision can be rationally controlled in either direction, providing a framework for achieving CAR-T cell development from PSCs.
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Affiliation(s)
- Suwen Li
- Department of Medicine, Division of Hematology-Oncology, David Geffen School of Medicine (DGSOM), University of California, Los Angeles, Los Angeles, CA 90095, USA; Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA; Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Chloe S Wang
- Department of Medicine, Division of Hematology-Oncology, David Geffen School of Medicine (DGSOM), University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Amélie Montel-Hagen
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Ho-Chung Chen
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Shawn Lopez
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Olivia Zhou
- Department of Medicine, Division of Hematology-Oncology, David Geffen School of Medicine (DGSOM), University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Kristy Dai
- Department of Medicine, Division of Hematology-Oncology, David Geffen School of Medicine (DGSOM), University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Steven Tsai
- Department of Medicine, Division of Hematology-Oncology, David Geffen School of Medicine (DGSOM), University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - William Satyadi
- Department of Medicine, Division of Hematology-Oncology, David Geffen School of Medicine (DGSOM), University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Carlos Botero
- Department of Medicine, Division of Hematology-Oncology, David Geffen School of Medicine (DGSOM), University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Claudia Wong
- Department of Medicine, Division of Hematology-Oncology, David Geffen School of Medicine (DGSOM), University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - David Casero
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Gay M Crooks
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA; Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA; Broad Stem Cell Research Center (BSCRC), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA; Jonsson Comprehensive Cancer Center (JCCC), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA; Molecular Biology Institute, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Christopher S Seet
- Department of Medicine, Division of Hematology-Oncology, David Geffen School of Medicine (DGSOM), University of California, Los Angeles, Los Angeles, CA 90095, USA; Broad Stem Cell Research Center (BSCRC), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA; Jonsson Comprehensive Cancer Center (JCCC), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA; Molecular Biology Institute, University of California, Los Angeles, Los Angeles, CA 90095, USA.
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6
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Thalji S, Aldakkak M, Christians K, Clarke C, George B, Kamgar M, Erickson B, Hall W, Chisholm P, Kulkarni N, Doucette S, Evans D, Tsai S. Neoadjuvant Chemotherapy for Pancreatic Cancer: Quality over Quantity. J Surg Oncol 2023. [PMID: 36960919 DOI: 10.1002/jso.27265] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 02/19/2023] [Accepted: 02/26/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND AND OBJECTIVES The ideal duration of neoadjuvant chemotherapy (NACT) in patients with localized pancreatic adenocarcinoma (PDAC) treated with curative intent is unclear. We sought to determine the prognostic significance of both duration of NACT and Carbohydrate Antigen 19-9 (CA19-9) normalization to NACT. METHODS We examined patients with resectable and borderline resectable PDAC treated with NACT and chemoradiation. Patients were compared by NACT duration (2 vs 4 months) and by CA19-9 normalization after NACT. RESULTS Among 171 patients, 83 (49%) received two months of NACT and 88 (51%) received four months. After NACT completion, 115 (67%) patients had persistently elevated CA19-9 and 56 (33%) had normalized. Of the 125 patients who had successful surgery, 73 (58%) had normalized CA19-9 postoperatively. Duration of NACT was not associated with overall survival (OS) while CA19-9 normalization after NACT (regardless of duration) was associated with improved OS (HR 0.56, 95% CI 0.35-0.89, p=0.02). Adjuvant chemotherapy was associated with improved OS among patients without CA19-9 normalization after NACT (HR 0.42, CI 0.20-0.86, p=0.02) but not among those that normalized, independent of duration. CONCLUSIONS CA19-9 normalization after NACT is a clinically significant endpoint of treatment; patients without CA19-9 normalization may benefit from additional therapy. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Sz Thalji
- Department of Surgery, Division of Surgical Oncology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - M Aldakkak
- Department of Surgery, Division of Surgical Oncology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kk Christians
- Department of Surgery, Division of Surgical Oncology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Cn Clarke
- Department of Surgery, Division of Surgical Oncology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - B George
- Department of Medicine, Division of Medical Oncology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - M Kamgar
- Department of Medicine, Division of Medical Oncology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ba Erickson
- Department of Radiation Oncology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Wa Hall
- Department of Radiation Oncology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - P Chisholm
- Department of Medicine, Division of Gastroenterology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - N Kulkarni
- Department of Radiology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - S Doucette
- Department of Pathology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Db Evans
- Department of Surgery, Division of Surgical Oncology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - S Tsai
- Department of Surgery, Division of Surgical Oncology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
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7
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Stout K, Adomako R, Almerstani M, Shin D, Tandon H, Schleifer J, Payne J, Easley A, Khan F, Windle J, Tsai S, Anderson D, Naksuk N. Prevalence of modifiable risk factors and related poor cardiovascular outcomes following atrial fibrillation ablation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.432] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) has become a global epidemic. Early catheter ablation and therapies modifying risk factors (RF) have been shown to improve outcomes of AF ablation. However, the time invested in pursuing risk factor modification may delay ablation, which could negate the procedural benefit.
Purpose
This study sought to investigate the prevalence and impact of potentially modifiable RF among AF patients undergoing catheter ablation in clinical practice.
Methods
This retrospective study included 724 consecutive patients undergoing AF ablation at a tertiary care center from 2012–2019. Pre-specified modifiable risks were examined, including the time from AF diagnosis to ablation, fluctuation/increase in BMI >5% prior to ablation, mean systolic/diastolic blood pressure >125/80 mmHg, obstructive sleep apnea with CPAP noncompliance, hyperlipidemia without statin therapy, tobacco use, excessive alcohol use, and diabetes mellitus with hemoglobin A1c (HbA1c) >6.5%. The primary outcome was a composite of recurrent atrial arrhythmias, cardiovascular (CV) hospitalizations and mortality following AF ablation. A multivariate analysis was performed.
Results
The mean age was 61±10 years old, 32.5% were female and 72.2% had persistent AF. Many study patients had modifiable RF, ranging from 4.7% with excessive alcohol use to 64.0% experiencing delayed AF ablation. The mean time from AF diagnosis to ablation was 4.7 years. During a mean follow-up of 1.6 years after ablation, 467 (64.5%) patients met the primary outcome. Independent RF for the primary outcome were an increase/fluctuation in BMI >5% (adjusted hazard ratio [AHR] 1.31, 95% confidence interval [CI] 1.07–1.60; P=0.008), diabetes with HbA1c >6.5% (AHR 1.50, 95% CI 1.09–2.03; P=0.014) and hyperlipidemia without statin therapy (AHR 1.30, 95% CI 1.08–1.57; P=0.005). Delayed AF ablation over 1.5 years did not alter the outcome, Figure 1.
