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Hamilton E, Oliveira M, Turner N, García-Corbacho J, Hernando C, Ciruelos EM, Kabos P, Borrego MR, Armstrong A, Patel MR, Vaklavas C, Twelves C, Boni V, Incorvati J, Brier T, Gibbons L, Klinowska T, Lindemann JPO, Morrow CJ, Sykes A, Baird R. A Phase 1 dose escalation and expansion trial of the next-generation oral SERD camizestrant in women with ER-positive, HER2-negative advanced breast cancer: SERENA-1 monotherapy results. Ann Oncol 2024:S0923-7534(24)00138-8. [PMID: 38729567 DOI: 10.1016/j.annonc.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND SERENA-1 (NCT03616587) is a Phase 1, multi-part, open-label study of camizestrant in pre- and post-menopausal women with ER+, HER2- advanced breast cancer. Parts A and B aim to determine the safety and tolerability of camizestrant monotherapy and define doses for clinical evaluation. Patients and Methods Women aged 18 years or older with metastatic or recurrent ER+, HER2- breast cancer, refractory (or intolerant) to therapy were assigned 25 mg up to 450 mg once daily (QD; escalation) or 75, 150, or 300 mg QD (expansion). Safety and tolerability, anti-tumor efficacy, pharmacokinetics, and impact on ESR1m circulating tumor (ct)DNA levels were assessed. RESULTS By 9 March 2021, 108 patients received camizestrant monotherapy at 25-450 mg doses. Of these, 93 (86.1%) experienced treatment-related adverse events (TRAEs), 82.4% of which were grade 1 or 2. The most common TRAEs were visual effects (56%), (sinus) bradycardia (44%), fatigue (26%), and nausea (15%). There were no TRAEs grade 3 or higher, or treatment-related serious adverse events (TRSAEs) at doses ≤150 mg. Median tmax was achieved ∼2-4 hours post-dose at all doses investigated, with an estimated half-life of 20-23 hours. Efficacy was observed at all doses investigated, including in patients with prior CDK4/6 inhibitor and/or fulvestrant treatment, with and without baseline ESR1 mutations, and with visceral disease, including liver metastases. CONCLUSIONS Camizestrant is a next-generation oral SERD and pure ER antagonist with a tolerable safety profile. The pharmacokinetics profile supports once-daily dosing, with evidence of pharmacodynamic and clinical efficacy in heavily pre-treated patients, regardless of ESR1m. This study established 75, 150 and 300 mg QD doses for Phase 2 testing (SERENA-2, NCT04214288 and SERENA-3, NCT04588298).
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Affiliation(s)
- E Hamilton
- Sarah Cannon Research Institute, Nashville, TN, USA
| | - M Oliveira
- Medical Oncology Department, Vall d'Hebron University Hospital and Breast Cancer Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - N Turner
- Breast Cancer Now, Toby Robins Research Centre, Institute of Cancer Research, London, UK
| | | | - C Hernando
- Department of Medical Oncology, Hospital Clinico Universitario de Valencia, Biomedical Research Institute (INCLIVA), Valencia, Spain
| | - E M Ciruelos
- Medical Oncology Department, 12 de Octubre University Hospital, Madrid, Spain
| | - P Kabos
- Division of Medical Oncology, University of Colorado, CO, USA
| | - M R Borrego
- Department of Medical Oncology, H U Virgen del Rocio, Seville, Spain
| | - A Armstrong
- The Christie NHS Foundation Trust and the University of Manchester, Manchester, UK
| | - M R Patel
- Florida Cancer Specialists/Sarah Cannon Research Institute/Sarasota Memorial Hospital, Sarasota, FL, USA
| | - C Vaklavas
- Huntsman Cancer Institute, University of Utah, UT, USA
| | - C Twelves
- Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds, UK
| | - V Boni
- START Madrid, CIOCC, Madrid, Spain
| | - J Incorvati
- Fox Chase Cancer Center, East Norriton-Hospital Outpatient Center, Philadelphia, PA, USA
| | - T Brier
- Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, UK
| | - L Gibbons
- Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, UK
| | - T Klinowska
- Late Development, Oncology R&D, AstraZeneca, Cambridge, UK
| | - J P O Lindemann
- Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, UK
| | - C J Morrow
- Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, UK
| | - A Sykes
- Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, UK
| | - R Baird
- Cancer Research UK, Cambridge Centre, Cambridge, UK.
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Subramanian MP, Eaton DB, Labilles UL, Heiden BT, Chang SH, Yan Y, Schoen MW, Patel MR, Kreisel D, Nava RG, Thomas TS, Meyers BF, Kozower BD, Puri V. Exposure to Agent Orange is associated with increased recurrence after surgical treatment of stage I non-small cell lung cancer. J Thorac Cardiovasc Surg 2024; 167:1591-1600.e2. [PMID: 37709166 DOI: 10.1016/j.jtcvs.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 07/31/2023] [Accepted: 09/02/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE Approximately 3 million Americans served in the armed forces during the Vietnam War. Veterans have a higher incidence rate of lung cancer compared with the general population, which may be related to exposures sustained during service. Agent Orange, one of the tactical herbicides used by the armed forces as a means of destroying crops and clearing vegetation, has been linked to the development of several cancers including non-small cell lung cancer. However, traditional risk models of lung cancer survival and recurrence often do not include such exposures. We aimed to examine the relationship between Agent Orange exposure and overall survival and disease recurrence for surgically treated stage I non-small cell lung cancer. METHODS We performed a retrospective cohort study using a uniquely compiled dataset of US Veterans with pathologic I non-small cell lung cancer. We included adult patients who served in the Vietnam War and underwent surgical resection between 2010 and 2016. Our 2 comparison groups included those with identified Agent Orange exposure and those who were unexposed. We used multivariable Cox proportional hazards and Fine and Gray competing risk analyses to examine overall survival and disease recurrence for patients with pathologic stage I disease, respectively. RESULTS A total of 3958 Vietnam Veterans with pathologic stage I disease were identified (994 who had Agent Orange exposure and 2964 who were unexposed). Those who had Agent Orange exposure were more likely to be male, to be White, and to live a further distance from their treatment facility (P < .05). Tumor size distribution, grade, and histology were similar between cohorts. Multivariable Cox proportional hazards modeling identified similar overall survival between cohorts (Agent Orange exposure hazard ratio, 0.97; 95% CI, 0.86-1.09). Patients who had Agent Orange exposure had a 19% increased risk of disease recurrence (hazard ratio, 1.19; 95% CI, 1.02-1.40). CONCLUSIONS Veterans with known Agent Orange exposure who undergo surgical treatment for stage I non-small cell lung cancer have an approximately 20% increased risk of disease recurrence compared with their nonexposed counterparts. Agent Orange exposure should be taken into consideration when determining treatment and surveillance regimens for Veteran patients.
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Affiliation(s)
- Melanie P Subramanian
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo.
| | - Daniel B Eaton
- Veterans Affairs St Louis Health Care System, St Louis, Mo
| | | | - Brendan T Heiden
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | - Su-Hsin Chang
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | - Yan Yan
- Veterans Affairs St Louis Health Care System, St Louis, Mo; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | - Martin W Schoen
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Mo; Division of Hematology and Medical Oncology, Department of Internal Medicine, Saint Louis University School of Medicine, St Louis, Mo
| | - Mayank R Patel
- Veterans Affairs St Louis Health Care System, St Louis, Mo
| | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | - Ruben G Nava
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | - Theodore S Thomas
- Department of Medical Oncology, Washington University School of Medicine, St Louis, Mo
| | - Bryan F Meyers
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo
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Subramanian MP, Eaton DB, Heiden BT, Brandt WS, Labilles UL, Chang SH, Yan Y, Schoen MW, Patel MR, Kreisel D, Nava RG, Thomas T, Meyers BF, Kozower BD, Puri V. Lobe-specific lymph node sampling is associated with lower risk of cancer recurrence. JTCVS Open 2024; 17:271-283. [PMID: 38420561 PMCID: PMC10897676 DOI: 10.1016/j.xjon.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/06/2023] [Accepted: 11/13/2023] [Indexed: 03/02/2024]
Abstract
Objective Adequate intraoperative lymph node (LN) assessment is a critical component of early-stage non-small cell lung cancer (NSCLC) resection. The National Comprehensive Cancer Network and the American College of Surgeons Commission on Cancer (CoC) recommend station-based sampling minimums agnostic to tumor location. Other institutions advocate for lobe-specific LN sampling strategies that consider the anatomic likelihood of LN metastases. We examined the relationship between lobe-specific LN assessment and long-term outcomes using a robust, highly curated cohort of stage I NSCLC patients. Methods We performed a cohort study using a uniquely compiled dataset from the Veterans Health Administration and manually abstracted data from operative and pathology reports for patients with clinical stage I NSCLC (2006-2016). For simplicity in comparison, we included patients who had right upper lobe (RUL) or left upper lobe (LUL) tumors. Based on modified European Society of Thoracic Surgeons guidelines, lobe-specific sampling was defined for RUL tumors (stations 2, 4, 7, and 10 or 11) and LUL tumors (stations 5 or 6, 7, and 10 or 11). Our primary outcome was the risk of cancer recurrence, as assessed by Fine and Gray competing risks modeling. Secondary outcomes included overall survival (OS) and pathologic upstaging. Analyses were adjusted for relevant patient, disease, and treatment variables. Results Our study included 3534 patients with RUL tumors and 2667 patients with LUL tumors. Of these, 277 patients (7.8%) with RUL tumors and 621 patients (23.2%) with LUL tumors met lobe-specific assessment criteria. Comparatively, 34.7% of patients met the criteria for count-based assessment, and 25.8% met the criteria for station-based sampling (ie, any 3 N2 stations and 1 N1 station). Adherence to lobe-specific assessment was associated with lower cumulative incidence of recurrence (adjusted hazard ratio [aHR], 0.83; 95% confidence interval [CI], 0.70-0.98) and a higher likelihood of pathologic upstaging (aHR, 1.49; 95% CI, 1.20-1.86). Lobe-specific assessment was not associated with OS. Conclusions Adherence to intraoperative LN sampling guidelines is low. Lobe-specific assessment is associated with superior outcomes in early-stage NSCLC. Quality metrics that assess adherence to intraoperative LN sampling, such as the CoC Operative Standards manual, also should consider lobe-specific criteria.
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Affiliation(s)
- Melanie P Subramanian
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | - Daniel B Eaton
- Veterans Affairs St Louis Health Care System, St Louis, Mo
| | - Brendan T Heiden
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | - Whitney S Brandt
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | | | - Su-Hsin Chang
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | - Yan Yan
- Veterans Affairs St Louis Health Care System, St Louis, Mo
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | - Martin W Schoen
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Mo
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Saint Louis University School of Medicine, St Louis, Mo
| | - Mayank R Patel
- Veterans Affairs St Louis Health Care System, St Louis, Mo
| | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | - Ruben G Nava
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | - Theodore Thomas
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Saint Louis University School of Medicine, St Louis, Mo
| | - Bryan F Meyers
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo
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Tohmasi S, Eaton DB, Heiden BT, Rossetti NE, Rasi V, Chang SH, Yan Y, Gopukumar D, Patel MR, Meyers BF, Kozower BD, Puri V, Schoen MW. Inhaled medications for chronic obstructive pulmonary disease predict surgical complications and survival in stage I non-small cell lung cancer. J Thorac Dis 2023; 15:6544-6554. [PMID: 38249867 PMCID: PMC10797395 DOI: 10.21037/jtd-23-1273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/20/2023] [Indexed: 01/23/2024]
Abstract
Background Lung function is routinely assessed prior to surgical resection for non-small cell lung cancer (NSCLC). Further assessment of chronic obstructive pulmonary disease (COPD) using inhaled COPD medications to determine disease severity, a readily available metric of disease burden, may predict postoperative outcomes and overall survival (OS) in lung cancer patients undergoing surgery. Methods We retrospectively evaluated clinical stage I NSCLC patients receiving surgical treatment within the Veterans Health Administration from 2006-2016 to determine the relationship between number and type of inhaled COPD medications (short- and long-acting beta2-agonists, muscarinic antagonists, or corticosteroids prescribed within 1 year before surgery) and postoperative outcomes including OS using multivariable models. We also assessed the relationship between inhaled COPD medications, disease severity [measured by forced expiratory volume in 1 second (FEV1)], and diagnosis of COPD. Results Among 9,741 veterans undergoing surgery for clinical stage I NSCLC, patients with COPD were more likely to be prescribed inhaled medications than those without COPD [odds ratio (OR) =5.367, 95% confidence interval (CI): 4.886-5.896]. Increased severity of COPD was associated with increased number of prescribed inhaled COPD medications (P<0.0001). The number of inhaled COPD medications was associated with prolonged hospital stay [adjusted OR (aOR) =1.119, 95% CI: 1.076-1.165), more major complications (aOR =1.117, 95% CI: 1.074-1.163), increased 90-day mortality (aOR =1.088, 95% CI: 1.013-1.170), and decreased OS [adjusted hazard ratio (aHR) =1.061, 95% CI: 1.042-1.080]. In patients with FEV1 ≥80% predicted, greater number of prescribed inhaled COPD medications was associated with increased 30-day mortality (aOR =1.265, 95% CI: 1.062-1.505), prolonged hospital stay (aOR =1.130, 95% CI: 1.051-1.216), more major complications (aOR =1.147, 95% CI: 1.064-1.235), and decreased OS (aHR =1.058, 95% CI: 1.022-1.095). When adjusting for other drug classes and covariables, short-acting beta2-agonists were associated with increased 90-day mortality (aOR =1.527, 95% CI: 1.120-2.083) and decreased OS (aHR =1.087, 95% CI: 1.005-1.177). Conclusions In patients with early-stage NSCLC, inhaled COPD medications prescribed prior to surgery were associated with both short- and long-term outcomes, including in patients with FEV1 ≥80% predicted. Routine assessment of COPD medications may be a simple method to quantify operative risk in early-stage NSCLC patients.
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Affiliation(s)
- Steven Tohmasi
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Daniel B. Eaton
- Veterans Affairs St. Louis Health Care System, St. Louis, MO, USA
| | - Brendan T. Heiden
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Nikki E. Rossetti
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Valerio Rasi
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Su-Hsin Chang
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Yan Yan
- Veterans Affairs St. Louis Health Care System, St. Louis, MO, USA
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Deepika Gopukumar
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Mayank R. Patel
- Veterans Affairs St. Louis Health Care System, St. Louis, MO, USA
| | - Bryan F. Meyers
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Benjamin D. Kozower
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Veterans Affairs St. Louis Health Care System, St. Louis, MO, USA
| | - Martin W. Schoen
- Veterans Affairs St. Louis Health Care System, St. Louis, MO, USA
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
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Heiden BT, Eaton DB, Brandt WS, Chang SH, Yan Y, Schoen MW, Patel MR, Kreisel D, Nava RG, Meyers BF, Kozower BD, Puri V. Development and Validation of the VA Lung Cancer Mortality (VALCAN-M) Score for 90-Day Mortality Following Surgical Treatment of Clinical Stage I Lung Cancer. Ann Surg 2023; 278:e634-e640. [PMID: 36250678 PMCID: PMC10106524 DOI: 10.1097/sla.0000000000005725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim was to develop and validate the Veterans Administration (VA) Lung Cancer Mortality (VALCAN-M) score, a risk prediction model for 90-day mortality following surgical treatment of clinical stage I nonsmall-cell lung cancer (NSCLC). BACKGROUND While surgery remains the preferred treatment for functionally fit patients with early-stage NSCLC, less invasive, nonsurgical treatments have emerged for high-risk patients. Accurate risk prediction models for postoperative mortality may aid surgeons and other providers in optimizing patient-centered treatment plans. METHODS We performed a retrospective cohort study using a uniquely compiled VA data set including all Veterans with clinical stage I NSCLC undergoing surgical treatment between 2006 and 2016. Patients were randomly split into derivation and validation cohorts. We derived the VALCAN-M score based on multivariable logistic regression modeling of patient and treatment variables and 90-day mortality. RESULTS A total of 9749 patients were included (derivation cohort: n=6825, 70.0%; validation cohort: n=2924, 30.0%). The 90-day mortality rate was 4.0% (n=390). The final multivariable model included 11 factors that were associated with 90-day mortality: age, body mass index, history of heart failure, forced expiratory volume (% predicted), history of peripheral vascular disease, functional status, delayed surgery, American Society of Anesthesiology performance status, tumor histology, extent of resection (lobectomy, wedge, segmentectomy, or pneumonectomy), and surgical approach (minimally invasive or open). The c statistic was 0.739 (95% CI=0.708-0.771) in the derivation cohort. CONCLUSIONS The VALCAN-M score uses readily available treatment-related variables to reliably predict 90-day operative mortality. This score can aid surgeons and other providers in objectively discussing operative risk among high-risk patients with clinical stage I NSCLC considering surgery versus other definitive therapies.
