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Cho A, Hudson A, Colvin E, Hayes S, Wheeler H, Howell V. GENE-20. IDENTIFYING POTENTIAL GENES AND MECHANISMS DRIVING IDH-MUTANT GLIOMA PROGRESSION AND RECURRENCE THROUGH RNA-SEQUENCING. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Gliomas are the most common primary brain tumors in adults. IDH-mutated low-grade gliomas of astrocytic lineage (astrocytomas) have a relatively indolent clinical course; however, over time they progress to a higher grade. Molecular studies revealed recurrent tumors harbor more mutations upon malignant progression when treated with chemotherapy and/or radiotherapy compared to treatment-naïve tumors. However, genes which promote progression and recurrence in these tumors are unknown. This study aims to identify the transcriptional drivers of progression and recurrence of IDH-mutant gliomas. Longitudinal comparison of transcriptional profiles was performed on 6 matched pairs of primary lesions and their higher-grade recurrent lesion collected 1 to 8 years later. Three patients received no treatment and three patients received radiotherapy alone between their first and second surgeries. RNA was extracted from frozen specimens and following quality control, analyzed with the Illumina Next-Generation Sequencing platform (HiSeq HT paired end, TruSeq Kit). Comparison of RNA-seq results from primary and recurrent specimens identified 2042 differentially expressed genes (FC ≥2) for the no-treatment group and 2066 differentially expressed genes for the radiotherapy group. These genes include CADM2, SPP1, NDRG2 and CA9 which are associated with pro-tumor processes such as signal transduction, cell adhesion and treatment resistance. Validation is in progress. Identifying key genes driving glioma progression and recurrence will increase our understanding of the nature of these tumors and reveal core processes and potential novel targets that may be exploited for additional therapies for this deadly cancer.
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Affiliation(s)
- Angela Cho
- Bill Walsh Translational Cancer Research Laboratory, The University of Sydney Northern Clinical School & Northern Sydney Local Health District Research (Kolling Institute of Medical Research), Sydney, Australia
| | - Amanda Hudson
- Bill Walsh Translational Cancer Research Laboratory, The University of Sydney Northern Clinical School & Northern Sydney Local Health District Research (Kolling Institute of Medical Research), St Leonards, New South Wales, Australia
| | - Emily Colvin
- Bill Walsh Translational Cancer Research Laboratory, The University of Sydney Northern Clinical School & Northern Sydney Local Health District Research (Kolling Institute of Medical Research), Sydney, Australia
| | - Sarah Hayes
- Bill Walsh Translational Cancer Research Laboratory, The University of Sydney Northern Clinical School & Northern Sydney Local Health District Research (Kolling Institute of Medical Research), Sydney, Australia
| | - Helen Wheeler
- Bill Walsh Translational Cancer Research Laboratory, The University of Sydney Northern Clinical School & Northern Sydney Local Health District Research (Kolling Institute of Medical Research), St Leonards, New South Wales, Australia
| | - Viive Howell
- Bill Walsh Translational Cancer Research Laboratory, The University of Sydney Northern Clinical School & Northern Sydney Local Health District Research (Kolling Institute of Medical Research), St Leonards, New South Wales, Australia
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McKelvey K, Hudson A, Kumar R, Long G, Scolyer R, Wilmott J, Attrill G, Clarke S, Wheeler H, Diakos C, Howell V. IMMU-04. TEMPORAL AND SPATIAL MODULATION OF THE IMMUNE RESPONSE OF THE MURINE GL261 GLIOMA TUMOUR MICROENVIRONMENT. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
INTRODUCTION
Glioma is a debilitating and early fatal cancer arising in the glial cells of brain. Glioblastoma, the most aggressive form of gliomas, has a 5-year survival rate of 5% with treatment options limited to surgery, radiotherapy or chemotherapy with temozolomide.
OBJECTIVE
While radiation and immunotherapies are routinely studied in the murine Gl261 glioma model, little is known about its inherent immune response. In this study we quantified the temporal and spatial localisation of immune cell populations and mediators during glioma development.
