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Ford JD, Clark DG, Copland L, Pearce T, Harper SL. Projected decrease in trail access in the Arctic. Commun Earth Environ 2023; 4:23. [PMID: 38665204 PMCID: PMC11041733 DOI: 10.1038/s43247-023-00685-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 01/18/2023] [Indexed: 04/28/2024]
Abstract
Transportation systems in northern Canada are highly sensitive to climate change. We project how access to semi-permanent trails on land, water, and sea ice might change this century in Inuit Nunangat (the Inuit homeland in northern Canada), using CMIP6 projections coupled with trail access models developed with community members. Overall trail access is projected to diminish, with large declines in access for sea ice trails which play a central role for Inuit livelihoods and culture; limits to adaptation in southern regions of Inuit Nunangat within the next 40 years; a lengthening of the period when no trails are accessible; and an unequal distribution of impacts according to the knowledge, skills, equipment, and risk tolerance of trail users. There are opportunities for adaptation through efforts to develop skillsets and confidence in travelling in more marginal environmental conditions, which can considerably extend the envelope of days when trails are accessible and months when this is possible. Such actions could reduce impacts across emissions scenarios but their potential effectiveness declines at higher levels of global warming, and in southern regions only delays when sea ice trails become unusable.
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Affiliation(s)
- J. D. Ford
- Priestley International Centre for Climate, University of Leeds, Leeds, UK
| | - D. G. Clark
- Canadian Climate Institute, Vancouver, BC Canada
| | - L. Copland
- Department of Geography, Environment and Geomatics, University of Ottawa, Ottawa, ON Canada
| | - T. Pearce
- Department Geography, Earth, and Environmental Sciences, University of Northern British Columbia, Prince George, BC Canada
| | - S. L. Harper
- School of Public Health, University of Alberta, Edmonton, AB Canada
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2
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Nisnboym M, Vincze S, Raphael I, Sneiderman C, Xiong Z, Li B, Day K, Latoche J, Nedrow J, Anderson C, Pearce T, Pollack I, Lieberman F, Drappatz J, Edwards W, Kohanbash G. NIMG-58. IMMUNOPET OF 89ZR-DFO-CD69 AB VISUALIZES T-CELL ACTIVATION AND PREDICTS SURVIVAL FOLLOWING IMMUNOTHERAPY IN MURINE GBM MODEL. Neuro Oncol 2022. [PMCID: PMC9661031 DOI: 10.1093/neuonc/noac209.676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
INTRODUCTION
Glioblastoma (GBM) is the most malignant brain tumor in adults, with a dismal prognosis despite aggressive therapy. Immunotherapy is currently being evaluated as a treatment modality for recurrent GBM. MRI is not adequate for response assessment to immunotherapy even after using refined response assessment criteria. Thus, there is a need for the development of neuroimaging techniques for response assessment. T-cells are key mediators of cancer immunotherapy responses and upregulation of CD69 is a marker of T-cell activation. Our aim is to use PET/CT imaging to non-invasively quantify CD69 in vivo, following immunotherapy, and correlate the expression to survival.
METHODS
CD69 was evaluated by flow cytometry and immunofluorescence staining on human and mouse in vitro activated T-cells and on dissociated tumors from GL261 glioma-bearing mice treated with anti-PD1/anti-CTLA4 immunotherapy (ICI). Single-cell RNA sequencing (ScRNAseq) datasets from recurrent GBM patients receiving (n=20) or not receiving (n=22) ICI were examined for CD69 expression on tumor infiltrating lymphocyte (TIL) populations. PET/CT was performed on mice (n=30) receiving radiolabeled anti-CD69 antibody (89Zr-DFO-anti-CD69) to evaluate response to ICI therapy. Standard uptake values (SUV) were compared between ICI and controls and in relationship to survival.
RESULTS
We confirmed CD69 upregulation upon T-cell activation in vitro. Ex vivo, CD69 expression significantly increased on TILs early after ICI treatment compared to control (63.46% vs 24.37% CD69+/TILs, respectively; p=0.017). ScRNAseq demonstrated significant elevated CD69 expression in almost all TIL populations tested in recurrent GBM patients treated with ICI compared with a control group. ImmunoPET demonstrated significantly higher anti-CD69 tracer uptake in ICI-treated mice compared with controls. Most importantly, we observed a strong positive correlation between survival and immunoPET SUV (r=0.9425, p=0.016) in the ICI-treatment group, but not within the control group.
CONCLUSIONS
Our study demonstrates the potential incorporation of CD69 ImmunoPET as response assessment to ICI for GBM patients.
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Affiliation(s)
- Michal Nisnboym
- Department of Neurological Surgery, University of Pittsburgh , Pittsburgh, PA , USA
| | - Sarah Vincze
- Department of Neurological Surgery, University of Pittsburgh , Pittsburgh, PA , United States
| | - Itay Raphael
- Department of Neurological Surgery, University of Pittsburgh , Pittsburgh, PA , USA
| | - Chaim Sneiderman
- Department of Neurological Surgery, University of Pittsburgh , Pittsburgh, PA , USA
| | - Zujian Xiong
- Department of Neurological Surgery, University of Pittsburgh , Pittsburgh, PA , United States
| | - Bo Li
- Department of Neurological Surgery, University of Pittsburgh , Pittsburgh, PA , USA
| | - Kathryn Day
- In Vivo Imaging Facility, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, United States , pittsburgh , USA
| | - Joseph Latoche
- In Vivo Imaging Facility, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, United States , pittsburgh , USA
| | - Jessie Nedrow
- In Vivo Imaging Facility, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, United States , pittsburgh , USA
| | - Carolyn Anderson
- Department of Chemistry, University of Missouri, Columbia, MO, United States , columbia , USA
| | - Thomas Pearce
- University of Pittsburgh Medical Center , Pittsburgh , USA
| | - Ian Pollack
- Department of Neurological Surgery, University of Pittsburgh , Pittsburgh, PA , USA
| | | | - Jan Drappatz
- Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center , Pittsburgh, PA , USA
| | - Wilson Edwards
- Department of Biochemistry, University of Missouri, Columbia, MO, United States , columbia , USA
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Gersey Z, Mallela A, Zhang X, Pease M, Abdelhakiem M, Pearce T, Lieberman F, Mantica M, Phillips R, Bagley S, Nasrallah M, Binder Z, Brem S, Chen I, O’Rourke DM, Zinn P, Siddiqui Z, Amankulor N. SURG-42. MOLECULAR PROFILE CONSENSUS CLUSTERING DEFINES CLINICALLY DISTINCT GROUPS IN IDH WILD-TYPE GLIOBLASTOMA. Neuro Oncol 2022. [PMCID: PMC9661205 DOI: 10.1093/neuonc/noac209.1171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
OBJECTIVES
Although the impact of surgery in glioblastoma (GBM) is well-established, there is insufficient data to determine how surgical resection affects overall survival (OS). The impact of other GBM genomic alterations on EOR-induced survival remains poorly understood. Here, we leverage a large cohort of GBM patients with genomic data to establish the impact of genomic alterations on resection-dependent overall survival in GBM.
