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Klempner S, Sirard C, Chao J, Chiu V, Mahalingam D, Uronis H, Kagey M, Baum J, Dayyani F, Song J, Wang J, Iqbal S, Tejani M, Sonbol M, Scott A, Wainberg Z, Ajani J. 1384P DKN-01 in combination with tislelizumab and chemotherapy as a first-line therapy in unselected patients with advanced gastroesophageal adenocarcinoma (GEA): DisTinGuish trial. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Salgia NJ, Chehrazi-Raffle A, Hsu J, Zengin Z, Salgia S, Chawla NS, Meza L, Malhotra J, Dizman N, Muddasani R, Ruel N, Cianfrocca M, Gong J, Anand S, Chiu V, Yeh J, Pal SK. Characterizing the relationships between tertiary and community cancer providers: Results from a survey of medical oncologists in Southern California. Cancer Med 2021; 10:5671-5680. [PMID: 34331372 PMCID: PMC8366095 DOI: 10.1002/cam4.4119] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/12/2021] [Accepted: 06/14/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Tertiary cancer centers offer clinical expertise and multi-modal approaches to treatment alongside the integration of research protocols. Nevertheless, most patients receive their cancer care at community practices. A better understanding of the relationships between tertiary and community practice environments may enhance collaborations and advance patient care. METHODS A 31-item survey was distributed to community and tertiary oncologists in Southern California using REDCap. Survey questions assessed the following attributes: demographics and features of clinical practice, referral patterns, availability and knowledge of clinical trials and precision medicine, strategies for knowledge acquisition, and integration of community and tertiary practices. RESULTS The survey was distributed to 98 oncologists, 85 (87%) of whom completed it. In total, 52 (61%) respondents were community practitioners and 33 (38%) were tertiary oncologists. A majority (56%) of community oncologists defined themselves as general oncologists, whereas almost all (97%) tertiary oncologists reported a subspecialty. Clinical trial availability was the most common reason for patient referrals to tertiary centers (73%). The most frequent barrier to tertiary referral was financial considerations (59%). Clinical trials were offered by 97% of tertiary practitioners compared to 67% of community oncologists (p = 0.001). Most oncologists (82%) reported only a minimal-to-moderate understanding of clinical trials available at regional tertiary centers. CONCLUSIONS Community oncologists refer patients to tertiary centers primarily with the intent of clinical trial enrollment; however, significant gaps exist in their knowledge of trial availability. Our results identify the need for enhanced communication and collaboration between community and tertiary providers to expand patients' access to clinical trials.
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Affiliation(s)
- Nicholas J Salgia
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Alexander Chehrazi-Raffle
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - JoAnn Hsu
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Zeynep Zengin
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Sabrina Salgia
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Neal S Chawla
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Luis Meza
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Jasnoor Malhotra
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Nazli Dizman
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Ramya Muddasani
- Department of Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Nora Ruel
- Biostatistics and Mathematical Modeling Core, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Mary Cianfrocca
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Jun Gong
- Division of Hematology/Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sidharth Anand
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Victor Chiu
- Division of Hematology/Oncology, UCLA-Olive View Medical Center, Los Angeles, CA, USA
| | - James Yeh
