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Ramalingam S, de Castro G, Garassino M, Mazieres J, Sanborn R, Smit E, Spigel D, Thomas M, Velcheti V, Zhi E, Neibauer MW, Stojadinovic A, Peters S. 1360TiP First-line (1L) maintenance therapy with niraparib (nira) + pembrolizumab (pembro) vs placebo + pembro in advanced/metastatic non-small cell lung cancer (NSCLC): Phase III ZEAL-1L study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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2
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Ramalingam S, Arora S, Whipple Neibauer M, Zhou J, Hazard S, Frenkl T, Stojadinovic A, Peters S. P83.02 Niraparib + Pembrolizumab (Pembro) Versus Placebo + Pembro 1L Maintenance Therapy in Advanced NSCLC: ZEAL-1L Phase III Study. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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3
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Protic M, Bilchik A, Nissan A, Knezevic SU, Kukic B, Kresoja M, Veljkovic R, Zivojinov M, Stojadinovic A. International prospective multi-center clinical trial with adherence to surgical and pathological quality measures: Influence of body mass index (BMI) on outcome in colon cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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4
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Maestroni U, Vicente D, Del Rio P, Ziglioli F, Dinale F, Campobasso D, Ferretti S, Stojadinovic A, Avital I. Laparoscopic adrenalectomy for large adrenal masses: a challenge or a routine? MINERVA CHIR 2014; 69:59-64. [PMID: 24847892] [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: 06/03/2023]
Abstract
AIM The increased incidence of malignancy and the concern for higher rate of complications with laparoscopic resection of larger tumors typically limits laparoscopic adrenalectomy to small adrenal masses. We used our prospectively collected database to compare laparoscopic adrenalectomy outcomes between small and large adrenal tumors. METHODS Operative details and outcomes were compared by adrenal mass size size: Group A≤4 cm and Group B>4 cm, for consecutive laparoscopic adrenalectomies performed between 2009 and 2013. RESULTS Group A (N.=50) and Group B (N.=27) subjects had similar operative times (131 vs. 132 min, P=0.48). Group B subjects were older, had more adrenal malignancies, and had a higher blood loss with a slightly larger change in hemoglobin than Group A subjects; however, no subject required blood transfusion and complication rates were similar between groups (4% vs. 11%, P=0.34). One subject from each group required conversion to open adrenalectomy. CONCLUSION Laparoscopic adrenalectomy can be performed safely for adrenal masses >4 cm and size is not a contraindication to the laparoscopic approach.
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Affiliation(s)
- U Maestroni
- Department of Surgery University Hospital of Parma, Parma, Italy -
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5
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Wallace T, Torre T, Grob M, Yu J, Avital I, Brücher BLDM, Stojadinovic A, Man Y. Current approaches, challenges and future directions for monitoring treatment response in prostate cancer. J Cancer 2014; 5:3-24. [PMID: 24396494 PMCID: PMC3881217 DOI: 10.7150/jca.7709] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [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: 09/19/2013] [Accepted: 11/01/2013] [Indexed: 01/23/2023] Open
Abstract
Prostate cancer is the most commonly diagnosed non-cutaneous neoplasm in men in the United States and the second leading cause of cancer mortality. One in 7 men will be diagnosed with prostate cancer during their lifetime. As a result, monitoring treatment response is of vital importance. The cornerstone of current approaches in monitoring treatment response remains the prostate-specific antigen (PSA). However, with the limitations of PSA come challenges in our ability to monitor treatment success. Defining PSA response is different depending on the individual treatment rendered potentially making it difficult for those not trained in urologic oncology to understand. Furthermore, standard treatment response criteria do not apply to prostate cancer further complicating the issue of treatment response. Historically, prostate cancer has been difficult to image and no single modality has been consistently relied upon to measure treatment response. However, with newer imaging modalities and advances in our understanding and utilization of specific biomarkers, the future for monitoring treatment response in prostate cancer looks bright.
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Affiliation(s)
- T.J. Wallace
- 1. Bon Secours Cancer Institute, Bon Secours Health Care System, Richmond VA, USA
- 2. Division of Radiation Oncology, Bon Secours Health Care System, Richmond VA, USA
- 3. Virginia Urology, Richmond VA, USA
| | - T. Torre
- 1. Bon Secours Cancer Institute, Bon Secours Health Care System, Richmond VA, USA
- 2. Division of Radiation Oncology, Bon Secours Health Care System, Richmond VA, USA
- 3. Virginia Urology, Richmond VA, USA
| | - M. Grob
- 4. Department of Urology, Virginia Commonwealth University Health System, Richmond VA, USA
| | - J. Yu
- 5. Department of Radiology, Virginia Commonwealth University Health System, Richmond VA, USA
| | - I. Avital
- 1. Bon Secours Cancer Institute, Bon Secours Health Care System, Richmond VA, USA
- 6. Division of Surgical Oncology, Bon Secours Health Care System, Richmond VA, USA
| | - BLDM Brücher
- 1. Bon Secours Cancer Institute, Bon Secours Health Care System, Richmond VA, USA
- 6. Division of Surgical Oncology, Bon Secours Health Care System, Richmond VA, USA
- 7. INCORE, International Consortium of Research Excellence of the Theodor-Billroth-Adademy
| | - A. Stojadinovic
- 1. Bon Secours Cancer Institute, Bon Secours Health Care System, Richmond VA, USA
- 6. Division of Surgical Oncology, Bon Secours Health Care System, Richmond VA, USA
- 7. INCORE, International Consortium of Research Excellence of the Theodor-Billroth-Adademy
| | - Y.G. Man
- 1. Bon Secours Cancer Institute, Bon Secours Health Care System, Richmond VA, USA
- 6. Division of Surgical Oncology, Bon Secours Health Care System, Richmond VA, USA
- 8. South Hospital of Nanjing, Nanjing, China
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Holfeld J, Zimpfer D, Albrecht-Schgoer K, Stojadinovic A, Paulus P, Thomas A, Schaden W, Kirchmair R, Aharinejad S, Grimm M. Direct epicardial shock wave therapy improves ventricular function in a porcine model of ischemic heart disease: evidence for induction of angiogenesis and stimulation of VEGF receptors. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5672] [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: 11/14/2022] Open
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7
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Feng SH, Stojadinovic A, Izadjoo M. Distinctive stages and strain variations of A. baumannii biofilm development under shear flow. J Wound Care 2013; 22:173-4, 176-8, 180-1. [PMID: 23702669 DOI: 10.12968/jowc.2013.22.4.173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine and characterise the process of Acinetocbacter baumannii biofilm development under shear flow. METHOD Using an automated flow-cell system with microfluidic channels connected to an imaging system, I 0 clinical wound isolates of A. baumannii were examined for their ability to form biofilms under shear flow, on the glass surface of the flow through device. Flow biofilm development by this organism was observed to comprise four stages: attachment, microcolony formation, maturation with three dimensional structures, and dispersion. RESULTS A. baumannii adheres readily to glass surfaces and quickly forms biofilm. Significant variations were observed among these I 0 clinical strains in their ability to attach and form flow biofilms. CONCLUSION These specific characteristics in biofilm formation may contribute to this organism's ability to disseminate within health-care environments.
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Affiliation(s)
- S H Feng
- Henry M. Jackson Foundation for theAdvancement of Military Medicine, Gaithersburg, MD, USA.
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Wallace T, Avital I, Stojadinovic A, Brücher BLDM, Cote E, Yu J. Multi-Parametric MRI-Directed Focal Salvage Permanent Interstitial Brachytherapy for Locally Recurrent Adenocarcinoma of the Prostate: A Novel Approach. J Cancer 2013; 4:146-51. [PMID: 23412660 PMCID: PMC3572406 DOI: 10.7150/jca.5419] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 01/15/2013] [Indexed: 11/15/2022] Open
Abstract
Even with the technological advances of dose-escalated IMRT with the addition of the latest image guidance technologies, local failures still occur. The combination of MRI-based imaging techniques can yield quantitative information that reflects on the biological properties of prostatic tissues. These techniques provide unique information that can be used for tumor detection in the treated gland. With the advent of these improved imaging modalities, it has become possible to more effectively image local recurrences within the prostate gland. With better imaging, these focal recurrences can be differentially targeted with salvage brachytherapy minimizing rectal and bladder toxicity. Here we report a novel use of MRI-directed focal brachytherapy after local recurrence. This technique offers a unique opportunity to safely and successfully treat recurrent prostate cancer, previously treated with definitive radiation therapy. The use of multi-parametric MRI-directed focal salvage permanent interstitial brachytherapy for locally recurrent adenocarcinoma of the prostate is a promising strategy to avoid more aggressive and expensive treatments that are associated with increased morbidity, potentially improving survival at potentially lower costs.
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Affiliation(s)
- T Wallace
- 1. Bon Secours Cancer Institute, Bon Secours Health System, Richmond VA, USA; ; 2. Division of Radiation Oncology, Bon Secours Health system, Richmond VA, USA
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Carcoforo P, Raiji MT, Palini GM, Pedriali M, Maestroni U, Soliani G, Detroia A, Zanzi MV, Manna AL, Crompton JG, Langan RC, Stojadinovic A, Avital I. Primary anorectal melanoma: an update. J Cancer 2012. [PMID: 23193431 PMCID: PMC3508425 DOI: 10.7150/jca.5187] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The anorectum is a rare anatomic location for primary melanoma. Mucosal melanoma is a distinct biological and clinical entity from the more common cutaneous melanoma. It portrays worse prognosis than cutaneous melanoma, with distant metastases being the overwhelming cause of morbidity and mortality. Surgery is the treatment of choice, but significant controversy exists over the extent of surgical resection. We present an update on the state of the art of anorectal mucosal melanoma. To illustrate the multimodality approach to anorectal melanoma, we present a typical patient.