METHODS
537 IDH WT GBMs from UPMC were analyzed using Glioseq next generation sequencing panel. Using molecular profiles derived from Glioseq data, semi-supervised Monte Carlo reference-based consensus clustering was used to define 5 distinct groups. Cox Proportional Hazards models were used to identify predictors of OS within molecular groups.
RESULTS
Clustering of 537 IDH wild-type GBM identified 5 distinct groups: 1: TERT mutated/MGMT methylated/EGFR mutated or gain; 2: TERT mutated /MGMT methylated/p53 mutated; 3: TERT WT; 4: TERT mutated/MGMT methylated/CDKN2A loss; 5: TERT mutated/MGMT unmethylated. Thresholds in postoperative residual contrast enhancing volume (rCEV) and residual non-contrast enhancing volume (rNCEV) were identified which marked significant differences in median overall survival (MOS) between molecular groups in rCEV -Group 1: 11.7cc, Group 2: 14.4cc, Group 3: 1.1cc, Group 4: 0.1cc, and Group 5 1.1cc. Sex, age, KPS >70, temozolomide, and radiation along with thresholded rCEV and rNCEV were used in multivariate Cox analyses. Groups demonstrated distinct predictors of OS: radiation only in Group 1 tumors, low rCEV in Group 2 tumors, younger age, temodar, low CEV, and KPS >70 in Group 3 tumors, female sex, younger age, radiation, KPS >70 low rCEV in Group 4 tumors, and KPS >70, temodar, and low rCEV in Group 5 tumors.
CONCLUSIONS
Clustering results suggest that there are clinically distinct molecular groups of IDH wild-type glioblastomas. Age, sex, KPS >70, temozolomide treatment, radiation therapy, and EOR have varying affects on these molecular groups.
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Affiliation(s)
- Zachary Gersey
- University of Pittsburgh School of Medicine, Department of Neurological Surgery , Pittsburgh, PA , USA
| | - Arka Mallela
- University of Pittsburgh School of Medicine, Department of Neurological Surgery , Pittsburgh, PA , USA
| | - Xiaoran Zhang
- University of Pittsburgh School of Medicine, Department of Neurological Surgery , Pittsburgh, PA , USA
| | - Matthew Pease
- University of Pittsburgh School of Medicine, Department of Neurological Surgery , Pittsburgh, PA , USA
| | - Mohamed Abdelhakiem
- University of Pittsburgh School of Medicine, Department of Radiation Oncology , Pittsburgh, PA , USA
| | - Thomas Pearce
- University of Pittsburgh Medical Center , Pittsburgh, PA , USA
| | | | - Megan Mantica
- University of Pittsburgh School of Medicine, Department of Neurology , Pittsburgh, PA , USA
| | | | - Stephen Bagley
- University of Pennsylvania, Department of Medicine , Philadelphia, PA , USA
| | - MacLean Nasrallah
- University of Pennsylvania, Department of Pathology , Philadelphia, PA , USA
| | - Zev Binder
- University of Pennsylvania , Philadelphia, PA , USA
| | - Steven Brem
- Hospital of the University of Pennsylvania , Philadelphia, PA , USA
| | - Isaac Chen
- Hospital of the University of Pennsylvania , Philadelphia, PA , USA
| | | | - Pascal Zinn
- University of Pittsburgh School of Medicine, Department of Neurological Surgery , Pittsburgh, PA , USA
| | - Zaid Siddiqui
- University of Pittsburgh School of Medicine, Department of Radiation Oncology , Pittsburgh, PA , USA
| | - Nduka Amankulor
- Hospital of the University of Pennsylvania , Philadelphia, PA , USA
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Cruz A, Locke A, Halligan K, Sanders L, Cheney A, Stanton ACJ, Koncar R, Broniscer A, Vaske OM, Pearce T, Marker D, Wiley C, Mack SC, Filbin M, Pollack IF, Agnihotri S. TMIC-54. THE ROLE OF TUMOR MICROENVIRONMENT DERIVED GROWTH FACTORS IN PEDIATRIC BRAIN TUMORS. Neuro Oncol 2022. [PMCID: PMC9661267 DOI: 10.1093/neuonc/noac209.1098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
High-grade gliomas (HGGs) are the most common fatal intrinsic brain tumors in pediatric patients. H3K27-altered diffuse midline gliomas (H3K27-DMGs), a subgroup of HGGs defined by a histone 3 position 27 alteration, are especially aggressive and result in the poorest patient outcomes. Despite in-depth genomic characterization, the 5-year survival rate has yet to improve beyond 2% following diagnosis. A common feature of H3K27-DMGs is infiltration of microglia, macrophages, other myeloid cells, collectively referred to as GAMs, and a small population of T-cells. The contribution of non-tumor cells in the tumor microenvironment (TME) can both promote and or inhibit tumor growth, thus representing an opportunity in the pursuit of novel therapeutics. Using bioinformatic analysis on a human H3K37-DMG single cell-RNA sequencing dataset, we reveal several cell-to-cell communication signaling networks, mediated by ligand and receptor pairs, between GAMs and tumor cells, respectively.
HYPOTHESIS
Microglial-derived growth factors activate oncogenic signaling pathways via paracrine signaling axes, thus promoting H3K27-DMG tumor cell proliferation and growth.
