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McDiarmid MA, Hines S, Cloeren M, Gucer P, Condon M, Oliver M, Roth T, Lewin-Smith MR, Strathmann F, Velez-Quinones MA, Gaitens JM. The Department of Veterans' Affairs Depleted Uranium Cohort in the Time of COVID-19: Translating a Traditional Surveillance Protocol to a Telehealth Platform. J Occup Environ Med 2023; 65:670-676. [PMID: 37167933 PMCID: PMC10417219 DOI: 10.1097/jom.0000000000002875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE In 2021, 37 members of a cohort of depleted uranium-exposed Gulf War I veterans were evaluated using a protocol tailored to accommodate COVID-19 safety practices on a telehealth platform. METHODS Individual elements of the legacy protocol were reviewed for urgency and feasibility of inclusion in a modified, telehealth platform. RESULTS The redesigned protocol included a participant readiness for telehealth assessment, nurse and physician telehealth visits, collection of usual health questionnaires, and urine collections for exposure monitoring for uranium and other fragment-related metal measures. CONCLUSIONS Despite some limitations in scope, the telehealth platform permitted a visual "visit" with surveillance participants who expressed a high comfort level with the format. The telehealth platform has apparent utility for occupational surveillance and should be explored as a standard approach for surveillance outside of public health emergencies.
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McDiarmid MA, Gaitens JM, Hines S, Cloeren M, Breyer R, Condon M, Oliver M, Roth T, Gucer P, Kaup B, Brown L, Brown CH, Dux M, Glick D, Lewin-Smith MR, Strathmann F, Xu H, Velez-Quinones MA, Streeten E. Surveillance of Depleted Uranium-exposed Gulf War Veterans: More Evidence for Bone Effects. Health Phys 2021; 120:671-682. [PMID: 33867437 DOI: 10.1097/hp.0000000000001395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
ABSTRACT Gulf War I veterans who were victims of depleted uranium (DU) "friendly-fire" incidents have undergone longitudinal health surveillance since 1994. During the spring of 2019, 36 members of the cohort were evaluated with a monitoring protocol including exposure assessment for total and isotopic uranium concentrations in urine and a comprehensive review of health outcomes, including measures of bone metabolism and bone mineral density (BMD) determination. Elevated urine U concentrations were observed in cohort members with retained depleted uranium (DU) shrapnel fragments. In addition, a measure of bone resorption, N-telopeptide, showed a statistically significant increase in those in the high DU subgroup, a finding consistent with a statistically significant decrease in bone mass also observed in this high DU subgroup compared to the low DU subgroup. After more than 25 y since first exposure to DU, an aging cohort of military veterans continues to show few U-related health effects in known target organs of U toxicity. The new finding of impaired BMD in the high DU subgroup has now been detected in two consecutive surveillance visits. While this is a biologically plausible uranium effect, it is not reflected in other measures of bone metabolism in the full cohort, which have largely been within normal limits. However, ongoing accrual of the U burden from fragment absorption over time and the effect of aging further impairing BMD suggest the need for future surveillance assessments of this cohort.
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Affiliation(s)
| | | | | | | | - Richard Breyer
- Department of Veterans Affairs Medical Center Baltimore, MD
| | - Marian Condon
- Department of Veterans Affairs Medical Center Baltimore, MD
| | | | | | | | - Bruce Kaup
- Department of Veterans Affairs Medical Center Baltimore, MD
| | | | - Clayton H Brown
- Biophysical Toxicology, The Joint Pathology Center, Silver Spring, MD
| | - Moira Dux
- Department of Veterans Affairs Medical Center Baltimore, MD
| | - Danielle Glick
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Michael R Lewin-Smith
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 655 W Baltimore S, Baltimore, MD 21201
| | - Frederick Strathmann
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 655 W Baltimore S, Baltimore, MD 21201
| | - Hanna Xu
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 655 W Baltimore S, Baltimore, MD 21201
| | - Maria A Velez-Quinones
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 655 W Baltimore S, Baltimore, MD 21201
| | - Elizabeth Streeten
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