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Affiliation(s)
- Brendan T Heiden
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO
| | | | - Whitney S Brandt
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Su-Hsin Chang
- VA St. Louis Health Care System, St. Louis, MO
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO
| | - Yan Yan
- VA St. Louis Health Care System, St. Louis, MO
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO
| | - Martin W Schoen
- VA St. Louis Health Care System, St. Louis, MO
- Department of Internal Medicine, Division of Hematology and Medical Oncology, Saint Louis University School of Medicine, St. Louis, MO
| | | | - Daniel Kreisel
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO
- VA St. Louis Health Care System, St. Louis, MO
| | - Ruben G Nava
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO
- VA St. Louis Health Care System, St. Louis, MO
| | - Bryan F Meyers
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Benjamin D Kozower
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Varun Puri
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO
- VA St. Louis Health Care System, St. Louis, MO
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Heiden BT, Eaton DB, Chang SH, Yan Y, Schoen MW, Chen LS, Smock N, Patel MR, Kreisel D, Nava RG, Meyers BF, Kozower BD, Puri V. Assessment of Duration of Smoking Cessation Prior to Surgical Treatment of Non-small Cell Lung Cancer. Ann Surg 2023; 277:e933-e940. [PMID: 34793352 PMCID: PMC9114169 DOI: 10.1097/sla.0000000000005312] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To define the relationship between the duration of smoking cessation and postoperative complications for patients with lung cancer undergoing surgical treatment. BACKGROUND Smoking increases the risk of postoperative morbidity and mortality in patients with lung cancer undergoing surgical treatment. Although smoking cessation before surgery can mitigate these risks, the ideal duration of preoperative smoking cessation remains unclear. METHODS Using a uniquely compiled Veterans Health Administration dataset, we performed a retrospective cohort study of patients with clinical stage I non-small cell lung cancer undergoing surgical treatment between 2006 and 2016. We characterized the relationship between duration of preoperative smoking cessation and risk of postoperative complications or mortality within 30-days using multivariable restricted cubic spline functions. RESULTS The study included a total of 9509 patients, of whom 6168 (64.9%) were smoking at the time of lung cancer diagnosis. Among them, only 662 (10.7%) patients stopped smoking prior to surgery. Longer duration between smoking cessation and surgery was associated with lower odds of major complication or mortality (adjusted odds ratio [aOR] for every additional week, 0.919; 95% confidence interval [CI], 0.850-0.993; P = 0.03). Compared to nonsmokers, patients who quit at least 3 weeks before surgery had similar odds of death or major complication (aOR, 1.005; 95% CI, 0.702-1.437; P = 0.98) whereas those who quit within 3 weeks of surgery had significantly higher odds of death or major complication (aOR, 1.698; 95% CI, 1.203-2.396; P = 0.003). CONCLUSION Smoking cessation at least 3 weeks prior to the surgical treatment of lung cancer is associated with reduced morbidity and mortality. Providers should aggressively encourage smoking cessation in the preoperative period, since it can disproportionately impact outcomes in early-stage lung cancer.
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Affiliation(s)
- Brendan T. Heiden
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | | | - Su-Hsin Chang
- VA St. Louis Health Care System, St. Louis, MO
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Yan Yan
- VA St. Louis Health Care System, St. Louis, MO
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Martin W. Schoen
- VA St. Louis Health Care System, St. Louis, MO
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO
| | - Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO
| | - Nina Smock
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | | | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
- VA St. Louis Health Care System, St. Louis, MO
| | - Ruben G. Nava
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
- VA St. Louis Health Care System, St. Louis, MO
| | - Bryan F. Meyers
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Benjamin D. Kozower
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
- VA St. Louis Health Care System, St. Louis, MO
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Heiden BT, Eaton DB, Chang SH, Yan Y, Schoen MW, Thomas TS, Patel MR, Kreisel D, Nava RG, Meyers BF, Kozower BD, Puri V. Association between imaging surveillance frequency and outcomes following surgical treatment of early-stage lung cancer. J Natl Cancer Inst 2023; 115:303-310. [PMID: 36442509 PMCID: PMC9996218 DOI: 10.1093/jnci/djac208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/14/2022] [Accepted: 11/08/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Recent studies have suggested that more frequent postoperative surveillance imaging via computed tomography following lung cancer resection may not improve outcomes. We sought to validate these findings using a uniquely compiled dataset from the Veterans Health Administration, the largest integrated health-care system in the United States. METHODS We performed a retrospective cohort study of veterans with pathologic stage I non-small cell lung cancer receiving surgery (2006-2016). We assessed the relationship between surveillance frequency (chest computed tomography scans within 2 years after surgery) and recurrence-free survival and overall survival. RESULTS Among 6171 patients, 3047 (49.4%) and 3124 (50.6%) underwent low-frequency (<2 scans per year; every 6-12 months) and high-frequency (≥2 scans per year; every 3-6 months) surveillance, respectively. Factors associated with high-frequency surveillance included being a former smoker (vs current; adjusted odds ratio [aOR] = 1.18, 95% confidence interval [CI] = 1.05 to 1.33), receiving a wedge resection (vs lobectomy; aOR = 1.21, 95% CI = 1.05 to 1.39), and having follow-up with an oncologist (aOR = 1.58, 95% CI = 1.42 to 1.77), whereas African American race was associated with low-frequency surveillance (vs White race; aOR = 0.64, 95% CI = 0.54 to 0.75). With a median (interquartile range) follow-up of 7.3 (3.4-12.5) years, recurrence was detected in 1360 (22.0%) patients. High-frequency surveillance was not associated with longer recurrence-free survival (adjusted hazard ratio = 0.93, 95% CI = 0.83 to 1.04, P = .22) or overall survival (adjusted hazard ratio = 1.04, 95% CI = 0.96 to 1.12, P = .35). CONCLUSIONS We found that high-frequency surveillance does not improve outcomes in surgically treated stage I non-small cell lung cancer. Future lung cancer treatment guidelines should consider less frequent surveillance imaging in patients with stage I disease.
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Affiliation(s)
- Brendan T Heiden
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Su-Hsin Chang
- VA St. Louis Health Care System, St. Louis, MO, USA
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Yan Yan
- VA St. Louis Health Care System, St. Louis, MO, USA
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Martin W Schoen
- VA St. Louis Health Care System, St. Louis, MO, USA
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Theodore S Thomas
- VA St. Louis Health Care System, St. Louis, MO, USA
- Divisions of Hematology and Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
- VA St. Louis Health Care System, St. Louis, MO, USA
| | - Ruben G Nava
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
- VA St. Louis Health Care System, St. Louis, MO, USA
| | - Bryan F Meyers
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
- VA St. Louis Health Care System, St. Louis, MO, USA
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Heiden BT, Eaton DB, Chang SH, Yan Y, Baumann AA, Schoen MW, Tohmasi S, Rossetti NE, Patel MR, Kreisel D, Nava RG, Meyers BF, Kozower BD, Puri V. Association Between Surgical Quality Metric Adherence and Overall Survival Among US Veterans With Early-Stage Non-Small Cell Lung Cancer. JAMA Surg 2023; 158:293-301. [PMID: 36652269 PMCID: PMC9857796 DOI: 10.1001/jamasurg.2022.6826] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/16/2022] [Indexed: 01/19/2023]
Abstract
Importance Surgical resection remains the preferred treatment for functionally fit patients diagnosed with early-stage non-small cell lung cancer (NSCLC). Process-based intraoperative quality metrics (QMs) are important for optimizing long-term outcomes following curative-intent resection. Objective To develop a practical surgical quality score for patients diagnosed with clinical stage I NSCLC who received definitive surgical treatment. Design, Setting, and Participants This retrospective cohort study used a uniquely compiled data set of US veterans diagnosed with clinical stage I NSCLC who received definitive surgical treatment from October 2006 through September 2016. The data were analyzed from April 1 to September 1, 2022. Based on contemporary treatment guidelines, 5 surgical QMs were defined: timely surgery, minimally invasive approach, anatomic resection, adequate lymph node sampling, and negative surgical margin. The study developed a surgical quality score reflecting the association between these QMs and overall survival (OS), which was further validated in a cohort of patients using data from the National Cancer Database (NCDB). The study also examined the association between the surgical quality score and recurrence-free survival (RFS). Exposures Surgical treatment of early-stage NSCLC. Main Outcomes and Measures Overall survival and RFS. Results The study included 9628 veterans who underwent surgical treatment between 2006 and 2016. The cohort consisted of 1446 patients who had a mean (SD) age of 67.6 (7.9) years and included 9278 males (96.4%) and 350 females (3.6%). Among the cohort, 5627 individuals (58.4%) identified as being smokers at the time of surgical treatment. The QMs were met as follows: timely surgery (6633 [68.9%]), minimally invasive approach (3986 [41.4%]), lobectomy (6843 [71.1%]) or segmentectomy (532 [5.5%]), adequate lymph node sampling (3278 [34.0%]), and negative surgical margin (9312 [96.7%]). The median (IQR) follow-up time was 6.2 (2.5-11.4) years. An integer-based score (termed the Veterans Affairs Lung Cancer Operative quality [VALCAN-O] score) from 0 (no QMs met) to 13 (all QMs met) was constructed, with higher scores reflecting progressively better risk-adjusted OS. The median (IQR) OS differed substantially between the score categories (score of 0-5 points, 2.6 [1.0-5.7] years of OS; 6-8 points, 4.3 [1.7-8.6] years; 9-11 points, 6.3 [2.6-11.4] years; and 12-13 points, 7.0 [3.0-12.5] years; P < .001). In addition, risk-adjusted RFS improved in a stepwise manner between the score categories (6-8 vs 0-5 points, multivariable-adjusted hazard ratio [aHR], 0.62; 95% CI, 0.48-0.79; P < .001; 12-13 vs 0-5 points, aHR, 0.39; 95% CI, 0.31-0.49; P < .001). In the validation cohort, which included 107 674 nonveteran patients, the score remained associated with OS. Conclusions and Relevance The findings of this study suggest that adherence to intraoperative QMs may be associated with improved OS and RFS. Efforts to improve adherence to surgical QMs may improve patient outcomes following curative-intent resection of early-stage lung cancer.
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Affiliation(s)
- Brendan T. Heiden
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | | | - Su-Hsin Chang
- VA St Louis Healthcare System, St Louis, Missouri
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Yan Yan
- VA St Louis Healthcare System, St Louis, Missouri
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Ana A. Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Martin W. Schoen
- VA St Louis Healthcare System, St Louis, Missouri
- Division of Hematology and Medical Oncology, Department of Internal Medicine, St Louis University School of Medicine, St Louis, Missouri
| | - Steven Tohmasi
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Nikki E. Rossetti
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | | | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
- VA St Louis Healthcare System, St Louis, Missouri
| | - Ruben G. Nava
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
- VA St Louis Healthcare System, St Louis, Missouri
| | - Bryan F. Meyers
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Benjamin D. Kozower
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
- VA St Louis Healthcare System, St Louis, Missouri
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Heiden BT, Eaton DB, Chang SH, Yan Y, Schoen MW, Patel MR, Kreisel D, Nava RG, Meyers BF, Kozower BD, Puri V. Comparison Between Veteran and Non-Veteran Populations With Clinical Stage I Non-small Cell Lung Cancer Undergoing Surgery. Ann Surg 2023; 277:e664-e669. [PMID: 34550662 PMCID: PMC8581073 DOI: 10.1097/sla.0000000000004928] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aim of this study was to compare quality of care and outcomes between Veteran and non-Veteran patients undergoing surgery for clinical stage I non-small cell lung cancer (NSCLC). BACKGROUND Prior studies and the lay media have questioned the quality of care that Veterans with lung cancer receive through the VHA. We hypothesized Veterans undergoing surgery for early-stage NSCLC receive high quality care and have similar outcomes compared to the general population. METHODS We performed a retrospective cohort study of patients with clinical stage I NSCLC undergoing resection from 2006 to 2016 using a VHA dataset. Propensity score matching for baseline patient- and tumor-related variables was used to compare operative characteristics and outcomes between the VHA and the National Cancer Database (NCDB). RESULTS The unmatched cohorts included 9981 VHA and 176,304 NCDB patients. The VHA had more male, non-White patients with lower education levels, higher incomes, and higher Charlson/Deyo scores. VHA patients had inferior unadjusted 30-day mortality (VHA 2.1% vs NCDB 1.7%, P = 0.011) and median overall survival (69.0 vs 88.7 months, P < 0.001). In the propensity matched cohort of 6792 pairs, VHA patients were more likely to have minimally invasive operations (60.0% vs 39.6%, P < 0.001) and only slightly less likely to receive lobectomies (70.1% vs 70.7%, P = 0.023). VHA patients had longer lengths of stay (8.1 vs 7.1 days, P < 0.001) but similar readmission rates (7.7% vs 7.0%, P = 0.132). VHA patients had significantly better 30-day mortality (1.9% vs 2.8%, P < 0.001) and median overall survival (71.4 vs 65.2 months, P < 0.001). CONCLUSIONS Despite having more comorbidities, Veterans receive exceptional care through the VHA with favorable outcomes, including significantly longer overall survival, compared to the general population.
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Affiliation(s)
- Brendan T. Heiden
- Division of Cardiothoracic Surgery, Department of Surgery,
Washington University School of Medicine, St. Louis, MO
| | | | - Su-Hsin Chang
- VA St. Louis Health Care System, St. Louis, MO
- Division of Public Health Sciences, Department of Surgery,
Washington University School of Medicine, St. Louis, MO
| | - Yan Yan
- VA St. Louis Health Care System, St. Louis, MO
- Division of Public Health Sciences, Department of Surgery,
Washington University School of Medicine, St. Louis, MO
| | - Martin W. Schoen
- VA St. Louis Health Care System, St. Louis, MO
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO
| | | | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Department of Surgery,
Washington University School of Medicine, St. Louis, MO
- VA St. Louis Health Care System, St. Louis, MO
| | - Ruben G. Nava
- Division of Cardiothoracic Surgery, Department of Surgery,
Washington University School of Medicine, St. Louis, MO
- VA St. Louis Health Care System, St. Louis, MO
| | - Bryan F. Meyers
- Division of Cardiothoracic Surgery, Department of Surgery,
Washington University School of Medicine, St. Louis, MO
| | - Benjamin D. Kozower
- Division of Cardiothoracic Surgery, Department of Surgery,
Washington University School of Medicine, St. Louis, MO
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery,
Washington University School of Medicine, St. Louis, MO
- VA St. Louis Health Care System, St. Louis, MO
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Italiya JM, Patel MR, Golaviya AV, Patel SS, Thakkar BK, Jakhesara SJ, Joshi CG, Koringa PG. RNA-sequencing attest increased sperm motility in bovine spermatozoa treated with ethanolic extract of Putranjiva roxburghii. 3 Biotech 2023; 13:33. [PMID: 36619823 PMCID: PMC9810775 DOI: 10.1007/s13205-022-03452-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/24/2022] [Indexed: 01/05/2023] Open
Abstract
In the course of time, scientific communities have a growing interest in understanding ethano medicines. The Putranjiva roxburghii, a native plant of the Indian Subcontinent is described as a "Child amulet tree" in Ayurveda. Based on the fact that this herbal medicine has an indispensable component of integrative medicine, the present study was planned to assess the effect of ethanolic dried extract of Putranjiva seeds on the motility of X and Y-bearing bovine spermatozoa. The in-vitro effect of seed extract diluted in S-TALP medium on bull semen has been evaluated by Computer Assisted Semen Analysis (CASA) shows a marked increase in the motility of spermatozoa. Motile and non-motile spermatozoa have been separated by glass wool column from the control as well as treated group. The X and Y-bearing sperm quantification have been carried out by droplet digital polymerase chain reaction (ddPCR). The extract didn't exert any differential effect on the motility and viability of X and Y chromosome-bearing spermatozoa. The transcriptome profiling (RNA-Seq) identified 93 differentially expressed genes between the extract treated and control group. It unveils the up-regulation of CATSPER, AKAP3, SPAG, ADAM1B, ADAM2 and ADAM32 genes that are involved in increasing sperm motility. Transcriptome profile also unveil the expression of ZAR1, CYP17A1, APPL2, HOXB4 and SP9 genes involved with embryonic development processes in Putranjiva extract-treated motile spermatozoa. The results envisaged the medicinal value of Putranjiva herb on increased fertility due to combinatory effect like increased sperm motility and favourableness on embryogenesis. The study ruled out the possibility of herbs having any biased effect on the selection of either male or female-bearing spermatozoa in the bull. Supplementary Information The online version contains supplementary material available at 10.1007/s13205-022-03452-4.