METHODS
I will validate these findings and test their therapeutic potential using co-culture studies, CRISPR and shRNA gene silencing, and phospho-proteomics technology.
RELEVANCE
This research provides further insights on the contribution of non-tumor cells in the TME towards H3K27-DMG cell proliferation and growth and could potentially inform future therapy paradigms.
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Affiliation(s)
- Andrea Cruz
- University of Pittsburgh School of Medicine , Pittsburgh, PA , USA
| | - Abigail Locke
- University of Pittsburgh School of Medicine , Pittsburgh , USA
| | | | - Lauren Sanders
- University of California, Santa Cruz , Santa Cruz, CA , USA
| | | | | | - Robert Koncar
- University of Pittsburgh School of Medicine , Pittsburgh , USA
| | | | - Olena M Vaske
- University of California, Santa Cruz , Santa Cruz, CA , USA
| | - Thomas Pearce
- University of Pittsburgh Medical Center , Pittsburgh , USA
| | - Daniel Marker
- University of Pittsburgh Medical Center , Pittsburgh , USA
| | - Clayton Wiley
- University of Pittsburgh Medical Center , Pittsburgh , USA
| | - Stephen C Mack
- St Jude Children's Research Hospital , Memphis, TN , USA
| | - Mariella Filbin
- Dana-Farber Boston Children’s Cancer and Blood Disorders Center , Boston , USA
| | - Ian F Pollack
- Children's Hospital of Pittsburgh , Pittsburgh , USA
| | - Sameer Agnihotri
- University of Pittsburgh School of Medicine , Pittsburgh, PA , USA
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Cevik L, Landrove MV, Aslan MT, Khammad V, Garagorry Guerra FJ, Cabello-Izquierdo Y, Wang W, Zhao J, Becker AP, Czeisler C, Rendeiro AC, Véras LLS, Zanon MF, Reis RM, Matsushita MDM, Ozduman K, Pamir MN, Ersen Danyeli A, Pearce T, Felicella M, Eschbacher J, Arakaki N, Martinetto H, Parwani A, Thomas DL, Otero JJ. Information theory approaches to improve glioma diagnostic workflows in surgical neuropathology. Brain Pathol 2022; 32:e13050. [PMID: 35014126 PMCID: PMC9425010 DOI: 10.1111/bpa.13050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/11/2021] [Accepted: 12/15/2021] [Indexed: 11/29/2022] Open
Abstract
Aims Resource‐strained healthcare ecosystems often struggle with the adoption of the World Health Organization (WHO) recommendations for the classification of central nervous system (CNS) tumors. The generation of robust clinical diagnostic aids and the advancement of simple solutions to inform investment strategies in surgical neuropathology would improve patient care in these settings. Methods We used simple information theory calculations on a brain cancer simulation model and real‐world data sets to compare contributions of clinical, histologic, immunohistochemical, and molecular information. An image noise assay was generated to compare the efficiencies of different image segmentation methods in H&E and Olig2 stained images obtained from digital slides. An auto‐adjustable image analysis workflow was generated and compared with neuropathologists for p53 positivity quantification. Finally, the density of extracted features of the nuclei, p53 positivity quantification, and combined ATRX/age feature was used to generate a predictive model for 1p/19q codeletion in IDH‐mutant tumors. Results Information theory calculations can be performed on open access platforms and provide significant insight into linear and nonlinear associations between diagnostic biomarkers. Age, p53, and ATRX status have significant information for the diagnosis of IDH‐mutant tumors. The predictive models may facilitate the reduction of false‐positive 1p/19q codeletion by fluorescence in situ hybridization (FISH) testing. Conclusions We posit that this approach provides an improvement on the cIMPACT‐NOW workflow recommendations for IDH‐mutant tumors and a framework for future resource and testing allocation.
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Affiliation(s)
- Lokman Cevik
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Mehmet Tahir Aslan
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Francisco Jose Garagorry Guerra
- Facultad de Medicina, UdeLaR, Cátedra de Anatomía Patológica, Hospital de Clínicas Manuel Quintela, Universidad de la República, Uruguay
| | | | - Wesley Wang
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jing Zhao
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Aline Paixao Becker
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Catherine Czeisler
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | | | | | - Rui Manuel Reis
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | | | - Koray Ozduman
- Department of Neurosurgery, Acibadem MAA University, Istanbul, Turkey
| | - M Necmettin Pamir
- Department of Neurosurgery, Acibadem MAA University, Istanbul, Turkey
| | - Ayca Ersen Danyeli
- Department of Pathology, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Thomas Pearce
- Division of Neuropathology, Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michelle Felicella
- Division of Neuropathology, Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Jennifer Eschbacher
- Department of Pathology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Naomi Arakaki
- Departamento de Neuropatología y Biología Molecular, Instituto de Investigaciones Neurológicas Dr Raúl Carrea (FLENI), Buenos Aires, Argentina
| | - Horacio Martinetto
- Departamento de Neuropatología y Biología Molecular, Instituto de Investigaciones Neurológicas Dr Raúl Carrea (FLENI), Buenos Aires, Argentina
| | - Anil Parwani
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Diana L Thomas
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - José Javier Otero
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Abdallah HM, Gersey ZC, Muthiah N, McDowell MM, Pearce T, Costacou T, Snyderman CH, Wang EW, Gardner PA, Zenonos GA. An Integrated Management Paradigm for Skull Base Chordoma Based on Clinical and Molecular Characteristics. J Neurol Surg B Skull Base 2021; 82:601-607. [PMID: 34745826 DOI: 10.1055/s-0041-1730958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022] Open
Abstract
Objective Previous work categorized skull base chordoma (SBC) into three genetic risk groups based on 1p36 and homozygous 9p21(p16) deletions, accounting for a wide variability in prognosis (A = low-risk, B = intermediate-risk, C = high-risk). However, it remains unclear how these groups could guide management. Study Design By integrating surgical outcome and adjuvant radiation (AdjXRT) information with genetic data on 152 tumors, we sought to develop an evidence-based management algorithm for SBC. Results Gross total resections (GTRs) were associated with improved progression free survival (PFS) in all genetic groups. For Group C tumors, GTR and AdjXRT independently contributed to PFS (multivariate Cox proportional hazard ratio [HR] = 0.14, p = 0.002, and HR = 0.40, p = 0.047, respectively). For Group B tumors, AdjXRT improved outcomes only when GTR was not feasible (log-rank p = 0.008), but not following GTR (log-rank p = 0.54). However, 24 of 25 Group A tumors underwent GTR, and AdjXRT for these did not confer any benefit (log-Rank p = 0.285). The high GTR rates in Group A could be explained by smaller tumor sizes (mean = 0.98cc/4.08cc/4.92cc for Group A/B/C, respectively, p = 0.031) and lack of invasiveness. Group A tumors were also more frequently diagnosed in young people ( p = 0.002) as asymptomatic lesions ( p = 0.001), suggesting that they could be precursors to tumors in higher risk groups. Conclusion Genotypic grouping by 1p36 and homozygous 9p21(p16) deletions can predict prognosis in SBC and guide management. GTR remains the cornerstone of SBC treatment and can be sufficient without AdjXRT in low and intermediate risk tumors. Low-risk tumors are associated with a less invasive phenotype, which makes them more amenable to GTR.