METHODS
Mice were inoculated with 1x106 Gl261 cells at AP0.1mm, ML1.0mm, DV2.6mm Bregma. Tumour morphology, local and systemic immune cell populations were assessed at Day-0, 1, 3, 7, 14, and 21 post-inoculation by MRI, immunohistochemistry for Ki67+ proliferation and CD31+ vessel density; local immune infiltrate by multiplex immunofluorescence (VECTRA®;PerkinElmer); systemic immunity in spleen, bone marrow and peripheral blood by 16-parameter flow cytometry (LSRFortessa™;BD Biosciences); and multiplex immunoassay (Bio-Plex®;Bio-Rad) for plasma cytokines/chemokines.
RESULTS
From Day-3 tumours were distinguishable with high Ki67+ (> 30%) and increased tissue vascularisation (26.38±1.45 vessels/field; p< 0.05). Ki67 remained high until Day-21 with visible necrotic regions, increased vessel density and lumen area within tumour region. Increasing tumour proliferation/malignancy and vascularisation were associated with significant temporal changes in immune cell populations within the tumour (p< 0.05) and systemic compartments (p=0.02- p< 0.0001). Of note, at Day-14 NK, M1, PMN-MDSCs and M-MDSCs in the tumour infiltrate declined, coinciding with a decrease in 16/24 plasma cytokine/chemokines levels. Tumour infiltrating immune cell populations did not correlate with peripheral blood populations. However, a decrease in plasma cytokine/chemokine levels may indicate ‘immune exhaustion’.
CONCLUSIONS
The data derived provide baseline characteristics to study changes associated with multi-modal treatment strategies and to sequence therapies to maintain immune modulation. This information will contribute to the identification of novel combination therapies.
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Affiliation(s)
- Kelly McKelvey
- Bill Walsh Translational Cancer Research Laboratory, The University of Sydney Northern Clinical School & Northern Sydney Local Health District Research (Kolling Institute of Medical Research), St Leonards, NSW, Australia
| | - Amanda Hudson
- Bill Walsh Translational Cancer Research Laboratory, The University of Sydney Northern Clinical School & Northern Sydney Local Health District Research (Kolling Institute of Medical Research), St Leonards, NSW, Australia
| | - Ramyashree Kumar
- Bill Walsh Translational Cancer Research Laboratory, The University of Sydney Northern Clinical School & Northern Sydney Local Health District Research (Kolling Institute of Medical Research), St Leonards, NSW, Australia
| | - Georgina Long
- Melanoma Institute Australia & Mater Hospital, North Sydney, NSW, Australia
| | - Richard Scolyer
- Melanoma Institute Australia & Royal Prince Alfred Hospital, North Sydney, NSW, Australia
| | - James Wilmott
- Melanoma Institute Australia, North Sydney, NSW, Australia
| | - Grace Attrill
- Melanoma Institute Australia, North Sydney, NSW, Australia
| | - Stephen Clarke
- Bill Walsh Translational Cancer Research Laboratory, The University of Sydney Northern Clinical School & Northern Sydney Local Health District Research (Kolling Institute of Medical Research), St Leonards, NSW, Australia
| | - Helen Wheeler
- Bill Walsh Translational Cancer Research Laboratory, The University of Sydney Northern Clinical School & Northern Sydney Local Health District Research (Kolling Institute of Medical Research), St Leonards, NSW, Australia
| | - Connie Diakos
- Bill Walsh Translational Cancer Research Laboratory, The University of Sydney Northern Clinical School & Northern Sydney Local Health District Research (Kolling Institute of Medical Research), St Leonards, NSW, Australia
| | - Viive Howell
- Bill Walsh Translational Cancer Research Laboratory, The University of Sydney Northern Clinical School & Northern Sydney Local Health District Research (Kolling Institute of Medical Research), St Leonards, NSW, Australia
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Itchins M, Hayes S, Hudson A, Howell V, Tan S, Clarke S, Solomon B, Pavlakis N. P2.01-11 ALKternate: A Proof of Concept Study in ALK-Rearranged NSCLC Alternating Lorlatinib with Crizotinib After Disease Progression. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Itchins M, Hudson A, Hayes S, Harvie R, Wei G, Buckland M, Clarke S, Howell V, Pavlakis N. P1.01-129 Preclinical Genetic Evaluation of Alternating ALK TKI Therapy Versus Continuous Dosing in ALK NSCLC to Inform the ALKternate Clinical Trial. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.844] [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: 10/25/2022]