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Affiliation(s)
- P Carcoforo
- 1. Section of General Surgery, Department of Surgical, Anaesthesiological and Radiological Sciences, University of Ferrara, Ferrara, Italy
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Affiliation(s)
- M.R. Alavi
- Diagnostics and Translational Research Center, Henry M. Jackson Foundation for Advancement of Military Medicine, Maryland, USA
- Combat Wound Initiative Program, Maryland, USA
| | - A. Stojadinovic
- Combat Wound Initiative Program, Maryland, USA
- Uniformed Services University of the Health Sciences, Maryland, USA
| | - M.J. Izadjoo
- Diagnostics and Translational Research Center, Henry M. Jackson Foundation for Advancement of Military Medicine, Maryland, USA
- Combat Wound Initiative Program, Maryland, USA
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Carcoforo P, Raiji MT, Langan RC, Lanzara S, Portinari M, Maestroni U, Palini GM, Zanzi MV, Bonazza S, Pedriali M, Feo CV, Stojadinovic A, Avital I. Infiltrating lobular carcinoma of the breast presenting as gastrointestinal obstruction: a mini review. J Cancer 2012; 3:328-32. [PMID: 22866167 PMCID: PMC3408697 DOI: 10.7150/jca.4735] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [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: 06/13/2012] [Accepted: 07/03/2012] [Indexed: 12/18/2022] Open
Abstract
One in twelve American women will develop breast cancer, with infiltrating lobular carcinoma (ILC) comprising approximately 15% of these cases. The incidence of ILC has been increasing over the last several decades. It has been hypothesized that this increase is associated with combined replacement hormonal therapy. Although pathologically distinct from infiltrating ductal carcinoma (IDC), ILC is treated in the same manner as IDC. However, ILC demonstrates significantly different patterns of late local recurrence and distant metastasis. The incidence of extra-hepatic gastrointestinal metastases is reported to be 6% to 18%, with stomach being most common. Herein, we present a brief review of the literature and a typical case involving ILC initially presenting as a small bowel obstruction. Evidence suggests that the late clinical patterns of ILC are distinctly separate from IDC and physicians need be cognizant of its late local recurrence and unique late metastatic pattern. Different follow up strategy should be entertained in patients with ILC.
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Affiliation(s)
- P Carcoforo
- 1. Section of General Surgery, Department of Surgical, Anaesthesiological and Radiological Sciences, Azienda Ospedaliero-Universitaria, Arcispedale Sant'Anna, Ferrara, Italy
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12
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Henry L, Helou L, Solomon N, Chang A, Libutti S, Stojadinovic A. Current Practice Patterns Regarding the Conduct of Thyroidectomy and Parathyroidectomy amongst Surgeons - A Survey Study. J Cancer 2012; 3:207-16. [PMID: 22606210 PMCID: PMC3354416 DOI: 10.7150/jca.4452] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Accepted: 05/02/2012] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Heterogeneity of surgical care exists among surgeons regarding the conduct of thyroidectomy and parathyroidectomy. AIM To identify the current patterns of technical conduct of operation amongst surgeons performing thyroidectomy or parathyroidectomy. METHODS A survey was designed and beta-tested on five surgical oncologists for face validity and usability. The final version of this survey was constructed and disseminated using the professional version of the internet-based survey mechanism Survey Monkey and consisted of two eligibility questions and 22 questions regarding thyroidectomy/parathyroidectomy treatment patterns. The survey was disseminated electronically to American Association of Endocrine Surgeons (AAES) and American College of Surgeons (ACS) members. Survey results were collected, tabulated and analyzed. Responses among groups were compared using two sample T- tests. Significant responses were subsequently analyzed in generalized linear models to ascertain if significance remained with control of covariates. RESULTS Of 420 initial web survey visits, 236 (56.2%) surveys were completed. The majority of respondents reported being 'fellowship trained', experienced and 'high-volume' surgeons. The most common fellowship trainings were endocrine (46%), oncology (22%), head & neck (13%), or combinations of the three fellowships (14%). Most surgeons reported that they dissect the course of the recurrent laryngeal nerve (RLN) without using neuromonitoring. Nearly a third of respondents reported routinely using the Harmonic scalpel during the conduct of the operations. Significant differences emerged regarding operative technique according to residency training type, fellowship training, surgeon volume, and practice setting, but only those associated with residency training type and annual surgeon surgical volume remained significant within generalized linear models. CONCLUSION Most surgeons who responded to this survey do not routinely use RLN neuromonitoring and most dissect the RLN during thyroidectomy. There are multiple variations in technique according to surgical training, surgeon volume, experience, and practice setting; however, only differences by residency training type and surgeon volume remained correlated significantly to surgeons' approaches to thyroidectomy and parathyroidectomy in multivariate analysis. These data may be useful for surgeons reflecting upon their individual practice, as well as for further defining current standards of practice from a medico legal perspective.
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Affiliation(s)
- Lr Henry
- 1. Indiana University Health, Goshen Center for Cancer Care, Goshen, Indiana, USA
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13
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Man YG, Fu SW, Liu AJ, Stojadinovic A, Izadjoo MJ, Chen L, Gardner WA. Aberrant expression of chromogranin A, miR-146a, and miR-146b-5p in prostate structures with focally disrupted basal cell layers: an early sign of invasion and hormone-refractory cancer? Cancer Genomics Proteomics 2011; 8:235-244. [PMID: 21980038] [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: 05/31/2023] Open
Abstract
Our recent studies have suggested that prostate tumor invasion is triggered by autoimmunoreactions induced focal basal cell layer disruptions (FBCLD) that selectively favor monoclonal proliferation of the overlying progenitors or of a biologically more aggressive cell clone. As circulating chromogranin-A (CgA) levels are found to correlate with tumor progression and the status of hormone refractoriness, our current study attempted to assess whether CgA-positive cells would be preferentially distributed in epithelial structures with FBCLD. Paraffin-embedded specimens from 50 patients with organ-confined prostate cancer were subjected to double immunohistochemical analysis with monoclonal antibodies to basal cells and CgA. From each case, 3-5 randomly selected fields were digitally photographed and the photos were magnified 400% and the numbers of CgA-positive cells in epithelial structures with non-disrupted, focally disrupted, and lost basal cell layer were separately counted. The averaged number of cell for each category was statistically compared with the Pearson's Chi-square test. In addition, morphologically similar structures with and without CgA-positive cell clusters were microdissected from four selected cases and subjected to a comparison of differential micro-RNA expression levels. Our study revealed that, although isolated CgA-positive cells were seen in both the basal cell layer and the luminal cell population in all cases, only 8 cases (16%) harbored large clusters of CgA-positive cells that were concentrated in a given area, in which all or nearly all cells appeared to share a similar morphological and immunohistochemical profile. Microdissected epithelial structures with CgA-positive cell clusters exhibited a more than 5- and 7-fold lower expression of miR-146a and miR-146b-5p than their CgA-negative counterparts. As focal basal cell layer disruptions and the reduction or loss of miR-146a and miR-146b-5p has been documented to correlate with prostate tumor invasion and hormone refractoriness, our findings suggest that aberrant CgA expression in epithelial structures with FBCLD may represent an early sign of these events.
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Affiliation(s)
- Y G Man
- Senior Scientist, Diagnostic and Translational Research Center, Henry Jackson Foundation, Gaithersburg, MD 20879, USA.
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14
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Mazeh H, Halle D, Ilyayev N, Stojadinovic A, Mitrani-Rosenbaum S, Roistacher M, Mizrahi I, Ariel I, Eid A, Freund H, Nissan A. Development of a MicroRNA Based Molecular Assay For The Detection Of Thyroid Cancer In FNAB Samples. J Surg Res 2011. [DOI: 10.1016/j.jss.2010.11.376] [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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15
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Esquivel J, Chua TC, Stojadinovic A, Melero JT, Levine EA, Gutman M, Howard R, Piso P, Nissan A, Gomez-Portilla A, Gonzalez-Bayon L, Gonzalez-Moreno S, Shen P, Stewart JH, Sugarbaker PH, Barone RM, Hoefer R, Morris DL, Sardi A, Sticca RP. Accuracy and clinical relevance of computed tomography scan interpretation of peritoneal cancer index in colorectal cancer peritoneal carcinomatosis: a multi-institutional study. J Surg Oncol 2010; 102:565-70. [PMID: 20976729 DOI: 10.1002/jso.21601] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Evaluation of peritoneal metastases by computed tomography (CT) scans is challenging and has been reported to be inaccurate. METHODS A multi-institutional prospective observational registry study of patients with peritoneal carcinomatosis from colorectal cancer was conducted and a subset analysis was performed to examine peritoneal cancer index (PCI) based on CT and intraoperative exploration. RESULTS Fifty-two patients (mean age 52.6 ± 12.4 years) from 16 institutions were included in this study. Inaccuracies of CT-based assessment of lesion sizes were observed in the RUQ (P = 0.004), LLQ (P < 0.0005), RLQ (P = 0.003), distal jejunum (P = 0.004), and distal ileum (P < 0.0005). When CT-PCI was classified based on the extent of carcinomatosis, 17 cases (33%) were underestimations, of which, 11 cases (21%) were upstaged from low to moderate, 4 cases (8%) were upstaged from low to severe, and 2 cases (4%) were upstaged from moderate to severe. Relevant clinical discordance where an upstage occurred to severe carcinomatosis constituted a true inaccuracy and was observed in six cases (12%). CONCLUSIONS The actual clinical impact of inaccuracies of CT-PCI was modest. CT-PCI will remain as a mandatory imaging tool and may be supplemented with other tools including positron emission tomography scan or diagnostic laparoscopy, in the patient selection for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
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Affiliation(s)
- J Esquivel
- Department of Surgical Oncology, St Agnes Hospital, Baltimore, Maryland 21229, USA.