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Affiliation(s)
- Jignesh M. Italiya
- Department of Animal Biotechnology, College of Veterinary Science and Animal Husbandry, Anand Agricultural University, Anand, Gujarat India
- Centre for Infectious Animal Diseases, Faculty of Tropical AgriSciences, Czech University of Life Sciences, Prague, Czech Republic
| | - Mayank R. Patel
- Department of Animal Genetics and Breeding, College of Veterinary Science and Animal Husbandry, Anand Agricultural University, Anand, Gujarat India
| | - Akash V. Golaviya
- Department of Veterinary Microbiology, College of Veterinary Science and Animal Husbandry, Anand Agricultural University, Anand, Gujarat India
| | - Shiven S. Patel
- Department of Animal Genetics and Breeding, College of Veterinary Science and Animal Husbandry, Anand Agricultural University, Anand, Gujarat India
| | - Bhumi K. Thakkar
- Department of Animal Biotechnology, College of Veterinary Science and Animal Husbandry, Anand Agricultural University, Anand, Gujarat India
| | - Subhash J. Jakhesara
- Department of Animal Biotechnology, College of Veterinary Science and Animal Husbandry, Anand Agricultural University, Anand, Gujarat India
| | - Chaitanya G. Joshi
- Gujarat Biotechnology Research Centre (GBRC), Gandhinagar, Gujarat 382010 India
| | - Prakash G. Koringa
- Department of Animal Biotechnology, College of Veterinary Science and Animal Husbandry, Anand Agricultural University, Anand, Gujarat India
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Heiden BT, Eaton DB, Chang SH, Yan Y, Schoen MW, Patel MR, Kreisel D, Nava RG, Meyers BF, Kozower BD, Puri V. Assessment of Updated Commission on Cancer Guidelines for Intraoperative Lymph Node Sampling in Early Stage NSCLC. J Thorac Oncol 2022; 17:1287-1296. [PMID: 36049657 DOI: 10.1016/j.jtho.2022.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/18/2022] [Accepted: 08/02/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The American College of Surgeons Commission on Cancer recently updated its sampling recommendations for early stage NSCLC from at least 10 lymph nodes to at least one N1 (hilar) and three N2 (mediastinal) lymph node stations. Nevertheless, intraoperative lymph node sampling minimums remain subject to debate. We sought to evaluate these guidelines in patients with early stage NSCLC. METHODS We performed a cohort study using a uniquely compiled data set from the Veterans Health Administration. We manually abstracted data from operative notes and pathology reports of patients with clinical stage I NSCLC receiving surgery (2006-2016). Adequacy of lymph node sampling was defined using count-based (≥10 lymph nodes) and station-based (≥three N2 and one N1 nodal stations) minimums. Our primary outcome was recurrence-free survival. Secondary outcomes were overall survival and pathologic upstaging. RESULTS The study included 9749 patients. Count-based and station-based sampling guidelines were achieved in 3302 (33.9%) and 2559 patients (26.3%), respectively, with adherence to either sampling guideline increasing over time from 35.6% (2006) to 49.1% (2016). Adherence to station-based sampling was associated with improved recurrence-free survival (multivariable-adjusted hazard ratio = 0.815, 95% confidence interval: 0.667-0.994, p = 0.04), whereas adherence to count-based sampling was not (adjusted hazard ratio = 0.904, 95% confidence interval: 0.757-1.078, p = 0.26). Adherence to either station-based or count-based guidelines was associated with improved overall survival and higher likelihood of pathologic upstaging. CONCLUSIONS Our study supports station-based sampling minimums (≥three N2 and one N1 nodal stations) for early stage NSCLC; however, the marginal benefit compared with count-based guidelines is minimal. Further efforts to promote widespread adherence to intraoperative lymph node sampling minimums are critical for improving patient outcomes after curative-intent lung cancer resection.
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Affiliation(s)
- Brendan T Heiden
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
| | | | - Su-Hsin Chang
- VA St. Louis Health Care System, St. Louis, Missouri; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Yan Yan
- VA St. Louis Health Care System, St. Louis, Missouri; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Martin W Schoen
- VA St. Louis Health Care System, St. Louis, Missouri; Division of Hematology and Medical Oncology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
| | | | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri; VA St. Louis Health Care System, St. Louis, Missouri
| | - Ruben G Nava
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri; VA St. Louis Health Care System, St. Louis, Missouri
| | - Bryan F Meyers
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri; VA St. Louis Health Care System, St. Louis, Missouri
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Rymer J, Takagi H, Koweek L, Ng N, Douglas P, Fairbairn T, Berman D, De Bruyne B, Bax JJ, Nieman K, Rogers C, Noorgaard BL, Patel MR, Leipsic J, Daubert M. Anatomic and functional discordance among patients with non-obstructive coronary disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.205] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Non-obstructive coronary artery disease (CAD) is associated with increased adverse cardiovascular (CV) events. However, it is unclear if functional stenosis, as assessed by FFRCT <0.80, further stratifies risk among patients with non-obstructive CAD and which factors contribute to this anatomic-functional discordance (stenosis <50% and FFRCT <0.80).
Purpose
We hypothesized that patients with anatomically non-obstructive CAD by CTA and an abnormal FFRCT value of ≤0.80 have a phenomenon termed anatomic-functional discordance, and this discordance would be associated with increased adverse outcomes.
Methods
Patients in the ADVANCE (Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Care) Registry who had exclusively non-obstructive CAD (anatomic stenosis <50%) were stratified by FFRCT >0.80 in all coronary vessels (concordant) vs. FFRCT <0.80 in at least one vessel (discordant). Baseline patient demographics, coronary computed tomography angiography findings, downstream testing and clinical outcomes were compared between groups. The primary composite endpoint included revascularization, CV hospitalization, heart failure, arrhythmia, non-fatal myocardial infarction, unplanned hospitalization for an acute coronary syndrome leading to urgent revascularization, and all-cause death.
Results
Among 1,261 patients with non-obstructive CAD, 543 (43.1%) had functional stenosis with FFRCT <0.80. Patients in the discordant group were older, more likely to have hypertension, hyperlipidemia, and had significantly higher indexed left ventricular (LV) mass and significantly lower coronary volume-to-mass ratios when compared with patients in the concordant group. Downstream non-invasive testing was more common among patients with discordance (35.9% vs 20.2%, p<0.0001) and more frequently resulted in a positive downstream test (10.3% vs. 3.3%, p<0.0001). Invasive angiography was also more common among patients with discordance (25.2% vs. 11.6%, p<0.0001). Anatomic-functional discordance was associated with higher rates of CV hospitalization and percutaneous coronary intervention (both p<0.0001), but no significant difference in all-cause death. After adjustment, anatomic-functional discordance was associated with a significantly higher risk of the composite endpoint (adjusted HR 2.79, 95% CI 1.67–4.65), Figure 1. As shown in Figure 2, the more vessels with anatomic-functional discordance, the higher the rate of adverse cardiac events.
Conclusion
Anatomic-functional discordance was present in nearly half of patients with exclusively non-obstructive CAD. The lower coronary volume: LV mass ratio may reflect abnormal coronary physiology at lower thresholds of anatomical stenosis among those with discordance. Compared to patients with concordance, patients with discordance had worse clinical outcomes suggesting that anatomic-functional discordance may stratify risk for adverse CV events among patients with non-obstructive CAD.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): The analysis was an investigator-initiated analysis sponsored by Heart Flow.
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Affiliation(s)
- J Rymer
- Duke University , Durham , United States of America
| | - H Takagi
- University of British Columbia , Vancouver , Canada
| | - L Koweek
- Duke University , Durham , United States of America
| | - N Ng
- Heart Flow , Mountain View , United States of America
| | - P Douglas
- Duke University , Durham , United States of America
| | - T Fairbairn
- Liverpool Heart and Chest Hospital , Liverpool , United Kingdom
| | - D Berman
- William Beaumont Hospital , Royal Oak , United States of America
| | | | - J J Bax
- Leiden University Medical Center , Leiden , The Netherlands
| | - K Nieman
- Stanford University Medical Center , Stanford , United States of America
| | - C Rogers
- Heart Flow , Mountain View , United States of America
| | | | - M R Patel
- Duke University , Durham , United States of America
| | - J Leipsic
- University of British Columbia , Vancouver , Canada
| | - M Daubert
- Duke University , Durham , United States of America
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Szarek M, Debus ES, Nehler MR, Anand SS, Patel MR, Haskell LP, Muehlhofer ES, Berkowitz SD, Bauersachs RM, Bonaca MP. Total hospitalizations after peripheral arterial revascularization in the VOYAGER trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1982] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In the VOYAGER PAD trial, rivaroxaban reduced first and total (first and subsequent) occurrences of major adverse limb and cardiovascular events in patients with peripheral artery disease (PAD) after lower extremity revascularization (LER), but also increased incident bleeding.
Purpose
Assessment of disease burden by the onset of a particular set of events does not necessarily capture all consequences of a disease process that negatively impact patients' quality of life, motivating the adoption of more patient-centered outcomes. The present analysis of VOYAGER PAD describes the total incidence and duration of hospitalizations reported during the study as a broader measure of total disease burden and net benefit of rivaroxaban therapy.
Methods
Patients were randomized 1:1 to rivaroxaban 2.5 mg twice daily plus aspirin (n=3286) or aspirin alone (n=3278). Investigators documented the primary reason and duration for each hospitalization occurring after randomization. Total hospitalization rates were estimated by events per 100 patient-years. Treatment group comparisons on total hospitalizations as a time-to-event outcome were by marginal proportional hazards models with death as a competing terminal event, while days in hospital were compared by zero-inflated Poisson regression. All analyses were intention-to-treat.
Results
A total of 7156 hospitalizations (3265 first, 3891 subsequent) occurred during a median 2.5 years of follow-up, with nearly 40% being hospitalizations for PAD and a small fraction attributed to bleeding events (Figure 1). The rivaroxaban rate was lower for PAD hospitalizations and higher for bleeding event hospitalizations, with more hospitalizations prevented than caused (Table 1). Mean days in hospital among patients hospitalized at least once was significantly lower in the rivaroxaban group for any reason, for PAD, and for bleeding, so that total days in hospital was numerically lower for rivaroxaban.
Conclusion
Patients with PAD undergoing LER have a high rate of subsequent hospitalizations after an index procedure, driven by re-hospitalizations for PAD. Rivaroxaban decreased both the incidence and duration of PAD hospitalizations. While rivaroxaban increased incident hospitalizations due to bleeding, the mean durations of these hospitalizations were lower relative to placebo, leading to fewer total days in hospital for bleeding (1252 vs. 1531 total days). These findings may be useful for clinicians and patients weighing the risks and benefits of rivaroxaban in PAD after revascularization.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): BayerJanssen
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Affiliation(s)
- M Szarek
- University of Colorado , Aurora , United States of America
| | - E S Debus
- The University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - M R Nehler
- University of Colorado , Aurora , United States of America
| | - S S Anand
- Population Health Research Institute , Hamilton , Canada
| | - M R Patel
- Duke Clinical Research Institute , Durham , United States of America
| | - L P Haskell
- Janssen Research and Development , Raritan , United States of America
| | | | - S D Berkowitz
- University of Colorado , Aurora , United States of America
| | | | - M P Bonaca
- University of Colorado , Aurora , United States of America
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Arps K, Harrington J, Carnicelli AP, Wu A, Chiswell K, Chamberlain AM, Chrischilles E, Jones WS, Raj V, Steinberg BA, Mundl H, Viethen T, Granger CB, Piccini JP, Patel MR. Incidence and risk factors for major bleeding events in atrial fibrillation patients on direct oral anticoagulant therapy: data from the National Patient-Centered Clinical Research Network. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.624] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Direct oral anticoagulation (DOACs) prevent stroke in patients with atrial fibrillation (AF) and have a superior safety profile compared with vitamin K antagonists (VKA). Yet, better definition of incidence and risk factors for major bleeding associated with DOACs in clinical practice may be important given emerging stroke prevention technologies, both pharmacologic and nonpharmacologic.
Purpose
To describe the incidence of and risk factors for major bleeding in individuals with AF on DOAC therapy.
Methods
We reviewed electronic health record data for two patient cohorts with AF prescribed DOACs: (1) Duke University Health System (DUHS) (2010–2018) and (2) Sites within the Patient-Centered Clinical Research Network (PCORnet) (2015–2019) which had ≥6 years assimilated data from both inpatient and outpatient encounters (7 sites). In each cohort, we assessed the 5-year incidence of major bleeding events defined as hospitalization for intracranial hemorrhage, or hospitalization for gastro-intestinal bleeding or procedure to control bleeding accompanied by transfusion within ±7 days or death within 30 days. Multivariable Fine-Gray proportional hazards modeling in each cohort was performed to evaluate independent risk factors for major bleeding on DOAC therapy.
Results
The cohorts included 10,625 patients (DUHS) and 58,321 patients (PCORnet) with AF. Major bleeding events occurred within 5 years of diagnosis in 639 (7.9%) of DUHS patients and 2568 (6.6%) of PCORnet patients (Table 1). The DUHS model predicted time to first major bleeding event with a C-index of 0.756 (95% CI 0.737, 0.775) and the PCORNet model had a c-index of 0.745 (0.736, 0.755) (Table 2). Independent factors associated with major bleeding consistent across both models (p<0.001 in PCORnet for all unless noted) were higher CHA2DS2-VASc scores, lower eGFR, anemia (HR per 1-point increase in hemoglobin up to 12 g/dL 0.79 [0.76, 0.82]), prior major bleeding (HR 2.70 [2.22, 3.30]), cancer (HR 1.23 [1.12, 1.36]), recent cardiac surgery (HR 0.70 [0.51, 0.97]; p=0.030), alcohol use (HR 1.56 [1.29, 1.88]), aspirin use (HR 1.44 [1.32, 1.57]), and selective serotonin reuptake inhibitor use (HR 1.30 [1.19, 1.42]).
Conclusions
Across a large and geographically diverse contemporary population, risk of bleeding on DOAC for stroke prevention in AF remains a frequent and important clinical problem. There is an unmet need for stroke prevention therapies with improved safety profiles. We identified risk factors for major bleeding events on DOAC therapy, some of which are not represented in traditional risk scores, which may inform shared decision making for stroke prevention.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Bayer Pharmaceuticals
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Affiliation(s)
- K Arps
- Duke Clinical Research Institute , Durham , United States of America
| | - J Harrington
- Duke Clinical Research Institute , Durham , United States of America
| | - A P Carnicelli
- Duke Clinical Research Institute , Durham , United States of America
| | - A Wu
- Duke Clinical Research Institute , Durham , United States of America
| | - K Chiswell
- Duke Clinical Research Institute , Durham , United States of America
| | | | - E Chrischilles
- University of Iowa , Iowa City , United States of America
| | - W S Jones
- Duke Clinical Research Institute , Durham , United States of America
| | - V Raj
- Allina Health , Minneapolis , United States of America
| | - B A Steinberg
- University of Utah , Salt Lake City , United States of America
| | - H Mundl
- Bayer AG , Wuppertal , Germany
| | | | - C B Granger
- Duke Clinical Research Institute , Durham , United States of America
| | - J P Piccini
- Duke Clinical Research Institute , Durham , United States of America
| | - M R Patel
- Duke Clinical Research Institute , Durham , United States of America
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Harrington J, Arps K, Wu A, Carnicelli AP, Chiswell K, Chrischilles E, Shantha G, Vanwormer J, Mundl H, Viethan T, Alexander JH, Lopes RD, Washam J, Patel MR. Reduced dose, but not reduced risk: rates of inappropriate apixaban dose reduction and stroke and bleeding incidence. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2709] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Patients with atrial fibrillation (AF) should be prescribed standard-dose (5mg twice daily) apixaban for stroke prevention unless they meet 2 or more criteria: age ≥80, weight ≤60kg, and/or creatinine ≤1.5mg/dL, in which case a reduced-dose (2.5mg twice daily) is indicated. Despite this, some clinicians may also prescribe reduced-dose apixaban to patients who do not meet criteria for dose reduction, in an effort to reduce bleeding risk.
Purpose
To assess apixaban prescribing patterns in patients with AF based on dose reduction criteria and to characterize baseline demographics and incidence of ischemic stroke, major bleeding, and intracranial hemorrhage (ICH) for patients stratified by standard-dose, appropriately reduced-dose, and inappropriately reduced-dose apixaban.
Methods
Using pooled data from 8 large hospitals in PCORnet, a multicenter national healthcare research network, we assessed the standard and reduced-dose apixaban prescribing patterns for patients with AF, with additional stratification of patients prescribed 2.5mg based on presence or absence of 2+ criteria for dose reduction. We then assessed baseline characteristics and 5-year event rate of ischemic stroke, major bleeding, ICH and death.
Results
Of 45,947 patients with AF on apixaban and available dosing information, 38,861 (85%) were prescribed apixaban 5mg and 7086 (15%) were prescribed 2.5mg. Of patients prescribed apixaban 2.5mg, 4321 (61%) did not meet criteria for dose reduction. Patients on reduced dose apixaban were more likely to be female and have comorbidities such as heart failure, hypertension, and prior ischemic stroke. These trends were more pronounced for patients meeting dose adjustment criteria than those not meeting criteria (Table 1).
Unadjusted analyses found patients on 2.5mg of apixaban were significantly more likely to experience ischemic stroke, major bleeding, and all-cause death. Patients with 2+ dose reduction criteria on 2.5mg of apixaban had the highest rates of each event, but patients who were prescribed reduced dose without meeting criteria were also at elevated risk (Table 2).