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Affiliation(s)
- Hussein M Abdallah
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Zachary C Gersey
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Nallammai Muthiah
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Michael M McDowell
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Thomas Pearce
- Department of Pathology, Division of Neuropathology, University of Pittsburgh Medical Center, Division of Neuropathology, Pittsburgh, Pennsylvania, United States
| | - Tina Costacou
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Carl H Snyderman
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Eric W Wang
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Georgios A Zenonos
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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Seheult JN, Stram MN, Pearce T, Bub CB, Emery SP, Kutner J, Watanabe-Okochi N, Sperry JL, Takanashi M, Triulzi DJ, Yazer MH. The risk to future pregnancies of transfusing Rh(D)-negative females of childbearing potential with Rh(D)-positive red blood cells during trauma resuscitation is dependent on their age at transfusion. Vox Sang 2021; 116:831-840. [PMID: 33491789 DOI: 10.1111/vox.13065] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/16/2020] [Accepted: 12/30/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND A risk assessment model for predicting the risk of haemolytic disease of the fetus and newborn (HDFN) in future pregnancies following the transfusion of Rh(D)-positive red blood cell (RBC)-containing products to females of childbearing potential (FCP) was developed, accounting for the age that the FCP is transfused in various countries. METHODS The HDFN risk prediction model included the following inputs: risk of FCP death in trauma, Rh(D) alloimmunization rate following Rh(D)-positive RBC transfusion, expected number of live births following resuscitation, probability of carrying an Rh(D)-positive fetus, the probability of HDFN in an Rh(D)-positive fetus carried by an alloimmunized mother. The model was implemented in Microsoft R Open, and one million FCPs of each age between 18 and 49 years old were simulated. Published data from eight countries, including the United States, were utilized to generate country-specific HDFN risk estimates. RESULTS The risk predictions showed similar characteristics for each country in that the overall risk of having a pregnancy affected by HDFN was higher if the FCP was younger when she received her Rh(D)-positive transfusion than if she was older. In the United States, the overall risk of HDFN if the FCP was transfused at age 18 was 3·4% (mild: 1·20%, moderate: 0·45%; severe: 1·15%; IUFD: 0·57%); the risk was approximately 0% if the FCP was 43 years or older at the time of transfusion. CONCLUSION This model can be used to predict HDFN outcomes when establishing transfusion policies as it relates to the administration of Rh(D)-positive products for massively bleeding FCPs.
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Affiliation(s)
- Jansen N Seheult
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Vitalant, Pittsburgh, PA, USA
| | | | - Thomas Pearce
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Stephen P Emery
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jose Kutner
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | - Jason L Sperry
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Minoko Takanashi
- Japanese Red Cross Society Blood Service Headquarters, Tokyo, Japan
| | - Darrell J Triulzi
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Vitalant, Pittsburgh, PA, USA
| | - Mark H Yazer
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Vitalant, Pittsburgh, PA, USA
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Tap W, Papai Z, van Tine B, Attia S, Ganjoo K, Jones R, Schuetze S, Reed D, Chawla S, Riedel R, Krarup-Hansen A, Italiano A, Hohenberger P, Grignani G, Cranmer L, Alcindor T, Lopez-Pousa A, Pearce T, Kroll S, Schoffski P. Randomized phase 3, multicenter, open-label study comparing evofosfamide (Evo) in combination with doxorubicin (D) vs. D alone in patients (pts) with advanced soft tissue sarcoma (STS): Study TH-CR-406/SARC021. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw388.01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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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Clark DG, Ford JD, Berrang-Ford L, Pearce T, Kowal S, Gough WA. The role of environmental factors in search and rescue incidents in Nunavut, Canada. Public Health 2016; 137:44-9. [PMID: 27423419 DOI: 10.1016/j.puhe.2016.06.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/30/2016] [Accepted: 06/06/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Unintentional injury is a leading cause of morbidity and mortality in Nunavut, where the importance of land-based activities and reliance on semi-permanent trails create unique risk profiles. Climate change is believed to be exacerbating these risks, although no studies have quantitatively examined links between environmental conditions and injury and distress in the Canadian Arctic. We examine the correlation between environmental conditions and land-based search and rescue (SAR) incidents across Nunavut. STUDY DESIGN Case study. METHODS Case data were acquired from the Canadian National Search and Rescue Secretariat. Gasoline sales from across the territory are then used to model land-use and exposure. We compare weather and ice conditions during 202 SAR incidents to conditions during 755 non-SAR days (controls) between 2013 and 2014. RESULTS We show daily ambient temperature, ice concentration, ice thickness, and variation in types of ice to be correlated with SAR rates across the territory during the study period. CONCLUSIONS These conditions are projected to be affected by future climate change, which could increase demand for SAR and increase injury rates in the absence of targeted efforts aimed at prevention and treatment. This study provides health practitioners and public health communities with clearer understanding to prepare, respond to, and prevent injuries across the Arctic.