Conclusion
Substantial portions of patients undergoing AF ablation have potentially modifiable RF. Increased or fluctuating BMI, diabetes with HbA1c >6.5%, and hyperlipidemia not treated with statin therapy portend an increased risk of recurrent atrial arrhythmia, CV hospitalizations and mortality. These findings underscore an importance pursuing RF management in patients with AF to reduce adverse outcomes after ablation.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The Jensen Family Research Sponsorship at the University of Nebraska Medical Center
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Affiliation(s)
- K Stout
- University of Nebraska Medical Center , Omaha , United States of America
| | - R Adomako
- University of Nebraska Medical Center , Omaha , United States of America
| | - M Almerstani
- University of Nebraska Medical Center , Omaha , United States of America
| | - D Shin
- University of Nebraska Medical Center , Omaha , United States of America
| | - H Tandon
- University of Nebraska Medical Center , Omaha , United States of America
| | - J Schleifer
- University of Nebraska Medical Center , Omaha , United States of America
| | - J Payne
- University of Nebraska Medical Center , Omaha , United States of America
| | - A Easley
- University of Nebraska Medical Center , Omaha , United States of America
| | - F Khan
- University of Nebraska Medical Center , Omaha , United States of America
| | - J Windle
- University of Nebraska Medical Center , Omaha , United States of America
| | - S Tsai
- University of Nebraska Medical Center , Omaha , United States of America
| | - D Anderson
- University of Nebraska Medical Center , Omaha , United States of America
| | - N Naksuk
- University of Nebraska Medical Center , Omaha , United States of America
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8
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Tsai S. The effects of lithium and inflammation on the atherosclerosis of older bipolar patients at high risk for cardiovascular disease. Eur Psychiatry 2022. [PMCID: PMC9564629 DOI: 10.1192/j.eurpsy.2022.1018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Atherosclerosis can result in serious cardiovascular disease (CVD) and is associated with inflammation and psychopharmacological treatment in bipolar disorder. Objectives We attempt to investigate the effects of lithium and inflammation on the atherosclerotic development in older bipolar adults at high risk for cardiovascular disease. Methods The euthymic out-patients with bipolar I disorder aged over 45 years and concurrent endocrine or cardiovascular disease were recruited to measure their bilateral carotid intima media thickness (CIMT) and circulating levels of lithium, valproate, sTNF-R1, sIL-6R, and lipid profile. All clinical information were obtained by directly interviewing patients and reviewing all medical records. Results Forty eight patients with mean 48.3 years old and mean 27.2 years of age at illness onset were recruited. After controlling for the body mass index, multivariate regression analyses showed that older age, lower lithium level, and higher plasma sTNF-R1 level were associated with higher CIMT and collectively accounting for 33.1% of the variance in CIMT. Blood level of low density lipid or valproate has none relationship with CIMT. Conclusions Lithium treatment may protect older bipolar patient, even those at high risk for CVD, from atherosclerotic development. Furthermore, persistent inflammatory activation, particularly macrophage activation, may be associated with the accelerating development of atherosclerosis. Disclosure No significant relationships.
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9
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Tandon H, Stout K, Shin D, Ruskamp R, Payne J, Goyal N, Tsai S, Easley A, Khan F, Windle J, Anderson D, Schleifer JW, Naksuk N. Pre-ablation interatrial conduction delay or block predicts atrial fibrillation recurrence after ablation among obese patients. Europace 2022. [DOI: 10.1093/europace/euac053.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Obesity is associated with greater risk of atrial fibrillation (AF) recurrence post-ablation and higher incidence of conduction delay compared to non-obese patients. Pre-ablation P-wave duration (PWD) and morphology (PWM) indicating interatrial delay are easily assessed in the clinic and may predict AF recurrence post-ablation in these patients.
Purpose
Evaluate the predictive value of PWD and PWM on AF recurrence post-ablation in obese patients.
Methods
Pre-ablation PWD and PWM (negative P-wave in lead II or III) were analyzed on consecutive patients with BMI ≥30 kg/m2 who underwent initial AF ablation from 2012–19. The primary outcome was recurrent AF after a 3-month post-ablation blanking period. Multivariate analysis adjusted for baseline characteristics was performed.
Results
For 205 patients (61.0±9.5 years old, 39.0% female), mean BMI was 36.9±5.7 kg/m2 and 71.7% had persistent AF pre-ablation. Recurrent AF post-ablation occurred in 115 (56.1%) during a median follow up of 491 (270, 1001) days. PWD >130 ms was significantly associated with higher AF recurrence (AHR of 1.62, 95%CI 1.04-2.57, p=0.03) after adjusting for age, persistent AF and left atrial volume index (LAVI). In a subgroup with LAVI <42 mL/m2 (n=112), PWD >130 ms and negative P-waves in lead II or III were independently associated with increased risk of recurrent AF (AHR 2.06, 95%CI 1.12-3.91; p=0.019 and AHR 1.94, 95% CI 1.00-3.56; p=0.05, respectively) (Figure 1).
Conclusion
AF recurred in >50% of obese patients within 1.5 years of ablation. Pre-ablation PWD >130 ms and negative P-waves in lead II or III independently predicted recurrent AF post-ablation in this cohort of obese patients. These easily assessed findings add predictive value to other risk factors.
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Affiliation(s)
- H Tandon
- University Of Nebraska Medical Center, Omaha, United States of America
| | - K Stout
- University Of Nebraska Medical Center, Omaha, United States of America
| | - D Shin
- University Of Nebraska Medical Center, Omaha, United States of America
| | - R Ruskamp
- University Of Nebraska Medical Center, Omaha, United States of America
| | - J Payne
- University Of Nebraska Medical Center, Omaha, United States of America
| | - N Goyal
- University Of Nebraska Medical Center, Omaha, United States of America
| | - S Tsai
- University Of Nebraska Medical Center, Omaha, United States of America
| | - A Easley
- University Of Nebraska Medical Center, Omaha, United States of America
| | - F Khan
- University Of Nebraska Medical Center, Omaha, United States of America
| | - J Windle
- University Of Nebraska Medical Center, Omaha, United States of America
| | - D Anderson
- University Of Nebraska Medical Center, Omaha, United States of America
| | - JW Schleifer
- University Of Nebraska Medical Center, Omaha, United States of America
| | - N Naksuk
- University Of Nebraska Medical Center, Omaha, United States of America
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10
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Montel-Hagen A, Tsai S, Seet CS, Crooks GM. Generation of Artificial Thymic Organoids from Human and Murine Hematopoietic Stem and Progenitor Cells. Curr Protoc 2022; 2:e403. [PMID: 35384408 DOI: 10.1002/cpz1.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The generation of T cells is a complex, carefully orchestrated process that occurs in the thymus. The ability to mimic T cell differentiation in vitro has opened up avenues to better understand different stages of thymopoiesis but has also enabled the in vitro production of mature T cells suitable for immunotherapy. Among existing protocols, the artificial thymic organoid (ATO) system has been shown to be the most efficient at producing mature conventional T cells. In this serum-free model, human or murine hematopoietic stem and progenitor cells (HSPCs) are combined with a murine stromal cell line expressing a Notch ligand in a 3D cell aggregate. In ATOs, although only simple medium changes are required throughout the cultures, HSPCs differentiate into T cells with kinetics and phenotypes similar to those of endogenous thymopoiesis. This article describes protocols for the generation of ATOs from human and murine HSPCs. © 2022 Wiley Periodicals LLC. Basic Protocol 1: Expansion and preparation of MS5-hDLL4 or MS5-mDLL4 cells Basic Protocol 2: Isolation of human hematopoietic stem and progenitor cells (HSPCs; CD34+ cells) Support Protocol 1: Transduction of human HSPCs (CD34+ cells) Basic Protocol 3: Production of thymic progenitors and mature T cells from human HSPCs in artificial thymic organoids (ATOs) Support Protocol 2: Phenotype analysis of human ATO cells by flow cytometry Basic Protocol 4: Isolation of murine HSPCs (Lin- Sca1+ cKit+; LSK) and hematopoietic stem cells (LSK CD150+ CD48-) Basic Protocol 5: Production of thymic progenitors and mature T cells from murine HSPCs in ATOs Support Protocol 3: Phenotype analysis of murine ATO cells by flow cytometry Alternate Protocol: Generation of ATOs from single HSPCs.