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Trendowski MR, El-Charif O, Ratain MJ, Monahan P, Mu Z, Wheeler HE, Dinh PC, Feldman DR, Ardeshir-Rouhani-Fard S, Hamilton RJ, Vaughn DJ, Fung C, Kollmannsberger C, Mushiroda T, Kubo M, Hannigan R, Strathmann F, Einhorn LH, Fossa SD, Travis LB, Dolan ME. Clinical and Genome-Wide Analysis of Serum Platinum Levels after Cisplatin-Based Chemotherapy. Clin Cancer Res 2019; 25:5913-5924. [PMID: 31296530 PMCID: PMC6774840 DOI: 10.1158/1078-0432.ccr-19-0113] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/17/2019] [Accepted: 07/09/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE Serum platinum is measurable for years after completion of cisplatin-based chemotherapy (CBC). We report the largest investigation of serum platinum levels to date of 1,010 testicular cancer survivors (TCS) assessed 1-35 years after CBC and evaluate genetic contributions to these levels. EXPERIMENTAL DESIGN Eligible TCS given 300 or 400 (±15) mg/m2 cisplatin underwent extensive audiometric testing, clinical examination, completed questionnaires, and had crude serum platinum levels measured. Associations between serum platinum and various risk factors and toxicities were assessed after fitting a biexponential model adjusted for follow-up time and cumulative cisplatin dose. A genome-wide association study (GWAS) was performed using the serum platinum residuals of the dose and time-adjusted model. RESULTS Serum platinum levels exceeded the reference range for approximately 31 years, with a strong inverse relationship with creatinine clearance at follow-up (age-adjusted P = 2.13 × 10-3). We observed a significant, positive association between residual platinum values and luteinizing hormone (age-adjusted P = 6.58 × 10-3). Patients with high residual platinum levels experienced greater Raynaud phenomenon than those with medium or low levels (age-adjusted ORhigh/low = 1.46; P = 0.04), as well as a higher likelihood of developing tinnitus (age-adjusted ORhigh/low = 1.68, P = 0.07). GWAS identified one single-nucleotide polymorphism (SNP) meeting genome-wide significance, rs1377817 (P = 4.6 × 10-8, a SNP intronic to MYH14). CONCLUSIONS This study indicates that residual platinum values are correlated with several cisplatin-related toxicities. One genetic variant is associated with these levels.
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Affiliation(s)
| | - Omar El-Charif
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Mark J Ratain
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Patrick Monahan
- Department of Medical Oncology, Indiana University, Indianapolis, Indiana
| | - Zepeng Mu
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Heather E Wheeler
- Departments of Biology and Computer Science, Loyola University Chicago, Chicago, Illinois
| | - Paul C Dinh
- Department of Medical Oncology, Indiana University, Indianapolis, Indiana
| | - Darren R Feldman
- Department of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | - Robert J Hamilton
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - David J Vaughn
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chunkit Fung
- J.P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | | | | | - Michiaki Kubo
- RIKEN Center for Integrative Medical Science, Yokohama, Japan
| | - Robyn Hannigan
- School for the Environment, University of Massachusetts Boston, Boston, Massachusetts
| | | | - Lawrence H Einhorn
- Department of Medical Oncology, Indiana University, Indianapolis, Indiana
| | - Sophie D Fossa
- Department of Oncology, Oslo University Hospital, Radiumhospital, Oslo, Norway
| | - Lois B Travis
- Department of Medical Oncology, Indiana University, Indianapolis, Indiana.
| | - M Eileen Dolan
- Department of Medicine, University of Chicago, Chicago, Illinois.
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McDiarmid MA, Cloeren M, Gaitens JM, Hines S, Streeten E, Breyer RJ, Brown CH, Condon M, Roth T, Oliver M, Brown L, Dux M, Lewin-Smith MR, Strathmann F, Velez-Quinones MA, Gucer P. Surveillance results and bone effects in the Gulf War depleted uranium-exposed cohort. J Toxicol Environ Health A 2018; 81:1083-1097. [PMID: 30373484 DOI: 10.1080/15287394.2018.1538914] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/16/2018] [Accepted: 10/18/2018] [Indexed: 06/08/2023]
Abstract
A small group of Gulf War I veterans wounded in depleted uranium (DU) friendly-fire incidents have been monitored in a clinical surveillance program since 1993. During the spring of 2017, 42 members of the cohort were evaluated with a protocol which includes exposure monitoring for total and isotopic uranium concentrations in urine and a comprehensive assessment of health outcomes including measures of bone metabolism, and for participants >50 years, bone mineral density (BMD) determination. Elevated urine U concentrations were observed in cohort members with retained DU shrapnel fragments. Only the mean serum estradiol concentration, a marker of bone metabolism, was found to be significantly different for lower-vs- higher urine U (uU) cohort sub-groups. For the first time, a significant deficit in BMD was observed in the over age 50, high uU sub-group. After more than 25 years since first exposure to DU, an aging cohort of military veterans continues to exhibit few U-related adverse health effects in known target organs of U toxicity. The new finding of reduced BMD in older cohort members, while biologically plausible, was not suggested by other measures of bone metabolism in the full (all ages) cohort, as these were predominantly within normal limits over time. Only estradiol was recently found to display a difference as a function of uU grouping. As BMD is further impacted by aging and the U-burden from fragment absorption accrues in this cohort, a U effect may be clarified in future surveillance visits.