Conclusion
Many patients prescribed reduced-dose apixaban do not meet criteria for dose reduction. Because patients prescribed reduced dose apixaban are older and have more cardiovascular risk factors, their incidence of stroke, major bleeding, and death exceeds that of full dose treated patients. These risks exist both for patients who do and do not meet criteria for dose reduction, suggesting potential under-treatment for the majority of dose-reduced patients.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Bayer
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Affiliation(s)
- J Harrington
- Duke Clinical Research Institute , Durham , United States of America
| | - K Arps
- Duke Clinical Research Institute , Durham , United States of America
| | - A Wu
- Duke Clinical Research Institute , Durham , United States of America
| | - A P Carnicelli
- Duke Clinical Research Institute , Durham , United States of America
| | - K Chiswell
- Duke Clinical Research Institute , Durham , United States of America
| | - E Chrischilles
- University of Iowa College of Public Health , Iowa , United States of America
| | - G Shantha
- Wake Forest Baptist Health , Winston-Salem , United States of America
| | - J Vanwormer
- Marshfield Clinic Research Institute , Marshfield , United States of America
| | - H Mundl
- Bayer AG , Wuppertal , Germany
| | | | - J H Alexander
- Duke Clinical Research Institute , Durham , United States of America
| | - R D Lopes
- Duke Clinical Research Institute , Durham , United States of America
| | - J Washam
- Duke Clinical Research Institute , Durham , United States of America
| | - M R Patel
- Duke Clinical Research Institute , Durham , United States of America
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Heiden BT, Eaton DB, Chang SH, Yan Y, Baumann AA, Schoen MW, Patel MR, Kreisel D, Nava RG, Meyers BF, Kozower BD, Puri V. Racial Disparities in the Surgical Treatment of Clinical Stage I Non-Small Cell Lung Cancer Among Veterans. Chest 2022; 162:920-929. [PMID: 35405111 PMCID: PMC9562435 DOI: 10.1016/j.chest.2022.03.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Prior studies in the civilian population have reported racial disparities in lung cancer outcomes following surgical treatment, including inferior quality of care and worse survival. It is unclear if racial disparities exist in the Veterans Health Administration (VHA), the largest integrated health care system in the United States. RESEARCH QUESTION Do racial disparities affect early-stage non-small cell lung cancer (NSCLC) outcomes following surgical treatment within the VHA? STUDY DESIGN AND METHODS This retrospective cohort study was conducted in veterans with clinical stage I NSCLC undergoing surgical treatment in the VHA system. Demographic characteristics, access to care, surgical quality measures, and short- and long-term oncologic outcomes between White and Black veterans were evaluated. RESULTS From 2006 to 2016, a total of 18,800 veterans with clinical stage I NSCLC were included. The rates of definitive surgical treatment were similar between Black (57.3%) and White (58.1%) veterans (P = .42). The final study cohort included 9,842 patients receiving surgical treatment, of whom 8,356 (84.9%) were White and 1,486 (15.1%) were Black. Black patients were younger and more likely to smoke, although comorbidities were similar between the two groups. Black patients were somewhat less likely to receive adequate lymph node sampling (30.6% vs 33.3%; P = .050); however, other access-to-care metrics and surgical quality measures, including rates of anatomic lobectomy (71.9% vs 69.4%; P = .189) and positive margins (3.2% vs 3.1%; P = .955), were similar between the two groups. Although Black veterans were less likely to experience major postoperative complications, there was no difference in 30-day readmission, 30-day mortality, or disease-free survival between the two groups. Black patients had significantly better risk-adjusted overall survival (hazard ratio, 0.802; 95% CI, 0.729-0.883; P < .001). INTERPRETATION Among veterans with NSCLC undergoing surgical treatment through the VHA, Black patients received comparable care with equivalent if not superior outcomes compared with White patients.
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Affiliation(s)
- Brendan T Heiden
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO.
| | | | - Su-Hsin Chang
- VA St. Louis Health Care System, St. Louis, MO; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Yan Yan
- VA St. Louis Health Care System, St. Louis, MO; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Ana A Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Martin W Schoen
- VA St. Louis Health Care System, St. Louis, MO; Division of Hematology and Medical Oncology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO
| | | | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO; VA St. Louis Health Care System, St. Louis, MO
| | - Ruben G Nava
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO; VA St. Louis Health Care System, St. Louis, MO
| | - Bryan F Meyers
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO; VA St. Louis Health Care System, St. Louis, MO
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Heiden BT, Eaton DB, Chang SH, Yan Y, Schoen MW, Chen LS, Smock N, Patel MR, Kreisel D, Nava RG, Meyers BF, Kozower BD, Puri V. The Impact of Persistent Smoking After Surgery on Long-term Outcomes After Stage I Non-small Cell Lung Cancer Resection. Chest 2022; 161:1687-1696. [PMID: 34919892 PMCID: PMC9248074 DOI: 10.1016/j.chest.2021.12.634] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Smoking at the time of surgical treatment for lung cancer increases the risk for perioperative morbidity and mortality. The prevalence of persistent smoking in the postoperative period and its association with long-term oncologic outcomes are poorly described. RESEARCH QUESTION What is the relationship between persistent smoking and long-term outcomes in early-stage lung cancer after surgical treatment? STUDY DESIGN AND METHODS We performed a retrospective cohort study using a uniquely compiled Veterans Health Administration dataset of patients with clinical stage I non-small cell lung cancer (NSCLC) undergoing surgical treatment between 2006 and 2016. We defined persistent smoking as individuals who continued smoking 1 year after surgery and characterized the relationship between persistent smoking and disease-free survival and overall survival. RESULTS This study included 7,489 patients undergoing surgical treatment for clinical stage I NSCLC. Of 4,562 patients (60.9%) who were smoking at the time of surgery, 2,648 patients (58.0%) continued to smoke at 1 year after surgery. Among 2,927 patients (39.1%) who were not smoking at the time of surgical treatment, 573 (19.6%) relapsed and were smoking at 1 year after surgery. Persistent smoking at 1 year after surgery was associated with significantly shorter overall survival (adjusted hazard ration [aHR], 1.291; 95% CI, 1.197-1.392; P < .001). However, persistent smoking was not associated with inferior disease-free survival (aHR, 0.989; 95% CI, 0.884-1.106; P = .84). INTERPRETATION Persistent smoking after surgery for stage I NSCLC is common and is associated with inferior overall survival. Providers should continue to assess smoking habits in the postoperative period given its disproportionate impact on long-term outcomes after potentially curative treatment for early-stage lung cancer.
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Affiliation(s)
- Brendan T Heiden
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO.
| | - Daniel B Eaton
- Division of Research and Education, VA St. Louis Health Care System, St. Louis, MO
| | - Su-Hsin Chang
- Division of Research and Education, VA St. Louis Health Care System, St. Louis, MO; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Yan Yan
- Division of Research and Education, VA St. Louis Health Care System, St. Louis, MO; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Martin W Schoen
- Division of Research and Education, VA St. Louis Health Care System, St. Louis, MO; Division of Hematology and Medical Oncology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO
| | - Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO; Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO
| | - Nina Smock
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Mayank R Patel
- Division of Research and Education, VA St. Louis Health Care System, St. Louis, MO
| | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO; Division of Research and Education, VA St. Louis Health Care System, St. Louis, MO
| | - Ruben G Nava
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO; Division of Research and Education, VA St. Louis Health Care System, St. Louis, MO
| | - Bryan F Meyers
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO; Division of Research and Education, VA St. Louis Health Care System, St. Louis, MO
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18
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Nanna MG, Wang TY, Chiswell K, Sun JL, Vemulapalli S, Hoffmann U, Patel MR, Udelson JE, Fordyce CB, Douglas PS. Estimating the real-world performance of the PROMISE minimal-risk tool. Am Heart J 2021; 239:100-109. [PMID: 34077743 DOI: 10.1016/j.ahj.2021.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/25/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Stable chest pain is a common indication for cardiac catheterization. We assessed the prognostic value of the Prospective Multicenter Imaging Study for Evaluation (PROMISE) Minimal-Risk Tool in identifying patients who are at very low risk of obstructive coronary artery disease (CAD) or downstream cardiovascular adverse outcomes. METHODS We applied the PROMISE Minimal-Risk Tool to consecutive patients without known CAD who underwent elective cardiac catheterization for stable angina from January 1, 2000 to December 31, 2014 in the Duke Databank for Cardiovascular Disease (DDCD). Patients with scores >0.46 (top decile of lowest-risk from the PROMISE cohort) were classified as low-risk. Logistic regression modeling compared likelihood of freedom from obstructive coronary artery disease on index angiography, 2-year survival, and 2-year survival free of myocardial infarction (MI) and MI/revascularization between low- and non low-risk patients. Alternative cut points to define low- risk patients were also explored. RESULTS Among 6251 patients undergoing cardiac catheterization for stable chest pain, 1082 (17.3%) were low-risk per the PROMISE minimal-risk tool. Among low risk patients, obstructive coronary artery disease was observed in 14.9% and left main disease (≥ 50% Stenosis) was rare (0.9%). Compared with other patients, low risk patients had a higher likelihood of freedom from obstructive coronary disease on index catheterization (85.1% vs. 44.2%, OR 4.84, 95% CI 4.06-5.77). Low risk patients had significantly higher survival (98.2% vs. 94.4%, OR 3.18, 95% CI 1.99-5.08), MI-free survival (97.2% vs. 91.9%, OR 3.03, 95% CI 2.07-4.45), and MI/revascularization-free survival (86.2 vs. 59.9%, OR 4.19, 95% CI 3.48-5.05) at 2 years than non-low risk patients. Operating characteristics for predicting the outcomes of interest varied modestly depending on the low-risk cut-point used but the positive predictive value for 2 year freedom from death was >98% regardless. CONCLUSION The PROMISE minimal-risk tool identifies 17% of stable chest pain patients referred to cardiac catheterization as low risk. These patients have a low prevalence of obstructive CAD and better survival than non-low risk patients. While this suggests that these patients are unlikely to benefit from catheterization, further research is needed to confirm a favorable downstream prognosis with medical management alone.
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Heiden BT, Eaton DB, Engelhardt KE, Chang SH, Yan Y, Patel MR, Kreisel D, Nava RG, Meyers BF, Kozower BD, Puri V. Analysis of Delayed Surgical Treatment and Oncologic Outcomes in Clinical Stage I Non-Small Cell Lung Cancer. JAMA Netw Open 2021; 4:e2111613. [PMID: 34042991 PMCID: PMC8160592 DOI: 10.1001/jamanetworkopen.2021.11613] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE The association between delayed surgical treatment and oncologic outcomes in patients with non-small cell lung cancer (NSCLC) is poorly understood given that prior studies have used imprecise definitions for the date of cancer diagnosis. OBJECTIVE To use a uniform method to quantify surgical treatment delay and to examine its association with several oncologic outcomes. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was conducted using a novel data set from the Veterans Health Administration (VHA) system. Included patients had clinical stage I NSCLC and were undergoing resection from 2006 to 2016 within the VHA system. Time to surgical treatment (TTS) was defined as the time between preoperative diagnostic computed tomography imaging and surgical treatment. We evaluated the association between TTS and several delay-associated outcomes using restricted cubic spline functions. Data analyses were performed in November 2021. EXPOSURE Wait time between cancer diagnosis and surgical treatment (ie, TTS). MAIN OUTCOMES AND MEASURES Several delay-associated oncologic outcomes, including pathologic upstaging, resection with positive margins, and recurrence, were assessed. We also assessed overall survival. RESULTS Among 9904 patients who underwent surgical treatment for clinical stage I NSCLC, 9539 (96.3%) were men, 4972 individuals (50.5%) were currently smoking, and the mean (SD) age was 67.7 (7.9) years. The mean (SD) TTS was 70.1 (38.6) days. TTS was not associated with increased risk of pathologic upstaging or positive margins. Recurrence was detected in 4158 patients (42.0%) with median (interquartile range) follow-up of 6.15 (2.51-11.51) years. Factors associated with increased risk of recurrence included younger age (hazard ratio [HR] for every 1-year increase in age, 0.992; 95% CI, 0.987-0.997; P = .003), higher Charlson Comorbidity Index score (HR for every 1-unit increase in composite score, 1.055; 95% CI, 1.037-1.073; P < .001), segmentectomy (HR vs lobectomy, 1.352; 95% CI, 1.179-1.551; P < .001) or wedge resection (HR vs lobectomy, 1.282; 95% CI, 1.179-1.394; P < .001), larger tumor size (eg, 31-40 mm vs <10 mm; HR, 1.209; 95% CI, 1.051-1.390; P = .008), higher tumor grade (eg, II vs I; HR, 1.210; 95% CI, 1.085-1.349; P < .001), lower number of lymph nodes examined (eg, ≥10 vs <10; HR, 0.866; 95% CI, 0.803-0.933; P < .001), higher pathologic stage (III vs I; HR, 1.571; 95% CI, 1.351-1.837; P < .001), and longer TTS, with increasing risk after 12 weeks. For each week of surgical delay beyond 12 weeks, the hazard for recurrence increased by 0.4% (HR, 1.004; 95% CI, 1.001-1.006; P = .002). Factors associated with delayed surgical treatment included African American race (odds ratio [OR] vs White race, 1.267; 95% CI, 1.112-1.444; P < .001), higher area deprivation index [ADI] score (OR for every 1 unit increase in ADI score, 1.005; 95% CI, 1.002-1.007; P = .002), lower hospital case load (OR for every 1-unit increase in case load, 0.998; 95% CI, 0.998-0.999; P = .001), and year of diagnosis, with less recent procedures more likely to have delay (OR for each additional year, 0.900; 95% CI, 0.884-0.915; P < .001). Patients with surgical treatment within 12 weeks of diagnosis had significantly better overall survival than those with procedures delayed more than 12 weeks (HR, 1.132; 95% CI, 1.064-1.204; P < .001). CONCLUSIONS AND RELEVANCE Using a more precise definition for TTS, this study found that surgical procedures delayed more than 12 weeks were associated with increased risk of recurrence and worse survival. These findings suggest that patients with clinical stage I NSCLC should undergo expeditious treatment within that time frame.
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Affiliation(s)
- Brendan T. Heiden
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St Louis, Missouri
| | | | - Kathryn E. Engelhardt
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St Louis, Missouri
| | - Su-Hsin Chang
- VA St Louis Health Care System, St Louis, Missouri
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St Louis, Missouri
| | - Yan Yan
- VA St Louis Health Care System, St Louis, Missouri
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St Louis, Missouri
| | | | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St Louis, Missouri
- VA St Louis Health Care System, St Louis, Missouri
| | - Ruben G. Nava
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St Louis, Missouri
- VA St Louis Health Care System, St Louis, Missouri
| | - Bryan F. Meyers
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St Louis, Missouri
| | - Benjamin D. Kozower
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St Louis, Missouri
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St Louis, Missouri
- VA St Louis Health Care System, St Louis, Missouri
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Mc Keown L, McElwaine JN, Bourke MC, Sylvest ME, Patel MR. The formation of araneiforms by carbon dioxide venting and vigorous sublimation dynamics under martian atmospheric pressure. Sci Rep 2021; 11:6445. [PMID: 33742009 PMCID: PMC7979800 DOI: 10.1038/s41598-021-82763-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 01/18/2021] [Indexed: 11/22/2022] Open
Abstract
The local redistribution of granular material by sublimation of the southern seasonal \documentclass[12pt]{minimal}
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\begin{document}$${\hbox {CO}}_2$$\end{document}CO2 ice deposit is one of the most active surface shaping processes on Mars today. This unique geomorphic mechanism is hypothesised to be the cause of the dendritic, branching, spider-like araneiform terrain and associated fans and spots—features which are native to Mars and have no Earth analogues. However, there is a paucity of empirical data to test the validity of this hypothesis. Additionally, it is unclear whether some araneiform patterns began as radial and then grew outward, or whether troughs connected at mutual centres over time. Here we present the results of a suite of laboratory experiments undertaken to investigate if the interaction between a sublimating \documentclass[12pt]{minimal}
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\begin{document}$${\hbox {CO}}_2$$\end{document}CO2 ice overburden containing central vents and a porous, mobile regolith will mobilise grains from beneath the ice in the form of a plume to generate araneiform patterns. We quantify the branching and area of the dendritic features that form. We provide the first observations of plume activity via \documentclass[12pt]{minimal}
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\begin{document}$${\hbox {CO}}_2$$\end{document}CO2 sublimation and consequent erosion to form araneiform features. We show that \documentclass[12pt]{minimal}
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\begin{document}$${\hbox {CO}}_2$$\end{document}CO2 sublimation can be a highly efficient agent of sediment transport under present day Martian atmospheric pressure and that morphometry is governed by the Shields parameter.
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Affiliation(s)
- Lauren Mc Keown
- Trinity College Dublin, College Green, Dublin 2, Ireland. .,The Open University, Walton Hall, Milton Keynes, MK7 6AA, United Kingdom.
| | - J N McElwaine
- Durham University, Durham, DH1, UK.,Planetary Science Institute, 1700 E Fort Lowell Rd, Tucson, AZ, 85719, USA
| | - M C Bourke
- Trinity College Dublin, College Green, Dublin 2, Ireland
| | - M E Sylvest
- The Open University, Walton Hall, Milton Keynes, MK7 6AA, United Kingdom
| | - M R Patel
- The Open University, Walton Hall, Milton Keynes, MK7 6AA, United Kingdom
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Gore A, Baugnon K, Beitler J, Saba NF, Patel MR, Wu X, Boyce BJ, Aiken AH. Posttreatment Imaging in Patients with Head and Neck Cancer without Clinical Evidence of Recurrence: Should Surveillance Imaging Extend Beyond 6 Months? AJNR Am J Neuroradiol 2020; 41:1238-1244. [PMID: 32554418 DOI: 10.3174/ajnr.a6614] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/18/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Early detection of residual or recurrent disease is important for effective salvage treatment in patients with head and neck cancer. Current National Comprehensive Cancer Network guidelines do not recommend standard surveillance imaging beyond 6 months unless there are worrisome signs or symptoms on clinical examination and offer vague guidelines for imaging of high-risk patients beyond that timeframe. Our goal was to evaluate the frequency of clinically occult recurrence in patients with head and neck squamous cell carcinoma with positive imaging findings (Neck Imaging Reporting and Data Systems scores of 2-4), especially after 6 months. MATERIALS AND METHODS This institutional review board-approved, retrospective data base search queried neck CT reports with Neck Imaging Reporting and Data Systems scores of 2-4 from June 2014 to March 2018. The electronic medical records were reviewed to determine outcomes of clinical and radiologic follow-up, including symptoms, physical examination findings, pathologic correlation, and clinical notes within 3 months of imaging. RESULTS A total of 255 cases, all with Neck Imaging Reporting and Data Systems scores of 2 or 3, met the inclusion criteria. Fifty-nine patients (23%) demonstrated recurrence (45 biopsy-proven, 14 based on clinical and imaging progression), and 21 patients (36%) had clinically occult recurrence (ie, no clinical evidence of disease at the time of the imaging examination). The median overall time to radiologically detected, clinically occult recurrence was 11.4 months from treatment completion. CONCLUSIONS Imaging surveillance beyond the first posttreatment baseline study was critical for detecting clinically occult recurrent disease in patients with head and neck squamous cell carcinoma. More than one-third of all recurrences were seen in patients without clinical evidence of disease; and 81% of clinically occult recurrences occurred beyond 6 months.