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Affiliation(s)
- D G Clark
- Department of Geography, McGill University, Montreal, QC, Canada.
| | - J D Ford
- Department of Geography, McGill University, Montreal, QC, Canada
| | - L Berrang-Ford
- Department of Geography, McGill University, Montreal, QC, Canada
| | - T Pearce
- Department of Geography, Sustainability Research Centre, University of the Sunshine Coast, Sippy Downs, Qld, Australia; Department of Geography, University of Guelph, ON, Canada
| | - S Kowal
- Department of Physical and Environmental Sciences, University of Toronto, Scarborough, ON, Canada
| | - W A Gough
- Department of Physical and Environmental Sciences, University of Toronto, Scarborough, ON, Canada
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Goldman J, Belani C, Novello S, von Pawel J, Csoszi T, Orlov S, Kroll S, Pearce T. Randomized, Double-Blind, Placebo-Controlled Trial of Evofosfamide (TH-302) in Combination with Pemetrexed in Advanced Non-Squamous Non-Small Cell Lung Cancer. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv050.46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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11
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Affiliation(s)
- T Pearce
- Bristol Royal Infirmary, Bristol, UK.
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12
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Gooch K, Marshall DA, Faris PD, Khong H, Wasylak T, Pearce T, Johnston DWC, Arnett G, Hibbert J, Beaupre LA, Zernicke RF, Frank C. Comparative effectiveness of alternative clinical pathways for primary hip and knee joint replacement patients: a pragmatic randomized, controlled trial. Osteoarthritis Cartilage 2012; 20:1086-94. [PMID: 22796513 DOI: 10.1016/j.joca.2012.06.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 04/23/2012] [Accepted: 06/21/2012] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Total hip replacement (THR) and total knee replacement (TKR) (arthroplasty) surgery for end-stage osteoarthritis (OA) are ideal candidates for optimization through an algorithmic care pathway. Using a comparative effectiveness study design, we compared the effectiveness of a new clinical pathway (NCP) featuring central intake clinics, dedicated inpatient resources, care guidelines and efficiency benchmarks vs. the standard of care (SOC) for THR or TKR. METHODS We compared patients undergoing primary THR and TKR who received surgery in NCP vs. SOC in a randomised controlled trial within the trial timeframe. 1,570 patients (1,066 SOC and 504 NCP patients) that underwent surgery within the study timeframe from urban and rural practice settings were included. The primary endpoint was improvement in Western Ontario and McMaster University osteoarthritis index (WOMAC) overall score over 12 months post-surgery. Secondary endpoints were improvements in the physical function (PF) and bodily pain (BP) domains of the Short Form 36 (SF-36). RESULTS NCP patients had significantly greater improvements from baseline WOMAC scores compared to SOC patients after adjusting for covariates (treatment effect=2.56; 95% confidence interval (CI) [1.10-4.01]). SF-36 BP scores were significantly improved for both hip and knee patients in the NCP (treatment effect=3.01, 95% CI [0.70-5.32]), but SF-36 PF scores were not. Effects of the NCP were more pronounced in knee patients. CONCLUSION While effect sizes were small compared with major effects of the surgery itself, an evidence-informed clinical pathway can improve health related quality of life (HRQoL) of hip and knee arthroplasty patients with degenerative joint disorder in routine clinical practice for up to 12 months post-operatively. CLINICALTRIALS.GOV IDENTIFIER: NCT00277186.
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MESH Headings
- Aged
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/rehabilitation
- Arthroplasty, Replacement, Hip/standards
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/rehabilitation
- Arthroplasty, Replacement, Knee/standards
- Critical Pathways
- Female
- Health Status
- Humans
- Male
- Osteoarthritis, Hip/physiopathology
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/physiopathology
- Osteoarthritis, Knee/surgery
- Pain/etiology
- Pain/physiopathology
- Postoperative Complications/etiology
- Quality of Life
- Recovery of Function
- Severity of Illness Index
- Technology Assessment, Biomedical/methods
- Treatment Outcome
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Affiliation(s)
- K Gooch
- School of Public Health, Curtin University, Western Australia, Australia; Alberta Bone & Joint Health Institute, University of Calgary, Canada.
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Pearce T, Philip S, Brown J, Koh DM, Burn PR. Bone metastases from prostate, breast and multiple myeloma: differences in lesion conspicuity at short-tau inversion recovery and diffusion-weighted MRI. Br J Radiol 2012; 85:1102-6. [PMID: 22457319 DOI: 10.1259/bjr/30649204] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The objective of this study was to compare the relative conspicuity of bone metastases on short-tau inversion recovery (STIR) and diffusion-weighted MRI (DWI) whole-body MR sequences for breast, prostate and myeloma malignancies. METHODS 44 whole-body MRI scans were reviewed retrospectively (coronal T(1) weighted, STIR and DWI with b=800). On each scan, up to four of the largest bone lesions were identified on T(1) weighting, and the region of interest signal intensity was measured on STIR and DWI, as well as the background signal intensity. The mean lesion signal to background ratio was calculated for each patient and then for each malignancy group. RESULTS In prostate cancer patients, the DWI signal/background ratio was greater than that of STIR in 22 out of 24 patients (mean DWI lesion/background ratio 3.91, mean STIR lesion/background ratio 2.31; p=0.0001). In multiple myeloma, the DWI ratio was higher in 6/7 patients (DWI group mean ratio 7.59, STIR group mean ratio 3.7; p=0.0366). In 13 breast cancer patients, mean STIR and DWI signal/background were similar (DWI group mean ratio 4.13, group mean STIR ratio 4.26; p=0.8587). CONCLUSION Bone lesion conspicuity measured by lesion/background signal intensity was higher on DWI b=800 than on STIR in patients with prostate cancer and multiple myeloma. DWI should be used in whole-body MR oncology protocols in these conditions to maximise lesion detection.