- Division of Hematology and Medical Oncology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Sumanta K Pal
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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Shah M, Yoshino T, Tebbutt N, Grothey A, Tabernero J, Xu R, Taieb J, Cervantes A, Oh S, Yamaguchi K, Fakih M, Falcone A, Wu C, Chiu V, Tomasek J, Bendell J, Fontaine M, Hitron M, Xu B, Van Cutsem E. O-7 FOLFIRI ± napabucasin in patients with previously treated metastatic colorectal cancer: Overall survival results from the phase 3 CanStem303C study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.011] [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] Open
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Reed S, Getahun D, Gatz J, Armstrong M, Raine-Bennett T, Zhou X, Fassett M, Peipert J, Saltus C, Im T, Alabaster A, Hunter S, Takhar H, Chillemi G, Xie F, Wang J, Chiu V, Frenz A, Shi J, Lynen R, Asiimwe A, Anthony M. 78 Postpartum timing of IUD insertion is associated with risk of uterine perforation: Results from APEX IUD. Contraception 2020. [DOI: 10.1016/j.contraception.2020.07.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hanna DL, Iqbal S, Habib D, Tsao-Wei DD, Barzi A, Thomas JS, Chiu V, Siddiqi I, Bhavsar RD, Jensen NG, DeLeon C, Lenz HJ, Gill PS, El-Khoueiry AB. A phase Ib study of sEphB4-HSA combined with first-line chemotherapy in patients (pts) with advanced pancreatic (PC) and biliary cancers (BC). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4640 Background: EphB4, a receptor kinase expressed in most epithelial tumors, binds EphrinB2 to affect cancer cell growth, apoptosis and angiogenesis. EphB4 overexpression is associated with advanced stage and shorter survival in multiple cancers. sEphB4-HSA, the albumin-bound extracellular fragment of EphB4, is a first-in-class inhibitor which blocks EphB4-EphrinB2 bidirectional signaling and results in downstream suppression of KRAS, PI3K, and promotes recruitment of CD3 and CD8 T cells into the tumor. The RP2D of sEphB4-HSA is 10 mg/Kg IV q week. Here, we report on sEphB4-HSA in combination with standard first-line chemotherapy. Methods: Pts with advanced PC or BC and no prior therapy for metastatic disease were eligible and enrolled into separate cohorts. Pts with PC received gemcitabine 1,000 mg/m2 + nab-paclitaxel 125 mg/m2 on Days 1, 8, 15 of a 28-day cycle. Pts with BC received gemcitabine 1,000 mg/m2 + cisplatin 25 mg/m2 on Days 1, 8 of a 21-day cycle. sEphB4-HSA 10 mg/kg IV was given weekly starting in Cycle 2. Response was assessed every 2 cycles. Primary endpoint was safety and tolerability; secondary endpoints were objective response rate (ORR) by RECIST 1.1, PFS, OS. Expression of EphrinB2 and EphB4 in tumor was examined by IHC and classified as 1+ (weak staining); 2+ (moderate staining); 3+ (strong, uniform staining). Results: A total of 44 pts with advanced PC (n = 21) and BC (n = 23; 70% gallbladder cancer) were enrolled. Median age 66 yrs; ECOG 1 (70%), 52% male. Median number of cycles received were 5 (PC) and 7 (BC). Median PFS was 5.6 mo in PC and 5.8 mo in BC (95% CI: 3.1-8.1 [PC]; 2.7-7.0 [BC]). Median OS was 7.9 mo in PC and 9.1 mo in BC (95% CI: 6.5-15.0 [PC]; 5.4-15.0 [BC]). In response evaluable pts (20 PC, 22 BC), ORR was 40% in PC (95% CI: 21%, 63%) and 23% in BC (95% CI: 9%, 45%). Stable disease was noted in 48% of PC and 61% of BC pts. The most common grade 3 or 4 treatment-related AEs in ≥10% of pts in both cohorts combined were hypertension (n = 16; 36%), neutropenia (n = 15; 34%), anemia (n = 14; 32%), thrombocytopenia (n = 7, 16%), fatigue (n = 7, 16%). In the PC cohort, there was an association between EphB4 expression and objective response (p = 0.009). Conclusions: sEphB4-HSA has a manageable safety profile in combination with chemotherapy in pts with PC and BC. Clinical activity is manifested by a high disease control rate in both cohorts and a promising RR in PC. Additional biomarker analyses will be presented. Future studies combining chemoimmunotherapy with sEphB4-HSA in pancreatic cancer are planned. Clinical trial information: NCT02495896 .