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Itchins M, Hudson A, Harvie R, Zaw T, Mckay M, Clarke S, Howell V, Pavlakis N, Hayes S. P1.01-24 Preclinical Proteomic Evaluation of Alternating ALK TKI Therapy Versus Continuous Dosing in ALK NSCLC to Inform the ALKternate Clinical Trial. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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McKelvey K, Hudson A, Wheeler H, Diakos C, Howell V. TMIC-39. UNRAVELLING THE TUMOUR MICROENVIRONMENT OF GLIOMA. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.1098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kelly McKelvey
- Bill Walsh Translational Cancer Laboratory, The University of Sydney Northern Clinical School, Faculty of Health and Medicine; Northern Sydney Local Heath District Research (Kolling Institute); Sydney Vital Translational Research Centre, St Leonards, NSW, Australia
| | - Amanda Hudson
- Bill Walsh Translational Cancer Laboratory, The University of Sydney Northern Clinical School, Faculty of Health and Medicine; Northern Sydney Local Heath District Research (Kolling Institute); Sydney Vital Translational Research Centre, St Leonards, NSW, Australia
| | - Helen Wheeler
- Bill Walsh Translational Cancer Laboratory, The University of Sydney Northern Clinical School, Faculty of Health and Medicine; Northern Sydney Local Heath District Research (Kolling Institute), St Leonards, NSW, Australia
| | - Connie Diakos
- Bill Walsh Translational Cancer Laboratory, The University of Sydney Northern Clinical School, Faculty of Health and Medicine; Northern Sydney Local Heath District Research (Kolling Institute); Sydney Vital Translational Research Centre, St Leonards, NSW, Australia
| | - Viive Howell
- Bill Walsh Translational Cancer Laboratory, The University of Sydney Northern Clinical School, Faculty of Health and Medicine; Northern Sydney Local Heath District Research (Kolling Institute); Sydney Vital Translational Research Centre, St Leonards, NSW, Australia
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McKelvey K, Hudson A, Wheeler H, Diakos C, Howell V. P04.18 Unravelling the tumour microenvironment of glioma. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.252] [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: 11/12/2022] Open
Affiliation(s)
- K McKelvey
- Bill Walsh Translational Cancer Laboratory, The University of Sydney Northern Clinical School, Faculty of Health and Medicine; Northern Sydney Local Heath District Research (Kolling Institute); Sydney Vital Translational Research Centre, St Leonards, Australia
- Mark Hughes Foundation, Hunter Medical Research Institute, New Lambton Heights, Australia
| | - A Hudson
- Bill Walsh Translational Cancer Laboratory, The University of Sydney Northern Clinical School, Faculty of Health and Medicine; Northern Sydney Local Heath District Research (Kolling Institute); Sydney Vital Translational Research Centre, St Leonards, Australia
- The Brain Cancer Group, North Shore Private Hospital, St Leonards, Australia
| | - H Wheeler
- Bill Walsh Translational Cancer Laboratory, The University of Sydney Northern Clinical School, Faculty of Health and Medicine; Northern Sydney Local Heath District Research (Kolling Institute); Sydney Vital Translational Research Centre, St Leonards, Australia
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Australia
| | - C Diakos
- Bill Walsh Translational Cancer Laboratory, The University of Sydney Northern Clinical School, Faculty of Health and Medicine; Northern Sydney Local Heath District Research (Kolling Institute); Sydney Vital Translational Research Centre, St Leonards, Australia
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Australia
| | - V Howell
- Bill Walsh Translational Cancer Laboratory, The University of Sydney Northern Clinical School, Faculty of Health and Medicine; Northern Sydney Local Heath District Research (Kolling Institute); Sydney Vital Translational Research Centre, St Leonards, Australia
- The Brain Cancer Group, North Shore Private Hospital, St Leonards, Australia
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Cho A, Hayes S, Hudson A, Colvin E, Wheeler H, Howell V. CBIO-05. UNDERSTANDING MECHANISMS OF IDH-MUTANT, 1p19q INTACT GLIOMA PROGRESSION THROUGH USE OF LATEST-GENERATION MASS SPECTROMETRY. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.127] [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: 11/13/2022] Open