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Affiliation(s)
- A Gore
- From the Departments of Radiology and Imaging Sciences (A.G., K.B., X.W., A.H.A.)
| | - K Baugnon
- From the Departments of Radiology and Imaging Sciences (A.G., K.B., X.W., A.H.A.)
| | | | - N F Saba
- Hematology/Oncology (N.F.S.).,Otolaryngology (N.F.S., M.R.P., B.J.B., A.H.A.), Emory University School of Medicine, Atlanta, Georgia
| | - M R Patel
- Otolaryngology (N.F.S., M.R.P., B.J.B., A.H.A.), Emory University School of Medicine, Atlanta, Georgia
| | - X Wu
- From the Departments of Radiology and Imaging Sciences (A.G., K.B., X.W., A.H.A.)
| | - B J Boyce
- Otolaryngology (N.F.S., M.R.P., B.J.B., A.H.A.), Emory University School of Medicine, Atlanta, Georgia
| | - A H Aiken
- From the Departments of Radiology and Imaging Sciences (A.G., K.B., X.W., A.H.A.) .,Otolaryngology (N.F.S., M.R.P., B.J.B., A.H.A.), Emory University School of Medicine, Atlanta, Georgia
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Surie D, Interrante JD, Pathmanathan I, Patel MR, Anyalechi G, Cavanaugh JS, Kirking HL. Policies, practices and barriers to implementing tuberculosis preventive treatment-35 countries, 2017. Int J Tuberc Lung Dis 2020; 23:1308-1313. [PMID: 31931915 DOI: 10.5588/ijtld.19.0018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Tuberculosis preventive treatment (TPT) reduces the development of tuberculosis (TB) disease and mortality in people living with human immunodeficiency virus (HIV) infection. Despite this known effectiveness, global uptake of TPT has been slow. We aimed to assess current status of TPT implementation in countries supported by the US President's Emergency Plan for AIDS Relief (PEPFAR).METHODS: We surveyed TB-HIV program staff at US Centers for Disease Control and Prevention (CDC) country offices in 42 PEPFAR-supported countries about current TPT policies, practices, and barriers to implementation. Surveys completed from July to December 2017 were analyzed.RESULTS: Of 42 eligible PEPFAR-supported countries, staff from 35 (83%) CDC country offices completed the survey. TPT was included in national guidelines in 33 (94%) countries, but only 21 (60%) reported nationwide programmatic TPT implementation. HIV programs led TPT implementation in 20/32 (63%) countries, but TB programs led drug procurement in 18/32 (56%) countries. Stock outs were frequent, as 21/28 (75%) countries reported at least one isoniazid stock out in the previous year.CONCLUSION: Despite widespread inclusion of TPT in guidelines, programmatic TPT implementation lags. Successful scale-up of TPT requires uninterrupted drug supply chains facilitated by improved leadership and coordination between HIV and TB programs.
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Affiliation(s)
- D Surie
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA
| | - J D Interrante
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA
| | - I Pathmanathan
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA
| | - M R Patel
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA
| | - G Anyalechi
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA
| | - J S Cavanaugh
- Office of the Global AIDS Coordinator, Washington DC, USA
| | - H L Kirking
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA
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Patel MR, Lamprou DA, Vavia PR. Synthesis, Characterization, and Drug Delivery Application of Self-assembling Amphiphilic Cyclodextrin. AAPS PharmSciTech 2019; 21:11. [PMID: 31808011 DOI: 10.1208/s12249-019-1572-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/10/2019] [Indexed: 01/12/2023] Open
Abstract
The main aim of the research was to synthesize amphiphilic cyclodextrin (AMCD) by substituting C12 alkyl chain to a β-cyclodextrin (βCD) in a single step and to study its self-assembly in an aqueous medium. The drug delivery application of the AMCD was also evaluated by encapsulating tamoxifen citrate as a model hydrophobic drug. AMCD was able to self-assemble in aqueous media, forming nanovesicles of size < 200 nm, capable of encapsulating tamoxifen citrate (TMX). Molecular docking and MD simulation studies revealed the interaction between TMX and AMCD which formed a stable complex. TEM and AFM studies showed that nanovesicles were perfectly spherical having a smooth surface and a theoretical AMCD bilayer thickness of ~ 7.2 nm as observed from SANS studies. XRD and DSC studies revealed that TMX was amorphized and molecularly dispersed in AMCD bilayer which was released slowly following Fickian diffusion. AMCD has excellent hemocompatibility as opposed to βCD and no genotoxicity. IC50 of TMX against MCF-7 cell lines was significantly reduced from 11.43 to 7.96 μg/ml after encapsulation in nanovesicle because of nanovesicles being endocytosed by the MCF-7 cells. AMCD was well tolerated by IV route at a dose of > 2000 mg/kg in rats. Pharmacokinetic profile of TMX after encapsulation was improved giving 3-fold higher AUC; extended mean residence time is improving chances of nanovesicle to extravasate in tumor via EPR effect.
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Patel MR, Pearson VK, Evans DJ, Summers DJ, Paton S, Truscott P, Pottage T, Bennett A, Gow JPD, Goodyear MD, Mason JP, Leese MR, Patel RD. The transfer of unsterilized material from Mars to Phobos: Laboratory tests, modelling and statistical evaluation. Life Sci Space Res (Amst) 2019; 23:112-134. [PMID: 31791600 DOI: 10.1016/j.lssr.2019.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 06/10/2023]
Abstract
Sample return missions to Phobos are the subject of future exploration plans. Given the proximity of Phobos to Mars, Mars' potential to have supported life, and the possibility of material transfer from Mars to Phobos, careful consideration of planetary protection is required. If life exists, or ever existed, on Mars, there is a possibility that material carrying organisms could be present on Phobos and be collected by a sample return mission such as the Japanese Martian Moons eXplorer (MMX). Here we describe laboratory experiments, theoretical modelling and statistical analysis undertaken to quantify whether the likelihood of a sample from Phobos material containing unsterilized material transferred from Mars is less than 10-6, the threshold to transition between restricted and unrestricted sample return classification for planetary protection. We have created heat, impact and radiation sterilization models based on the Phobos environment, and through statistical analyses investigated the level of sterilization expected for martian material transferred to Phobos. These analyses indicate that radiation is the major sterilization factor, sterilizing the Phobos surface over timescales of millions of years. The specific events of most relevance in the Phobos sample return context are the 'young' cratering events on Mars that result in Zunil-sized craters, which can emplace a large mass of martian material on Phobos, in a short period of time, thus inhibiting the effects of radiation sterilization. Major unknowns that cannot yet be constrained accurately enough are found to drive the results - the most critical being the determination of exact crater ages to statistical certainty, and the initial biological loading on Mars prior to transfer. We find that, when taking a conservative perspective and assuming the best-case scenario for organism survival, for a 100 g sample of the Phobos regolith to be below the planetary protection requirement for unrestricted sample return, the initial biological loading on Mars must be <8.2 × 103cfu kg-1. For the planned MMX mission, a ∼10 g sample to be obtained from a 25-30 mm diameter core as planned would require an initial martian biological loading to be <1.6 × 104cfu kg-1, in order to remain compliant with the planetary protection threshold.
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Affiliation(s)
- M R Patel
- School of Physical Sciences, The Open University, Milton Keynes MK7 6AA, UK.
| | - V K Pearson
- School of Physical Sciences, The Open University, Milton Keynes MK7 6AA, UK
| | - D J Evans
- Fluid Gravity Engineering Ltd, The Old Coach House, 1 West Street, Emsworth PO 10 7DX, UK
| | - D J Summers
- Thales Alenia Space UK Ltd., Bld 660, Bristol Business Park, Cold Harbour Lane, Bristol BS16 1EJ, UK
| | - S Paton
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - P Truscott
- Kallisto Consultancy Limited, Farnborough, Hampshire GU14 9AJ, UK
| | - T Pottage
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - A Bennett
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - J P D Gow
- School of Physical Sciences, The Open University, Milton Keynes MK7 6AA, UK
| | - M D Goodyear
- School of Physical Sciences, The Open University, Milton Keynes MK7 6AA, UK
| | - J P Mason
- School of Physical Sciences, The Open University, Milton Keynes MK7 6AA, UK
| | - M R Leese
- School of Physical Sciences, The Open University, Milton Keynes MK7 6AA, UK
| | - R D Patel
- Indospace Ltd, Abingdon, Oxfordshire, UK
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Hiatt W, Hopley CW, Kavanagh S, Patel MR, Baumgartner I, Berger JS, Blomster JI, Fowkes FGR, Jones WS, Katona BG, Mahaffey KW, Norgren L. P935Effect of hypertension and systolic blood pressure on cardiovascular and limb outcomes in patients with symptomatic peripheral artery disease: the EUCLID trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Hypertension is a risk factor for major adverse cardiac events (MACE) in patients with symptomatic peripheral artery disease (PAD).
Purpose
The effects of a history of hypertension and baseline systolic blood pressure (SBP) on MACE and major adverse limb events (MALE), including acute limb ischemia and major amputation, were evaluated in the Examining Use of tiCagreLor In paD (EUCLID) trial.
Methods
EUCLID randomized 13,885 patients with PAD and found no benefit of ticagrelor compared with clopidogrel on risk of MACE or MALE. The median duration of follow up was approximately 30 months. This post hoc, subgroup analysis evaluated the effects of hypertension history at baseline on the hazard for MACE and MALE. An adjusted restricted cubic spline regression analysis evaluated the association of SBP with MACE and MALE.
Results
A clinical history of hypertension was present in 10,857 (78%) patients at baseline and these patients were more likely to be older, female, white or African American, and reside in North America compared with the 3026 without hypertension. Hypertension was associated with a higher prevalence of concomitant cardiovascular diseases, polyvascular disease, diabetes, and prior coronary interventions. MACE occurred at a rate of 4.63 events/100 pt-yrs in participants with hypertension and 3.64 events/100 pt-yrs in participants without hypertension, (adjusted hazard ratio [aHR] 0.94, 95% CI 0.82–1.08; p=0.38). MALE occurred at a rate of 1.11 events/100 pt-yrs in those with hypertension and 1.38 events/100 pt-yrs in those without hypertension (p=0.054) (aHR 0.93 (95% CI 0.73, 1.18) p=0.55. The adjusted spline model for MACE and SBP demonstrated a significantly non-linear relationship with a HR 1.08 (95% CI 1.01, 1.15), p=0.0275 for every 10-unit decrease <135 mmHg SBP and HR 1.11 (1.06, 1.16), p<0.0001 for every 10-unit increase >135 mmHg (figure). There was no association between baseline SBP and MALE events.
Conclusions
A history of hypertension was not associated with a higher adjusted hazard for MACE or MALE in participants with PAD. In contrast, SBP at baseline was associated with increased risk of MACE at values both above and below 135 mmHg.
Acknowledgement/Funding
EUCLID was sponsored by AstraZeneca
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Affiliation(s)
- W Hiatt
- CPC Clinical Research, University of Colorado School of Medicine, Aurora, United States of America
| | - C W Hopley
- Geisel School of Medicine, Dartmouth College, Department of Medicine, Section of Nephrology and Hypertension, Hanover, United States of America
| | - S Kavanagh
- CPC Clinical Research, Aurora, United States of America
| | - M R Patel
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, United States of America
| | - I Baumgartner
- Swiss Cardiovascular Center, University of Bern, Bern, Switzerland
| | - J S Berger
- New York University School of Medicine, Departments of Medicine and Surgery, New York, United States of America
| | | | - F G R Fowkes
- University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, Edinburgh, United Kingdom
| | - W S Jones
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, United States of America
| | - B G Katona
- AstraZeneca Gaithersburg, Gaithersburg, United States of America
| | - K W Mahaffey
- Stanford Center for Clinical Research, Stanford University School of Medicine, Stanford, United States of America
| | - L Norgren
- Orebro University, Faculty of Medicine and Health, Orebro, Sweden
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Prasad N, Patel MR, Pandey A, Jaiswal A, Bhadauria D, Kaul A, Sharma RK, Mohindra S, Pandey G, Goel A, Gupta A. Direct-acting Antiviral Agents in Hepatitis C Virus-infected Renal Allograft Recipients: Treatment and Outcome Experience from Single Center. Indian J Nephrol 2018; 28:220-225. [PMID: 29962673 PMCID: PMC5998719 DOI: 10.4103/ijn.ijn_190_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Hepatitis C virus (HCV) infection in renal allograft recipient is associated with increased morbidity and mortality. At present, only few studies related to treatment and outcomes of HCV-infected renal allograft recipients with DAAs have been published. We aimed the study to assess the efficacy and safety of sofosbuvir-based regimens in HCV-infected renal allograft recipients. We analyzed data of 22 eligible HCV-infected renal allograft recipients (14 genotype-3, 6 genotype-1, one each genotype-2 and 4) who were treated with DAAs at our institute. DAA regimen included sofosbuvir and ribavirin with or without ledipasvir or daclatasvir for 12–24 weeks. Patients were followed up for 24 weeks after completion of treatment. A rapid viral response of 91%, end of therapy response of 100%, and sustained viral response at 12 and 24 weeks of 100% with rapid normalization of liver enzymes were observed. Therapy was well tolerated except for ribavirin-related anemia. A significant decrease in tacrolimus trough levels was observed and most patients required increase in tacrolimus dose during the study. Treatment with newer DAAs is effective and safe for the treatment of HCV-infected renal allograft recipients.
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Affiliation(s)
- N Prasad
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - M R Patel
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Pandey
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Jaiswal
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - D Bhadauria
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Kaul
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - R K Sharma
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - S Mohindra
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - G Pandey
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Goel
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Gupta
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Abstract
<p class="p1">The fabrication and characterisation of micro spark gap switch for single shot firing applications are given in detailed . A circular switch with triggering electrode is realised on alumina substrate and can be integratable easily with the electronics for ignition applications. Circular switch is realised on 25 mil alumina substrate within substrate diameter of 10 mm. The switch measurement shows having repeatable performance of pulse peak current of around 2000 A and less than 100 ns rise time. This article details the design, development including fabrication aspects of spark switch with trigger capabilities along with characterisation of switch on alumina substrates.<span class="Apple-converted-space"> </span></p>
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Krieger DA, Hudgins PA, Nayak GK, Baugnon KL, Corey AS, Patel MR, Beitler JJ, Saba NF, Liu Y, Aiken AH. Initial Performance of NI-RADS to Predict Residual or Recurrent Head and Neck Squamous Cell Carcinoma. AJNR Am J Neuroradiol 2017; 38:1193-1199. [PMID: 28364010 DOI: 10.3174/ajnr.a5157] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/22/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The Head and Neck Imaging Reporting and Data System (NI-RADS) surveillance template for head and neck cancer includes a numeric assessment of suspicion for recurrence (1-4) for the primary site and neck. Category 1 indicates no evidence of recurrence; category 2, low suspicion of recurrence; category 3, high suspicion of recurrence; and category 4, known recurrence. Our purpose was to evaluate the performance of the NI-RADS scoring system to predict local and regional disease recurrence or persistence. MATERIALS AND METHODS This study was classified as a quality-improvement project by the institutional review board. A retrospective database search yielded 500 consecutive cases interpreted using the NI-RADS template. Cases without a numeric score, non-squamous cell carcinoma primary tumors, and primary squamous cell carcinoma outside the head and neck were excluded. The electronic medical record was reviewed to determine the subsequent management, pathology results, and outcome of clinical and radiologic follow-up. RESULTS A total of 318 scans and 618 targets (314 primary targets and 304 nodal targets) met the inclusion criteria. Among the 618 targets, 85.4% were scored NI-RADS 1; 9.4% were scored NI-RADS 2; and 5.2% were scored NI-RADS 3. The rates of positive disease were 3.79%, 17.2%, and 59.4% for each NI-RADS category, respectively. Univariate association analysis demonstrated a strong association between the NI-RADS score and ultimate disease recurrence, with P < .001 for primary and regional sites. CONCLUSIONS The baseline performance of NI-RADS was good, demonstrating significant discrimination among the categories 1-3 for predicting disease.
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Affiliation(s)
- D A Krieger
- From the Department of Radiology, Hackensack University Medical Center (D.A.K.), Hackensack, New Jersey
| | - P A Hudgins
- Departments of Radiology and Imaging Sciences (P.A.H., A.H.A., K.L.B., A.S.C.)
| | - G K Nayak
- Department of Radiology (G.K.N.), New York University School of Medicine, New York, New York
| | - K L Baugnon
- Departments of Radiology and Imaging Sciences (P.A.H., A.H.A., K.L.B., A.S.C.)
| | - A S Corey
- Departments of Radiology and Imaging Sciences (P.A.H., A.H.A., K.L.B., A.S.C.)
| | - M R Patel
- Otolaryngology Head and Neck Surgery (M.R.P., J.J.B.), Emory University School of Medicine, Atlanta, Georgia
| | - J J Beitler
- Otolaryngology Head and Neck Surgery (M.R.P., J.J.B.), Emory University School of Medicine, Atlanta, Georgia.,Departments of Radiation Oncology (J.J.B.).,Hematology and Medical Oncology (J.J.B., N.F.S.)
| | - N F Saba
- Hematology and Medical Oncology (J.J.B., N.F.S.)
| | - Y Liu
- Biostatistics (Y.L.), Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - A H Aiken
- Departments of Radiology and Imaging Sciences (P.A.H., A.H.A., K.L.B., A.S.C.)