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Affiliation(s)
- Amélie Montel-Hagen
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, California
| | - Steven Tsai
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Christopher S Seet
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California.,Broad Stem Cell Research Center, UCLA, Los Angeles, California.,Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, California
| | - Gay M Crooks
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, California.,Broad Stem Cell Research Center, UCLA, Los Angeles, California.,Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, California.,Division of Pediatric Hematology-Oncology, Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, California
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11
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AlMasri S, Zenati M, Hammad A, Singhi A, Paniccia A, Lee K, Aldakkak M, Evans D, Tsai S, Zureikat A, Ellsworth S. Implications of SMAD4 Status in Pancreatic Carcinoma Treated With Radiation Therapy: A Multi-Institutional Analysis. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Conger R, Mora J, Straza M, Erickson B, Lawton C, Schultz C, Currey A, Bedi M, Saeed H, Tsai S, Siker M, Hall W. Evolution in the Presence and Evidence Category of Radiation Therapy Treatment Recommendations in National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Cable BM, Farooqi AS, Tsai S, Plyler R, Lee A, Parisien RL, Kelly JD. Humeral Head Morphology Influences Outcomes of Arthroscopic Interposition Glenoid Patch Allograft for Glenohumeral Arthritis. Arthrosc Sports Med Rehabil 2021; 3:e1421-e1429. [PMID: 34712980 PMCID: PMC8527262 DOI: 10.1016/j.asmr.2021.07.004] [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: 01/08/2021] [Accepted: 07/11/2021] [Indexed: 12/05/2022] Open
Abstract
Purpose To determine short- to midterm patient-reported outcomes of arthroscopic soft-tissue interposition arthroplasty using acellular dermal allograft with a minimum follow-up of 1 year and to assess outcomes in patients with and without flattening of the humeral head. Methods Patients with a diagnosis of primary glenohumeral arthritis who underwent arthroscopic soft-tissue interposition arthroplasty with an acellular dermal allograft from July 2010 to November 2019 were retrospectively enrolled. Inclusion criteria were a primary diagnosis of glenohumeral arthritis and Outerbridge 4 full-thickness cartilage loss of ≥50% of the glenoid articular surface. Patients underwent arthroscopic debridement, microfracture, and biological arthroscopic soft-tissue interposition arthroplasty with an acellular dermal matrix. Postoperative outcomes included American Shoulder and Elbow Surgeon (ASES) score, Single Assessment Numeric Evaluation (SANE) score, Penn Shoulder Score (PSS), numeric rating scale (NRS) pain score, analgesic use, and conversion to total shoulder arthroplasty (TSA). Results were stratified according to humeral head morphology on preoperative radiographs. Results A total of 25 patients were included, with a mean age of 56.0 years (range 19.2 to 74.8) and a mean follow-up of 3.36 years (range 1.03 to 8.98). The mean postoperative ASES score was 64.1 (range 11.7 to 100.0), SANE score was 62% (range 5% to 100%), and PSS was 61.2 (range 10.6 to 97.9). Additionally, 56% of patients rated their shoulder function as improved or much improved, and 36% of patients converted to TSA at a mean of 2.35 years. Patients with and without humeral flattening had similar postoperative ASES scores (P = .44), SANE scores (P = .90), PSS (P = .73), and conversions to TSA (P = .83). Patients with humeral flattening were more likely to have shoulder pain at night (83.3% versus 28.6%, P = .02). Conclusion Arthroscopic soft-tissue interposition arthroplasty with an acellular dermal allograft resulted in satisfactory short- to mid-term postoperative outcomes for younger patients with glenohumeral arthritis but demonstrated a TSA conversion rate of 36%. Patients with humeral head flattening also had satisfactory shoulder function but were more likely to experience shoulder pain at night. Level of Evidence Level IV, therapeutic case series
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Affiliation(s)
| | | | | | | | | | - Robert L. Parisien
- Address correspondence to Robert L. Parisien, M.D., University of Pennsylvania, Philadelphia, PA 19103, U.S.A.
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14
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Stout K, Tandon H, Adomako R, Schleifer J, Payne J, Easley A, Khan F, Windle J, Tsai S, Anderson D, Peeraphatdit T, Naksuk N. Poor glycemic control in diabetic patients increases the risk of recurrent atrial arrhythmia and cardiovascular hospitalizations among morbidly obese patients undergoing atrial fibrillation ablation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0513] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Obesity and atrial fibrillation (AF) coexist and share multiple cardiovascular risk factors. Lifestyle modifications can reduce AF burden in obese patients. However, the time invested in pursing lifestyle changes may delay AF ablation, which could negate the procedural benefit.
Purpose
To examine the effects of lifestyle modifications and the timing of catheter ablation on morbidly obese patients with AF.
Methods
This retrospective study included 217 consecutive AF patients with a body mass index (BMI) ≥35 kg/m2 undergoing AF ablation at a tertiary care center from 2012 to 2019. Modifiable risks were examined, including the time from AF diagnosis to ablation, fluctuation of BMI >5% or an increase in BMI >3% prior to ablation, mean systolic blood pressure >130 mmHg or diastolic blood pressure >80 mmHg, obstructive sleep apnea with CPAP noncompliance, hyperlipidemia without statin therapy, tobacco use, excessive alcohol use, and diabetes mellitus with hemoglobin A1c (HbA1c) ≥6.5%. The primary outcome was a composite of recurrent atrial arrhythmias and cardiovascular (CV) hospitalizations following AF ablation. A multivariate analysis adjusting for age, gender and modifiable risks was performed.
Results
The mean age was 61±9 years old, 58% were female and 45% had persistent AF. A substantial portion of the study patients had modifiable risk factors, ranging from 2.7% with excessive alcohol use to 67.3% experiencing delayed AF ablation, Figure 1. The median time from diagnosed AF to ablation was 1.3 years. During a mean follow-up of 2.9 years after AF ablation, 136 (62.7%) patients met the primary outcome. Only HbA1c ≥6.5% was an independent risk factor with adjusted hazard ratio of 1.57, 95% confidence interval 1.02–2.36, P=0.0412, Figure 2A. Delayed AF ablation did not alter the outcome, Figure 2B. There was no interaction between time of ablation and HbA1c ≥6.5% (P=0.67).
Conclusion
Substantial portions of morbidly obese patients undergoing AF ablation have potentially modifiable risk factors. Poor glycemic control with HbA1c ≥6.5% predicts an increased risk of recurrent atrial arrhythmias and CV hospitalizations, while delayed AF ablation does not. This finding underscores an importance of optimizing HbA1c in morbidly obese patients with AF to reduce adverse outcomes after ablation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K.M Stout
- University of Nebraska Medical Center, Cardiovascular Medicine, Omaha, United States of America
| | - H Tandon
- University of Nebraska Medical Center, Cardiovascular Medicine, Omaha, United States of America
| | - R Adomako
- University of Nebraska Medical Center, Cardiovascular Medicine, Omaha, United States of America
| | - J.W Schleifer
- University of Nebraska Medical Center, Cardiovascular Medicine, Omaha, United States of America
| | - J Payne
- University of Nebraska Medical Center, Cardiovascular Medicine, Omaha, United States of America
| | - A Easley
- University of Nebraska Medical Center, Cardiovascular Medicine, Omaha, United States of America
| | - F Khan
- University of Nebraska Medical Center, Cardiovascular Medicine, Omaha, United States of America
| | - J Windle
- University of Nebraska Medical Center, Cardiovascular Medicine, Omaha, United States of America
| | - S Tsai
- University of Nebraska Medical Center, Cardiovascular Medicine, Omaha, United States of America
| | - D Anderson
- University of Nebraska Medical Center, Cardiovascular Medicine, Omaha, United States of America
| | - T Peeraphatdit
- University of Nebraska Medical Center, Cardiovascular Medicine, Omaha, United States of America
| | - N Naksuk
- University of Nebraska Medical Center, Cardiovascular Medicine, Omaha, United States of America