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Hudson A, Parker N, Khong P, Parkinson J, Ikin R, Zhu Y, Wheeler H, Howell V. CBIO-10. GLIOBLASTOMA RECURRENCE CORRELATES WITH INCREASED APE1 AND AN IMMUNE-SUPPRESSION MICROENVIRONMENT. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Itchins M, Kao S, Hayes S, Howell V, Gill A, Cooper W, O'Connell R, Clarke S, Pavlakis N. P1.01-011 Pattern of Care and Survival of ALK Rearranged Non-Small Cell Lung Cancer in Two Australian Referral Centers. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.665] [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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Haefliger S, Hudson A, Hayes S, Pavlakis N, Howell V. P2.01-012 Acquired Chemotherapy Resistance in vitro: miRNA Profiles of Chemotherapy Resistant Squamous Lung Cancer Cell Lines. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1064] [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: 10/20/2022]
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Howell V, Thoppil A, Mariyaselvam M, Jones R, Young H, Sharma S, Blunt M, Young P. Disinfecting the iPad: evaluating effective methods. J Hosp Infect 2014; 87:77-83. [DOI: 10.1016/j.jhin.2014.01.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 01/28/2014] [Indexed: 12/01/2022]
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Carmichael C, Tang JZ, Metcalf D, Shi W, Henley K, Ng A, Hyland C, Di Rago L, Mifsud S, Jenkins N, Copeland N, Howell V, Zhao ZJ, Alexander W, Kile B. Overexpression of the ETS-family transcription factor ERG and dysregulated cytokine signaling drive erythroid leukemia development in mice. Exp Hematol 2013. [DOI: 10.1016/j.exphem.2013.05.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cummings IM, Howell V, Thoppil A, Flaxman E, Sharma S, Blunt MC, Young PJ. Chlorhexidine cleaning of re-usable bougies. Anaesthesia 2013; 68:830-4. [DOI: 10.1111/anae.12269] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2013] [Indexed: 11/27/2022]
Affiliation(s)
| | - V. Howell
- Queen Elizabeth Hospital; Kings Lynn; UK
| | - A. Thoppil
- Queen Elizabeth Hospital; Kings Lynn; UK
| | - E. Flaxman
- Queen Elizabeth Hospital; Kings Lynn; UK
| | - S. Sharma
- Queen Elizabeth Hospital; Kings Lynn; UK
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Kan C, Hahn M, Cowley M, Kaplan W, Howell V, Marsh D. 517 Genomic Instability is a Hallmark Feature of Serous Epithelial Ovarian Cancer and May Contribute to MicroRNA Dysregulation. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)71179-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ryan PJ, Howell V, Jones J, Hardy EJ. Lung cancer, caring for the caregivers. A qualitative study of providing pro-active social support targeted to the carers of patients with lung cancer. Palliat Med 2008; 22:233-8. [PMID: 18477717 DOI: 10.1177/0269216307087145] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Carers of patients with lung cancer often have a short time to access the support they require. The Macmillan Carers Project (MCP) was set up to provide non-clinical social support targeted in the community to the carers of patients with lung cancer and this study describes its evaluation. METHODS Prospective case study using interviews with the carers, project workers and health and social care professionals to obtain qualitative data for thematic analysis. 81 patients' carers received support from the MCP; 20 carers, 2 MCP workers and their manager and 10 other professionals (chest consultant physician, lung cancer clinical nurse specialist, GP, four Macmillan nurses, hospice social worker and two community social workers) were interviewed. RESULTS Patients were predominantly male (62%), mean age 71 years and carers were predominantly female (70%) mean age 63 years. Carers identified the MCP as providing emotional support, more time, practical help, financial advice, information and back-up for a myriad of problems. Although there was some overlap with other services, the MCP was valued by carers and professionals as filling a gap in social care. CONCLUSIONS The unique aspect of this study was support targeted to the carers of a single cancer site (lung) rather than generic cancer support. As lung cancer may progress rapidly, patients and their carers have a short time to gather new information, access services and adjust to their new circumstances and roles. By focusing on the needs of carers from the time of lung cancer diagnosis, we have shown that the MCP was a valued additional service, well received by carers, patients and professionals.