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Affiliation(s)
| | - Syma Iqbal
- Division of Medical Oncology, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA
| | - Diane Habib
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Denice D. Tsao-Wei
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Afsaneh Barzi
- USC Keck School of Medicine Norris Comprehensive Cancer Center, Los Angeles, CA
| | | | | | | | | | | | | | | | | | - Anthony B. El-Khoueiry
- Division of Medical Oncology, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA
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Patel R, Chiu V, Spicer DV. Decreasing time to initiation of inpatient chemotherapy at LAC+USC medical center utilizing an admission checklist. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.27_suppl.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
262 Background: Delays in the initiation of chemotherapy for scheduled inpatient admissions cause excess lengths of stay and shift infusion start times to the evenings when hospital staffing is decreased. We sought to characterize delays in our admission process and assess the feasibility of using an admission checklist to shorten start times in a large academic safety-net hospital. Baseline data for scheduled chemotherapy admissions in July and August of 2017 (n = 25) showed a mean time to chemotherapy initiation of 14.6 hours and mean excess LOS was 0.7 midnights. Significant delays were identified in the time between ordering and resulting of pre-chemotherapy labs (average 2.6 hours), and the time required to obtain imaging to confirm peripheral-inserted central catheter (PICC) position (1.6 hours). Methods: We created a checklist of a standardized admission workflow for physicians, which included moving all pre-chemotherapy labs, pharmacy verification of chemotherapy regimen, and PICC imaging to the outpatient setting. We organized multiple staff in-services to introduce the admission workflow prior to implementation on May 1, 2018. We then performed a retrospective chart review of all scheduled inpatient chemotherapy admissions from May to August of 2018. Results: In the first 2 months after intervention, the mean time to chemotherapy initiation was 8.5 hrs, representing a 42% reduction. In the subsequent 2 months, the mean time to chemotherapy initiation was 11.6 hours, representing a 21% reduction from baseline. Mean excess LOS was 0.4 midnights and 0.5 midnights for those time periods, respectively. For the entire post-intervention group, 7 out of 26 patients obtained pre-chemotherapy labs in the outpatient setting. Conclusions: We observed an initial mean reduction of 6.1 hours in the time to start chemotherapy, as well as a reduction in mean excess length of stay with the introduction of a new admission workflow and admission checklist. We observed incomplete adoption of the checklist, and an increase in time to chemotherapy initiation after the first two months of implementation, suggesting that physician non-adherence represents a significant barrier to maintaining these reductions.
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Affiliation(s)
- Ronak Patel
- Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - Victor Chiu
- Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - Darcy V. Spicer
- Keck School of Medicine of University of Southern California, Los Angeles, CA
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Marshall L, Chiu V, Geddes J, Zhou H, Adams A. Occurrence of fall injury in relation to degenerative spinal conditions: a case-control study of adults from Southern California. Ann Epidemiol 2019. [DOI: 10.1016/j.annepidem.2019.06.040] [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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Chiu V, Hogen R, Sher L, Wadé N, Conti D, Martynova A, Li H, Liang G, O'Connell C. Telomerase Variants in Patients with Cirrhosis Awaiting Liver Transplantation. Hepatology 2019; 69:2652-2663. [PMID: 30964210 PMCID: PMC6594079 DOI: 10.1002/hep.30557] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 01/27/2019] [Indexed: 12/16/2022]
Abstract
Telomeres are repetitive DNA sequences that protect the ends of linear chromosomes, and they are maintained by a ribonucleoprotein complex called telomerase. Variants in genes encoding for telomerase components have been associated with a spectrum of disease in the lung, skin, bone marrow, and liver. Mutations in the telomerase reverse transcriptase and telomerase RNA component genes have been observed at a higher prevalence in patients with liver disease compared with the general population; however, the presence of variants in other components of the telomerase complex and their impact on clinical outcomes has not been explored. We evaluated 86 patients with end-stage liver disease for variants in an expanded panel of eight genes, and found that 17 patients (20%) had likely deleterious variants by in silico analysis. Seven unique likely deleterious variants were identified in the regulator of telomere elongation helicase 1 (RTEL1) gene that encodes for a DNA helicase important in telomere maintenance and genomic stability. In gene burden association analysis of their clinical data, the presence of any RTEL1 variant was associated with a 29% lower baseline white blood cell count (95% confidence interval [CI], -7% to -46%; P Value = 0.01) compared with patients without RTEL1 variants, and the presence of any exonic missense RTEL1 variant was associated with a 42% lower baseline platelet count (95% CI, -5% to -65%: P Value = 0.03). The presence of any telomerase variant was associated with an increased number of readmissions within 1 year after transplantation demonstrated by an incident rate ratio (IRR) of 3.15 (95% CI, 1.22 to 8.57). No association with survival was observed. Conclusion: Among patients who underwent liver transplantation, the presence of any exonic missense variant was associated with a longer postoperative length of stay with an IRR of 2.16 (95% CI, 1.31 to 3.68).