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Oliai C, Crosetti A, De Vos S, Eradat H, Mead MD, Larson SM, Tsai S, Liu A, Khachatrian G, Hannigan C, Yamada RE, Rokni N, Timmerman J. IL-1 receptor antagonist for prevention of severe immune effector cell-associated neurotoxicity syndrome. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.7566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7566 Background: Progress in chimeric antigen receptor (CAR) T-cell therapy has included reduction in life-threatening toxicity. Rates of severe cytokine release syndrome (CRS) have declined from 50% in early trials to 7% in the most recent real-world experience. However, rates of severe immune effector cell-associated neurotoxicity (ICANS) associated with axicabtagene ciloleucel (Axicel) remain unchanged. IL-1 is a major driver of ICANS pathophysiology that is produced upstream of IL-6. The IL-1 receptor antagonist, Anakinra, can prevent neurotoxicity in animal models when given at fever onset. We present our early experience of the first 13 participants enrolled into a phase II trial evaluating Anakinra to prevent severe ICANS (NCT4205838). Methods: This investigator-sponsored trial included adults eligible for standard-of-care Axicel for large B-cell lymphoma after ≥2 lines of intensive chemoimmunotherapy. Participants received Anakinra 100 mg SQ q6h x 12-36 doses until ICANS returned to grade ≤1. The trigger to initiate Anakinra was any grade ICANS or grade ≥3 CRS in the absence of ICANS. A protocol modification, made after the first 3 participants were treated, changed the trigger for Anakinra to grade ≥2 CRS. In addition to Anakinra, all participants received standard-of-care interventions for CRS and ICANS. The primary objective is to estimate the efficacy of Anakinra in preventing severe ICANS (grade ≥3) according to ASTCT 2018 consensus grading. Results: To date, 13 participants have been enrolled, and 7 met criteria to initiate Anakinra and received the first dose prior to severe ICANS. Median age was 56 years (range, 23-84 years). Of the 7 participants whom received Anakinra prior to severe ICANS, only 1 of 7 (14%) developed grade 3 ICANS. The most common adverse event was injection site reaction, which peaked at grade 2. There were no unexpected toxicities. Once the protocol was amended to initiate Anakinra for grade ≥2 CRS (N = 4), no participant developed severe ICANS, and only one participant met the institutional standard to receive corticosteroids (Table). Conclusions: Anakinra is feasible to initiate in the non-prophylactic setting in patients at increased risk for severe ICANS. These early results demonstrate potential to reduce severe ICANS associated with Axicel to a rate similar to other CAR T-cell products, and to reduce corticosteroid use. Further enrollment to the pre-planned sample size of N=36 is required to demonstrate statistical efficacy. Serum IL-1 analysis is also ongoing. Clinical trial information: NCT4205838. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | - Annabel Liu
- University of California, Los Angeles, Los Angeles, CA
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16
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Harn H, Wang S, Lai Y, Van Handel B, Liang Y, Tsai S, Schiessl IM, Sarkar A, Xi H, Hughes M, Kaemmer S, Tang M, Peti-Peterdi J, Pyle A, Woolley T, Evseenko D, Jiang T, Chuong C. 609 Symmetry breaking of tissue mechanics in wound induced hair follicle regeneration. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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17
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Nasief H, Hall W, Zheng C, Tsai S, Erickson B, Li A. A Multi-biomarker Panel Including Delta Radiomics to Predict Distant Metastasis after Chemoradiation Therapy of Pancreatic Adenocarcinoma. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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18
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Montel-Hagen A, Sun V, Casero D, Tsai S, Zampieri A, Jackson N, Li S, Lopez S, Zhu Y, Chick B, He C, de Barros SC, Seet CS, Crooks GM. In Vitro Recapitulation of Murine Thymopoiesis from Single Hematopoietic Stem Cells. Cell Rep 2020; 33:108320. [PMID: 33113379 PMCID: PMC7727762 DOI: 10.1016/j.celrep.2020.108320] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/01/2020] [Accepted: 10/06/2020] [Indexed: 12/16/2022] Open
Abstract
We report a serum-free, 3D murine artificial thymic organoid (M-ATO)
system that mimics normal murine thymopoiesis with the production of all T cell
stages, from early thymic progenitors to functional single-positive (CD8SP and
CD4SP) TCRαβ and TCRγδ cells. RNA sequencing aligns
M-ATO-derived populations with phenotypically identical primary thymocytes.
M-ATOs initiated with Rag1−/− marrow
produce the same differentiation block as seen in the endogenous thymus, and
Notch signaling patterns in M-ATOs mirror primary thymopoiesis. M-ATOs initiated
with defined hematopoietic stem cells (HSCs) and lymphoid progenitors from
marrow and thymus generate each of the downstream differentiation stages,
allowing the kinetics of T cell differentiation to be tracked. Remarkably,
single HSCs deposited into each M-ATO generate the complete trajectory of T cell
differentiation, producing diverse TCR repertoires across clones that largely
match endogenous thymus. M-ATOs represent a highly reproducible and efficient
experimental platform for the interrogation of clonal thymopoiesis from
HSCs. Montel-Hagen et al. develop a murine artificial thymic organoid (M-ATO)
system to reproduce thymopoiesis in vitro from bone marrow stem
and progenitor cells (HSPCs). This method efficiently recapitulates the
phenotypic and transcriptional features of normal murine T cell development even
when initiated with a single HSC.
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Affiliation(s)
- Amélie Montel-Hagen
- Department of Pathology & Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Victoria Sun
- Department of Pathology & Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA; Molecular Biology Interdepartmental Program, UCLA, Los Angeles, CA, USA
| | - David Casero
- Department of Pathology & Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Steven Tsai
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Alexandre Zampieri
- Department of Pathology & Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Nicholas Jackson
- Department of Pathology & Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Suwen Li
- Department of Pathology & Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA; Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, CA, USA; Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, UCLA, Los Angeles, CA, USA
| | - Shawn Lopez
- Department of Pathology & Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Yuhua Zhu
- Department of Pathology & Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Brent Chick
- Department of Pathology & Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Chongbin He
- Department of Pathology & Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Stéphanie C de Barros
- Department of Pathology & Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Christopher S Seet
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA; Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, UCLA, Los Angeles, CA, USA; Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA
| | - Gay M Crooks
- Department of Pathology & Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA; Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, UCLA, Los Angeles, CA, USA; Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA; Division of Pediatric Hematology-Oncology, Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
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Sun V, Montel-Hagen A, Casero D, Tsai S, Zampieri A, Jackson N, Li S, Lopez S, Zhu Y, De Barros S, Seet C, Crooks G. 3040 – IN VITRO RECAPITULATION OF MURINE T CELL DEVELOPMENT FROM SINGLE HEMATOPOIETIC STEM CELLS. Exp Hematol 2020. [DOI: 10.1016/j.exphem.2020.09.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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20
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Tsai S, Lee P, Gordon C, Cayanan E, Lee C. 0819 Objective Sleep Efficiency is Associated with Longitudinal Risk of High Depressive Symptoms in Pregnant Women. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Sleep disturbances are one of the most frequent complaints identified during routine prenatal care visits. Sleep and mood disturbances are often intertwined, and depression in particular is a leading cause of disability and disease burden worldwide. The purpose of this study was to examine the predictive association of objective actigraphic and subjective sleep disturbances with depressive symptoms in pregnant women.
Methods
We recruited 204 first-trimester pregnant women from a large university-affiliated hospital. They provided baseline socio-demographic and health information, wore a wrist actigraph for 7 days, and completed the Pittsburgh Sleep Quality Index and Center for Epidemiologic Studies - Depression Scale and repeated this again in the second and third trimesters. Each data collection was scheduled at least 8 weeks apart. Unadjusted and multivariable adjusted odds ratios with 95% confidence intervals were used to evaluate sleep disturbances at 1st trimester and risk of high depressive symptoms at follow-up.
Results
A total of 121 (59.3%) women had actigraphic sleep efficiency of < 85% and 92 (45.1%) had Pittsburgh Sleep Quality Index global scores > 5 indicative of poor sleep quality. In multivariable adjusted models, 1st trimester objectively measured sleep efficiency < 85% was associated with 2.65-, 3.86-, and 5.27-fold increased odds having risk of high depressive symptoms at 2nd trimester, 3rd trimester, and both 2nd and 3rd trimesters, respectively. No subjective sleep disturbance variables were significantly associated with risk of high depressive symptoms in multivariate adjusted models.
Conclusion
Objectively assessed poor sleep efficiency in the 1st trimester plays a crucial role in the development of both elevated and persistent high depressive symptoms in pregnancy. Future studies using objective sleep measurements and clinical diagnostic interviews are warranted to examine whether early interventions to improve sleep may help reduce high depressive symptom risk and lower depression rates in women during pregnancy.
Support
This study was funded by the Ministry of Science and Technology, Taiwan (MOST-101-2314-B-002-049-MY3).