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Affiliation(s)
- Melissa A McDiarmid
- a Department of Veterans Affairs Medical Center Baltimore , Baltimore , MD , USA
- b Department of Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Marianne Cloeren
- a Department of Veterans Affairs Medical Center Baltimore , Baltimore , MD , USA
- b Department of Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Joanna M Gaitens
- a Department of Veterans Affairs Medical Center Baltimore , Baltimore , MD , USA
- b Department of Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Stella Hines
- a Department of Veterans Affairs Medical Center Baltimore , Baltimore , MD , USA
- b Department of Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Elizabeth Streeten
- b Department of Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Richard J Breyer
- a Department of Veterans Affairs Medical Center Baltimore , Baltimore , MD , USA
| | - Clayton H Brown
- d Department of Epidemiology and Preventive Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Marian Condon
- a Department of Veterans Affairs Medical Center Baltimore , Baltimore , MD , USA
| | - Tracy Roth
- a Department of Veterans Affairs Medical Center Baltimore , Baltimore , MD , USA
- b Department of Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Marc Oliver
- a Department of Veterans Affairs Medical Center Baltimore , Baltimore , MD , USA
- b Department of Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Lawrence Brown
- a Department of Veterans Affairs Medical Center Baltimore , Baltimore , MD , USA
- c Department of Pathology , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Moira Dux
- a Department of Veterans Affairs Medical Center Baltimore , Baltimore , MD , USA
| | - Michael R Lewin-Smith
- e Environmental Toxicology Laboratory, The Joint Pathology Center , University of Maryland School of Medicine , Silver Spring , MD , USA
| | - Frederick Strathmann
- e Environmental Toxicology Laboratory, The Joint Pathology Center , University of Maryland School of Medicine , Silver Spring , MD , USA
| | - Maria A Velez-Quinones
- e Environmental Toxicology Laboratory, The Joint Pathology Center , University of Maryland School of Medicine , Silver Spring , MD , USA
| | - Patricia Gucer
- a Department of Veterans Affairs Medical Center Baltimore , Baltimore , MD , USA
- b Department of Medicine , University of Maryland School of Medicine , Baltimore , MD , USA
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Gehrie EA, Keiser A, Haglock-Adler CJ, Strathmann F, Booth GS. Detecting Pharmaceuticals in the Red Blood Cell Inventory of a Hospital Blood Bank. J Pediatr 2017; 189:227-231.e1. [PMID: 28669612 DOI: 10.1016/j.jpeds.2017.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/22/2017] [Accepted: 06/05/2017] [Indexed: 01/13/2023]
Abstract
We tested 220 red blood cell units for the presence of pharmaceuticals; 15 units (6.8%) were confirmed to contain low concentrations of opiates, benzodiazepines, stimulants, or barbiturates. Further study is needed to determine whether these drugs, which are not prohibited in donated blood by current Food and Drug Administration standards, could mediate adverse reactions in children.
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Affiliation(s)
- Eric A Gehrie
- Department of Pathology, Johns Hopkins University, Baltimore, MD
| | - Amaris Keiser
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| | | | | | - Garrett S Booth
- Department of Pathology, Johns Hopkins University, Baltimore, MD.