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Affiliation(s)
- Victor Chiu
- Norris Comprehensive Cancer Center and Hospital, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCA,Division of Hematology, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCA
| | - Rachel Hogen
- Department of Surgery, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCA
| | - Linda Sher
- Department of Surgery, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCA
| | - Niquelle Wadé
- Department of Preventive Medicine, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCA
| | - David Conti
- Department of Preventive Medicine, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCA
| | - Anastasia Martynova
- Norris Comprehensive Cancer Center and Hospital, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCA,Division of Hematology, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCA
| | - Hongtao Li
- Department of Urology, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCA
| | - Gangning Liang
- Norris Comprehensive Cancer Center and Hospital, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCA,Department of Urology, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCA
| | - Casey O'Connell
- Norris Comprehensive Cancer Center and Hospital, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCA,Division of Hematology, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCA
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9
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Horng Y, Chiu V, Horng Y. The effect of adding eccentric exercises to conventional physical therapy for patients with rotator cuff tendinopathy. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.329] [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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10
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Hermel DJ, Chiu V, Hermel MH, Tulpule A, Akhtari M. Cardiac birth defects in a twin infant born to a woman with chronic myeloid leukemia on dasatinib. J Oncol Pharm Pract 2017; 25:699-702. [PMID: 29207935 DOI: 10.1177/1078155217745710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Preclinical animal studies have demonstrated an association between maternal use of tyrosine kinase inhibitors and embryofetal toxicity; yet, multiple clinical case series have reported normal pregnancy outcomes and healthy infants in women on these medications during the course of their pregnancy. We describe a case of a woman with chronic myeloid leukemia who had taken the second-generation tyrosine kinase inhibitor dasatinib during the first 12 weeks of her dichorionic diamniotic twin pregnancy and subsequently delivered two low-birth weight infants, one with severe cardiac malformations and the other without apparent birth abnormalities. To our knowledge, this is the first reported case of fetal cardiovascular defects in an infant born to a woman on dasatinib during a twin pregnancy and supports current recommendations to avoid this medication during pregnancy. We also review relevant preclinical and clinical studies of tyrosine kinase inhibitor use during pregnancy and explore alternative therapeutic options for patients with chronic myeloid leukemia during pregnancy to aid clinicians in the appropriate management of these patients so as to minimize both maternal and fetal risks.
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Affiliation(s)
- David J Hermel
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, Department Medicine, University of Southern California-Keck School of Medicine
| | - Victor Chiu
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, Department Medicine, University of Southern California-Keck School of Medicine
| | - Melody H Hermel
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, Department Medicine, University of Southern California-Keck School of Medicine
| | - Anil Tulpule
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, Department Medicine, University of Southern California-Keck School of Medicine
| | - Mojtaba Akhtari
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, Department Medicine, University of Southern California-Keck School of Medicine
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Yaghoubian A, Lee S, Chiu V, de Virgilio C. “July Effect” and Appendicitis. J Surg Res 2010. [DOI: 10.1016/j.jss.2009.11.181] [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: 11/26/2022]
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12
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Hwang JM, Cosmatos H, Rao A, Chiu V, Wang R, Kagan R, Jim H, Tome M. Combined modality treatment for stage IV squamous cell carcinoma of the oropharynx. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.5609] [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: 11/20/2022] Open
Affiliation(s)
- J. M. Hwang
- Southern CA Kaiser Permanente Medcl Cent, Los Angeles, CA
| | - H. Cosmatos
- Southern CA Kaiser Permanente Medcl Cent, Los Angeles, CA
| | - A. Rao
- Southern CA Kaiser Permanente Medcl Cent, Los Angeles, CA
| | - V. Chiu
- Southern CA Kaiser Permanente Medcl Cent, Los Angeles, CA
| | - R. Wang
- Southern CA Kaiser Permanente Medcl Cent, Los Angeles, CA
| | - R. Kagan
- Southern CA Kaiser Permanente Medcl Cent, Los Angeles, CA
| | - H. Jim
- Southern CA Kaiser Permanente Medcl Cent, Los Angeles, CA
| | - M. Tome
- Southern CA Kaiser Permanente Medcl Cent, Los Angeles, CA
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Abstract
PURPOSE To assess the known-groups and construct validity of measures from the CHAMPS Physical Activity Questionnaire, Physical Activity Survey for the Elderly (PASE), and the Yale Physical Activity Survey (YPAS). METHODS The three questionnaires were administered to a convenience sample of older adults (N = 87) recruited from community centers and retirement homes. Validation measures included the SF-36 measures of physical functioning, general health, mental health, and pain; body mass index; performance-based tests of lower body functioning and endurance; and Mini-Logger activity monitor data from ankle and waist sensors. Validity was estimated by testing hypotheses about associations between physical activity and validation measures. RESULTS As hypothesized, differences in activity levels on all measures were found between older adults in retirement homes (less active) and community centers (more active) (P-values < 0.0001). Correlations of physical activity measures with performance-based measures ranged from 0.44 to 0.68, conforming to hypotheses; hypotheses regarding associations with the SF-36 measures were also confirmed. Body mass index was not correlated with any of the physical activity measures, contrary to hypotheses. Correlations of physical activity measures with Mini-Logger counts ranged from 0.36 to 0.59 (ankle) and 0.42 to 0.61 (waist) as hypothesized. Correlations among the measures from the three instruments ranged from 0.58 to 0.68. CONCLUSIONS The PASE, YPAS, and CHAMPS each demonstrated acceptable validity, as all measures met nearly all hypotheses. Higher validity coefficients were found for subgroups (men, 65-74 yr, retirement home), suggesting that these instruments may perform better for certain segments of the older adult population.