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Abstract
OBJECTIVE To isolate and identify antibiotic-resistant bacteria from the exudate of a complex wound and determine if antibiotic resistance genes are chromosomal or plasmid borne. METHOD Antibiotic resistant bacteria from wound exudate of a single clinical sample were selected on agar media with ampicillin. A single colony was further screened for resistance to kanamycin by antibiotic-supplemented agar and to other antibiotics by an automated Phoenix instrument. Identification of the isolate was carried out by biochemical profiling and by 16S rDNA analysis. RESULTS Approximately 51% of total bacteria in the wound exudate with identical colony morphotype were resistant to 100 microg/ml of ampicillin. A single colony from this population also demonstrated resistance to 50 microg/ml of kanamycin on kanamycin-supplemented agar. Further antimicrobial sensitivity testing by the Phoenix instrument indicated resistance to inhibitory concentrations of amoxicillin-clavulanate, ampicillin-sulbactam, cefazolin, gentamicin, nitrofurantoin, tobramycin, and trimethoprim-sulfamethoxazole. Biochemical and 16S rDNA analysis identified this bacterial isolate as a member of genus Enterobacter. A plasmid preparation from this isolate successfully transferred ampicillin and kanamycin resistance to E. coli competent cells. E. coli transformants displayed two resistance phenotypes and the plasmids from these transformants displayed two different restriction type patterns, with one correlating to ampicillin and kanamycin resistance and the other only to ampicillin resistance. CONCLUSION A multiple antibiotic-resistant Enterobacter spp. from the wound fluid of a clinical sample was found to carry an antibiotic-resistant plasmid in a closely related species E. coli. The presence of antibiotic resistance plasmid in Enterobacteria that are part of the normal microbial flora of the human gut and skin could lead to the spread of resistance phenotype and emergence of antibiotic resistant pathogens. This study suggests normal human microbial fl ora could be a potential reservoir for resistance genes.
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Affiliation(s)
- M R Alavi
- Wound Biology and Translational Research Division, Armed Forces Institute of Pathology, Washington DC, USA.
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Clive KS, Summers TA, Clifton GT, Patil R, Tyler J, Holmes JP, Mittendorf EA, Stojadinovic A, Ponniah S, Peoples GE. Assessment of circulating tumor cell (CTC) patterns among disease-free breast cancer patients vaccinated with adjuvant HER2/neu-based peptide vaccines. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.2542] [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: 11/20/2022] Open
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Utz E, Elster E, Tadaki D, Gage F, Perdue P, Stojadinovic A, Hawksworth J, Brown T. 228. Matrix Metalloprotease (MMP) Expression is Associated With Wound Failure in Traumatic War Injuries. J Surg Res 2009. [DOI: 10.1016/j.jss.2008.11.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hawksworth J, Broewn T, Keiser P, Stojadinovic A, Perdue P, Dunne J, Gage F, Tadaki D, Elster E. QS398. War Wound Infection is Associated With a Systemic and Wound Tissue Inflammatory Profile. J Surg Res 2009. [DOI: 10.1016/j.jss.2008.11.709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Gates JD, Benavides LC, Carmichael MG, Hueman MT, Holmes JP, Khoo S, Stojadinovic A, von Hofe E, Ponniah S, Peoples GE. Circulating regulatory (CD4+CD25+FOXP3+) T cells decrease in breast cancer patients after vaccination with an Ii-Key-modified class II HER2/ neu peptide (AE37). Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-3134] [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]
Abstract
Abstract
Abstract #3134
Background: CD4+CD25+FOXP3+ regulatory T cells (Tregs) have been implicated in the suppression of immune responses against various tumors. To monitor the potential induction of Tregs in breast cancer (BrCa) patients receiving a modified HLA Class II HER2/neu peptide (AE37) vaccine in a clinical trial, we have analyzed peripheral blood lymphocytes (PBL) from vaccinated patients for the presence of Tregs and correlated our findings with ex vivo immune assays and in vivo delayed type hypersensitivity (DTH) responses to the vaccine. Methods: Fifteen BrCa patients have completed 6 monthly injections of the AE37+GM-CSF vaccine in a dose escalation safety study. The AE37 peptide consists of a HER2/neu peptide (776-790) linked to the Ii-Key moiety of the HLA Class II-associated invariant chain, which enhances epitope interaction with the Class II molecule. PBL obtained pre- and post-vaccination were stained with anti-CD4/CD25 (n=15) and FOXP3 (n=9) antibodies (PCH101 and 236A/E7) and analyzed by flow cytometry. Cells were also stimulated ex vivo with AE37 peptide to measure IFN-γ ELISPOT, proliferation (3H-thymidine-cpm) and cytokine secretion (TGF-β). DTH responses to the AE37 peptide pre- and post-vaccination were also recorded. Results: The mean CD4+ and CD4+CD25+ T cell populations for all patients (n=15) did not change from pre- to post-vaccination (CD4+ = 52.3+3.3% vs. 50.5+3.9%, p=0.6; CD4+CD25+ = 1.9+0.2% vs. 2.4+0.5%, p=0.2). Tregs (CD4+CD25+FOXP3+) were reduced in all 9 patients tested pre- to post-vaccination for both FOXP3 antibodies (Ab) (FOXP3 Ab1 = 2.1+0.2% vs. 1.1+0.1%, p=0.002; FOXP3 Ab2 = 2.0+0.2% vs. 1.0+0.2%, p=0.0009). There was no difference in pre- to post-vaccination levels of TGF-β (2720+582 pg/ml vs. 3387+848 pg/ml; p=0.9). AE37-specific proliferative responses increased from pre- to post-vaccination (34+23cpm vs. 6427+1431 cpm; p<0.001). ELISPOT demonstrated an increased response from pre- to long term (6-12mo.) post-vaccination (Median – 2 vs. 34 spots/106 cells; p=0.003). DTH responses increased in all patients from pre- to post-vaccination (3.6+1.4 mm vs. 56.0+9.4 mm; p<0.0001), and there appeared to be an inverse relationship between the degree of Treg reduction and the size of DTH response to AE37 (R2=0.83).
 Discussion: The novel AE37 HER2/neu peptide vaccine does not result in increased levels of Tregs. Furthermore, the reduced levels of Tregs in vaccinated patients appear to be associated with more robust responses in ex vivo immune assays and in vivo DTH reactions suggesting that the AE37 vaccine may be clinically useful.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3134.
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Affiliation(s)
- JD Gates
- 1 Dept. of Surgery, Brooke Army Medical Center, Ft. Sam Houston, TX
| | - LC Benavides
- 1 Dept. of Surgery, Brooke Army Medical Center, Ft. Sam Houston, TX
| | - MG Carmichael
- 2 Cancer Vaccine Development Program, USMCI, Dept. of Surgery, USUHS, Bethesda, MD
| | - MT Hueman
- 2 Cancer Vaccine Development Program, USMCI, Dept. of Surgery, USUHS, Bethesda, MD
| | - JP Holmes
- 3 Dept. of Hematology/Oncology, Naval Medical Center San Diego, San Diego, CA
| | - S Khoo
- 2 Cancer Vaccine Development Program, USMCI, Dept. of Surgery, USUHS, Bethesda, MD
| | - A Stojadinovic
- 4 Dept. of Surgery, Walter Reed Army Medical Center, Washington, DC
| | | | - S Ponniah
- 2 Cancer Vaccine Development Program, USMCI, Dept. of Surgery, USUHS, Bethesda, MD
| | - GE Peoples
- 1 Dept. of Surgery, Brooke Army Medical Center, Ft. Sam Houston, TX
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Gates JD, Benavides LC, Stojadinovic A, Mittendorf EA, Holmes JP, Carmichael MG, McCall S, Milford AL, Merrill GA, Ponniah S, Peoples GE. Monitoring circulating tumor cells in cancer vaccine trials. Hum Vaccin 2008; 4:389-92. [PMID: 18437056 DOI: 10.4161/hv.4.5.6115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The presence of circulating tumor cells (CTC) from various cancers has provided a wealth of information and possibilities. As the role of CTC detection in the treatment assessment of metastatic breast cancer becomes standard, there is interest in applying this tool in cancer vaccine development and clinical trial monitoring. Since we lack a proven immunologic assay that correlates with clinical response, CTC detection, quantification and phenotypic characterization may be a useful surrogate for clinical outcome. The Cancer Vaccine Development Program is involved in the development of HER2/neu peptide based vaccine development for the prevention of recurrence in HER2/neu expressing cancers like breast cancer. The CellSearch System (Veridex, LLC Warren, NJ) has been used by our lab in conjunction with in vivo and/or in vitro immunologic measurements to define a monitoring tool that could predict clinical response. Once validated, this assay could significantly shorten clinical trials and lead to more efficient assessment of potentially promising cancer vaccines.
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Affiliation(s)
- J D Gates
- Department of Surgery, General Surgery Service, Brooke Army Medical Center, Ft. Sam Houston, Texas 78234, USA
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Amin A, Stojadinovic A, Holmes JP, Storrer CE, Smith AM, Jama YH, Craig D, Ponniah S, Peoples GE. Assessment of circulating tumor cell (CTC) patterns among disease-free breast cancer patients vaccinated with a preventive HER2/neu E75-peptide vaccine. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.3059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3059 Background: The quantity of CTC and post-treatment reduction predict outcome in medically treated metastatic breast cancer patients (BCa); however, the impact on survival of CTC in patients at risk for recurrence rendered free of disease after multimodality treatment is unknown. We conducted a pilot study to assess CTC in clinically disease-free node-positive (NP) BCa patients, and to determine the effect on CTC of vaccination with the immunogenic HER2/neu peptide E75. Methods: The CellSearch System (Veridex, LLC Warren, NJ) was used to enumerate total CTC and HER2/neu+ CTC in 20 ml of blood from selected samples obtained from patients (n=16) throughout and after the E75 vaccination series. Standard prognostic factors were collected on these patients as were measures of their immunologic response to the vaccine. Results: 14/16 patients (88%) had at least 1 CTC and 10/16 (63%) had 2 or more CTC identified. Standard clinical prognostic factors (tumor size, grade, lymph nodes and HER2/neu overexpression) did not correlate with number of CTC. Thus far, 9 patients have had multiple samples collected prior to, during and/or after the vaccine series. Early levels of CTC were significantly higher (mean±SE=5.2±0.5) vs. post-vaccination levels (0.3±0.1, p=0.005). Levels of HER2/neu+ CTC were also significantly different (early 3.4±0.3 vs. post 0.4±0.1, p=0.01). All patients showed a decline in CTC from early to post levels while demonstrating HER2/neu immunity as measured by DTH to the E75 peptide post- vaccination (22.9±1.8 mm vs. control 4±0.9 mm, p=0.006). Conclusions: CTCs are readily demonstrated in clinically disease-free NP BCa patients. Prognostic indicators do not seem to correlate with the number of CTCs. CTCs decline during the course of vaccination. These data suggest a potential role for the CTC assay in assessing response to preventive vaccine-based immunotherapy. The views expressed in this abstract are those of the authors and do not necessarily reflect the official policy or position of the Departments of Army or Navy, Department of Defense or the U.S. Government. No significant financial relationships to disclose.