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Affiliation(s)
- S Tsai
- National Taiwan University, Taipei, TAIWAN
| | - P Lee
- National Taiwan University Hospital, Taipei, TAIWAN
| | - C Gordon
- University of Sydney, Sydney, AUSTRALIA
| | - E Cayanan
- University of Sydney, Sydney, AUSTRALIA
| | - C Lee
- National Taiwan University, Taipei, TAIWAN
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Edinger JD, Walmboldt F, Holm K, Johnson RL, Simmons B, Tsai S, Morin C. 0509 Use of Blinded Hypnotic Tapering for Hypnotic Discontinuation. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Many patients have difficulties achieving hypnotic discontinuation due to anxiety that arises when they knowingly reduce their hypnotic dose or withhold it entirely. This study tested a blinded tapering approach to reduce patients’ anxiety and help them discontinue their hypnotics.
Methods
The study sample included 78 (M age = 55.2 ± 12.8 yrs.; 65.4% women) users of benzodiazepine and benzodiazepine receptor agonists. Following baseline assessments, enrollees first completed 4 sessions of cognitive behavioral insomnia therapy (CBTI). Subsequently they were randomized to one of three 20-week, double-blinded tapering protocols wherein their medication dosage either remained unchanged (CTRL) or was reduced by 25% or 10% every two weeks. At the end of the 20-week period the study blind was eliminated and those who completed one of the two blinded tapering protocols entered a 3-month follow-up period, whereas CTRL participants were offered an open label taper before completing the follow-up.
Results
Among those who completed one of the blinded tapering protocols, 92.9% totally discontinued their medication use by the end of the 20-week tapering phase, whereas 77.3% in the CTRL group discontinued hypnotic use by the end of their open label tapering. At follow-up 72.1% of those who completed blinded tapering remained medication free whereas only 52% of those who underwent open-label tapering remained medication free. Comparisons at follow-up showed those who received the open-label taper continued to use hypnotics on average 2-3 nights/week compared to about 1 time every other week for the blinded taper group (p = .05). The average weekly diazepam equivalent dose of medication used by the open label tapering group was about 5 times higher than the average weekly dose used by the blind tapering group (p = .025).
Conclusion
CBTI combined with blinded hypnotic tapering is a promising treatment approach for helping hypnotic users overcome their medication dependence.
Support
National Institute of Drug Abuse, Grant # R34 DA042329-01
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Affiliation(s)
- J D Edinger
- National Jewish Health, Denver, CO
- Duke University Medical Center, Durham, NC
| | | | - K Holm
- National Jewish Health, Denver, CO
| | | | | | - S Tsai
- National Jewish Health, Denver, CO
| | - C Morin
- Laval University, Quebec City, QC, CANADA
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Liao W, Lin S, Meng N, Tin H, Tsai S, Huang Y. 1134 Light Exposure At Daytime On Sleep Quality In Stroke Patient During Rehabilitation. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Lights maintain the day and night rhythm to set patients’ “wake-up cycle” and to stabilize their physiological functions, which may be expected to improve sleep. This study was aimed to investigate the relations between sleep quality and daytime light exposure in stroke patient during rehabilitation.
Methods
A cross-sectional study design was adopted and 120 stroke patients were recruited from rehabilitation wards of two medical centers and 116 patients completed this study. Research instruments including the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Sleep Log, and Somnowatch (Germany) for actigaphy sleep and light were used to collect data and urinary melatonin concentration were measured.
Results
47.4% of the patients had poor sleep quality (PSQI>5), 74.1% had actigraphic sleep efficiency less than 85%, and 90.5% waked more than 30 minutes after sleep onset. The average exposure time at lower level light (≤149 lux) were 288.8 minutes, accounting for 48% of the day (8:00-18:00). Compared to lower light exposure group (less than 319.5 min at >150 lux), those who exposed to higher level light (more than 319.5 min at >150 lux) had increased 52.1 minutes in actigraphic total sleep time (TST, t=-2.134, p=0.035), increased 8% in actigraphic sleep efficiency (SE, t=-2.053, p=0.042), and decreased 41.1 minutes in actigraphic wake-after-sleep-onset (WASO, t=2.209, p=0.029). Urinary melatonin concentration increased 52.7 pg/ml, but not statistically significant (t=-1.277, p=0.205). Result of multiple regression analysis showed that after controlling for age, gender, post-stroke complications, and environmental interference, time of bright light exposure significantly affected subjective sleep satisfaction (p=0.014), TST (p=0.04), SE (p=0.041), and WASO (p=0.026).
Conclusion
Increasing time of bright illumination (≥150 lux) during daytime may improve sleep quality. Results of this study provide empirical references for non-drug intervention to improve sleep quality in patients with stroke.
Support
This study was supported by the Ministry of Science and Technology, MOST 105-2628-B-040 -005 -MY2.
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Affiliation(s)
- W Liao
- China Medical University, Taichung, TAIWAN
| | - S Lin
- China Medical University Hospital, Taichung, TAIWAN
| | - N Meng
- China Medical University Hospital, Taichung, TAIWAN
| | - H Tin
- Chun Shan Medical University Hospital, Taichung, TAIWAN
| | - S Tsai
- Chun Shan Medical University Hospital, Taichung, TAIWAN
| | - Y Huang
- Chun Shan Medical University Hospital, Taichung, TAIWAN
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Baran J, Tsai S, Singleton D, Isaza A, Brodeur G, MacFarland S, Zelley K, Mamula P, Bauer AJ. OR22-02 PTEN Hamartoma Tumor Syndrome in Pediatrics: Triggers for Evaluation and the Value of Surveillance. J Endocr Soc 2020. [PMCID: PMC7209534 DOI: 10.1210/jendso/bvaa046.859] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Context: PTEN Hamartoma Tumor Syndrome (PHTS) comprises a collection of rare clinical disorders characterized by germline mutations in the tumor suppressor gene PTEN. Current guidelines recommend screening for thyroid tumors beginning in pediatric age at the time of PHTS diagnosis; however, the benefit of early surveillance has not been well defined. Patients/Objective: We conducted a retrospective, single-site cohort investigation of patients followed at the Children’s Hospital of Philadelphia with diagnosis of PHTS between January 2003 - June 2019. In total, 81 patients under 18 years of age were identified. Clinical features, PTEN mutation codon, thyroid and gastrointestinal (GI) features were extracted from the electronic health record. The aim of the study is to assess genotype-phenotype, the incidence of thyroid and gastrointestinal disease, and to determine whether current recommendations for thyroid surveillance are improving outcomes. Results: The most common clinical feature at presentation was macrocephaly (85%) followed by impaired development (42%), skin/oral lesions (31%), and autistic spectrum disorder (27%). GI polyps were the presenting feature in 5 patients, with 14 of 81 patients ultimately diagnosed secondary to constipation (71%), rectal bleeding (64%), and/or abdominal pain (50%). All polyps were benign. A total of 58 of 81 patients underwent thyroid surveillance, with 30 patients (52%) found to have a nodule(s). Ultimately, 16 patients underwent thyroidectomy, with 31% (5/16) diagnosed with thyroid cancer. All thyroid cancer patients were greater than 10 years of age at diagnosis and all displayed low-invasive behavior (ATA low-risk). Of the patients < 10 years at the time of thyroid ultrasound (US) surveillance, 74% (14/19) had a normal US. The remaining five patients who underwent thyroid surgery all had benign histology. No genotype-phenotype relations were found; however, patients with identical mutations were found to have similar clinical features. Conclusions: Patients with macrocephaly associated with impaired development, skin/oral lesions, thyroid nodules and/or early onset GI polyps should undergo germline testing for PHTS. There does not appear to be a clinical advantage to initiating thyroid US surveillance prior to 10 years of age. Early detection may not improve outcome of thyroid cancer as the majority of thyroid cancers display low-invasive behavior. In PHTS patients with a normal physical exam, thyroid ultrasound surveillance can be delayed until after 10 years of age. Early onset GI polyps may be the presenting diagnosis of PHTS.