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Affiliation(s)
- N D Harada
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, USA.
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14
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Lawrence JM, Umekubo MA, Chiu V, Petitti DB. Split sample analysis of serum folate levels after 18 days in frozen storage. Clin Lab 2001; 46:483-6. [PMID: 11034534] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Reliable measurement of folate is becoming increasingly important as links between dietary folate intake, the use of vitamins containing folic acid, and health outcomes such as birth defects and cardiovascular disease are identified. This study was undertaken to formally assess whether the quantity of folate in serum declines after the serum is frozen and stored. Blood samples from 83 pregnant women were tested for serum folate shortly after collection and again after 18 days of storage at -20 degrees C. A shift from higher to lower serum folate categories was observed after 18 days of storage. For the first test, 40.9 % of the samples were > or = 20 microg/L compared with 19.3 % of the test results on second test. For the 75 samples in the quantifiable range (< 40 microg/L), a mean decrease of 5.0 microg/L (+/- 0.5) of serum folate was observed (p < 0.0001). When compared to serum samples stored in a non frost-free freezer at -20 degrees C or -70 degrees C, serum stored in a frost-free freezer at -20 degrees C for even a short period of time may be relatively unstable and sensitive to minor temperature fluctuations associated with the freeze-thaw cycles.
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Affiliation(s)
- J M Lawrence
- Department of Research and Evaluation, Kaiser Permanente, Southern California, Pasadena 91101, USA.
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15
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Abstract
BACKGROUND Hospitalized hip fracture patients may receive physical therapy (PT) in acute and/or postacute settings. Patterns of PT use may vary by patient, clinical, and hospital characteristics. These patterns can be analyzed if the acute and postacute stays are linked. OBJECTIVES We classified the following patterns of PT use: acute PT only, skilled nursing facility (SNF) PT only, acute and SNF PT, and no PT. For each pattern, we compared (1) characteristics of hip fracture patients, (2) length of stay (LOS), and (3) discharge outcomes. SUBJECTS The study included 187,990 hospitalized hip fracture patients derived from Medicare administrative data. MEASURES Dependent variables were PT use patterns, acute hospital and SNF LOS, total episode days of care, and discharge destination. Independent variables were demographic, clinical, and facility characteristics. PT use patterns were also used as independent variables in the LOS and discharge destination models. RESULTS Patterns of PT use were influenced by demographic and clinical characteristics such as age, race, and surgery type. Similarly, different LOS measures and discharge destinations varied by the PT use patterns. Patients receiving acute PT had longer acute LOSs; however, those patients who were subsequently transferred to SNFs had shorter SNF LOSs and total episode days of care. Patients utilizing PT were more likely to be discharged to home after the acute or SNF stay. CONCLUSIONS Disparities in PT use exist for subgroups of patients such as the elderly and blacks. Providers should determine the most appropriate setting for initiation of PT to achieve better discharge outcomes with efficient use of resources.
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Affiliation(s)
- N D Harada
- UCLA School of Medicine, Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Health Care System, California 90073, USA
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17
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Abstract
OBJECTIVE To determine the usefulness of the 6-minute walk test as an integrated measure of mobility in older adults. DESIGN Observational study. SETTING Community centers and retirement homes in the Los Angeles area. PATIENTS Eighty-six older adults without significant disease. INTERVENTIONS None. MAIN OUTCOME MEASURES Assessments included the 6-minute walk, chair stands, standing balance, gait speed, body mass index, and self-reported physical functioning and general health perceptions. RESULTS One-week test-retest reliability of the 6-minute walk was .95. As hypothesized, the 6-minute walk distance was significantly greater for active than for inactive older adults (p < .0001), moderately correlated with chair stands (r = .67), standing balance (r = .52), and gait speed (r = -.73). It had a low correlation with body mass index (r = -.07). The correlation of the 6-minute walk with self-reported physical functioning was .55, and its correlation with general health perceptions was .39. Self-report and performance measures explained 69% of the variance in 6-minute walk scores. CONCLUSIONS The 6-minute walk test is reliable and is valid in relation to the performance and self-reported indicators of physical functioning tested in this study. It could serve as a useful integrated measure of mobility.