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Affiliation(s)
- T Pearce
- Department of Diagnostic Imaging, Musgrove Park Hospital, Taunton, UK
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14
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Wang D, Pearce T, Cobani V, Zekaj M, Adams N, Williamson A, Harkness C. Lessons from the other side of clinical trial accrual: Screen failures at the Josephine Ford Cancer Center/Henry Ford Health System in 2010. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e16624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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15
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Fonollosa J, Gutierrez-Galvez A, Lansner A, Martinez D, Rospars J, Beccherelli R, Perera A, Pearce T, Vershure P, Persaud K, Marco S. Biologically Inspired Computation for Chemical Sensing. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.procs.2011.09.066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chan KHS, Pearce T, Blake RW, Chow L, Wu S, Wong F, Li J. Simple mathematical and computational wear model for ultra-high-molecular-weight polyethylene total hip replacements. Appl Bionics Biomech 2007. [DOI: 10.1080/11762320701523679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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17
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Pearce T, Oakes S, Pope R, Williams J. Dynamic control of extracellular environment in in vitro neural recording systems. Conf Proc IEEE Eng Med Biol Soc 2007; 2004:4045-8. [PMID: 17271187 DOI: 10.1109/iembs.2004.1404129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A technique is presented for rapid fabrication of microfluidic channels on top of multichannel in vitro neural recording electrode arrays. The channels allow dynamic control of transient flow over localized areas of the array. Dorsal root ganglion neurons were integrated into the system. The device was used to demonstrate precise control of the extracellular microenvironment of individual cells on the array. Because the methods presented here are not specific to a particular cell type or neural recording system, the technique is amenable to a wide range of applications within the neuroscience field.
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Affiliation(s)
- T Pearce
- Department of Biomedical Engineering, University of Wisconsin--Madison, WI, USA
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18
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Abstract
BACKGROUND In rectal cancer a high risk of local recurrence has been reported for patients treated by surgery alone. It is also recognised that 20%-40% of rectal cancer patients continue to develop distant metastases and die, even when a very low risk of local recurrence has been achieved with the use of preoperative radiotherapy and total mesorectal excision (TME). Hence, the current design of randomised trials in rectal cancer continues to use the standard end points of local control and survival. This strategy is time-consuming. The recently published EORTC 22921 trial, which compared radiotherapy with chemoradiotherapy and tested the role of postoperative adjuvant chemotherapy, has taken 14 years from planning to results. The aim of this review was to use the evidence from both phase II and phase III trials to provide a comprehensive survey of alternative clinical trial end points in rectal cancer, where preoperative chemoradiation has now become the standard treatment. We describe their strengths and weaknesses. Some are clearly defined, easy to assess and can be obtained early, because surgical resection usually takes place within 6-8 weeks of the completion of treatment. Some pathological response end points reflect biological activity, although their effect on survival has yet to be validated in randomised controlled trials. We will propose measurement and analytical techniques for minimising bias and intra- and inter-observer variability of the non-validated end points in the hope of basing these judgements on as firm a ground as possible. METHODS A literature search identified both randomised and non-randomised trials of preoperative radiation therapy (RT) and chemoradiation therapy (CRT) in rectal cancer from 1993 to 2005. The aim was to find those studies that documented potential alternative end points. RESULTS Pathological parameters have been used as early end points to compare studies of preoperative radiotherapy or chemoradiation. In the light of the German CAO/ARO/AIO-94 study, which demonstrated an improved therapeutic ratio for preoperative treatment, enthusiasm for preoperative chemoradiation in the management of rectal cancer is increasing. Current evidence cannot indicate whether the degree of response to chemoradiation (e.g. complete pathological response; downsizing the primary tumour; sterilizing the regional nodes; tumour regression grades or residual cell density) or the achievement of a curative resection (CRM/R0 resection) is the best early clinical end point. Problems with these end points include lack of structured measurement and analysis techniques to control for intra- and inter-observer variation and lack of validation as surrogates for long-term clinical end points such as local control and survival. However, retrospective studies in rectal cancer have confirmed a strong association between the presence of microscopic tumour cells within 1 mm of the CRM and increased risks of both local recurrence and distant metastases. Further end points of current clinical relevance for which adequate methodologies for assessment are lacking include sphincter sparing end points, and assessment of long-term toxicities, ano-rectal function and their specific impact on quality of life. Recommendations are made as to the most appropriate information, which should be documented in future trials. CONCLUSIONS Pathological complete response following preoperative chemoradiation does not reliably predict late outcome. There are other events not mediated through this end point and there are also unintended effects (often an excess of non-cancer related deaths). Disease-free survival currently remains the best (because it is relatively quick) primary end point in designing randomised phase III studies of preoperative chemoradiation in rectal cancer, although it is necessary to control for postoperative adjuvant chemotherapy. However, the CRM status can substantially account for effects on disease-free and overall survival after chemoradiation, radiation or surgery alone. Hopefully, randomised controlled trials, which utilise these alternative clinical end points, will in future determine the precise percentages of the effect of different chemoradiation schedules on disease-free and overall survival.
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Affiliation(s)
- R Glynne-Jones
- Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, Middlesex, UK.
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Reinisch W, Hommes DW, Van Assche G, Colombel JF, Gendre JP, Oldenburg B, Teml A, Geboes K, Ding H, Zhang L, Tang M, Cheng M, van Deventer SJH, Rutgeerts P, Pearce T. A dose escalating, placebo controlled, double blind, single dose and multidose, safety and tolerability study of fontolizumab, a humanised anti-interferon gamma antibody, in patients with moderate to severe Crohn's disease. Gut 2006; 55:1138-44. [PMID: 16492717 PMCID: PMC1856289 DOI: 10.1136/gut.2005.079434] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION This study was designed to evaluate the safety of fontolizumab, a humanised anti-interferon gamma antibody, in patients with moderate to severe Crohn's disease (CD). PATIENTS AND METHODS Forty five patients with a CD activity index (CDAI) of 250-450 were randomised in a double blind, placebo controlled, dose escalating fashion to receive single doses of fontolizumab (0.1, 1.0, and 4.0 mg/kg) or placebo. By day 29, patients with clinical response were re-randomised to receive three additional doses of one half their initial fontolizumab dose or placebo at four weekly intervals. Primary objectives were safety and tolerability. Secondary outcomes included assessments of immunogenicity, clinical activity, and potential pharmacodynamic surrogates. RESULTS Treatment was generally well tolerated. There were slightly more reports of chills, flu-like syndrome, asthenia, nausea, and vomiting in the 1.0 mg and 4.0 mg/kg fontolizumab cohorts. Two serious adverse events rated as worsening of CD occurred under fontolizumab. Antibodies to fontolizumab were confirmed in one patient. No differences in clinical activity parameters were noted between any of the active treatment groups and placebo, with the placebo group having a particularly favourable outcome (60% response and 40% remission). By day 29, a more enhanced decrease in median Crohn's disease endoscopic index of severity (p = 0.02) and serum C reactive protein (p<0.001) was observed in the 4.0 mg/kg (n = 14) fontolizumab cohort compared with placebo (n = 10). Pharmacodynamic effects were observed by immunohistochemistry. CONCLUSIONS Fontolizumab was well tolerated with minimal immunogenicity at doses of up to 4.0 mg/kg in patients with CD. A biological activity of fontolizumab is suggested.