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Affiliation(s)
- P J Ryan
- Hereford County Hospital, Hereford, UK.
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Gimm O, Nguyen Thanh P, Bloching M, Lorenz K, Howell V, Marsh D, Dralle H. Hyperparathyroidism-jaw tumor (HPT-JT)-syndrome: three case reports. Exp Clin Endocrinol Diabetes 2005. [DOI: 10.1055/s-2005-862986] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Barlow-Stewart K, Burnett L, Proos A, Howell V, Huq F, Lazarus R, Aizenberg H. A genetic screening programme for Tay-Sachs disease and cystic fibrosis for Australian Jewish high school students. J Med Genet 2003; 40:e45. [PMID: 12676918 PMCID: PMC1735444 DOI: 10.1136/jmg.40.4.e45] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Marsh DJ, Theodosopoulos G, Howell V, Richardson AL, Benn DE, Proos AL, Eng C, Robinson BG. Rapid mutation scanning of genes associated with familial cancer syndromes using denaturing high-performance liquid chromatography. Neoplasia 2001; 3:236-44. [PMID: 11494117 PMCID: PMC1505599 DOI: 10.1038/sj.neo.7900154] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2001] [Accepted: 03/02/2001] [Indexed: 02/08/2023]
Abstract
Germline mutations in tumor suppressor genes, or less frequently oncogenes, have been identified in up to 19 familial cancer syndromes including Li-Fraumeni syndrome, familial paraganglioma, familial adenomatous polyposis coli and breast and ovarian cancers. Multiple genes have been associated with some syndromes as approximately 26 genes have been linked to the development of these familial cancers. With this increased knowledge of the molecular determinants of familial cancer comes an equal expectation for efficient genetic screening programs. We have trialled denaturing high-performance liquid chromatography (dHPLC) as a tool for rapid germline mutation scanning of genes implicated in three familial cancer syndromes -- Cowden syndrome (PTEN mutation), multiple endocrine neoplasia type 2 (RET mutation) and von Hippel-Lindau disease (VHL mutation). Thirty-two mutations, including 21 in PTEN, 9 in RET plus a polymorphism, and 2 in VHL, were analyzed using the WAVE DNA fragment analysis system with 100% detection efficiency. In the case of the tumor suppressor gene PTEN, mutations were scattered along most of the gene. However, mutations in the RET proto-oncogene associated with multiple endocrine neoplasia type 2 were limited to specific clusters or "hot spots." The use of GC-clamped primers to scan for mutations scattered along PTEN exons was shown to greatly enhance the sensitivity of detection of mutant hetero- and homoduplex peaks at a single denaturation temperature compared to fragments generated using non--GC-clamped primers. Thus, when scanning tumor suppressor genes for germline mutation using dHPLC, the incorporation of appropriate GC-clamped primers will likely increase the efficiency of mutation detection.
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Affiliation(s)
- D J Marsh
- Cancer Genetics, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia.