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Affiliation(s)
- N D Harada
- Geriatric Research, Education, and Clinical Center of the Department of Veterans Affairs Medical Center, West Los Angeles, University of California Los Angeles School of Medicine, 90073, USA
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Dai Q, Choy E, Chiu V, Romano J, Slivka SR, Steitz SA, Michaelis S, Philips MR. Mammalian prenylcysteine carboxyl methyltransferase is in the endoplasmic reticulum. J Biol Chem 1998; 273:15030-4. [PMID: 9614111 DOI: 10.1074/jbc.273.24.15030] [Citation(s) in RCA: 234] [Impact Index Per Article: 9.0] [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: 11/06/2022] Open
Abstract
Prenylcysteine carboxyl methyltransferase (pcCMT) is the third of three enzymes that posttranslationally modify C-terminal CAAX motifs and thereby target CAAX proteins to the plasma membrane. Here we report the molecular characterization and subcellular localization of the first mammalian (human myeloid) pcCMT. The deduced amino acid sequence of mammalian pcCMT predicts a multiple membrane-spanning protein with homologies to the yeast pcCMT, STE14, and the mammalian band 3 anion transporter. The human gene complemented a ste14 mutant. pcCMT mRNAs were ubiquitously expressed in human tissues. An anti-pcCMT antiserum detected a 33-kDa protein in myeloid cell membranes. Ectopically expressed recombinant pcCMT had enzymatic activity identical to that observed in neutrophil membranes. Mammalian pcCMT was not expressed at the plasma membrane but rather restricted to the endoplasmic reticulum. Thus, the final enzyme in the sequence that modifies CAAX motifs is located in membranes topologically removed from the CAAX protein target membrane.
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Affiliation(s)
- Q Dai
- Departments of Medicine and Cell Biology, New York University School of Medicine, New York, New York 10016, USA
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Abstract
BACKGROUND AND PURPOSE The purpose of this study was to determine the effectiveness of an individualized physical therapy mobility training program on the gait, balance, and functional performance of elderly individuals living in residential care facilities. SUBJECTS Twenty-seven elderly individuals with impaired balance and difficulty performing at least one functional activity participated in the study. The subjects ranged in age from 71 to 97 years (mean = 87.1, SD = 6.7). METHODS Balance and gait speed were assessed at baseline and following physical therapy that consisted of exercises to improve specific functional limitations. Outcomes were reassessed 1 month following completion of the physical therapy. RESULTS Gait and balance outcomes were analyzed using a one-way repeated-measures analysis of variance. Improvement was obtained in balance, which was maintained at 1 month follow-up. Gait speed did not improve to a level of statistical significance. CONCLUSION AND DISCUSSION After physical therapy, subjects improved in balance and functional performance. An improvement in gait speed may require a longer duration of treatment.
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Affiliation(s)
- N Harada
- Health Services Research Associate, Geriatric Research, Education, and Clinical Center, Veterans Administration Medical Center-West Los Angeles, USA
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Harada N, Chiu V, Damron-Rodriguez J, Fowler E, Siu A, Reuben DB. Screening for balance and mobility impairment in elderly individuals living in residential care facilities. Phys Ther 1995; 75:462-9. [PMID: 7770493 DOI: 10.1093/ptj/75.6.462] [Citation(s) in RCA: 107] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE The rapid growth of the elderly population has resulted in a corresponding rise in the number of elderly individuals who experience disability during their lifetimes. The purpose of this study was to test the usefulness of four established clinical measures of balance, gait, and subjective perceptions of fear of falling as screening methods for referring community-dwelling elderly individuals living in residential care facilities for detailed physical therapy evaluation and possible intervention. SUBJECTS The subjects were a convenience sample of 53 elderly individuals living in two residential care facilities for the elderly. METHODS Subjects were tested on each of four clinical measures of balance and mobility. Their performance on these measures was compared with a physical therapist's brief evaluation of disability and appropriateness for more detailed evaluation. The usefulness of these tools as screening methods was determined by calculating sensitivity and specificity levels using the physical therapist's evaluation as a standard. RESULTS The sensitivity and specificity levels of the four clinical measures in their application as screening tests for referral to physical therapy were as follows: Berg Balance Scale, 84% and 78%; balance subscale of the Tinetti Performance-Oriented Mobility Assessment, 68% and 78%; gait speed, 80% and 89%; and Tinetti Fall Efficacy Scale, 59% and 82%. The combination of two tests, Berg Balance Scale and gait speed, yielded the highest sensitivity of 91% and the highest specificity of 70% when a subject tested positive on at least one test. CONCLUSION AND DISCUSSION These findings indicate the feasibility of developing screening methods for referring community-dwelling elderly individuals for a detailed physical therapy evaluation based on established clinical assessment measures, with a combination of tests measuring balance and gait demonstrating the most promising results.