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Affiliation(s)
- W Reinisch
- Universitaetsklinik Innere Medizin IV, Abteilung Gastroenterologie and Hepatologie, Vienna, Austria.
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20
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Hommes DW, Mikhajlova TL, Stoinov S, Stimac D, Vucelic B, Lonovics J, Zákuciová M, D'Haens G, Van Assche G, Ba S, Lee S, Pearce T. Fontolizumab, a humanised anti-interferon gamma antibody, demonstrates safety and clinical activity in patients with moderate to severe Crohn's disease. Gut 2006; 55:1131-7. [PMID: 16507585 PMCID: PMC1856291 DOI: 10.1136/gut.2005.079392] [Citation(s) in RCA: 156] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Interferon gamma is a potent proinflammatory cytokine implicated in the inflammation of Crohn's disease (CD). We evaluated the safety and efficacy of fontolizumab, a humanised anti-interferon gamma antibody, in patients with moderate to severe CD. METHODS A total of 133 patients with Crohn's disease activity index (CDAI) scores between 250 and 450, inclusive, were randomised to receive placebo or fontolizumab 4 or 10 mg/kg. Forty two patients received one dose and 91 patients received two doses on days 0 and 28. Investigators and patients were unaware of assignment. Study end points were safety, clinical response (decrease in CDAI of 100 points or more), and remission (CDAI < or =150). RESULTS There was no statistically significant difference in the primary end point of the study (clinical response) between the fontolizumab and placebo groups after a single dose at day 28. However, patients receiving two doses of fontolizumab demonstrated doubling in response rate at day 56 compared with placebo: 32% (9/28) versus 69% (22/32, p = 0.02) and 67% (21/31, p = 0.03) for the placebo, and 4 and 10 mg/kg fontolizumab groups, respectively. Stratification according to elevated baseline C reactive protein levels resulted in a decreased placebo response and pronounced differences in clinical benefit. Two grade 3 adverse events were reported and were considered to be related to CD. One death (during sleep) and one serious adverse event (an elective hospitalisation) occurred, both considered unrelated. CONCLUSION Treating active CD with fontolizumab was well tolerated and resulted in increased rates of clinical response and remission compared with placebo.
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Affiliation(s)
- D W Hommes
- Department Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, the Netherlands.
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21
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Dorr R, Karanes C, Spier C, Grogan T, Greer J, Moore J, Weinberger B, Schiller G, Pearce T, Litchman M, Dalton W, Roe D, List AF. Phase I/II study of the P-glycoprotein modulator PSC 833 in patients with acute myeloid leukemia. J Clin Oncol 2001; 19:1589-99. [PMID: 11250987 DOI: 10.1200/jco.2001.19.6.1589] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the maximum-tolerated dose, pharmacokinetic interaction, and activity of PSC 833 compared with daunorubicin (DNR) and cytarabine in patients with poor-risk acute myeloid leukemia. PATIENTS AND METHODS Patients received ara-C 3 g/m(2)/d on 5 consecutive days, followed by an IV loading dose of PSC 833 (1.5 mg/kg) and an 84-hour continuous infusion escalating from 6, 9, or 10 mg/kg/d. Daunorubicin was administered as a 72-hour continuous infusion at 34 or 45 mg/m2/d [corrected]. Responding patients received consolidation chemotherapy with DNR pharmacokinetics performed without PSC-833 on day 1, and with PSC-833 on day 4. Response was correlated with expression of P-glycoprotein and lung resistance protein (LRP), and in vitro sensitization of leukemia progenitors to DNR cytotoxicity by PSC 833. RESULTS All 43 patients are assessable for toxicity and response. Grade 3 or greater hyperbilirubinemia (70%) was the only dose-dependent toxicity. Four patients (9%) succumbed to treatment-related complications. Twenty-one patients (49%) achieved a complete remission or restored chronic phase, including 10 of 20 patients treated at the maximum-tolerated dose of 10 mg/kg/d of PSC-833 and 45 mg/m(2) of DNR. The 95% confidence interval for complete response was 33.9% to 63.7%. Administration of PSC 833 did not alter the mean area under the curve for DNR, although clearance decreased approximately two-fold (P =.04). Daunorubicinol clearance decreased 3.3-fold (P =.016). Remission rates were not effected by mdr-1 expression, but LRP overexpression was associated with chemotherapy resistance. CONCLUSION Combined treatment with infused PSC 833 and DNR is well tolerated and has activity in patients with poor risk acute myeloid leukemia. Administration of PSC 833 delays elimination of daunorubicinol, but yields variable changes in DNR systemic exposure.