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DeMichele AM, Harding JJ, Telli ML, Münster P, McKay RR, Iliopoulos O, Whiting S, Orford KW, Bennett MK, Mier JW, Owonikoko TK, Patel MR, Kalinsky K, Carvajal RD, Infante JR, Merit-Bernstam F. Abstract P6-11-05: Phase 1 study of CB-839, a small molecule inhibitor of glutaminase (GLS), in combination with paclitaxel (Pac) in patients (its) with triple negative breast cancer (TNBC). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-11-05] [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
Background: CB-839 is a first-in-class highly selective inhibitor of GLS, a key enzyme in the utilization of glutamine by cancer cells. TNBC has high GLS expression and is very dependent upon GLS-mediated conversion of glutamine to glutamate for tumor cell growth. CB-839 has antitumor activity in vitro and in vivo in preclinical models of TNBC. Recent studies demonstrate that glutamine utilization can contribute to resistance to paclitaxel, a therapy frequently used to treat TNBC patients. Paclitaxel sensitivity is dependent on down-regulation of the glutamine transporter, SLC1A5, and over-expression of SLC1A5 causes paclitaxel resistance. Consistent with these observations, inhibition of glutamine metabolism with CB-839 has demonstrated strong antitumor activity in combination with paclitaxel.
CX-839-001 is an ongoing Phase 1 trial of CB-839 as monotherapy and in combination with approved agents. We previously reported pharmacodynamic studies demonstrating robust inhibition of GLS in pt blood and tumors and excellent tolerability of CB-839 monotherapy in a variety of tumor types including TNBC. In light of the preclinical rationale and monotherapy tolerability a combination arm was opened testing CB-839 with paclitaxel (Pac-CB) in patients with advanced TNBC. We report here updated results on the Pac-CB dose escalation and expansion cohorts.
Methods: Patients with refractory advanced/metastatic TNBC (prior taxane therapy allowed) received escalating doses of CB-839 (400-800 mg BID) in combination with a fixed weekly Pac dose of 80 mg/m2 Days 1, 8, 15 of a 28 day cycle. Upon demonstration of safety and tolerability, an expansion cohort of TNBC pts was opened.
Results: To date, 15 pts have received Pac-CB at three dose levels of CB-839: 7 pts at 400 mg BID, 5 at 600 mg BID and 3 at 800 mg BID with the latter dose level not completed. 40% of enrolled patients have received >5 prior lines of systemic therapy for adv/met disease, and 10 pts have received prior taxane therapy including 5 in the adv/met setting. The Pac-CB combination has been well tolerated with one DLT during dose escalation (G4 neutropenia at 400 mg BID) and a low rate of dose reductions (2 for Pac and 1 for CB-839). Of 15 pts, the best overall response rate (BORR, see Table) has been PR in 20% (3 pts), SD in 47% (7 pts) and PD in 33% (5 pts) with 5 patients remaining on study. At doses ≥600 mg BID (n=8) the BORR is 38% (3 pts), and disease control rate (CR + PR + SD) is 88% (7 pts). All 3 pts with PRs have received prior Pac, including 2 pts with disease that was refractory to Pac in the advanced/metastatic setting.
Conclusions: The Pac-CB combination has been well tolerated and has demonstrated clinical activity in heavily pre-treated pts with TNBC. At doses ≥600 mg BID, BORR has been 38% and DCR 88%. Notably, PRs have occurred in pts with prior Pac therapy, including 2 pts with Pac-refractory disease in the adv/met setting. Updated data on the escalation and expansion cohorts will be presented.
Dose LevelTotal400 mg BID600 mg BID800 mg BIDRECIST Response Evaluable (N)15753PR3 (20%)02 (40%)1 (33%)SD7 (47%)3 (43%)2 (40%)2 (67%)DCR (CR+PR+SD)10 (67%)3 (43%)4 (80%)3 (100%)PD5 (33%)4 (57%)1 (20%)0
Citation Format: DeMichele AM, Harding JJ, Telli ML, Münster P, McKay RR, Iliopoulos O, Whiting S, Orford KW, Bennett MK, Mier JW, Owonikoko TK, Patel MR, Kalinsky K, Carvajal RD, Infante JR, Merit-Bernstam F. Phase 1 study of CB-839, a small molecule inhibitor of glutaminase (GLS), in combination with paclitaxel (Pac) in patients (its) with triple negative breast cancer (TNBC) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-11-05.
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Affiliation(s)
- AM DeMichele
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY; Stanford University, Stanford, CA; University of California, San Francisco, San Francisco, CA; Harvard University, Cambridge, MA; Emory University, Atlanta, GA; Florida Cancer Specialists, Sarasota, FL; Columbia University, New York, NY; Tennessee Oncology, Nashville, TN; University of Texas, Houston, TX; Calithera Biosciences, San Francisco, CA
| | - JJ Harding
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY; Stanford University, Stanford, CA; University of California, San Francisco, San Francisco, CA; Harvard University, Cambridge, MA; Emory University, Atlanta, GA; Florida Cancer Specialists, Sarasota, FL; Columbia University, New York, NY; Tennessee Oncology, Nashville, TN; University of Texas, Houston, TX; Calithera Biosciences, San Francisco, CA
| | - ML Telli
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY; Stanford University, Stanford, CA; University of California, San Francisco, San Francisco, CA; Harvard University, Cambridge, MA; Emory University, Atlanta, GA; Florida Cancer Specialists, Sarasota, FL; Columbia University, New York, NY; Tennessee Oncology, Nashville, TN; University of Texas, Houston, TX; Calithera Biosciences, San Francisco, CA
| | - P Münster
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY; Stanford University, Stanford, CA; University of California, San Francisco, San Francisco, CA; Harvard University, Cambridge, MA; Emory University, Atlanta, GA; Florida Cancer Specialists, Sarasota, FL; Columbia University, New York, NY; Tennessee Oncology, Nashville, TN; University of Texas, Houston, TX; Calithera Biosciences, San Francisco, CA
| | - RR McKay
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY; Stanford University, Stanford, CA; University of California, San Francisco, San Francisco, CA; Harvard University, Cambridge, MA; Emory University, Atlanta, GA; Florida Cancer Specialists, Sarasota, FL; Columbia University, New York, NY; Tennessee Oncology, Nashville, TN; University of Texas, Houston, TX; Calithera Biosciences, San Francisco, CA
| | - O Iliopoulos
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY; Stanford University, Stanford, CA; University of California, San Francisco, San Francisco, CA; Harvard University, Cambridge, MA; Emory University, Atlanta, GA; Florida Cancer Specialists, Sarasota, FL; Columbia University, New York, NY; Tennessee Oncology, Nashville, TN; University of Texas, Houston, TX; Calithera Biosciences, San Francisco, CA
| | - S Whiting
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY; Stanford University, Stanford, CA; University of California, San Francisco, San Francisco, CA; Harvard University, Cambridge, MA; Emory University, Atlanta, GA; Florida Cancer Specialists, Sarasota, FL; Columbia University, New York, NY; Tennessee Oncology, Nashville, TN; University of Texas, Houston, TX; Calithera Biosciences, San Francisco, CA
| | - KW Orford
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY; Stanford University, Stanford, CA; University of California, San Francisco, San Francisco, CA; Harvard University, Cambridge, MA; Emory University, Atlanta, GA; Florida Cancer Specialists, Sarasota, FL; Columbia University, New York, NY; Tennessee Oncology, Nashville, TN; University of Texas, Houston, TX; Calithera Biosciences, San Francisco, CA
| | - MK Bennett
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY; Stanford University, Stanford, CA; University of California, San Francisco, San Francisco, CA; Harvard University, Cambridge, MA; Emory University, Atlanta, GA; Florida Cancer Specialists, Sarasota, FL; Columbia University, New York, NY; Tennessee Oncology, Nashville, TN; University of Texas, Houston, TX; Calithera Biosciences, San Francisco, CA
| | - JW Mier
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY; Stanford University, Stanford, CA; University of California, San Francisco, San Francisco, CA; Harvard University, Cambridge, MA; Emory University, Atlanta, GA; Florida Cancer Specialists, Sarasota, FL; Columbia University, New York, NY; Tennessee Oncology, Nashville, TN; University of Texas, Houston, TX; Calithera Biosciences, San Francisco, CA
| | - TK Owonikoko
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY; Stanford University, Stanford, CA; University of California, San Francisco, San Francisco, CA; Harvard University, Cambridge, MA; Emory University, Atlanta, GA; Florida Cancer Specialists, Sarasota, FL; Columbia University, New York, NY; Tennessee Oncology, Nashville, TN; University of Texas, Houston, TX; Calithera Biosciences, San Francisco, CA
| | - MR Patel
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY; Stanford University, Stanford, CA; University of California, San Francisco, San Francisco, CA; Harvard University, Cambridge, MA; Emory University, Atlanta, GA; Florida Cancer Specialists, Sarasota, FL; Columbia University, New York, NY; Tennessee Oncology, Nashville, TN; University of Texas, Houston, TX; Calithera Biosciences, San Francisco, CA
| | - K Kalinsky
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY; Stanford University, Stanford, CA; University of California, San Francisco, San Francisco, CA; Harvard University, Cambridge, MA; Emory University, Atlanta, GA; Florida Cancer Specialists, Sarasota, FL; Columbia University, New York, NY; Tennessee Oncology, Nashville, TN; University of Texas, Houston, TX; Calithera Biosciences, San Francisco, CA
| | - RD Carvajal
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY; Stanford University, Stanford, CA; University of California, San Francisco, San Francisco, CA; Harvard University, Cambridge, MA; Emory University, Atlanta, GA; Florida Cancer Specialists, Sarasota, FL; Columbia University, New York, NY; Tennessee Oncology, Nashville, TN; University of Texas, Houston, TX; Calithera Biosciences, San Francisco, CA
| | - JR Infante
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY; Stanford University, Stanford, CA; University of California, San Francisco, San Francisco, CA; Harvard University, Cambridge, MA; Emory University, Atlanta, GA; Florida Cancer Specialists, Sarasota, FL; Columbia University, New York, NY; Tennessee Oncology, Nashville, TN; University of Texas, Houston, TX; Calithera Biosciences, San Francisco, CA
| | - F Merit-Bernstam
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY; Stanford University, Stanford, CA; University of California, San Francisco, San Francisco, CA; Harvard University, Cambridge, MA; Emory University, Atlanta, GA; Florida Cancer Specialists, Sarasota, FL; Columbia University, New York, NY; Tennessee Oncology, Nashville, TN; University of Texas, Houston, TX; Calithera Biosciences, San Francisco, CA
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Prasad N, Patel MR, Chandra A, Rangaswamy D, Sinha A, Bhadauria D, Sharma RK, Kaul A, Gupta A. Measured Glomerular Filtration Rate at Dialysis Initiation and Clinical Outcomes of Indian Peritoneal Dialysis Patients. Indian J Nephrol 2017; 27:301-306. [PMID: 28761233 PMCID: PMC5514827 DOI: 10.4103/ijn.ijn_75_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The optimal time for dialysis initiation remains controversial. Studies have failed to show better outcomes with early initiation of hemodialysis; even a few had shown increased adverse outcomes including poorer survival. Few studies have examined the same in patients on peritoneal dialysis (PD). Measured glomerular filtration rate (mGFR) not creatinine-based estimated GFR is recommended as the measure of kidney function in end-stage renal disease (ESRD) patients. The objective of this observational study was to compare the outcomes of Indian patients initiated on PD with different residual renal function (RRF) as measured by 24-h urinary clearance method. A total of 352 incident patients starting on chronic ambulatory PD as the first modality of renal replacement therapy were followed prospectively. Patients were categorized into three groups as per mGFR at the initiation of PD (≤5, >5–10, and >10 ml/min/1.73 m2). Patient survival and technique survival were compared among the three groups. Patients with GFR of ≤5 ml/min/1.73 m2 (hazard ratio [HR] - 3.42, 95% confidence interval [CI] - 1.85–6.30, P = 0.000) and >5–10 ml/min/1.73 m2 (HR - 2.16, 95% CI - 1.26–3.71, P = 0.005) had higher risk of mortality as compared to those with GFR of >10 ml/min/1.73 m2. Each increment of 1 ml/min/1.73 m2 in baseline GFR was associated with 10% reduced risk of death (HR - 0.90, 95% CI - 0.85–0.96, P = 0.002). Technique survival was poor in those with an initial mGFR of ≤5 ml/min/1.73 m2 as compared to other categories. RRF at the initiation was also an important factor predicting nutritional status at 1 year of follow-up. To conclude, initiation of PD at a lower baseline mGFR is associated with poorer patient and technique survival in Indian ESRD patients.
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Affiliation(s)
- N Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - M R Patel
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Chandra
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - D Rangaswamy
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Sinha
- Department of Dietetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - D Bhadauria
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - R K Sharma
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Kaul
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - A Gupta
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Junn JC, Baugnon KL, Lacayo EA, Hudgins PA, Patel MR, Magliocca KR, Corey AS, El-Deiry M, Wadsworth JT, Beitler JJ, Saba NF, Liu Y, Aiken AH. CT Accuracy of Extrinsic Tongue Muscle Invasion in Oral Cavity Cancer. AJNR Am J Neuroradiol 2016; 38:364-370. [PMID: 28059707 DOI: 10.3174/ajnr.a4993] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/30/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Extrinsic tongue muscle invasion in oral cavity cancer upstages the primary tumor to a T4a. Despite this American Joint Committee on Cancer staging criterion, no studies have investigated the accuracy or prognostic importance of radiologic extrinsic tongue muscle invasion, the feasibility of standardizing extrinsic tongue muscle invasion reporting, or the degree of agreement across different disciplines: radiology, surgery, and pathology. The purpose of this study was to assess the agreement among radiology, surgery, and pathology for extrinsic tongue muscle invasion and to determine the imaging features most predictive of extrinsic tongue muscle invasion with surgical/pathologic confirmation. MATERIALS AND METHODS Thirty-three patients with untreated primary oral cavity cancer were included. Two head and neck radiologists, 3 otolaryngologists, and 1 pathologist prospectively evaluated extrinsic tongue muscle invasion. RESULTS Fourteen of 33 patients had radiologic extrinsic tongue muscle invasion; however, only 8 extrinsic tongue muscle invasions were confirmed intraoperatively. Pathologists were unable to determine extrinsic tongue muscle invasion in post-formalin-fixed samples. Radiologic extrinsic tongue muscle invasion had 100% sensitivity, 76% specificity, 57% positive predictive value, and 100% negative predictive value with concurrent surgical-pathologic evaluation of extrinsic tongue muscle invasion as the criterion standard. On further evaluation, the imaging characteristic most consistent with surgical-pathologic evaluation positive for extrinsic tongue muscle invasion was masslike enhancement. CONCLUSIONS Evaluation of extrinsic tongue muscle invasion is a subjective finding for all 3 disciplines. For radiology, masslike enhancement of extrinsic tongue muscle invasion most consistently corresponded to concurrent surgery/pathology evaluation positive for extrinsic tongue muscle invasion. Intraoperative surgical and pathologic evaluation should be encouraged to verify radiologic extrinsic tongue muscle invasion to minimize unnecessary upstaging. Because this process is not routine, imaging can add value by identifying those cases most suspicious for extrinsic tongue muscle invasion, thereby prompting this more detailed evaluation by surgeons and pathologists.
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Affiliation(s)
- J C Junn
- From the Departments of Imaging Sciences (J.C.J., K.L.B., P.A.H., A.S.C., A.H.A.)
| | - K L Baugnon
- From the Departments of Imaging Sciences (J.C.J., K.L.B., P.A.H., A.S.C., A.H.A.)
| | - E A Lacayo
- Department of Radiology (E.A.L.), Georgetown University, Washington, DC
| | - P A Hudgins
- From the Departments of Imaging Sciences (J.C.J., K.L.B., P.A.H., A.S.C., A.H.A.)
| | - M R Patel
- Otolaryngology (M.R.P., M.E.-D., J.T.W.)
| | | | - A S Corey
- From the Departments of Imaging Sciences (J.C.J., K.L.B., P.A.H., A.S.C., A.H.A.)
| | - M El-Deiry
- Otolaryngology (M.R.P., M.E.-D., J.T.W.)
| | | | | | | | - Y Liu
- Statistics (Y.L.), Emory University School of Medicine, Atlanta, Georgia
| | - A H Aiken
- From the Departments of Imaging Sciences (J.C.J., K.L.B., P.A.H., A.S.C., A.H.A.)
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Thomas IR, Vandaele AC, Robert S, Neefs E, Drummond R, Daerden F, Delanoye S, Ristic B, Berkenbosch S, Clairquin R, Maes J, Bonnewijn S, Depiesse C, Mahieux A, Trompet L, Neary L, Willame Y, Wilque V, Nevejans D, Aballea L, Moelans W, De Vos L, Lesschaeve S, Van Vooren N, Lopez-Moreno JJ, Patel MR, Bellucci G. Optical and radiometric models of the NOMAD instrument part II: the infrared channels - SO and LNO. Opt Express 2016; 24:3790-3805. [PMID: 27333621 DOI: 10.1364/oe.24.003790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
NOMAD is a suite of three spectrometers that will be launched in 2016 as part of the joint ESA-Roscosmos ExoMars Trace Gas Orbiter mission. The instrument contains three channels that cover the IR and UV spectral ranges and can perform solar occultation, nadir and limb observations, to detect and map a wide variety of Martian atmospheric gases and trace species. Part I of this work described the models of the UVIS channel; in this second part, we present the optical models representing the two IR channels, SO (Solar Occultation) and LNO (Limb, Nadir and Occultation), and use them to determine signal to noise ratios (SNRs) for many expected observational cases. In solar occultation mode, both the SO and LNO channel exhibit very high SNRs >5000. SNRs of around 100 were found for the LNO channel in nadir mode, depending on the atmospheric conditions, Martian surface properties, and observation geometry.