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Affiliation(s)
- Julia Baran
- The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Steven Tsai
- University of Pennsylvania, Philadelphia, PA, USA
| | | | - Amber Isaza
- The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Garrett Brodeur
- The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Kristin Zelley
- The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Petar Mamula
- The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Tsai S, Pirruccio K, Ahn J. The brief window of time comprising a wheelchair transfer confers a significant fracture risk on elderly Americans. Public Health 2020; 182:1-6. [PMID: 32105994 DOI: 10.1016/j.puhe.2020.01.002] [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: 05/14/2019] [Revised: 12/23/2019] [Accepted: 01/10/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Wheelchairs grant increased mobility to their users but can result in injuries of varying severities, including fractures which are often associated with wheelchair transfers. However, this fracture burden remains poorly characterized in elderly Americans. The purpose of this study was to report demographic and environmental risk factors for these injuries. STUDY DESIGN We used data from the National Electronic Injury Surveillance System (NEISS) for the years 2007-2017 to perform a retrospective, cross-sectional analysis of wheelchair transfer fractures in patients aged 65 years and older. METHODS Each yearly sample in the NEISS database was queried between 2007 and 2017 for fractures associated with wheelchair transfers in patients aged 65 years or older. The narrative sections of the database were individually read and reviewed to identify cases in which a patient explicitly transferred into or out of a wheelchair while sustaining said fracture. RESULTS Between 2007 and 2017, the average number of patients aged 65 years and older presenting to US emergency departments was 3924 (95% confidence interval [CI] = 2792-5055). A significantly higher percentage of fractures (61.8%; 95% CI = 56.7%-66.8%) is associated with transferring out of wheelchairs. Moreover, such fractures were often associated with transferring to and from beds (29.9%; 95% CI = 25.4%-34.3%), with the hip (37.5%; 95% CI = 33.3%-41.6%) being the most commonly fractured anatomical region overall. A majority of patients required admission to the hospital (60.2%; 95%CI = 52.4%-68.0%) and most wheelchair transfer fractures occurred at home (44.1%; 95% CI = 36.7%-51.5%), with women (71.9%; 95% CI = 68.3%-75.6%) comprising the majority of these patients. CONCLUSIONS Our findings show that wheelchair transfers are associated with significant risk of severe fracture in elderly Americans. As such, wheelchair transfer events merit extra attention from healthcare providers because they comprise a brief window of time relative to the number of occupancy hours in full-time wheelchair users yet can result in significant morbidity and mortality. Preventative measures and patient education should be encouraged to preserve patient mobility and reduce injury.
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Affiliation(s)
- S Tsai
- Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - K Pirruccio
- Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - J Ahn
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Nasief H, Erickson B, Hall W, Zheng C, Schott D, Aldakkak M, Tsai S, Wang L, Li A. Improving Treatment Response Prediction Using a Combination of Delta-Radiomics and Clinical Biomarker. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.549] [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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26
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King N, Friedman J, Lin E, Traylor J, Wong J, Tsai S, Chaudhari A, Milad M. 102: Systematic review of major vascular injuries (MVI) during gynecologic lapraroscopy for benign indications. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2019.01.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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27
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Tsai S. Neuroendocrine Tumor Awareness Program in Taiwan. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.20700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background and context: Neuroendocrine tumor (NET) is difficult to detect. It's often presented with symptoms common to other diseases. To raise awareness and improve the understanding of NET, the International Neuroendocrine Cancer Alliance (INCA) announced 10th November as the World NET Cancer Day. HOPE FOUNDATION for CANCER CARE has joined the advocacy events since 2011. Aim: To raise awareness and to improve the understanding of NET. Strategy/Tactics: To raise the awareness of the 10 symptoms of NET. To provide correct information about NET. To improve the understanding of NET. Program/Policy process: We held a series of campaigns in November 2017, including: theme decorations in 11 hospitals, 3 parades and shows at public places, a new animation with online marketing and outdoor advertising. By combining online and offline events, we have reached as many people as possible to increase the awareness and improve the knowledge of NET. We built the first as well as the only NET Mandarin Web site ( www.net.org.tw ) Outcomes: We cooperated with 11 hospitals in Taiwan to display educational posters and wall stickers. The information of NET cancers not only reached the public but also oncologists. This event had 3 newspaper reports and 16 online news reports. We conducted 3 educational parades and shows with zebra theme in three main cities in Taiwan. The parade in capital city Taipei gained total 86 reports including 71 online news media, 8 television channels and 7 newspapers. We cooperated with a celebrity artist to create a zebra mascot, which represents international symbol for NET. In addition, we created awareness lightbox advertising and animated video with the mascot to attract public attention and raise awareness of NET. This animated video was published on YouTube platform, and had 504,209 impressions and 208,427 views by 31st December 2017. Moreover, it was broadcasted on taxis in Taiwan as well. It was broadcasted 1,163,248 times during the promotion period. We also implemented an online advocacy plan through Facebook. This plan was designed with 4 posts, which contained a comic strip, an online memory game, a profile picture frame and an animated video. This plan totally had 332,625 impressions and reached 154,089 people on the Internet. What was learned: According to our experience with cancer patients, we realize that utilizing mascot characters to deliver educational information is more easily perceived by the public. This year we designed a new mascot of NET which was applied to animated video and outdoor advertising. Also, we conducted 3 educational parades with zebra theme and traditional Taiwanese features, which opened up a new dimension in advocacy for cancer awareness. Overall, these events received good response from the public and oncologists. The NET Mandarin Web site also showed a significant result with an increase of 98% of monthly page views and 69.7% of new visitors views.
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Montel-Hagen A, Seet C, Li S, Chick B, Zhu Y, Lopez S, Chang P, Tsai S, He C, Chin CJ, Casero D, Crooks G. Directed Differentiation of Conventional T Cells From Human Pluripotent Stem Cells in an Artificial Organoid System. Exp Hematol 2018. [DOI: 10.1016/j.exphem.2018.06.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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29
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Khassawneh B, Bathgate C, Tsai S, Edinger J. 0434 Impact Of Short Sleep Duration And Hyperarousal On Cognitive Performance Among Individuals With Insomnia. Sleep 2018. [DOI: 10.1093/sleep/zsy061.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- B Khassawneh
- Department of Medicine, National Jewish Health, Denver, CO
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, JORDAN
| | - C Bathgate
- Department of Medicine, National Jewish Health, Denver, CO
| | - S Tsai
- Department of Medicine, National Jewish Health, Denver, CO
| | - J Edinger
- Department of Medicine, National Jewish Health, Denver, CO
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Edinger JD, Bathgate CJ, Tsai S. 0202 Daytime Hyperarousal Predicts Performance Deficits on Complex Tasks Among Insomnia Sufferers. Sleep 2018. [DOI: 10.1093/sleep/zsy061.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - S Tsai
- National Jewish Health, Denver, CO
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31
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Edinger JD, Wamboldt F, Holm K, Johnson RL, Simmons B, Tsai S, Morin CM. 0418 Blinded Hypnotic Tapering Promotes Hypnotic Discontinuation. Sleep 2018. [DOI: 10.1093/sleep/zsy061.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - K Holm
- National Jewish Health, Denver, CO
| | | | | | - S Tsai
- National Jewish Health, Denver, CO
| | - C M Morin
- Université Laval, Quebec City, QC, CANADA
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32
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Darling MR, Tsai S, Jackson-Boeters L, Daley TD, Diamandis EP. Human Kallikrein 3 (prostate-specific antigen) and Human Kallikrein 5 Expression in Salivary Gland Tumors. Int J Biol Markers 2018; 21:201-5. [PMID: 17177156 DOI: 10.1177/172460080602100401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The human kallikrein 5 protein (hK5) is expressed in many normal tissues, most notably in skin, breast, salivary gland and esophagus. It has also been shown to be a potential biomarker for breast, ovarian and testicular cancer. Human kallikrein 3 (hK3; prostate-specific antigen) is the most useful marker for adenocarcinoma of the prostate gland. The aim of this study was to determine whether hK3 and hK5 are expressed in salivary gland tissues and salivary gland tumors (both benign and malignant), in order to compare normal with tumor tissues. Pleomorphic adenomas, adenoid cystic carcinomas, polymorphous low-grade adenocarcinomas, acinic cell carcinomas, mucoepidermoid carcinomas and adenocarcinomas not otherwise specified of both minor and major salivary glands were examined. The results of this study indicate that most salivary gland tumors do not show high levels of expression of hK5. Staining was most prominent in keratinizing epithelia in pleomorphic adenomas. hK3 is not expressed in salivary gland tumors.