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Affiliation(s)
- A. Amin
- Cancer Vaccine Development Laboratory, Bethesda, MD; Walter Reed Army Medical Center, Washington, DC; Windber Medical Center, Windber, PA; Brooke Army Medical Center, Fort Sam Houston, TX
| | - A. Stojadinovic
- Cancer Vaccine Development Laboratory, Bethesda, MD; Walter Reed Army Medical Center, Washington, DC; Windber Medical Center, Windber, PA; Brooke Army Medical Center, Fort Sam Houston, TX
| | - J. P. Holmes
- Cancer Vaccine Development Laboratory, Bethesda, MD; Walter Reed Army Medical Center, Washington, DC; Windber Medical Center, Windber, PA; Brooke Army Medical Center, Fort Sam Houston, TX
| | - C. E. Storrer
- Cancer Vaccine Development Laboratory, Bethesda, MD; Walter Reed Army Medical Center, Washington, DC; Windber Medical Center, Windber, PA; Brooke Army Medical Center, Fort Sam Houston, TX
| | - A. M. Smith
- Cancer Vaccine Development Laboratory, Bethesda, MD; Walter Reed Army Medical Center, Washington, DC; Windber Medical Center, Windber, PA; Brooke Army Medical Center, Fort Sam Houston, TX
| | - Y. H. Jama
- Cancer Vaccine Development Laboratory, Bethesda, MD; Walter Reed Army Medical Center, Washington, DC; Windber Medical Center, Windber, PA; Brooke Army Medical Center, Fort Sam Houston, TX
| | - D. Craig
- Cancer Vaccine Development Laboratory, Bethesda, MD; Walter Reed Army Medical Center, Washington, DC; Windber Medical Center, Windber, PA; Brooke Army Medical Center, Fort Sam Houston, TX
| | - S. Ponniah
- Cancer Vaccine Development Laboratory, Bethesda, MD; Walter Reed Army Medical Center, Washington, DC; Windber Medical Center, Windber, PA; Brooke Army Medical Center, Fort Sam Houston, TX
| | - G. E. Peoples
- Cancer Vaccine Development Laboratory, Bethesda, MD; Walter Reed Army Medical Center, Washington, DC; Windber Medical Center, Windber, PA; Brooke Army Medical Center, Fort Sam Houston, TX
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Buckenmaier CC, Shields CH, Auton AA, Evans SL, Croll SM, Bleckner LL, Brown DS, Stojadinovic A. Continuous peripheral nerve block in combat casualties receiving low-molecular weight heparin. Br J Anaesth 2006; 97:874-7. [PMID: 17032662 DOI: 10.1093/bja/ael269] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Continuous peripheral nerve block (CPNB) is an important therapeutic tool in the anaesthetic and analgesic management of combat casualties at Walter Reed Army Medical Center (WRAMC). We describe our experience using CPNB techniques in combat trauma patients treated with low-molecular weight heparin (LMWH). Guidelines used at our institution for managing CPNB catheters in patients being treated with LMWH are introduced. METHODS From March 2003 to April 2005, 187 combat casualties treated by the WRAMC regional anaesthesia/acute pain section using CPNB were evaluated retrospectively by electronic chart review. Patient characteristic data, CPNB type, duration of CPNB, indication for LMWH [enoxaparin sodium injection (Lovenox-Sanofi Aventis, Bridgewater, NJ, USA)], enoxaparin dose (mg) before and after catheter insertion and removal, time from CPNB placement and removal to enoxaparin dose, and complications were recorded. RESULTS Median enoxaparin dose and time given before catheter insertion were 30 mg and 21 h, respectively. Median enoxaparin dose was also 30 mg given a median of 12 h after peripheral nerve catheter placement. Catheters remained in situ for a median of 8 days (range 1-33 days). Catheter specific complications were infrequent and identified in 7 (3.7%) patients (two catheter malfunction-kinking, catheter tip dislodgement in situ, two superficial catheter site infections and two catheter dislocations). There were no catheter-related bleeding complications evident in this study. CONCLUSIONS Information regarding the safety of CPNB in patients treated with LMWH for perioperative venous thromboembolism prevention is scarce. Our initial experience with CPNB and concurrent LMWH has not been complicated by catheter-related bleeding.
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Affiliation(s)
- C C Buckenmaier
- Army Regional Anesthesia and Pain Management Initiative, Anesthesia and Operative Service, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.
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Esquivel J, Sticca R, Sugarbaker P, Levine E, Yan TD, Alexander R, Baratti D, Bartlett D, Barone R, Barrios P, Bieligk S, Bretcha-Boix P, Chang CK, Chu F, Chu Q, Daniel S, de Bree E, Deraco M, Dominguez-Parra L, Elias D, Flynn R, Foster J, Garofalo A, Gilly FN, Glehen O, Gomez-Portilla A, Gonzalez-Bayon L, Gonzalez-Moreno S, Goodman M, Gushchin V, Hanna N, Hartmann J, Harrison L, Hoefer R, Kane J, Kecmanovic D, Kelley S, Kuhn J, Lamont J, Lange J, Li B, Loggie B, Mahteme H, Mann G, Martin R, Misih RA, Moran B, Morris D, Onate-Ocana L, Petrelli N, Philippe G, Pingpank J, Pitroff A, Piso P, Quinones M, Riley L, Rutstein L, Saha S, Alrawi S, Sardi A, Schneebaum S, Shen P, Shibata D, Spellman J, Stojadinovic A, Stewart J, Torres-Melero J, Tuttle T, Verwaal V, Villar J, Wilkinson N, Younan R, Zeh H, Zoetmulder F, Sebbag G. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: a consensus statement. Society of Surgical Oncology. Ann Surg Oncol 2006. [PMID: 17072675 DOI: 10.1245/s10434-007-9599-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Esquivel J, Sticca R, Sugarbaker P, Levine E, Yan TD, Alexander R, Baratti D, Bartlett D, Barone R, Barrios P, Bieligk S, Bretcha-Boix P, Chang CK, Chu F, Chu Q, Daniel S, de Bree E, Deraco M, Dominguez-Parra L, Elias D, Flynn R, Foster J, Garofalo A, Gilly FN, Glehen O, Gomez-Portilla A, Gonzalez-Bayon L, Gonzalez-Moreno S, Goodman M, Gushchin V, Hanna N, Hartmann J, Harrison L, Hoefer R, Kane J, Kecmanovic D, Kelley S, Kuhn J, Lamont J, Lange J, Li B, Loggie B, Mahteme H, Mann G, Martin R, Misih RA, Moran B, Morris D, Onate-Ocana L, Petrelli N, Philippe G, Pingpank J, Pitroff A, Piso P, Quinones M, Riley L, Rutstein L, Saha S, Alrawi S, Sardi A, Schneebaum S, Shen P, Shibata D, Spellman J, Stojadinovic A, Stewart J, Torres-Melero J, Tuttle T, Verwaal V, Villar J, Wilkinson N, Younan R, Zeh H, Zoetmulder F, Sebbag G. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: a consensus statement. Society of Surgical Oncology. Ann Surg Oncol 2006; 14:128-33. [PMID: 17072675 DOI: 10.1245/s10434-006-9185-7] [Citation(s) in RCA: 294] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Revised: 06/02/2006] [Accepted: 06/02/2006] [Indexed: 12/11/2022]
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Stojadinovic A, Hooke J, Shriver CD, Kovatich A, Nissan A, Ponniah S, Peoples GE, Moroni M. Differential expression of the 150-kd oxygen-regulated protein (ORP150) in benign, pre-malignant and malignant breast tissue. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.10770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10770 Background: Heat shock protein, ORP150, plays a role in hypoxia/ischemia and angiogenesis. Preliminary studies demonstrate increased ORP 150 expression in human cancer, and associate its over expression with aggressive tumor biology. This study further evaluates ORP150 expression in different stages of breast cancer, such as benign, pre-malignant and malignant breast lesions and correlates it with clinical-pathological data. Methods: Sixty-six prospectively collected paraffin-embedded breast tissue sections were reviewed for diagnostic confirmation (normal, n=25; DCIS, n=20; invasive breast cancer (Ca), n=21) and stained using ORP150 antibody immunohistochemistry (IHC). Antibody-staining levels in the benign, DCIS and invasive component of each lesion were reviewed independently by two pathologists and scored: 0 (lowest) to 3+ (highest). Clinical-pathological data was compared with ORP150 staining using ANOVA or T-Test as appropriate with significance determined by p<0.05. Results: Significant differential ORP150 staining was detected in benign-normal versus benign adjacent to invasive cancer, as well as in benign adjacent to DCIS versus benign adjacent to invasive cancer. ORP150 expression in the invasive portion of the breast cancer correlated significantly with tumor grade and absence of hormone receptor expression, presence of lymphovascular invasion and lymph node metastasis. Conclusions: ORP150 expression in breast cancer is associated with poor prognostic histological factors. As ORP150 is differentially expressed in benign tissue adjacent to invasive cancer, further study is warranted to determine its utility in detecting occult invasive cancer within benign biopsy specimens, as well as its putative role in tumor-stromal cell interactions. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- A. Stojadinovic