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Secker J, Davies P, Howell V. Joint commissioning for mental health services between primary health care and social care in Wales. Prim Health Care Res Dev 2000. [DOI: 10.1191/146342300676014085] [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: 11/05/2022] Open
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Longo DR, Kruse RL, LeFevre ML, Schramm WF, Stockbauer JW, Howell V. An investigation of social and class differences in very-low birth weight outcomes: a continuing public health concern. J Health Care Finance 1999; 25:75-89. [PMID: 10094061] [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: 02/11/2023]
Abstract
The objective of this study was to examine the relationship of nonmedical factors, including socioeconomic status, social class, education, race, and social support, to low birth weight. In a case-control study of all resident very-low-birth-weight births between December 1, 1989, and March 31, 1991, mothers completed an extensive survey related to their experience of pregnancy, including prenatal and postnatal care. Cases were defined as very-low-birth-weight (VLBW) infants and were matched to moderately-low-birth-weight and normal-birth-weight infants in race, age, and maternal residence. The hypothesis that social and class factors are more predictive of low birth weight than medical factors alone for women without chronic health problems was supported. Although the degree of the association varies depending on birth weight outcome, race even though addressed through matching--continued to play an important role in birth outcomes. A comparison of logistic model performance with and without the inclusion of social factors indicated the importance these variables play in prediction of birth outcomes. This is one of the few studies undertaken that explicitly investigates impact of patient factors on medical care.
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Affiliation(s)
- D R Longo
- School of Medicine, Family and Community Medicine, University of Missouri-Columbia, USA
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Howell V. Mental health. Time for a meeting of minds. Health Serv J 1998; 108:28-9. [PMID: 10180007] [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] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The policy agenda for mental health services requires managers to develop new skills. The government's overriding concern to restore confidence in the mental health system will demand that managers promote greater public understanding of services. Proficiency in working with other organisations will be crucial to success.
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Affiliation(s)
- V Howell
- Centre for Mental Health Services Development, King's College, UK
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Longo DR, Land G, Schramm W, Fraas J, Hoskins B, Howell V. Consumer reports in health care. Do they make a difference in patient care? JAMA 1997; 278:1579-84. [PMID: 9370503] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CONTEXT Consumer reports in health care are a relatively recent phenomenon. Primarily designed to assist consumers in making more informed decisions about their personal health care, they appear to have an important by-product-they led to positive changes in the behavior of clinicians and health care delivery organizations. While there has been much speculation on their impact on health care consumer behavior, consumer reports offer an effective strategy in improving the quality of patient care. OBJECTIVE To examine the impact of an obstetrics consumer report developed and issued by the Missouri Department of Health on hospital behavior. DESIGN AND SETTING A retrospective study of hospital behavior using both primary survey and secondary clinical data. PARTICIPANTS Consumer reports were issued in 1993 to all Missouri hospitals providing obstetrical services (n=90). A survey was conducted a year later, and the results were analyzed with other available data to determine the effect of the report. Two hospitals discontinued obstetrical services by the time of the survey; of the remaining 88 hospitals, 82 (93%) responded to the survey. MAIN OUTCOME MEASURES The following outcomes were examined: (1) number and percentage of hospitals that previously did not have services at the time report was issued, but had, or planned to have, services after a guide was published; (2) the percentage of obstetrical policies that were changed, planned to change, or are under discussion for change (car seat program, obstetrical follow-up services, formal transfer agreement, nurse educator for breast-feeding, and availability of tubal ligations); and (3) clinical outcomes, including satisfaction, appropriateness of charges, and the rates of cesarean delivery, high-risk infant transfer, ultrasound, vaginal birth after cesarean, very low birth weight, and newborn death. RESULTS Within 1 year of the report, approximately 50% of hospitals that did not have car seat programs, formal transfer agreements, or nurse educators for breast-feeding prior to the report either instituted or planned to institute these services. Hospitals in competitive markets that did not offer one of these services at the time of the report were more likely to institute a service and/or were about twice as likely to consider improving several indicators. Clinical outcome indicators all improved in the expected direction. CONCLUSION Public release of consumer reports may be useful not only in assisting consumers to make informed health care choices, but also in facilitating improvement in the quality of hospital services offered and care provided. Changes occur especially in competitive markets.