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Affiliation(s)
- M R Darling
- Division of Oral Pathology, Department of Pathology, University of Western Ontario, London, Ontario N6A 5C1, Canada.
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33
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Edinger J, Walmboldt F, Holm K, Burleson A, Simmons B, Tsai S, Morin C. Use of blinded hypnotic tapering protocols to help medication-dependent insomnia patients discontinue their hypnotic use. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.252] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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34
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Alvi F, Glaser L, Tolentino J, Chaudhari A, Milad M, Tsai S. Do Fibroids Reduce the Likelihood of Unanticipated Malignancy? J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Saeed H, Cheng H, Aldakkak M, Tsai S, Evans D, Christians K, Thomas J, George B, Ritch P, Hall W, Erickson B, Wittmann D. Neoadjuvant Chemoradiation With IMRT for Pancreatic Cancer is Associated With Minimal Toxicity without Compromising Local Control. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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36
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Walter J, Xu S, Daly R, Tsai S. Systematic review of female fertility risk for breast cancer neoadjuvant/adjuvant therapies: implications for fertility preservation counseling. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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37
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Ricker CN, Hanna DL, Peng C, Nguyen NT, Stern MC, Schmit SL, Idos GE, Patel R, Tsai S, Ramirez V, Lin S, Shamasunadara V, Barzi A, Lenz HJ, Figueiredo JC. DNA mismatch repair deficiency and hereditary syndromes in Latino patients with colorectal cancer. Cancer 2017. [PMID: 28640387 PMCID: PMC5610604 DOI: 10.1002/cncr.30790] [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] [Indexed: 12/23/2022]
Abstract
BACKGROUND The landscape of hereditary syndromes and clinicopathologic characteristics among US Latino/Hispanic individuals with colorectal cancer (CRC) remains poorly understood. METHODS A total of 265 patients with CRC who were enrolled in the Hispanic Colorectal Cancer Study were included in the current study. Information regarding CRC risk factors was elicited through interviews, and treatment and survival data were abstracted from clinical charts. Tumor studies and germline genetic testing results were collected from medical records or performed using standard molecular methods. RESULTS The mean age of the patients at the time of diagnosis was 53.7 years (standard deviation, 10.3 years), and 48.3% were female. Overall, 21.2% of patients reported a first‐degree or second‐degree relative with CRC; 3.4% met Amsterdam I/II criteria. With respect to Bethesda guidelines, 38.5% of patients met at least 1 criterion. Of the 161 individuals who had immunohistochemistry and/or microsatellite instability testing performed, 21 (13.0%) had mismatch repair (MMR)‐deficient (dMMR) tumors. dMMR tumors were associated with female sex (61.9%), earlier age at the time of diagnosis (50.4 ± 12.4 years), proximal location (61.9%), and first‐degree (23.8%) or second‐degree (9.5%) family history of CRC. Among individuals with dMMR tumors, 13 (61.9%) had a germline MMR mutation (MutL homolog 1 [MLH1] in 6 patients; MutS homolog 2 [MSH2] in 4 patients; MutS homolog 6 [MHS6] in 2 patients; and PMS1 homolog 2, mismatch repair system component [PMS2] in 1 patient). The authors identified 2 additional MLH1 mutation carriers by genetic testing who had not received immunohistochemistry/microsatellite instability testing. In total, 5.7% of the entire cohort were confirmed to have Lynch syndrome. In addition, 6 individuals (2.3%) had a polyposis phenotype. CONCLUSIONS The percentage of dMMR tumors noted among Latino individuals (13%) is similar to estimates in non‐Hispanic white individuals. In the current study, the majority of individuals with dMMR tumors were confirmed to have Lynch syndrome. Cancer 2017. © 2017 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. Cancer 2017;123:3732–3743. © 2017 American Cancer Society The landscape of hereditary syndromes and clinicopathologic characteristics among Latino/Hispanic individuals in the United States with colorectal cancer remains poorly understood. Using data from the Hispanic Colorectal Cancer Study, approximately 13% of cases in the current study appear to have mismatch repair‐deficient tumors, 61.9% of which will be confirmed to have Lynch syndrome.
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Affiliation(s)
- Charité N Ricker
- Department of Medicine, Division of Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Diana L Hanna
- Department of Medicine, Division of Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Cheng Peng
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Nathalie T Nguyen
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Mariana C Stern
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Stephanie L Schmit
- Department of Medicine, Division of Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.,Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida.,Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Greg E Idos
- Department of Medicine, Division of Gastrointestinal and Liver Disease, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Ravi Patel
- Department of Medicine, Division of Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Steven Tsai
- Department of Medicine, Division of Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Veronica Ramirez
- Department of Medicine, Division of Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Sonia Lin
- Department of Medicine, Division of Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Vinay Shamasunadara
- Department of Medicine, Division of Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Afsaneh Barzi
- Department of Medicine, Division of Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Heinz-Josef Lenz
- Department of Medicine, Division of Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Jane C Figueiredo
- Department of Medicine, Division of Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.,Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
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38
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Tsai S, Lee P, Lee C. 0818 SNORING AND BLOOD PRESSURE IN PREGNANT WOMEN. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.817] [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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39
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Wang H, Tsai S. 0979 INFANT FEEDING AND NOCTURNAL SLEEP. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.978] [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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40
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Rajamanickam ESP, Christians KK, Aldakkak M, Krepline AN, Ritch PS, George B, Erickson BA, Foley WD, Aburajab M, Evans DB, Tsai S. Poor Glycemic Control Is Associated with Failure to Complete Neoadjuvant Therapy and Surgery in Patients with Localized Pancreatic Cancer. J Gastrointest Surg 2017; 21:496-505. [PMID: 27896658 DOI: 10.1007/s11605-016-3319-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 10/31/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND The impact of glycemic control in patients with pancreatic cancer treated with neoadjuvant therapy is unclear. METHODS Glycated hemoglobin (HbA1c) values were measured in patients with localized pancreatic cancer prior to any therapy (pretreatment) and after neoadjuvant therapy prior to surgery (preoperative). HbA1c levels greater than 6.5% were classified as abnormal. Patients were categorized based on the change in HbA1c levels from pretreatment to preoperative: GrpA, always normal; Gr B, worsened; GrpC, improved; and GrpD, always abnormal. RESULTS Pretreatment HbA1c levels were evaluable in 123 patients; there were 67 (55%) patients in GrpA, 8 (6%) in GrpB, 22 (18%) in GrpC, and 26 (21%) in GrpD. Of the 123 patients, 92 (75%) completed all intended therapy to include surgery; 57 (85%) patients in GrpA, 4 (50%) patients in GrpB, 16 (72%) patients in GrpC, and 15 (58%) patients in GrpD (p = 0.01). Elevated preoperative carbohydrate antigen 19-9 (CA19-9) (OR 0.22;[0.07-0.66]), borderline resectable (BLR) disease stage (OR 0.20;[0.01-0.45]) and abnormal preoperative HbA1c (OR 0.30;[0.11-0.90]) were negatively associated with completion of all intended therapy. Abnormal preoperative HbA1c was associated with a 2.74-fold increased odds of metastatic progression during neoadjuvant therapy (p = 0.08). CONCLUSIONS Elevated preoperative HbA1c is associated with failure to complete neoadjuvant therapy and surgery and a trend for increased risk of metastatic progression.