- Walter Reed Army Medical Center, Washington, DC; Clinical Breast Care Project, Washington, DC; Clinical Breast Care Project, Windber, PA; Hadassah University Hospital Mount Scopus, Jerusalem, Israel; Immunology Research Center, Bethesda, MD
| | - J. Hooke
- Walter Reed Army Medical Center, Washington, DC; Clinical Breast Care Project, Washington, DC; Clinical Breast Care Project, Windber, PA; Hadassah University Hospital Mount Scopus, Jerusalem, Israel; Immunology Research Center, Bethesda, MD
| | - C. D. Shriver
- Walter Reed Army Medical Center, Washington, DC; Clinical Breast Care Project, Washington, DC; Clinical Breast Care Project, Windber, PA; Hadassah University Hospital Mount Scopus, Jerusalem, Israel; Immunology Research Center, Bethesda, MD
| | - A. Kovatich
- Walter Reed Army Medical Center, Washington, DC; Clinical Breast Care Project, Washington, DC; Clinical Breast Care Project, Windber, PA; Hadassah University Hospital Mount Scopus, Jerusalem, Israel; Immunology Research Center, Bethesda, MD
| | - A. Nissan
- Walter Reed Army Medical Center, Washington, DC; Clinical Breast Care Project, Washington, DC; Clinical Breast Care Project, Windber, PA; Hadassah University Hospital Mount Scopus, Jerusalem, Israel; Immunology Research Center, Bethesda, MD
| | - S. Ponniah
- Walter Reed Army Medical Center, Washington, DC; Clinical Breast Care Project, Washington, DC; Clinical Breast Care Project, Windber, PA; Hadassah University Hospital Mount Scopus, Jerusalem, Israel; Immunology Research Center, Bethesda, MD
| | - G. E. Peoples
- Walter Reed Army Medical Center, Washington, DC; Clinical Breast Care Project, Washington, DC; Clinical Breast Care Project, Windber, PA; Hadassah University Hospital Mount Scopus, Jerusalem, Israel; Immunology Research Center, Bethesda, MD
| | - M. Moroni
- Walter Reed Army Medical Center, Washington, DC; Clinical Breast Care Project, Washington, DC; Clinical Breast Care Project, Windber, PA; Hadassah University Hospital Mount Scopus, Jerusalem, Israel; Immunology Research Center, Bethesda, MD
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Stojadinovic A, Moskovitz O, Gallimidi Z, Fields S, Brooks AD, Brem R, Mucciola RN, Singh M, Shriver CD. Prospective study of electrical impedance scanning for identifying young women at risk for breast cancer. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.692] [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)
- A. Stojadinovic
- Walter Reed Army Medcl Ctr, Washington, DC; Machon Or, Bnai Zion Hosp, Haifa, Israel; Rambam Hosp, Haifa, Israel; Hadassah Univ Hosp, Mount Scopus, Jerusalem, Israel; Drexel Univ Medcl Coll, Philadelphia, PA; George Washington Univ, Washington, DC; Windbur Medcl Ctr, Johnstown, PA; Cornell Medcl Ctr, New York, NY
| | - O. Moskovitz
- Walter Reed Army Medcl Ctr, Washington, DC; Machon Or, Bnai Zion Hosp, Haifa, Israel; Rambam Hosp, Haifa, Israel; Hadassah Univ Hosp, Mount Scopus, Jerusalem, Israel; Drexel Univ Medcl Coll, Philadelphia, PA; George Washington Univ, Washington, DC; Windbur Medcl Ctr, Johnstown, PA; Cornell Medcl Ctr, New York, NY
| | - Z. Gallimidi
- Walter Reed Army Medcl Ctr, Washington, DC; Machon Or, Bnai Zion Hosp, Haifa, Israel; Rambam Hosp, Haifa, Israel; Hadassah Univ Hosp, Mount Scopus, Jerusalem, Israel; Drexel Univ Medcl Coll, Philadelphia, PA; George Washington Univ, Washington, DC; Windbur Medcl Ctr, Johnstown, PA; Cornell Medcl Ctr, New York, NY
| | - S. Fields
- Walter Reed Army Medcl Ctr, Washington, DC; Machon Or, Bnai Zion Hosp, Haifa, Israel; Rambam Hosp, Haifa, Israel; Hadassah Univ Hosp, Mount Scopus, Jerusalem, Israel; Drexel Univ Medcl Coll, Philadelphia, PA; George Washington Univ, Washington, DC; Windbur Medcl Ctr, Johnstown, PA; Cornell Medcl Ctr, New York, NY
| | - A. D. Brooks
- Walter Reed Army Medcl Ctr, Washington, DC; Machon Or, Bnai Zion Hosp, Haifa, Israel; Rambam Hosp, Haifa, Israel; Hadassah Univ Hosp, Mount Scopus, Jerusalem, Israel; Drexel Univ Medcl Coll, Philadelphia, PA; George Washington Univ, Washington, DC; Windbur Medcl Ctr, Johnstown, PA; Cornell Medcl Ctr, New York, NY
| | - R. Brem
- Walter Reed Army Medcl Ctr, Washington, DC; Machon Or, Bnai Zion Hosp, Haifa, Israel; Rambam Hosp, Haifa, Israel; Hadassah Univ Hosp, Mount Scopus, Jerusalem, Israel; Drexel Univ Medcl Coll, Philadelphia, PA; George Washington Univ, Washington, DC; Windbur Medcl Ctr, Johnstown, PA; Cornell Medcl Ctr, New York, NY
| | - R. N. Mucciola
- Walter Reed Army Medcl Ctr, Washington, DC; Machon Or, Bnai Zion Hosp, Haifa, Israel; Rambam Hosp, Haifa, Israel; Hadassah Univ Hosp, Mount Scopus, Jerusalem, Israel; Drexel Univ Medcl Coll, Philadelphia, PA; George Washington Univ, Washington, DC; Windbur Medcl Ctr, Johnstown, PA; Cornell Medcl Ctr, New York, NY
| | - M. Singh
- Walter Reed Army Medcl Ctr, Washington, DC; Machon Or, Bnai Zion Hosp, Haifa, Israel; Rambam Hosp, Haifa, Israel; Hadassah Univ Hosp, Mount Scopus, Jerusalem, Israel; Drexel Univ Medcl Coll, Philadelphia, PA; George Washington Univ, Washington, DC; Windbur Medcl Ctr, Johnstown, PA; Cornell Medcl Ctr, New York, NY
| | - C. D. Shriver
- Walter Reed Army Medcl Ctr, Washington, DC; Machon Or, Bnai Zion Hosp, Haifa, Israel; Rambam Hosp, Haifa, Israel; Hadassah Univ Hosp, Mount Scopus, Jerusalem, Israel; Drexel Univ Medcl Coll, Philadelphia, PA; George Washington Univ, Washington, DC; Windbur Medcl Ctr, Johnstown, PA; Cornell Medcl Ctr, New York, NY
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Arciero C, Peoples G, Stojadinovic A, Shriver C. The Utility of a Rapid Parathyroid Assay for Uniglandular, Multiglandular, and Recurrent Parathyroid Disease. Am Surg 2004. [DOI: 10.1177/000313480407000705] [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: 11/29/2022]
Abstract
The rapid parathyroid hormone assay (rPTH) is an effective tool in minimally invasive resections of parathyroid adenomas. However, there are relatively few reports examining its utility in the full spectrum of parathyroid disease. The purpose of this study was to examine the utility of the rapid parathyroid hormone assay in uniglandular, multiglandular, and recurrent hyperparathyroidism. A retrospective analysis of all patients undergoing parathyroid resection from June 2001 to March 2003 was undertaken. All patients underwent preoperative localization studies. Rapid parathyroid hormone (PTH) levels were drawn immediately prior to and 10 minutes following parathyroid resection. A decline of ≥50 per cent rPTH qualified as a successful/complete resection. Additional intraoperative samples were drawn as needed for patients with multiglandular disease. Of 46 treated patients who were examined (average age, 54 years), 30 had single, 12 patients had multigland disease, and 4 had recurrent/persistent hyperparathyroidism. Thirty-seven patients had primary hyperparathyroidism (32 with single and 3 with double adenomas; 2 with hyperplasia), 4 patients had secondary hyperparathyroidism, and 5 tertiary hyperparathyroidism. All procedures were considered successful, as every patient exhibited a postresection decrement in rPTH exceeding 50 per cent (average decrement, 91%). Although 2 patients exhibited a postoperative PTH increase exceeding 50 per cent of the preoperative value, all remained asymptomatic and eucalcemic (median follow-up, 21.5 months). The rPTH assay is an effective tool in determining success of parathyroidectomy in patients with primary uni- and multiglandular as well as recurrent hyperparathyroidism. It can be used to achieve minimally invasive neck dissections or guide surgical decision-making in more complex cases.