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Affiliation(s)
- D R Longo
- Department of Family and Community Medicine, School of Medicine, University of Missouri-Columbia, 65212, USA.
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Sable MR, Spencer JC, Stockbauer JW, Schramm WF, Howell V, Herman AA. Pregnancy wantedness and adverse pregnancy outcomes: differences by race and Medicaid status. Fam Plann Perspect 1997; 29:76-81. [PMID: 9099571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The relationship between pregnancy wantedness and adverse pregnancy outcomes was studied using data from 2,828 mothers who participated in the Missouri Maternal and Infant Health Survey. The wantedness of a pregnancy was measured using traditional classifications of mistimed and unwanted, as well as additional measures gauging how the woman felt about the pregnancy while she was pregnant. Fifty-eight percent of the very low birth weight infants and 59% of the moderately low birth weight infants resulted from unintended pregnancies, as did 62% of the normal-birth-weight infants. Logistic regression showed that mothers of very low birth weight infants were significantly more likely than those who had a normal-weight baby to report that they had felt unhappy about the pregnancy (odds ratio of 1.53). Very low birth weight was also associated with early denial of the pregnancy (1.54). Odds ratios associating these two unwantedness categories with low-birth-weight babies were higher among Medicaid recipients than among women not receiving Medicaid. Associations between very low birth weight and the denial variable were also significant among white women when very low birth weight outcomes were compared with normal outcomes, but there was no significant association among black women. There were no significant associations between low birth weight and the traditional unwantedness variables.
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Affiliation(s)
- M R Sable
- School of Social Work, University of Missouri-Columbia, USA
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Kledzik T, Howell V. On becoming an NICU. Neonatal Netw 1996; 15:25-33. [PMID: 9035649] [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: 02/03/2023]
Abstract
Over the past 20 years, there has been a dramatic change in the way nursing care is delivered in this 52-bed community hospital NICU. In the early 1970s, technologic and medical innovations produced a significant improvement in infant survival. The nurse's role at that time was to deliver the various prescribed treatments and master the array of new gadgetry. This approach escalated until the mid 1980s, when it was recognized that something very important was missing from nursing practice. This realization began an internal process in a small group of nurses that eventually expanded to include the majority of staff. The process is outlined in the text, and the outward changes that resulted from the internal process are outlined in the tables.
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Affiliation(s)
- T Kledzik
- Memorial Hospital NICU, Colorado Springs, CO 80809, USA
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Howell V. Taking care of the caretaker. JEMS 1988; 13:38-45. [PMID: 10290867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Teberg AJ, Pena I, Hoppenbrouwers T, Howell V. Factors involved in the decline of the developmental quotient in the very low birth weight infant during the first two years. J Perinatol 1987; 7:199-203. [PMID: 3504455] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The developmental status of 62 infants with birth weights less than 1,501 g was evaluated at nine or 12 months and at two years of age corrected for prematurity. The mean developmental scores were 99.8 at the first examination and 84.4 at the second, a significant drop (P less than 0.0001). Half of the infants (Group 1) dropped less than 16 points (mean score from 97.1 to 91.3) and half of the infants (Group 2) dropped less than 15 points (mean score from 102.8 to 76.9). The incidence of small for gestational age infants was overrepresented in Group 2. A multivariate analysis revealed that a group of factors including maternal hypertension and diabetes, gestational age, birth weight, and resuscitation at birth correctly classified 87 per cent of the infants into the two groups. The influence of this cluster of medical factors on developmental decline of the very low birth weight infant deserves further consideration.
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Affiliation(s)
- A J Teberg
- Department of Pediatrics, University of Southern California School of Medicine, Los Angeles 90033
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Lowry MF, Howell V, Bird S. Paramedical assessment of gestational age in the newborn. W INDIAN MED J 1976; 25:17-22. [PMID: 1266205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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