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Affiliation(s)
- E S Paul Rajamanickam
- Department of Surgery (Division of Surgical Oncology), Pancreatic Cancer Program, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI, 53226, USA
| | - K K Christians
- Department of Surgery (Division of Surgical Oncology), Pancreatic Cancer Program, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI, 53226, USA
| | - M Aldakkak
- Department of Surgery (Division of Surgical Oncology), Pancreatic Cancer Program, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI, 53226, USA
| | - A N Krepline
- Department of Surgery (Division of Surgical Oncology), Pancreatic Cancer Program, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI, 53226, USA
| | - P S Ritch
- Department of Medicine, Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - B George
- Department of Medicine, Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - B A Erickson
- Department of Radiation Oncology, Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - W D Foley
- Department of Radiology, Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - M Aburajab
- Department of Gastroenterology, Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - D B Evans
- Department of Surgery (Division of Surgical Oncology), Pancreatic Cancer Program, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI, 53226, USA
| | - S Tsai
- Department of Surgery (Division of Surgical Oncology), Pancreatic Cancer Program, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI, 53226, USA.
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Tsai S, Scott JF, Keller JJ, Gerstenblith MR. Cutaneous malignancies identified in an inpatient dermatology consultation service. Br J Dermatol 2017; 177:e116-e118. [PMID: 28231384 DOI: 10.1111/bjd.15401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S Tsai
- Department of Dermatology, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Lakeside 3500, 11100 Euclid Avenue, Cleveland, OH, 44106, U.S.A
| | - J F Scott
- Department of Dermatology, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Lakeside 3500, 11100 Euclid Avenue, Cleveland, OH, 44106, U.S.A
| | - J J Keller
- Department of Dermatology, Oregon Health & Science University, Portland, OR, U.S.A
| | - M R Gerstenblith
- Department of Dermatology, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Lakeside 3500, 11100 Euclid Avenue, Cleveland, OH, 44106, U.S.A
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Alvi FA, Matthews L, Tsai S, Chaudhari A. New Generation Mini-Laparoscopic Instruments in Common Gynecologic Procedures: A Demonstration of Feasibility in a Cadaveric Model. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Tsai S, Abdelhamid A, Khan MK, Elkarargy A, Widelitz RB, Chuong CM, Wu P. The Molecular Circuit Regulating Tooth Development in Crocodilians. J Dent Res 2016; 95:1501-1510. [PMID: 27872325 DOI: 10.1177/0022034516667724] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Alligators have robust regenerative potential for tooth renewal. In contrast, extant mammals can either renew their teeth once (diphyodont dentition, as found in humans) or not at all (monophyodont dentition, present in mice). Previously, the authors used multiple mitotic labeling to map putative stem cells in alligator dental laminae, which contain quiescent odontogenic progenitors. The authors demonstrated that alligator tooth cycle initiation is related to β-catenin/Wnt pathway activity in the dental lamina bulge. However, the molecular circuitry underlying the developmental progression of polyphyodont teeth remains elusive. Here, the authors used transcriptomic analyses to examine the additional molecular pathways related to the process of alligator tooth development. The authors collected juvenile alligator dental laminae at different developmental stages and performed RNA-seq. This data shows that Wnt, bone morphogenetic protein (BMP), and fibroblast growth factor (FGF) pathways are activated at the transition from pre-initiation stage (bud) to initiation stage (cap). Intriguingly, the activation of Wnt ligands, receptors and co-activators accompanies the inactivation of Wnt antagonists. In addition, the authors identified the molecular circuitry at different stages of tooth development. The authors conclude that multiple pathways are associated with specific stages of tooth development in the alligator. This data shows that Wnt pathway activation may play the most important role in the initiation of tooth development. This result may offer insight into ways to modulate the genetic controls involved in mammalian tooth renewal.
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Affiliation(s)
- S Tsai
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA.,Graduate School of Clinical Dentistry, National Taiwan University, Taipei, Taiwan.,Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan
| | - A Abdelhamid
- Qassim College of Dentistry, Qassim University, Saudi Arabia
| | - M K Khan
- Qassim College of Dentistry, Qassim University, Saudi Arabia
| | - A Elkarargy
- Qassim College of Dentistry, Qassim University, Saudi Arabia
| | - R B Widelitz
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - C M Chuong
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan.,Integrative Stem Cell Center, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - P Wu
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Hall W, Paulson E, Vistocky A, Tsai S, Koay E, Knechtges P, Evans D, Christians K, Ritch P, George B, Oshima K, Li A, Erickson B. Pancreatic Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) Radiomic Metrics Correlate With Pathologic Molecular Markers: An Exploratory Analysis. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hall W, Lans D, Arce-Lara C, Kelley M, Santana-Davila R, Marcus D, Tsai S, Ridolfi T, Erickson B, Gore E. Outcome Analysis of Treatment in Stage IIA, T3N0 Rectal Adenocarcinoma in the Veterans Health Administration (VHA). Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1058] [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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Mrkobrada M, Hill M, Chan M, Sigamani A, Cowan D, Kurz A, Sessler D, Jacka M, Graham M, Dasgupta M, Dunlop V, Emery D, Gulka I, Guyatt G, Heels-Ansdell D, Murkin J, Pettit S, Sahlas D, Sharma M, Sharma M, Srinathan S, St John P, Tsai S, Gelb A, O’Donnell M, Siu D, Chiu P, Sharath V, George A, Devereaux P. Covert stroke after non-cardiac surgery: a prospective cohort study. Br J Anaesth 2016; 117:191-7. [DOI: 10.1093/bja/aew179] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 11/13/2022] Open
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Huang Y, Tsai S, Cheng Y, Lai C, Ku C, Lee Y. A Xeno-free Fibrinogen Depletion Method Support Scalable Expansion of Human Mesenchymal Stem Cell. Cytotherapy 2016. [DOI: 10.1016/j.jcyt.2016.03.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Tsai S, Scott J, Keller J, Gerstenblith M. 641 Cutaneous malignancies identified by the Dermatology inpatient consult service. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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49
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Tsai S, Arbesman J, Thompson C, Gerstenblith M. 601 Melanoma in pediatric, adolescent, and young adult patients: A nineteen-year retrospective analysis. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Eskicioglu C, Forbes S, Tsai S, Francescutti V, Coates A, Grubac V, Sonnadara R, Simunovic M. Collaborative case conferences in rectal cancer: case series in a tertiary care centre. ACTA ACUST UNITED AC 2016; 23:e138-43. [PMID: 27122982 DOI: 10.3747/co.23.2894] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In many hospitals, resource barriers preclude the use of preoperative multidisciplinary cancer conferences (mccs) for consecutive patients with cancer. Collaborative cancer conferences (cccs) are modified mccs that might overcome such barriers. METHODS We established a ccc at an academic tertiary care centre to review preoperative plans for patients with rectal cancer. Attendees included only surgeons who perform colorectal cancer procedures and a radiologist with expertise in cross-sectional imaging. Individual reviews began with the primary surgeon presenting the case information and initial treatment recommendations. Cross-sectional images were then reviewed, the case was discussed, and consensus on ccc-treatment recommendations was achieved. Outcomes for the present study were changes in treatment recommendations defined as "major" (that is, redirection of patient to preoperative radiation from straight-to-surgery or uncertain plan, or redirection of the patient to straight-to-surgery from preoperative radiation or plan uncertain) or as "minor" (that is, referral to a multidisciplinary cancer clinic, request additional tests, change type of neoadjuvant therapy, change type of surgery). Chart reviews provided relevant patient, tumour, and treatment information. RESULTS Between September 2011 and September 2012, 101 rectal cancer patients were discussed at a ccc. Of the 35 management plans (34.7%) that were changed as a result, 8 had major changes, and 27 had minor changes. Available patient and tumour factors did not predict for a change in treatment recommendation. CONCLUSIONS Preoperative cccs at a tertiary-care centre changed treatment recommendations for one third of patients with rectal cancer. Given that no specific factor predicted for a treatment plan change, it is likely prudent that all rectal cancer patients undergo some form of collaborative review.
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Affiliation(s)
- C Eskicioglu
- Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, ON
| | - S Forbes
- Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, ON
| | - S Tsai
- Department of Radiology, Faculty of Health Sciences, McMaster University, Hamilton, ON
| | - V Francescutti
- Department of Surgery, Roswell Park Cancer Institute, Buffalo, NY, U.S.A
| | - A Coates
- Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, ON
| | - V Grubac
- Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, ON
| | - R Sonnadara
- Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, ON
| | - M Simunovic
- Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, ON;; Escarpment Cancer Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON
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