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Affiliation(s)
- R Dorr
- Section of Hematology/Oncology and Bone Marrow Transplantation Program, Arizona Cancer Center, Tucson 85724-5024, USA
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Rizzo J, Levine AM, Weiss GR, Pearce T, Kraynak M, Mueck R, Smith S, Von Hoff DD, Kuhn JG. Pharmacokinetic profile of Mitoguazone (MGBG) in patients with AIDS related non-Hodgkin's lymphoma. Invest New Drugs 1996; 14:227-34. [PMID: 8913846 DOI: 10.1007/bf00210796] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Mitoguazone is a unique chemotherapeutic agent whose activity is believed to result primarily from the competitive inhibition of S-adenosyl-methionine decarboxylase leading to a disruption in polyamine biosynthesis. Initial clinical trials demonstrated that the dose-limiting toxicities (mucositis and myelosuppression) of Mitoguazone were both dose and schedule dependent. Early pharmacokinetic studies of Mitoguazone in man revealed a prolonged half-life. Concurrent with a recent Phase II trial of Mitoguazone in patients with AIDS related non-Hodgkin's lymphoma, the single dose pharmacokinetics of Mitoguazone were characterized. Twelve patients received 600 mg/m2 of intravenous Mitoguazone over 30 minutes on an intermittent every 2 week schedule. Blood, urine, cerebrospinal fluid (CSF), pleural fluid and tissue samples were collected and analyzed by HPLC. Mitoguazone was cleared from the plasma triexponentially with a harmonic mean terminal half-life of 175 hours and a mean residence time of 192 hours. Peak plasma levels occurred immediately post-infusion, ranged from 6.47 to 42.8 micrograms/ml, and remained (for an extended period) well above the reported concentration for inhibition of polyamine biosynthesis. Plasma clearance averaged 4.73 l/hr/m2 with a relatively large apparent volume of distribution at steady-state of 1012 l/m2 indicating tissue sequestration. Renal excretion of unchanged Mitoguazone accounted for an average of 15.8% of the dose within 48 to 72 hours post-administration. Detectable levels of drug were present in random voided samples eight days post-dose. Mitoguazone levels in CSF ranged from 22 to 186 ng/ml post-dose with CSF/plasma ratios ranging from 0.6% to 7%. The pleural fluid/plasma ratio was approximately 1. Tissue levels of Mitoguazone were highest in the liver followed by lymph node, spleen and the brain.
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Affiliation(s)
- J Rizzo
- Cancer Therapy and Research Center, San Antonio, TX, 78229, USA
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Abstract
The aims of this study were to evaluate the accuracy of AN-DRG version 2.0 codings. Ninety-two separations, covering three of the most commonly occurring AN-DRG in psychiatry, were reviewed by a psychiatrist. The AN-DRG diagnosis was then compared to that given by morbidity coders. There was agreement for 69 (79 per cent) separations and disagreement for 18 (21 per cent) separations. Recoding of the 18 separations altered average length of stay data and the funding received. The high error rate of coding stimulated changes to the training of morbidity coders and registrars.
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Affiliation(s)
- P J Hay
- University of Adelaide, South Australia
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Coolican MB, Pearce T. After care bereavement program. Crit Care Nurs Clin North Am 1995; 7:519-27. [PMID: 7546514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Every year, 200 to 250 patients suffer the sudden death of a loved one in the emergency department at Hartford Hospital. Many families are not prepared for the grief they will experience and are left to grieve their loss alone. Recognizing the needs of these families led to the development of the Trauma Support After Care Program, which is described in this article.
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Remick SC, McSharry JJ, Wolf BC, Blanchard CG, Eastman AY, Wagner H, Portuese E, Wighton T, Powell D, Pearce T. Novel oral combination chemotherapy in the treatment of intermediate-grade and high-grade AIDS-related non-Hodgkin's lymphoma. J Clin Oncol 1993; 11:1691-702. [PMID: 8355036 DOI: 10.1200/jco.1993.11.9.1691] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
PURPOSE To determine the toxicity, response, and survival rate of orally administered combination chemotherapy in patients with AIDS-related intermediate- and high-grade non-Hodgkin's lymphoma. Secondary objectives included prospective quality-of-life assessment and quantitation of cell-associated p24 antigen (p24 Ag) by flow cytometry. PATIENTS AND METHODS Eighteen patients with biopsy-proven lymphoma were treated with oral chemotherapy consisting of lomustine (CCNU) 100 mg/m2 on day 1, etoposide 200 mg/m2 on days 1 through 3; cyclophosphamide 100 mg/m2 on days 22 through 31, and procarbazine 100 mg/m2 on days 22 through 31 at 6-week intervals. A variety of clinical assessments were performed: prospective quality-of-life assessment using the Functional Living Index-Cancer (FLIC) and Brief Symptom Inventory (BSI) instruments; indirect immunofluorescence with flow cytometry to measure cell-associated p24 antigen; and price of the oral regimen compared with two other intravenous combination chemotherapy regimens. RESULTS The overall objective response rate using Eastern Cooperative Oncology Group (ECOG) criteria was 61% (95% confidence interval, 39% to 84%), with seven complete remissions (39%) and four partial remissions (22%). The median survival duration was 7 months, with a range of 11 days to 36 months. The treatment-related mortality rate was 11%. One patient developed CNS progression. Myelosuppression was the most frequent and severe toxicity encountered. Predictor variables of performance status (PS), prior history of thrush, and CD4 lymphocyte count were found to be of prognostic value. In a separate analysis, scores on the three subscales of the BSI were also found to be predictive of complete response. The price of this regimen is several thousand dollars less than that of other intravenous combination chemotherapy regimens. CONCLUSION This regimen is active in patients with AIDS-related non-Hodgkin's lymphoma. Because it is important to design systemic cytotoxic chemotherapy regimens that are cost-effective, considerate of quality-of-life issues, and efficacious in this patient population, this approach should be compared with standard intravenous combination chemotherapy regimens in randomized controlled clinical trials.
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Pearce T, O'Shea JS, Wessen AF. Correlations between appointment keeping and reorganization of hospital ambulatory pediatric services. Pediatrics 1979; 64:81-7. [PMID: 450567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Over a period of 13 months before and after a university-affiliated hospital's daytime ambulatory pediatric facility was upgraded from an episodic care clinic to a primary care unit, 260 subjects were interviewed in an attempt to predict compliance with return appointment scheduling. The parents of patients more than 10 years of age were the least compliant, but most of the differences in compliance appeared due to the subject's evaluation of the diagnostic ability, thoroughness, and sympathy of the physician at the initial visit. Although no changes were noted in the subjects' demographic characteristics or in their general opinions of ambulatory health care delivery or of attitudes desired of physicians, their evaluations of recent visits improved and the missed appointment rate declined by 46% in the course of the study. Moreover, the pediatric house officers, who evaluated the patients, demonstrated an increased ability to assess the characteristics the subjects found important in physicians. Improvements are still needed, especially in the amount of communication between house officers, patients, and parents, but heeding clients' opinions about the provision of primary health care may help to make missed appointment rates negligible.
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