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Affiliation(s)
- C.A. Arciero
- From the Department of General Surgery, Walter Reed Army Medical Center, 6900 Georgia Ave, NW, Washington, D.C. 20307-5001
| | - G.E. Peoples
- From the Department of General Surgery, Walter Reed Army Medical Center, 6900 Georgia Ave, NW, Washington, D.C. 20307-5001
| | - A. Stojadinovic
- From the Department of General Surgery, Walter Reed Army Medical Center, 6900 Georgia Ave, NW, Washington, D.C. 20307-5001
| | - C.D. Shriver
- From the Department of General Surgery, Walter Reed Army Medical Center, 6900 Georgia Ave, NW, Washington, D.C. 20307-5001
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Arciero CA, Peoples GE, Stojadinovic A, Shriver CD. The utility of a rapid parathyroid assay for uniglandular, multiglandular, and recurrent parathyroid disease. Am Surg 2004; 70:588-92. [PMID: 15279180] [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: 04/30/2023]
Abstract
The rapid parathyroid hormone assay (rPTH) is an effective tool in minimally invasive resections of parathyroid adenomas. However, there are relatively few reports examining its utility in the full spectrum of parathyroid disease. The purpose of this study was to examine the utility of the rapid parathyroid hormone assay in uniglandular, multiglandular, and recurrent hyperparathyroidism. A retrospective analysis of all patients undergoing parathyroid resection from June 2001 to March 2003 was undertaken. All patients underwent preoperative localization studies. Rapid parathyroid hormone (PTH) levels were drawn immediately prior to and 10 minutes following parathyroid resection. A decline of > or = 50 per cent rPTH qualified as a successful/complete resection. Additional intraoperative samples were drawn as needed for patients with multiglandular disease. Of 46 treated patients who were examined (average age, 54 years), 30 had single, 12 patients had multigland disease, and 4 had recurrent/persistent hyperparathyroidism. Thirty-seven patients had primary hyperparathyroidism (32 with single and 3 with double adenomas; 2 with hyperplasia), 4 patients had secondary hyperparathyroidism, and 5 tertiary hyperparathyroidism. All procedures were considered successful, as every patient exhibited a postresection decrement in rPTH exceeding 50 per cent (average decrement, 91%). Although 2 patients exhibited a postoperative PTH increase exceeding 50 per cent of the preoperative value, all remained asymptomatic and eucalcemic (median follow-up, 21.5 months). The rPTH assay is an effective tool in determining success of parathyroidectomy in patients with primary uni- and multiglandular as well as recurrent hyperparathyroidism. It can be used to achieve minimally invasive neck dissections or guide surgical decision-making in more complex cases.
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Affiliation(s)
- C A Arciero
- Department of General Surgery, Walter Reed Army Medical Center, 6900 Georgia Ave, NW, Washington, DC 20307-5001, USA
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Abstract
BACKGROUND Immunohistochemical analysis of sentinel lymph nodes from patients with breast carcinoma and melanoma has been shown to increase the sensitivity for detecting lymph node metastases. To the authors' knowledge, this technique has not been described in patients with Merkel cell carcinoma. METHODS Lymphatic mapping and sentinel lymph node biopsy was performed on 26 patients with Merkel cell carcinoma between 1997 and 1999. All sentinel lymph nodes were analyzed with conventional hematoxylin and eosin (H&E) staining and then analyzed with immunohistochemical staining to evaluate whether this additional technique would increase the number of patients found to have lymph node metastasis. RESULTS The median age of the patients in the current study was 67 years and the median tumor size at the time of presentation was 2 cm. Lymph node metastases were identified in 5 of the 26 patients (19%). Three of these five lymph node positive patients were identified with H&E staining. The remaining two patients were identified only after immunohistochemical analysis. The median follow-up in this group of lymph node positive patients was 14 months, with 2 of the 5 lymph node positive patients developing a recurrence. The median follow-up in the 21 patients who were lymph node negative was 19 months, with only 1 patient having developed a recurrence at the time of last follow-up. CONCLUSIONS Immunohistochemical analysis of sentinel lymph nodes from patients with Merkel cell carcinoma appears to increase the sensitivity of detecting clinically occult lymph node metastases.
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Affiliation(s)
- P J Allen
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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Hoos A, Stojadinovic A, Mastorides S, Urist MJ, Polsky D, Di Como CJ, Brennan MF, Cordon-Cardo C. High Ki-67 proliferative index predicts disease specific survival in patients with high-risk soft tissue sarcomas. Cancer 2001; 92:869-74. [PMID: 11550160 DOI: 10.1002/1097-0142(20010815)92:4<869::aid-cncr1395>3.0.co;2-u] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [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: 11/08/2022]
Abstract
BACKGROUND Soft tissue sarcomas (STSs) are heterogeneous neoplasms that have variable clinical outcome. Several clinical parameters and few molecular markers, including Ki-67 proliferative index, have been shown to correlate with patient prognosis. To the authors' knowledge, no definitive report exists to identify one molecular marker that can be analyzed easily in a clinical setting and that predicts survival in a cohort of patients with high-risk STS of identical clinical characteristics but variable outcome. METHODS The influence of clinical prognostic factors was eliminated by selecting two patient groups with identical high-risk characteristics: large (> 10 cm), high-grade, deep, completely resected primary extremity STS (n = 47). Patients in the first group remained disease free (no evidence of disease [NED]) after primary tumor treatment (n = 19), whereas patients in the second group subsequently died of disease (DOD; n = 28). Triplicate 0.6-mm core biopsies from defined morphologic areas of paraffin embedded primary tumors were assembled on a tissue microarray and analyzed by immunohistochemistry with the MIB-1 antibody, and Ki-67 proliferative indices were correlated with patient outcome. RESULTS High Ki-67 proliferative index, defined as greater than 30% tumor cells showing nuclear immunoreactivity, was significantly more frequent in the DOD group than in the NED group and was associated with tumor-related mortality (P = 0.02). This marker identifies an especially aggressive malignant phenotype within a cohort of high-risk tumors that is based on well established clinical and pathologic parameters alone and is easy to use in a clinical setting. CONCLUSIONS On the basis of these data and previous reports, high Ki-67 proliferative index is suggested as a significant factor for predicting the prognosis of patients with high-risk STS and should be evaluated prospectively based on clinical trials.
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Affiliation(s)
- A Hoos
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Abstract
BACKGROUND Limb salvage after primary site failure of extremity soft tissue sarcoma is a challenging problem. Amputation may be the most effective treatment option in selected patients with local recurrence. We compared the outcome of patients treated with amputation versus limb-sparing surgery (LSS) for locally recurrent extremity sarcoma. METHODS From 1982 to 2000, 1178 patients with localized primary extremity sarcoma underwent LSS. Of these, 204 (17%) developed local recurrence. Eighteen (9%) required major amputation and the remainder underwent LSS, of which 34 were selected for matched-pair analysis according to established prognostic variables. Rates of recurrence or death were estimated by the Kaplan-Meier method. Following adjustment for prognostic variables, a Mantel-Haenszel test was used to compare the outcome between the two treatment groups. RESULTS Patients in each group were well matched. All patients had high-grade tumors deep to the fascia. Median time to local recurrence was similar for both groups. Median follow-up was 95 months. Amputation was associated with a significant improvement in local control of disease (94% vs. 74%; P = .04). We observed no difference in disease-free (P = .48), disease-specific (P = .74), or overall survival (P = .93) between the two groups. Median postrecurrence survival was 20 months and 5-year OS was 36% for the entire study group. CONCLUSIONS Limb-sparing treatment achieves local control in the majority of recurrent extremity sarcomas for which amputation is infrequently indicated. Amputation improves local disease control but not survival under these circumstances.
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Affiliation(s)
- A Stojadinovic
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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Stojadinovic A, Ghossein RA, Hoos A, Urist MJ, Spiro RH, Shah JP, Brennan MF, Shaha AR, Singh B. Hürthle cell carcinoma: a critical histopathologic appraisal. J Clin Oncol 2001; 19:2616-25. [PMID: 11352953 DOI: 10.1200/jco.2001.19.10.2616] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Controversy exists over the ability of morphology to predict the biologic behavior of Hürthle cell carcinoma. The aim of this study was to conduct a critical histopathologic review of Hürthle cell carcinoma and to correlate morphologic parameters with clinical outcome. PATIENTS AND METHODS Patients with histologically confirmed Hürthle cell carcinoma treated between 1940 and 2000 form the basis of this study. Adenomas were excluded. Tumors of unknown malignant behavior ([UMB] n = 17) had solid growth pattern, incomplete capsular invasion (Ci), or both but no vascular invasion (Vi). Minimally invasive carcinomas ([MIC] n = 23) had one focus of intra- or extracapsular Vi, one focus of complete Ci, or both. Widely invasive carcinomas ([WIC] n = 33) demonstrated more than one focus of Vi, more than one focus of Ci, or both. The primary end points were relapse-free survival (RFS) and disease-specific survival (DSS). Rates of recurrence/death were estimated by Kaplan-Meier method. The univariate influence of prognostic factors on end points was analyzed by log-rank test, and multivariate analysis was performed by Cox regression. RESULTS Median follow-up was 8 years. No patients with UMB or MIC relapsed or died of disease. Of WIC, 73% relapsed and 55% died of disease. Age, size, and extent of resection did not influence outcome. Adverse predictors of RFS and DSS among WIC were extrathyroidal extension, nodal metastasis, positive margin, and solid growth pattern (P <.05). Both Ci and Vi were associated with worse DSS (P <.05). On multivariate analysis, extrathyroidal extension and nodal metastases were independent predictors of outcome (P <.05). CONCLUSION Patients with Hürthle cell carcinoma have a prognosis that is predicted by well-defined histomorphologic characteristics. Unlike differentiated thyroid cancer, nodal metastases predict a worse outcome in widely invasive Hürthle cell carcinoma, as does extrathyroidal extension.