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Rolfe SM, Patel MR, Gilmour I, Olsson-Francis K, Ringrose TJ. Defining Multiple Characteristic Raman Bands of α-Amino Acids as Biomarkers for Planetary Missions Using a Statistical Method. ORIGINS LIFE EVOL B 2016; 46:323-46. [PMID: 26744263 PMCID: PMC4764629 DOI: 10.1007/s11084-015-9477-7] [Citation(s) in RCA: 10] [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: 01/04/2015] [Accepted: 08/26/2015] [Indexed: 11/05/2022]
Abstract
Biomarker molecules, such as amino acids, are key to discovering whether life exists elsewhere in the Solar System. Raman spectroscopy, a technique capable of detecting biomarkers, will be on board future planetary missions including the ExoMars rover. Generally, the position of the strongest band in the spectra of amino acids is reported as the identifying band. However, for an unknown sample, it is desirable to define multiple characteristic bands for molecules to avoid any ambiguous identification. To date, there has been no definition of multiple characteristic bands for amino acids of interest to astrobiology. This study examined l-alanine, l-aspartic acid, l-cysteine, l-glutamine and glycine and defined several Raman bands per molecule for reference as characteristic identifiers. Per amino acid, 240 spectra were recorded and compared using established statistical tests including ANOVA. The number of characteristic bands defined were 10, 12, 12, 14 and 19 for l-alanine (strongest intensity band: 832 cm-1), l-aspartic acid (938 cm-1), l-cysteine (679 cm-1), l-glutamine (1090 cm−1) and glycine (875 cm-1), respectively. The intensity of bands differed by up to six times when several points on the crystal sample were rotated through 360 °; to reduce this effect when defining characteristic bands for other molecules, we find that spectra should be recorded at a statistically significant number of points per sample to remove the effect of sample rotation. It is crucial that sets of characteristic Raman bands are defined for biomarkers that are targets for future planetary missions to ensure a positive identification can be made.
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Affiliation(s)
- S M Rolfe
- Planetary and Space Sciences, Department of Physical Sciences, The Open University, Robert Hooke Building, Walton Hall, Milton Keynes, MK7 6AA, UK.
| | - M R Patel
- Planetary and Space Sciences, Department of Physical Sciences, The Open University, Robert Hooke Building, Walton Hall, Milton Keynes, MK7 6AA, UK.,Space Science and Technology Department, STFC Rutherford Appleton Laboratory, Chilton, Didcot, Oxfordshire, OX11 0QX, UK
| | - I Gilmour
- Planetary and Space Sciences, Department of Physical Sciences, The Open University, Robert Hooke Building, Walton Hall, Milton Keynes, MK7 6AA, UK
| | - K Olsson-Francis
- Department of Environment, Earth and Ecosystems, The Open University, Milton Keynes, MK7 6AA, UK
| | - T J Ringrose
- Planetary and Space Sciences, Department of Physical Sciences, The Open University, Robert Hooke Building, Walton Hall, Milton Keynes, MK7 6AA, UK
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Thumma SC, Jacobson BA, Patel MR, Konicek BW, Franklin MJ, Jay-Dixon J, Sadiq A, De A, Graff JR, Kratzke RA. Antisense oligonucleotide targeting eukaryotic translation initiation factor 4E reduces growth and enhances chemosensitivity of non-small-cell lung cancer cells. Cancer Gene Ther 2015; 22:396-401. [PMID: 26227824 DOI: 10.1038/cgt.2015.34] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 06/30/2015] [Accepted: 07/10/2015] [Indexed: 12/12/2022]
Abstract
Elevated levels of eukaryotic translation initiation factor 4E (eIF4E) enhance translation of many malignancy-related proteins, such as vascular endothelial growth factor (VEGF), c-Myc and osteopontin. In non-small-cell lung cancer (NSCLC), levels of eIF4E are significantly increased compared with normal lung tissue. Here, we used an antisense oligonucleotide (ASO) to inhibit the expression of eIF4E in NSCLC cell lines. eIF4E levels were significantly reduced in a dose-dependent manner in NSCLC cells treated with eIF4E-specific ASO (4EASO) compared with control ASO. Treatment of NSCLC cells with the 4EASO resulted in decreased cap-dependent complex formation, decreased cell proliferation and increased sensitivity to gemcitabine. At the molecular level, repression of eIF4E with ASO resulted in decreased expression of the oncogenic proteins VEGF, c-Myc and osteopontin, whereas expression of β-actin was unaffected. Based on these findings, we conclude that eIF4E-silencing therapy alone or in conjunction with chemotherapy represents a promising approach deserving of further investigation in future NSCLC clinical trials.
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Affiliation(s)
- S C Thumma
- Division of Hematology, Department of Medicine, Oncology and Transplantation, University of Minnesota Medical School, Minneapolis, MN, USA
| | - B A Jacobson
- Division of Hematology, Department of Medicine, Oncology and Transplantation, University of Minnesota Medical School, Minneapolis, MN, USA
| | - M R Patel
- Division of Hematology, Department of Medicine, Oncology and Transplantation, University of Minnesota Medical School, Minneapolis, MN, USA
| | - B W Konicek
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - M J Franklin
- Division of Hematology, Department of Medicine, Oncology and Transplantation, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J Jay-Dixon
- Division of Hematology, Department of Medicine, Oncology and Transplantation, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A Sadiq
- Division of Hematology, Department of Medicine, Oncology and Transplantation, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A De
- Division of Hematology, Department of Medicine, Oncology and Transplantation, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J R Graff
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - R A Kratzke
- Division of Hematology, Department of Medicine, Oncology and Transplantation, University of Minnesota Medical School, Minneapolis, MN, USA
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Mishra V, Mohanty I, Patel MR, Patel KI. Development of Green Waterborne UV-Curable Castor Oil-Based Urethane Acrylate Coatings: Preparation and Property Analysis. International Journal of Polymer Analysis and Characterization 2015. [DOI: 10.1080/1023666x.2015.1050852] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Patel MR, Nana M, Yotebieng M, Tabala M, Behets F, Van Rie A. Delayed antiretroviral therapy despite integrated treatment for tuberculosis and HIV infection. Int J Tuberc Lung Dis 2015; 18:694-9. [PMID: 24903941 DOI: 10.5588/ijtld.13.0807] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Five primary health care clinics in Kinshasa, Democratic Republic of Congo. OBJECTIVE To examine timing and predictors of delayed initiation of antiretroviral therapy (ART) during anti-tuberculosis treatment. DESIGN Prospective observational cohort of adult patients receiving integrated treatment for tuberculosis (TB) and human immunodeficiency virus (HIV) who are expected to initiate ART at 1 month if CD4 count is <100 cells/mm(3) or if patient is World Health Organization (WHO) Clinical Stage 4 for reasons other than extra-pulmonary TB, at 2 months if CD4 count is 100-350 cells/mm(3), or at completion of anti-tuberculosis treatment if subsequently CD4 count is ≤ 350 cells/mm(3) or patient has WHO Clinical Stage 4. RESULTS Of 492 patients, 235 (47.8%) experienced delayed initiation of ART: 171 (72.8%) initiated ART late, after a median delay of 12 days (interquartile range [IQR] 4-27) and 64 (27.2%) never initiated ART. Contraindication to any antiretroviral drug (aOR 2.91, 95%CI 1.22-6.95), lower baseline CD4 count (aOR 1.20, 95%CI 1.08-1.33/100 cells/mm(3)), TB drug intolerance (aOR 1.93, 95%CI 1.23-3.02) and non-disclosure of HIV infection (aOR 1.50, 95%CI 1.03-2.18) predicted delayed ART initiation. CONCLUSION Despite fully integrated treatment, half of all patients experienced delayed ART initiation. Pragmatic approaches to ensure timely ART initiation in those at risk of delayed ART initiation are needed.
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Affiliation(s)
- M R Patel
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - M Nana
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - M Yotebieng
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - M Tabala
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - F Behets
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - A Van Rie
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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37
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Levi M, Moore KT, Castillejos CF, Kubitza D, Berkowitz SD, Goldhaber SZ, Raghoebar M, Patel MR, Weitz JI, Levy JH. Comparison of three-factor and four-factor prothrombin complex concentrates regarding reversal of the anticoagulant effects of rivaroxaban in healthy volunteers. J Thromb Haemost 2014; 12:1428-36. [PMID: 24811969 DOI: 10.1111/jth.12599] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 04/30/2014] [Indexed: 08/31/2023]
Abstract
BACKGROUND Four-factor prothrombin complex concentrates (PCCs), which contain factor II, FVII, FIX, and FX, have shown the potential to reverse the anticoagulant effect of rivaroxaban in healthy volunteers. The purpose of this study was to determine whether a three-factor PCC, which contains little FVII, has a similar effect. METHODS AND RESULTS We performed an open-label, single-center, parallel-group study comparing the effect of a three-factor PCC (Profilnine SD) with that of a four-factor PCC (Beriplex P/N) on the pharmacodynamics of rivaroxaban in 35 healthy volunteers. After receiving 4 days of rivaroxaban 20 mg twice daily to obtain supratherapeutic steady-state concentrations, volunteers were randomized to receive a single 50 IU kg(-1) bolus dose of four-factor PCC, three-factor PCC or saline 4 h after the morning dose of rivaroxaban on day 5, and the effects of these interventions on prothrombin time and thrombin generation were determined. Within 30 min, four-factor PCC reduced mean prothrombin time by 2.5-3.5 s, whereas three-factor PCC produced only a 0.6-1.0-s reduction. In contrast, three-factor PCC reversed rivaroxaban-induced changes in thrombin generation more than four-factor PCC. CONCLUSIONS This study demonstrates the potential of both three-factor and four-factor PCCs to at least partially reverse the anticoagulant effects of rivaroxaban in healthy adults. The discrepant effects of the PCC preparations may reflect differences in the procoagulant components present in each.
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Affiliation(s)
- M Levi
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Girgis IG, Patel MR, Peters GR, Moore KT, Mahaffey KW, Nessel CC, Halperin JL, Califf RM, Fox KAA, Becker RC. Population pharmacokinetics and pharmacodynamics of rivaroxaban in patients with non-valvular atrial fibrillation: results from ROCKET AF. J Clin Pharmacol 2014; 54:917-27. [PMID: 24668660 DOI: 10.1002/jcph.288] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 03/12/2014] [Indexed: 11/10/2022]
Abstract
Two once-daily rivaroxaban dosing regimens were compared with warfarin for stroke prevention in patients with non-valvular atrial fibrillation in ROCKET AF: 20 mg for patients with normal/mildly impaired renal function and 15 mg for patients with moderate renal impairment. Rivaroxaban population pharmacokinetic (PK)/pharmacodynamic (PD) modeling data from ROCKET AF patients (n = 161) are reported and are used to confirm established rivaroxaban PK and PK/PD models and to re-estimate values of the models' parameters for the current AF population. An oral one-compartment model with first-order absorption adequately described rivaroxaban PK. Age, renal function, and lean body mass influenced the PK model. Prothrombin time and prothrombinase-induced clotting time exhibited a near-linear relationship with rivaroxaban plasma concentration; inhibitory effects were observed through to 24 hours post-dose. Rivaroxaban plasma concentration and factor Xa activity had an inhibitory maximum-effect (Emax ) relationship. Renal function (on prothrombin time; prothrombinase-induced clotting time) and age (on factor Xa activity) had moderate effects on PK/PD models. PK and PK/PD models were shown to be adequate for describing the current dataset. These findings confirm the modeling and empirical results that led to the selection of doses tested against warfarin in ROCKET AF.
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Affiliation(s)
- I G Girgis
- Janssen Pharmaceuticals Research & Development, Raritan, NJ, USA
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Juric D, Saura C, Cervantes A, Kurkjian C, Patel MR, Sachdev J, Mayer I, Krop IE, Oliveira M, Sanabria S, Cheeti S, Lin RS, Graham RA, Wilson TR, Parmar H, Hsu JY, Von Hoff DD, Baselga J. Abstract PD1-3: Ph1b study of the PI3K inhibitor GDC-0032 in combination with fulvestrant in patients with hormone receptor-positive advanced breast cancer. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-pd1-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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
Background: GDC-0032 is a next-generation PI3K inhibitor with increased anti-tumor activity against PIK3CA mutant cancers. GDC-0032 is an orally bioavailable, potent, and selective inhibitor of Class I PI3K alpha, delta, and gamma isoforms, with 30-fold less inhibition of the PI3K beta isoform relative to the PI3K alpha isoform. Preclinical data show that GDC-0032 has enhanced activity against PI3K alpha isoform (PIK3CA) mutant breast cancer cell lines. Preclinical data also show enhanced antitumor activity when GDC-0032 is combined with fulvestrant.
Material and Methods: A Phase 1b dose escalation study was conducted with evaluation of GDC-0032 doses ranging from 6-9 mg QD in combination with fulvestrant 500mg q4wk (with loading dose of 500mg at day 1, 14 and 28) in a modified 3+3 design. A dose expansion cohort was conducted at the recommended Phase 2 dose of 6 mg QD. Safety and tolerability of GDC-0032 was assessed, as well as pharmacokinetics (PK), pharmacodynamic (PD) assessment of PI3K pathway inhibition by paired tumor biopsies and by FDG-PET, and anti-tumor activity by RECIST.
Results: As of 1 Mar 2013, 17 patients were enrolled onto this study with the completion of dose escalation. No dose limiting toxicities (DLTs) were observed at either the 6 mg or 9 mg dose levels. Adverse events (AEs) assessed by the investigator as related to GDC-0032 in ≥10% of patients, were diarrhea, hyperglycemia, stomatitis, fatigue, asthenia, decreased appetite, nausea, mucosal inflammation and rash. No observed apparent PK interactions were observed between GDC-0032 and fulvestrant. The median number of prior systemic therapies was 6. Metabolic partial responses via FDG-PET (≥ 20% decrease in mSUVmax) were observed in 8 out of 11 patients assessed (73%). Confirmed partial responses by RECIST have been observed at both the 6mg and 9mg GDC-0032 dose levels. These include patients who have had prior treatment with fulvestrant. As of 29 May 2013, enrollment onto the dose escalation and expansion cohort has been completed (n = 27). Updated data on safety, pharmacodynamics, efficacy, and biomarker correlates will be presented.
Conclusions: The combination of GDC-0032 and fulvestrant is a well-tolerated regimen with promising preliminary efficacy. GDC-0032 is being further investigated in combination with fulvestrant for patients with hormone receptor-positive advanced breast cancer.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr PD1-3.