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Affiliation(s)
- N Harada
- Veterans Administration Medical Center-West Los Angeles, CA, USA
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21
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Abstract
Abstract
The murine CTL hybridoma PMMI has been shown by the most sensitive techniques to be devoid of perforin. We thus used PMMI activated with PMA and ionomycin, to investigate possible alternate lytic pathways in CTLs in the absence of perforin. We found that PMMI is equipped with membrane TNF-alpha as a potential lytic mechanism, but TNF-alpha is unlikely to be involved in acute (4 h) lytic reactions. On the other hand, PMMI readily lyses target cells expressing the gene for the Fas Ag, but does not lyse target cells expressing fas antisense DNA. The generation of fas-dependent lysis required protein synthesis in PMMI, but target cell protein synthesis was not required for lysis. Lysis of Fas-positive target cells by PMMI was accompanied by DNA fragmentation, and both lysis and DNA fragmentation were blocked by inhibition of protein synthesis in the effector cell. We find the relative extent and kinetics of fas-dependent lysis and DNA fragmentation indistinguishable from that seen in "classical" CTL lytic assays. Both fas- and perforin-dependent lysis were blocked by inhibitors of poly(ADP) ribosylation. We found very little difference in the sequence of events in target cells lysed by the fas pathway compared with the classical (probably perforin) lytic pathway. Given the widespread distribution of fas, particularly in hematopoietic target cells, caution may be required in interpreting the relationship between parameters such as DNA fragmentation and 51Cr-release solely on the basis of the granule exocytosis model.
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Affiliation(s)
- C M Walsh
- Department of Biology, University of California, Los Angeles 90024
| | - A A Glass
- Department of Biology, University of California, Los Angeles 90024
| | - V Chiu
- Department of Biology, University of California, Los Angeles 90024
| | - W R Clark
- Department of Biology, University of California, Los Angeles 90024
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Walsh CM, Glass AA, Chiu V, Clark WR. The role of the Fas lytic pathway in a perforin-less CTL hybridoma. J Immunol 1994; 153:2506-14. [PMID: 7521365] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The murine CTL hybridoma PMMI has been shown by the most sensitive techniques to be devoid of perforin. We thus used PMMI activated with PMA and ionomycin, to investigate possible alternate lytic pathways in CTLs in the absence of perforin. We found that PMMI is equipped with membrane TNF-alpha as a potential lytic mechanism, but TNF-alpha is unlikely to be involved in acute (4 h) lytic reactions. On the other hand, PMMI readily lyses target cells expressing the gene for the Fas Ag, but does not lyse target cells expressing fas antisense DNA. The generation of fas-dependent lysis required protein synthesis in PMMI, but target cell protein synthesis was not required for lysis. Lysis of Fas-positive target cells by PMMI was accompanied by DNA fragmentation, and both lysis and DNA fragmentation were blocked by inhibition of protein synthesis in the effector cell. We find the relative extent and kinetics of fas-dependent lysis and DNA fragmentation indistinguishable from that seen in "classical" CTL lytic assays. Both fas- and perforin-dependent lysis were blocked by inhibitors of poly(ADP) ribosylation. We found very little difference in the sequence of events in target cells lysed by the fas pathway compared with the classical (probably perforin) lytic pathway. Given the widespread distribution of fas, particularly in hematopoietic target cells, caution may be required in interpreting the relationship between parameters such as DNA fragmentation and 51Cr-release solely on the basis of the granule exocytosis model.
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Affiliation(s)
- C M Walsh
- Department of Biology, University of California, Los Angeles 90024
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