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Affiliation(s)
- A Stojadinovic
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Hoos A, Urist MJ, Stojadinovic A, Mastorides S, Dudas ME, Leung DH, Kuo D, Brennan MF, Lewis JJ, Cordon-Cardo C. Validation of tissue microarrays for immunohistochemical profiling of cancer specimens using the example of human fibroblastic tumors. Am J Pathol 2001; 158:1245-51. [PMID: 11290542 PMCID: PMC1891917 DOI: 10.1016/s0002-9440(10)64075-8] [Citation(s) in RCA: 284] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Tissue microarrays allow high-throughput molecular profiling of cancer specimens by immunohistochemistry. Phenotype information of sections from arrayed biopsies on a multitissue block needs to be representative of full sections, as protein expression varies throughout the entire tumor specimen. To validate the use of tissue microarrays for immunophenotyping, we studied a group of 59 fibroblastic tumors with variable protein expression patterns by immunohistochemistry for Ki-67, p53, and the retinoblastoma protein (pRB). Data on full tissue sections were compared to the results of one, two, and three 0.6-mm core biopsies per tumor on a tissue array. Ki-67 and p53 staining was read as two categories (positive or negative). Concordance for this staining between tissue arrays with triplicate cores per tumor and full sections were 96 and 98%, respectively. For pRB staining was read as three categories (high, moderate, or negative), where concordance was 91%. The use of three cores per tumor resulted in lower numbers of lost cases and lower nonconcordance with standard full sections as compared to one or two cores per tumor. Correlations between phenotypes and clinical outcome were not significantly different between full section and array-based analysis. Triplicate 0.6-mm core biopsies sampled on tissue arrays provide a reliable system for high-throughput expression profiling by immunohistochemistry when compared to standard full sections. Triplicate cores offer a higher rate of assessable cases and a lower rate of nonconcordant readings than one or two cores. Concordance of triplicate cores is high (96 to 98%) for two category distinction and decreases with the complexity of the phenotypes being analyzed (91%).
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Affiliation(s)
- A Hoos
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Stojadinovic A, Hoos A, Karpoff HM, Leung DH, Antonescu CR, Brennan MF, Lewis JJ. Soft tissue tumors of the abdominal wall: analysis of disease patterns and treatment. Arch Surg 2001; 136:70-9. [PMID: 11146782 DOI: 10.1001/archsurg.136.1.70] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
HYPOTHESIS Abdominal wall tumors, though clinically similar, have varying degrees of biological behavior. DESIGN Retrospective review of prospective databases. SETTING Memorial Sloan-Kettering Cancer Center. PATIENTS Eighty-five patients with abdominal wall soft tissue tumors. MAIN OUTCOME MEASURES Primary endpoints included time to first local recurrence, distant metastases, and disease-related mortality. Survival analysis was performed by Kaplan-Meier method, and comparisons were made by log-rank analysis. RESULTS Thirty-nine desmoids, 32 soft tissue sarcomas (STS), and 14 dermatofibrosarcoma protuberans (DFSP) underwent surgery directed at achieving margin-negative resection. Unlike DFSP, most STS (77%) and desmoids(87%) were deep lesions requiring full-thickness abdominal wall resection and mesh reconstruction. Median follow-up time was 53 months, 101 months, and 31 months, with 5-year local recurrence-free survival rates of 97%, 100%, and 75%, for desmoids, DFSP, and STS, respectively. Desmoid tumors resected with positive microscopic margins had higher local failure rates (68% [positive margin] vs 100% [negative margin] 5-yr local recurrence-free survival, P<.05). For STS, high grade, deep location, and size at or above 5 cm were adverse prognostic factors for disease-specific and distant recurrence-free survival (P<.05); patients experiencing local recurrence was associated with decreased 5-year relapse-free survival rates (87% [primary] vs 50% [local recurrence], P<.05). Characteristically, no DFSP or desmoid developed distant metastases. Soft tissue sarcomas had significantly lower relapse-free survival rates than DFSP or desmoids (P<.05). CONCLUSION Abdominal wall tumors demonstrate a broad spectrum of biological behavior. Desmoids and DFSP are a local problem. High grade, size at or above 5 cm, and deep location predict distant failure and tumor-related mortality for patients with STS. Complete surgical resection is the recommended treatment approach to achieve local control. Stratification by prognostic factors will facilitate selection of patients with STS for adjuvant systemic therapies.
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Affiliation(s)
- A Stojadinovic
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA
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Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) of the head and neck is a rare, locally infiltrative, low-grade sarcoma. This study defines the clinical behavior of DFSP, evaluates the role of frozen section analysis, and identifies factors that predict local control. METHODS Hospital records and pathological slides were reviewed for 33 patients with pathologically confirmed head and neck DFSP treated at Memorial Sloan-Kettering Cancer Center between 1964 and 1999. Factors were analyzed by using Fisher's exact or chi2 tests. RESULTS For 21 primary and 12 recurrent patients, median age and tumor size at presentation was 39 years and 2.0 cm, respectively. Thirty-two (97%) patients were alive at a median follow-up of 82 months. Three patients recurred locally, all with smaller than 2-cm resection margins. Deep tumors were more likely to have a margin-positive resection than superficial lesions (P = .03). Gross margin 2 cm or more was a significant predictor of a negative histological margin (P<.001). There was a trend toward improved recurrence-free survival for tumors treated with wide (> or =2 cm) margin resection (P = .059). Accuracy, sensitivity, specificity, and false negative rates of frozen section were 80%, 43%, 100%, and 57%, respectively. CONCLUSIONS Wide margin resection of head and neck DFSP predicts negative histological margins and impacts favorably on local recurrence-free survival. Frozen section analysis does not assess resection margins accurately.
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Affiliation(s)
- A Stojadinovic
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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Stojadinovic A, Smallridge R, Nath J, Ding X, Shea-Donohue T. Anti-inflammatory effects of U74389F in a rat model of intestinal ischemia/reperfusion injury. Crit Care Med 1999; 27:764-70. [PMID: 10321667 DOI: 10.1097/00003246-199904000-00033] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the role of eicosanoid generation and neutrophilic infiltration in the protective effects of U74389F against ischemia/reperfusion injury in the small intestines of rats. DESIGN Prospective, randomized, controlled study. SETTING University research laboratory. SUBJECTS Adult, male Sprague-Dawley rats weighing between 200 and 300 g. INTERVENTIONS Groups (5-8) of rats treated with U74389F or vehicle were subjected to a sham operation and 30 mins of ischemia by occlusion of the superior mesenteric artery or 30 mins of ischemia followed by 60 or 120 mins of reperfusion. U74389F (2.5 mg/kg i.v.) or vehicle (citrate buffer) were slowly injected 2 mins before ischemia. MEASUREMENTS AND MAIN RESULTS Ischemia significantly (p < .05) increased mucosal injury (0 [normal] to 5) in both U74389F and untreated rats. In contrast, U74389F significantly (p < .05) attenuated the severity of injury after reperfusion. In vehicle-treated rats, ischemia/reperfusion significantly reduced villus height in both U74389F and untreated groups. However, the surface epithelial layer was intact in the U74389F but not in the vehicle-treated group. In addition, compared with the vehicle-treated group, U74389F significantly reduced neutrophil infiltration and prevented the increase in leukotriene B4 and prostaglandin E2 in response to ischemia and reperfusion. CONCLUSIONS This study demonstrates that the mechanism of U74389F against mesenteric ischemia/reperfusion includes a delay and reduction of neutrophilic infiltrate, an inhibition of leukotriene B4 production, and a facilitation of mucosal restitution.
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Affiliation(s)
- A Stojadinovic
- Department of Surgery, Walter Reed Army Medical Center, Washington, DC, USA
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Abstract
BACKGROUND It has been suggested that multiple sublethal insults are commonly associated with the development of multiple organ failure (MOF). The gut is considered to be pivotal in the pathogenesis of MOF. This study investigated the effects of repeated ischemia-reperfusion of the rat small intestine. METHODS Groups of rats underwent 30 min of superior mesenteric artery occlusion or sham operation followed by 24 h of reperfusion. They then received an additional 30 min of superior mesenteric artery occlusion and 2 h of reperfusion or sham operation. Small intestine was examined for mucosal injury, neutrophil infiltration, goblet cell number, and generation of the eicosanoids, prostaglandin E2, and leukotriene B4. Activation of neutrophils was assessed in systemic venous blood. RESULTS Animals subjected to two insults of ischemia-reperfusion demonstrated significantly less mucosal injury than animals undergoing one episode of ischemia and 2 h of reperfusion, despite increased neutrophil infiltration, leukotriene B4, and activated systemic neutrophils. Goblet cell number was elevated in animals 24 h after the first ischemia-reperfusion insult and remained enhanced after the second episode of ischemia-reperfusion. CONCLUSIONS The initial episode of ischemia-reperfusion caused an adaptive response associated with cytoarchitectural preservation following the subsequent insult. Increased mucus production was associated with mucosal protection. Nevertheless, repeated ischemia-reperfusion potentiated the local inflammatory response and the systemic activation of neutrophils.
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Affiliation(s)
- T J Miner
- Department of Surgery, Walter Reed Army Medical Center, Washington, D.C., USA
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Goldhill JM, Stojadinovic A, Kiang J, Smallridge R, Shea-Donohue T. Hyperthermia prevents functional, histological and biochemical abnormalities induced during ileitis. Neurogastroenterol Motil 1999; 11:69-76. [PMID: 10087537 DOI: 10.1046/j.1365-2982.1999.00130.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [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] [Indexed: 02/08/2023]
Abstract
Inflammatory bowel disease is associated with altered intestinal motility and epithelial damage. Hyperthermia induces heat shock protein expression, components of a basic cellular defence mechanism, and consequently prevents ischaemic damage. Here we investigate whether hyperthermia may prevent altered smooth muscle function as well as underlying inflammation in a model of inflammatory bowel disease. Ileal heat shock protein expression was induced in rats by hyperthermic shock (41.5 degrees C; 5 min). Two hours after heating or sham treatment, ileitis was evoked by TNBS. Ileal samples were taken 4 h later to determine the contractile response of circular muscle strips, and to measure heat shock protein expression, LTB4 generation and damage/inflammation. Ileitis was associated with an increase in the contractile response of circular muscle to substance P but not neurokinin A or nerve stimulation. Hyperthermia induced heat shock protein expression and also prevented this functional change as well as TNBS-induced LTB4 production, subsequent infiltration of neutrophils and epithelial damage. Thus, intestinal inflammation is associated with alterations in tachykinergic control of smooth muscle as well as inflammatory changes. Hyperthermia prevents these changes and induces heat shock protein expression. Pharmacological induction of these proteins may offer a novel clinical strategy in treating both of these aspects of disease.