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Owen W, Thatcher M, Crabtree K, Greer R, Strathmann F, Straseski J, Genzen J. Body Fluid Matrix Evaluation on a Roche cobas 8000 System. Am J Clin Pathol 2015. [DOI: 10.1093/ajcp/144.suppl2.070] [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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Lerch M, Strathmann F, Baird G. Development of a prognostic breast cancer diagnostic: Quantitative analysis of HER2 status using a multiplex bead assay on homogenized formalin fixed paraffin embedded breast tumor tissue (LB484). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.lb484] [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: 11/11/2022]
Affiliation(s)
- Melissa Lerch
- Lab Medicine University of WashingtonSeattleWAUnited States
| | | | - Geoffrey Baird
- Lab Medicine University of WashingtonSeattleWAUnited States
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Gehrie E, Keiser A, Dawling S, Travis J, Strathmann F, Booth GS. Primary prevention of pediatric lead exposure requires new approaches to transfusion screening. J Pediatr 2013; 163:855-9. [PMID: 23582137 PMCID: PMC4795168 DOI: 10.1016/j.jpeds.2013.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 01/22/2013] [Accepted: 03/04/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To facilitate further assessment of transfusion-associated lead exposure by designing a procedure to test packed red blood cells (pRBCs) prepared for transfusion. STUDY DESIGN The relationship between pRBCs and whole blood lead concentration was investigated in 27 samples using a modified clinical assay. Lead concentrations were measured in 100 pRBC units. RESULTS Our sample preparation method demonstrated a correlation between whole blood lead and pRBC lead concentrations (R(2) = 0.82). In addition, all 100 pRBC units tested had detectable lead levels. The median pRBC lead concentration was 0.8 μg/dL, with an SD of 0.8 μg/dL and a range of 0.2-4.1 μg/dL. In addition, after only a few days of storage, approximately 25% of whole blood lead was found in the supernatant plasma. CONCLUSION Transfusion of pRBCs is a source of lead exposure. Here we report the quantification of lead concentration in pRBCs. We found a >20-fold range of lead concentrations in the samples tested. Pretransfusion testing of pRBC units according to our proposed approach or donor screening of whole blood lead and selection of below-average units for transfusion to children would diminish an easily overlooked source of pediatric lead exposure.
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Affiliation(s)
- Eric Gehrie
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Amaris Keiser
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Sheila Dawling
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - James Travis
- ARUP Institute for Clinical and Experimental Pathology, University of Utah Health Sciences Center, Salt Lake City, UT
| | - Frederick Strathmann
- ARUP Institute for Clinical and Experimental Pathology, University of Utah Health Sciences Center, Salt Lake City, UT
- Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, UT
| | - Garrett S. Booth
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
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Mock DJ, Strathmann F, Blumberg BM, Mayer-Proschel M. Infection of murine oligodendroglial precursor cells with Human Herpesvirus 6 (HHV-6)--establishment of a murine in vitro model. J Clin Virol 2007; 37 Suppl 1:S17-23. [PMID: 17276361 DOI: 10.1016/s1386-6532(06)70006-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Human Herpesvirus 6 was previously demonstrated to infect human oligodendroglial precursor cells (OPCs) in vitro causing cell cycle arrest and premature differentiation with consequent loss of the precursor pool. OBJECTIVES To develop an in vitro murine OPC model to study the cell cycle and differentiation effects of HHV-6 in more readily available, genetically well-defined cells free of the risk of contamination with human herpesviruses. STUDY DESIGN Murine OPCs were exposed to infectious HHV-6A or HHV-6B and analyzed for production of viral transcripts, particles, and replicating virus. FACS analysis and specific markers were used to evaluate effects on cell cycling and differentiation. RESULTS HHV-6 infection of murine OPCs resulted in production of both immediate-early and some late transcripts but no replicating virus by TaqMan quantitative PCR or electron microscopy. Both a specific G1/S cell cycle arrest and premature loss of OPCs through differentiation into oligodendrocytes as previously seen with human precursors were recapitulated. CONCLUSIONS Infection of murine OPCs by HHV-6 reproduces the critical phenotypes of cell cycle arrest and altered differentiation seen in human cells. The murine system provides a highly defined, accessible, and reproducible source of cells permitting the elucidation of specific viral and cell cycle genes involved in CNS viral infections of OPCs.
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Affiliation(s)
- David J Mock
- Department of Neurology, University of Rochester, Rochester, NY 14642, USA.
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Mock DJ, Chugh P, Kim B, Pröschel C, Dietrich J, Strathmann F, Blumberg BM, Mayer-Pröschel M. Characterization of specific HHV-6 and cell cycle genes implicated in virus-mediated G1/S cell-cycle arrest of glial precursors. Retrovirology 2006. [PMCID: PMC1716977 DOI: 10.1186/1742-4690-3-s1-s65] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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