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Affiliation(s)
- J M Goldhill
- Division of Medicine, USUHS, Bethesda, MD 20814, USA
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Eror AT, Stojadinovic A, Starnes BW, Makrides SC, Tsokos GC, Shea-Donohue T. Antiinflammatory effects of soluble complement receptor type 1 promote rapid recovery of ischemia/reperfusion injury in rat small intestine. Clin Immunol 1999; 90:266-75. [PMID: 10080839 DOI: 10.1006/clim.1998.4635] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We examined the effect of soluble complement receptor type 1 (sCR1) on mucosal injury and inflammation in a rat model of ischemia/reperfusion. Groups of vehicle- and sCR1-treated rats underwent 30 min of mesenteric ischemia followed by 60 or 120 min of reperfusion. When compared to vehicle-treated rats, treatment with sCR1 (12 mg/kg) prior to 120 min of reperfusion significantly reduced mucosal injury, neutrophil infiltration, leukotriene B4 production, and restored villus height to control levels. The protective effect of sCR1 evident at 120 min of reperfusion was not observed at 60 min of reperfusion despite rapid inactivation of complement. These data suggest that complement inhibition minimized mucosal disruption by facilitating mucosal restitution or interrupting the inflammatory process. Delayed administration of sCR1 for 30 or 60 min into the reperfusion period progressively reduced the protection. sCR1-mediated rapid recovery of rat intestine after ischemia/reperfusion underscores the fundamental role of complement activation in neutrophil-mediated tissue injury.
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Affiliation(s)
- A T Eror
- Department of Surgery, Walter Reed Army Medical Center, Washington, DC, USA
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Allen PJ, Stojadinovic A, Shriver CD, Jaques DP. Contributions from surgeons to clinical trials and research on the management of soft tissue sarcoma. Ann Surg Oncol 1998; 5:437-41. [PMID: 9718173 DOI: 10.1007/bf02303862] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Surgical resection is the primary treatment for soft tissue sarcoma. Surgeons are in a position to develop and define appropriate treatment strategies for this disease. In an effort to define the contributions of surgeons to the management of sarcoma, the surgical and clinical oncology literature from January 1983 through June 1996 was reviewed. METHODS A computerized literature search of the Cancerlit database for January 1983 to June 1996 was performed. The search was limited to the topic of soft tissue sarcoma and was further confined to 15 journals that publish articles relevant to surgical management. These studies were then categorized by multiple parameters and analyzed. RESULTS The Cancerlit file contained 4478 articles in which sarcoma was the primary topic. When the search was limited to 15 journals frequently read by surgeons, 479 references (11%) were retrieved. Within the surgical literature, 95 of the 479 articles (20%) described prospective studies, of which 33 were prospective and randomized. These studies represent all but three of the prospective randomized trials within the literature during the time period reviewed. The management of patients with sarcoma was evaluated in 26 of the prospective randomized trials; of these, 13 trials evaluated adjuvant chemotherapy, three evaluated adjuvant radiotherapy, and ten evaluated the chemotherapeutic treatment of metastatic disease. Surgical oncologists were the first or senior author on 10 of the 16 prospective randomized studies regarding adjuvant radiation or chemotherapy. Four of the 16 trials evaluating adjuvant therapy contained more than 100 patients, and three of those four were from cooperative group efforts. All but one of the studies of adjuvant therapy with less than 100 patients were from single institutional trials. CONCLUSIONS Although the surgical and clinical oncology literature on soft tissue sarcoma is composed primarily of retrospective reviews, the prospective randomized trials reported represent almost all of the randomized trials in the literature and have significant contributions from surgeons. Surgeons can guide and design clinical trials, but overall patient accrual as represented by soft tissue sarcoma is low, and may be improved through cooperative group efforts.
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Affiliation(s)
- P J Allen
- Department of Surgery, Walter Reed Army Medical Center, Washington, DC 20307, USA
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Stojadinovic A, Shriver CD, Casler JD, Gaertner EM, York G, Jaques DP. Endoscopic laser excision of ectopic pyriform sinus parathyroid adenoma. Arch Surg 1998; 133:101-3. [PMID: 9438768 DOI: 10.1001/archsurg.133.1.101] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- A Stojadinovic
- General Surgery Service, Walter Reed Army Medical Center, Washington, DC 20307, USA
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Bamberger PK, Stojadinovic A, Shaked G, Golocovsky M. Biliary-pleural fistula presenting as a massive pleural effusion after thoracoabdominal penetrating trauma. J Trauma 1997; 43:162-3. [PMID: 9253934 DOI: 10.1097/00005373-199707000-00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- P K Bamberger
- Department of General Surgery, Walter Reed Army Medical Center, Washington, D.C. 20307-5001, USA
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Stojadinovic A, Kiang J, Goldhill J, Matin D, Smallridge R, Galloway R, Shea-Donohue T. Induction of the heat shock response prevents tissue injury during acute inflammation of the rat ileum. Crit Care Med 1997; 25:309-17. [PMID: 9034270 DOI: 10.1097/00003246-199702000-00020] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To determine if prior total body hyperthermia protected against subsequent acute ileitis induced by the cytotoxic lectin, ricin, in rats. The time course of heat shock mRNA and protein expression in the ileum was determined. The effects of heat stress on small intestinal mucosal integrity, arachidonic acid metabolism, and neutrophilic infiltrate were compared in heated and nonheated rats receiving vehicle or ricin intraluminally. The effect of hyperthermia on the circulating neutrophil superoxide production was also evaluated. DESIGN Prospective, randomized, controlled trial. SETTING University research laboratory. SUBJECTS Forty-one adult, male Sprague-Dawley rats, weighing 150 to 250 g, and 32 adult, inbred, male Fisher 344 rats, weighing 175 to 250 g. INTERVENTIONS Exposure to whole body hyperthermia and production of acute ileitis. Sprague-Dawley rats were divided randomly into four experimental groups: nonheated control group, heated control group, nonheated ricin group (1 mg/mL water, intraluminal), and heated ricin group. Sprague-Dawley rats in a separate study were assigned to seven groups based on the time of removal of the terminal ileum following hyperthermia: 0 min, or 1, 2, 4, 8, 12, and 24 hrs. Inbred Fisher 344 rats were allocated to the heated and nonheated groups for peripheral neutrophil superoxide generation studies. MEASUREMENTS AND MAIN RESULTS Whole body hyperthermia to a rectal temperature of 41 degrees C to 42 degrees C for 15 to 20 mins: a) was associated with marked mucosal cytoprotection against subsequent ricin-induced ileitis (Injury grade [from 0 = normal to 5 = severe]: 0.4 +/- 0.1 vs. 2.5 +/- 0.2, p < .001); b) prevented the ricin-induced reduction in villus height to crypt depth ratio (2.4 +/- 0.1 vs. 1.9 +/- 0.1, p < .01); and c) significantly reduced the number of infiltrating neutrophils when compared with nonheated ricin-treated rats (11 +/- 2 vs. 32 +/- 3 neutrophils/high-power field, p < .001). The hyperthermia-induced peak increase in heat shock protein (HSP)-70 mRNA at 2 hrs preceded that of HSP 70i at 4 hrs. Heat shock significantly reduced the ricin-induced increase in both basal (8.0 +/- 1.9 vs. 33.0 +/- 8.1 pg of leukotriene B4/mg protein, p < .05) and ionophore-stimulated (16.0 +/- 4.9 vs. 80.0 +/- 15.5 pg of leukotriene B4/mg protein, p < .001) generation of ileal leukotriene B4, but did not alter the cyclooxygenase product, prostaglandin E2. Hyperthermia did not alter peripheral neutrophil superoxide production. CONCLUSIONS This study assessed the effects of heat shock in the normal and acutely inflamed intestine. These data suggest that heat stress and increased expression of HSP 70i protect against acute intestinal inflammation. This protection is associated with significant reductions in ileal leukotriene B4 generation and neutrophilic infiltrate. Hyperthermia did not alter circulating neutrophil superoxide production. Thus, the mechanism of heat stress protection against acute ileitis may involve local intestinal inhibition of leukotriene B4 production and subsequent neutrophilic infiltration without altering the ability of systemic neutrophils to be activated.
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Affiliation(s)
- A Stojadinovic
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814-4799, USA
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Stojadinovic A, Kiang J, Smallridge R, Galloway R, Shea-Donohue T. Induction of heat-shock protein 72 protects against ischemia/reperfusion in rat small intestine. Gastroenterology 1995; 109:505-15. [PMID: 7615200 DOI: 10.1016/0016-5085(95)90339-9] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.2] [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] [Indexed: 01/26/2023]
Abstract
BACKGROUND & AIMS Induction of heat-shock protein 72 is associated with enhanced tolerance to subsequent nonthermal stresses. This study evaluated whether induction of heat-shock protein 72 protects against intestinal ischemia/reperfusion injury. METHODS Groups of nonheated and heated rats underwent sham operation, 30 minutes of ischemia by occlusion of the superior mesenteric artery, or ischemia followed by 60 minutes of reperfusion. Whole-body hyperthermia to a core temperature of 41.5-42 degrees C for 15-20 minutes was followed by passive cooling 2-3 hours before the experiment. Samples of small intestine were obtained for determination of heat-shock protein 72 production and ex vivo generation of prostaglandin E2 and leukotriene B4 and for histological assessment of mucosal injury and number of neutrophils. RESULTS Hyperthermia significantly increased heat-shock protein 72 production and significantly reduced ischemia/reperfusion-induced mucosal injury, neutrophilic infiltration, and leukotriene B4 production. Levels of leukotriene B4 and numbers of neutrophils were well correlated in nonheated (r = 0.72) but not in heated groups (r = -0.16). The elevation of prostaglandin E2 levels in response to ischemia and reperfusion was unaltered by hyperthermia. CONCLUSIONS The mechanism of heat stress-induced protection against intestinal ischemia/reperfusion injury involves inhibition of leukotriene B4 production and subsequent prevention of neutrophil activation and chemotaxis.
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Affiliation(s)
- A Stojadinovic
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
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