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Affiliation(s)
- D Juric
- Massachusetts General Hospital Cancer Center, Boston, MA; Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain; University of Oklahoma, Oklahoma City, OK; Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, FL; Virginia G. Piper Cancer Center/TGen, Scottsdale, AZ; Vanderbilt-Ingram Cancer Center, Nashville, TN; Dana Farber Cancer Institute, Boston, MA; Memorial Sloan-Kettering Cancer Center, New York, NY; Genentech, Inc., South San Francisco, CA
| | - C Saura
- Massachusetts General Hospital Cancer Center, Boston, MA; Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain; University of Oklahoma, Oklahoma City, OK; Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, FL; Virginia G. Piper Cancer Center/TGen, Scottsdale, AZ; Vanderbilt-Ingram Cancer Center, Nashville, TN; Dana Farber Cancer Institute, Boston, MA; Memorial Sloan-Kettering Cancer Center, New York, NY; Genentech, Inc., South San Francisco, CA
| | - A Cervantes
- Massachusetts General Hospital Cancer Center, Boston, MA; Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain; University of Oklahoma, Oklahoma City, OK; Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, FL; Virginia G. Piper Cancer Center/TGen, Scottsdale, AZ; Vanderbilt-Ingram Cancer Center, Nashville, TN; Dana Farber Cancer Institute, Boston, MA; Memorial Sloan-Kettering Cancer Center, New York, NY; Genentech, Inc., South San Francisco, CA
| | - C Kurkjian
- Massachusetts General Hospital Cancer Center, Boston, MA; Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain; University of Oklahoma, Oklahoma City, OK; Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, FL; Virginia G. Piper Cancer Center/TGen, Scottsdale, AZ; Vanderbilt-Ingram Cancer Center, Nashville, TN; Dana Farber Cancer Institute, Boston, MA; Memorial Sloan-Kettering Cancer Center, New York, NY; Genentech, Inc., South San Francisco, CA
| | - MR Patel
- Massachusetts General Hospital Cancer Center, Boston, MA; Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain; University of Oklahoma, Oklahoma City, OK; Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, FL; Virginia G. Piper Cancer Center/TGen, Scottsdale, AZ; Vanderbilt-Ingram Cancer Center, Nashville, TN; Dana Farber Cancer Institute, Boston, MA; Memorial Sloan-Kettering Cancer Center, New York, NY; Genentech, Inc., South San Francisco, CA
| | - J Sachdev
- Massachusetts General Hospital Cancer Center, Boston, MA; Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain; University of Oklahoma, Oklahoma City, OK; Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, FL; Virginia G. Piper Cancer Center/TGen, Scottsdale, AZ; Vanderbilt-Ingram Cancer Center, Nashville, TN; Dana Farber Cancer Institute, Boston, MA; Memorial Sloan-Kettering Cancer Center, New York, NY; Genentech, Inc., South San Francisco, CA
| | - I Mayer
- Massachusetts General Hospital Cancer Center, Boston, MA; Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain; University of Oklahoma, Oklahoma City, OK; Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, FL; Virginia G. Piper Cancer Center/TGen, Scottsdale, AZ; Vanderbilt-Ingram Cancer Center, Nashville, TN; Dana Farber Cancer Institute, Boston, MA; Memorial Sloan-Kettering Cancer Center, New York, NY; Genentech, Inc., South San Francisco, CA
| | - IE Krop
- Massachusetts General Hospital Cancer Center, Boston, MA; Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain; University of Oklahoma, Oklahoma City, OK; Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, FL; Virginia G. Piper Cancer Center/TGen, Scottsdale, AZ; Vanderbilt-Ingram Cancer Center, Nashville, TN; Dana Farber Cancer Institute, Boston, MA; Memorial Sloan-Kettering Cancer Center, New York, NY; Genentech, Inc., South San Francisco, CA
| | - M Oliveira
- Massachusetts General Hospital Cancer Center, Boston, MA; Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain; University of Oklahoma, Oklahoma City, OK; Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, FL; Virginia G. Piper Cancer Center/TGen, Scottsdale, AZ; Vanderbilt-Ingram Cancer Center, Nashville, TN; Dana Farber Cancer Institute, Boston, MA; Memorial Sloan-Kettering Cancer Center, New York, NY; Genentech, Inc., South San Francisco, CA
| | - S Sanabria
- Massachusetts General Hospital Cancer Center, Boston, MA; Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain; University of Oklahoma, Oklahoma City, OK; Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, FL; Virginia G. Piper Cancer Center/TGen, Scottsdale, AZ; Vanderbilt-Ingram Cancer Center, Nashville, TN; Dana Farber Cancer Institute, Boston, MA; Memorial Sloan-Kettering Cancer Center, New York, NY; Genentech, Inc., South San Francisco, CA
| | - S Cheeti
- Massachusetts General Hospital Cancer Center, Boston, MA; Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain; University of Oklahoma, Oklahoma City, OK; Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, FL; Virginia G. Piper Cancer Center/TGen, Scottsdale, AZ; Vanderbilt-Ingram Cancer Center, Nashville, TN; Dana Farber Cancer Institute, Boston, MA; Memorial Sloan-Kettering Cancer Center, New York, NY; Genentech, Inc., South San Francisco, CA
| | - RS Lin
- Massachusetts General Hospital Cancer Center, Boston, MA; Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain; University of Oklahoma, Oklahoma City, OK; Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, FL; Virginia G. Piper Cancer Center/TGen, Scottsdale, AZ; Vanderbilt-Ingram Cancer Center, Nashville, TN; Dana Farber Cancer Institute, Boston, MA; Memorial Sloan-Kettering Cancer Center, New York, NY; Genentech, Inc., South San Francisco, CA
| | - RA Graham
- Massachusetts General Hospital Cancer Center, Boston, MA; Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain; University of Oklahoma, Oklahoma City, OK; Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, FL; Virginia G. Piper Cancer Center/TGen, Scottsdale, AZ; Vanderbilt-Ingram Cancer Center, Nashville, TN; Dana Farber Cancer Institute, Boston, MA; Memorial Sloan-Kettering Cancer Center, New York, NY; Genentech, Inc., South San Francisco, CA
| | - TR Wilson
- Massachusetts General Hospital Cancer Center, Boston, MA; Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain; University of Oklahoma, Oklahoma City, OK; Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, FL; Virginia G. Piper Cancer Center/TGen, Scottsdale, AZ; Vanderbilt-Ingram Cancer Center, Nashville, TN; Dana Farber Cancer Institute, Boston, MA; Memorial Sloan-Kettering Cancer Center, New York, NY; Genentech, Inc., South San Francisco, CA
| | - H Parmar
- Massachusetts General Hospital Cancer Center, Boston, MA; Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain; University of Oklahoma, Oklahoma City, OK; Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, FL; Virginia G. Piper Cancer Center/TGen, Scottsdale, AZ; Vanderbilt-Ingram Cancer Center, Nashville, TN; Dana Farber Cancer Institute, Boston, MA; Memorial Sloan-Kettering Cancer Center, New York, NY; Genentech, Inc., South San Francisco, CA
| | - JY Hsu
- Massachusetts General Hospital Cancer Center, Boston, MA; Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain; University of Oklahoma, Oklahoma City, OK; Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, FL; Virginia G. Piper Cancer Center/TGen, Scottsdale, AZ; Vanderbilt-Ingram Cancer Center, Nashville, TN; Dana Farber Cancer Institute, Boston, MA; Memorial Sloan-Kettering Cancer Center, New York, NY; Genentech, Inc., South San Francisco, CA
| | - DD Von Hoff
- Massachusetts General Hospital Cancer Center, Boston, MA; Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain; University of Oklahoma, Oklahoma City, OK; Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, FL; Virginia G. Piper Cancer Center/TGen, Scottsdale, AZ; Vanderbilt-Ingram Cancer Center, Nashville, TN; Dana Farber Cancer Institute, Boston, MA; Memorial Sloan-Kettering Cancer Center, New York, NY; Genentech, Inc., South San Francisco, CA
| | - J Baselga
- Massachusetts General Hospital Cancer Center, Boston, MA; Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain; University of Oklahoma, Oklahoma City, OK; Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, FL; Virginia G. Piper Cancer Center/TGen, Scottsdale, AZ; Vanderbilt-Ingram Cancer Center, Nashville, TN; Dana Farber Cancer Institute, Boston, MA; Memorial Sloan-Kettering Cancer Center, New York, NY; Genentech, Inc., South San Francisco, CA
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Patel MR, Yotebieng M, Behets F, Vanden Driessche K, Nana M, Van Rie A. Outcomes of integrated treatment for tuberculosis and HIV in children at the primary health care level. Int J Tuberc Lung Dis 2013; 17:1206-11. [PMID: 23827656 DOI: 10.5588/ijtld.12.0833] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about the integration of tuberculosis (TB) and human immunodeficiency virus (HIV) treatment in pediatric populations. METHODS Prospective cohort of 31 HIV-infected children aged 3-18 years initiating anti-tuberculosis treatment at five primary health care (PHC) clinics in Kinshasa, Democratic Republic of Congo, to describe survival, clinical and immunological outcomes of nurse-centered integrated TB-HIV treatment. RESULTS Almost all of the children (87.1%) were diagnosed with HIV during TB diagnosis. Most (87.0%) were successfully treated for TB. Two (6.5%) died during anti-tuberculosis treatment; both presented with low CD4 counts (36 and 59 cells/mm(3) compared to a median of 228 cells/mm(3) in the entire cohort). Most (74.2%) initiated antiretroviral therapy (ART) during anti-tuberculosis treatment. Overall, a median CD4 count increase of 106 cells/mm(3) was observed (P = 0.014), an increase of 113 cells/mm(3) among children on ART and of 71.5 cells/mm(3) in those not on ART (P = 0.78). Median body mass index increase during anti-tuberculosis treatment was 2.1 kg/m(2) overall (P = 0.002), 2.2 kg/m(2) among children on ART and 0.72 kg/m(2) in those not on ART (P = 0.08). CONCLUSION Integrated, nurse-centered, pediatric TB-HIV treatment at the PHC level in highly resource-limited settings is feasible and effective in achieving successful outcomes, including high ART uptake, low mortality, and immunological and clinical improvement.
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Affiliation(s)
- M R Patel
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.
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Abstract
BACKGROUND AND OBJECTIVE Little is known about the factors that affect the microbial composition of supragingival biofilms. This study was designed to examine the relationship between total DNA probe counts of supragingival biofilm samples, clinical parameters and supragingival biofilm composition. MATERIAL AND METHODS Supragingival plaque samples were taken from 187 systemically healthy adult subjects (n = 4745 samples). All samples were individually analyzed for their content of 40 bacterial species using checkerboard DNA-DNA hybridization. The relationship between total DNA probe counts and microbial composition was examined by subsetting the data into 10 groups based on 10 percentile increments of the total DNA probe counts. Differences among groups in terms of species counts and proportions were sought, as well as relationships of total plaque DNA probe count and clinical parameters. RESULTS There was a wide distribution in mean total DNA probe counts among the 187 subjects. With increasing total plaque levels there was a change in the proportions of individual species and microbial complexes. 'Small plaques' were characterized by high proportions of species in the yellow, orange, purple and 'other' complexes; plaques of moderate mass were characterized by high proportions of Actinomyces and purple complex species, while 'large plaques' exhibited increased proportions of green and orange complex species. Measures of gingival inflammation, pocket depth and recession were significantly positively associated with total DNA probe counts. Increased plaque numbers were related to increased pocket depth irrespective of presence or absence of gingival inflammation. CONCLUSION The proportions of individual species and microbial complexes in supragingival biofilms are influenced by the total numbers of organisms in the biofilm.
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Affiliation(s)
- A D Haffajee
- Department of Periodontology, The Forsyth Institute, Boston, MA 02115, USA.
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Jones WS, Washam JB, Meine TJ, Patel MR. Drug-eluting versus bare metal stenting in acute myocardial infarction. A clinical review. Minerva Cardioangiol 2009; 57:585-595. [PMID: 19838149] [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: 05/28/2023]
Abstract
Coronary heart disease is a leading cause of death around the world. The treatment of acute myocardial infarction has evolved with the advent of novel thrombolytic agents, anticoagulants, antiplatelets, and innovative percutaneous techniques. The development of drug-eluting stents has dramatically lowered the risk of in-stent restenosis compared to bare metal stents. Clinicians in the United States and Europe have begun utilizing DES in the setting of AMI despite the fact that no practice guidelines exist to support their use. Lingering concerns exist about the reported increased risk of early and late stent thrombosis after DES implantation. In this review, we will highlight the >7,500 patients studied in randomized controlled trials and >30,000 registry patients comparing drug-eluting and bare metal stent implantation during acute myocardial infarction. In the selected patient populations of the 13 randomized controlled trials comparing drug-eluting and bare metal stent implantation, death/re-infarction/stent thrombosis were not different between groups while target vessel revascularization was significantly lower in the drug-eluting stent patients. In the "real world" registry studies, mortality/target vessel revascularization/stent thrombosis were less frequent in the first year after drug-eluting stent implantation while re-infarction was not different between the groups. While multiple questions remain regarding long-term follow up and especially late stent thrombosis, it appears that drug-eluting stents are effective at decreasing target vessel revascularization while not being associated with an elevated risk of death/re-infarction/stent thrombosis in the first year post myocardial infarction.
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Affiliation(s)
- W S Jones
- Division of Cardiology, Duke University, Durham, NC 27710, USA
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Jacobson BA, De A, Kratzke MG, Patel MR, Jay-Dixon J, Whitson BA, Sadiq AA, Bitterman PB, Polunovsky VA, Kratzke RA. Activated 4E-BP1 represses tumourigenesis and IGF-I-mediated activation of the eIF4F complex in mesothelioma. Br J Cancer 2009; 101:424-31. [PMID: 19603014 PMCID: PMC2720234 DOI: 10.1038/sj.bjc.6605184] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 06/17/2009] [Accepted: 06/17/2009] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Insulin-like growth factor (IGF)-I signalling stimulates proliferation, survival, and invasion in malignant mesothelioma and other tumour types. Studies have found that tumourigenesis is linked to dysregulation of cap-dependent protein translation. METHODS The effect of IGF stimulation on cap-mediated translation activation in mesothelioma cell lines was studied using binding assays to a synthetic 7-methyl GTP-cap analogue. In addition, cap-mediated translation was genetically repressed in these cells with a dominant active motive of 4E-BP1. RESULTS In most mesothelioma cell lines, IGF-I stimulation resulted in a hyperphosphorylation-mediated inactivation of 4E-BP1 compared with that in normal mesothelial cells. An inhibitor of Akt diminished IGF-I-mediated phosphorylation of 4E-BP1, whereas inhibiting MAPK signalling had no such effect. IGF-I stimulation resulted in the activation of the cap-mediated translation complex as indicated by an increased eIF4G/eIF4E ratio in cap-affinity assays. Akt inhibition reversed the eIF4G/eIF4E ratio. Mesothelioma cells transfected with an activated 4E-BP1 protein (4E-BP1(A37/A46)) were resistant to IGF-I-mediated growth, motility, and colony formation. In a murine xenograft model, mesothelioma cells expressing the dominant active 4E-BP1(A37/A46) repressor protein showed abrogated tumourigenicity compared with control tumours. CONCLUSION IGF-I signalling in mesothelioma cells drives cell proliferation, motility, and tumourigenesis through its ability to activate cap-mediated protein translation complex through PI3K/Akt/mTOR signalling.
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Affiliation(s)
- B A Jacobson
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
- Research Service, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN, 55417, USA
| | - A De
- Department of Pharmacology, University of Minnesota, Minneapolis, MN 55455, USA
| | - M G Kratzke
- Research Service, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN, 55417, USA
| | - M R Patel
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - J Jay-Dixon
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - B A Whitson
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - A A Sadiq
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - P B Bitterman
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - V A Polunovsky
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - R A Kratzke
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
- Research Service, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN, 55417, USA
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
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Haffajee AD, Teles RP, Patel MR, Song X, Yaskell T, Socransky SS. Factors affecting human supragingival biofilm composition. II. Tooth position. J Periodontal Res 2008; 44:520-8. [PMID: 18973539 DOI: 10.1111/j.1600-0765.2008.01155.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Little is known regarding the factors that affect the microbial composition of supragingival biofilms. This study was designed to test the hypothesis that tooth location affects the microbial composition of supragingival plaque beyond the effect due to plaque mass as reflected by total DNA probe count. MATERIAL AND METHODS Supragingival plaque samples were taken from the mesiobuccal aspect of each tooth in 187 subjects (n = 4745 samples). All samples were individually analyzed for their content of 40 bacterial species using checkerboard DNA-DNA hybridization. Significance of differences in mean species counts and proportions were determined among tooth surfaces and six tooth type categories: molars, bicuspids, incisors/canines in the mandible and maxilla separately using the Kruskal-Wallis test. Stepwise multiple linear regression was employed to examine the relationship between species proportions and total DNA probe count, tooth location, periodontal and smoking status, age and sex. RESULTS All species differed significantly among tooth types and among the six tooth categories. Higher plaque levels were seen on molars and lower incisors. Some differences observed between tooth types could be partly explained by the level of plaque. Teeth with high plaque mass exhibited high levels of Capnocytophaga gingivalis, Actinomyces naeslundii genospecies 2, Campylobacter rectus and Campylobacter showae. However, certain species, such as Veillonella parvula and Streptococcus sanguinis, differed significantly at different tooth locations despite similarities in plaque mass. Twenty of the test species exhibited a significant association with tooth location after adjusting for total DNA probe count and subject level factors. CONCLUSION While plaque mass was associated with differences in proportions of many species in supragingival biofilms, tooth location also was strongly associated with species proportions in both univariate and multivariate analyses.
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Affiliation(s)
- A D Haffajee
- Department of Periodontology, The Forsyth Institute, Boston, MA 02115, USA.
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Abstract
BACKGROUND/AIMS To examine microbial communities in supragingival biofilm samples. METHODS Supragingival plaque samples were taken from 187 subjects at baseline (n = 4745). Fifty-five subjects provided supragingival plaque samples at 1-7 days after professional tooth cleaning (n = 1456); 93 subjects provided 8044 samples between 3 and 24 months post-therapy. All samples were individually analyzed for their content of 40 bacterial species using checkerboard DNA-DNA hybridization. Microbial associations among species were sought using cluster analysis and community ordination techniques for the three groups separately. RESULTS Six complexes were formed for the baseline samples. Similar complexes were formed for the samples taken 3-24 months post-therapy. However, distinct changes were observed in microbial communities in samples taken during the 7 days of plaque redevelopment. The complexes related to clinical parameters of periodontal disease. CONCLUSION There were specific microbial complexes in supragingival plaque that were similar to those found in subgingival plaque samples with a few minor differences. The relation of previously unclustered taxa to the complexes was also described.
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Affiliation(s)
- A D Haffajee
- Department of Periodontology, The Forsyth Institute, Boston, MA 02115, USA.
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Cedar SH, Cooke JA, Patel MR, Luo Z, Minger SL. The therapeutic potential of human embryonic stem cells. Indian J Med Res 2007; 125:17-24. [PMID: 17332653] [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: 05/14/2023] Open
Abstract
Due to lack of suitable organ donors, future degenerative diseases and traumas could be treated with stem cell engraftment. To do this, large numbers of cells must be grown and maintained in culture. These cells must also be capable to differentiate into all the cells of the body. Embryonic stem cells fulfill many of the necessary criteria for clinical translation for use in therapeutic transplantation for a myriad of diseases. There are still many issues including immunological, cell cycling and differentiation that must be overcome for them to reach their potential use in the clinical arena.
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Affiliation(s)
- S H Cedar
- Stem Cell Biology Laboratory, Wolfson Centre for Age Related Disease, King's College, London, UK
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Abstract
Vanilla ice cream was made with a mix composition of 10.5% milk fat, 10.5% milk SNF, 12% beet sugar, and 4% corn syrup solids. None of the batches made contained stabilizer or emulsifier. The control (treatment 1) contained 3.78% protein. Treatments 2 and 5 contained 30% more protein, treatments 3 and 6 contained 60% more protein, and treatments 4 and 7 contained 90% more protein compared with treatment 1 by addition of whey protein concentrate or milk protein concentrate powders, respectively. In all treatments, levels of milk fat, milk SNF, beet sugar, and corn syrup solids were kept constant at 37% total solids. Mix protein content for treatment 1 was 3.78%, treatment 2 was 4.90%, treatment 5 was 4.91%, treatments 3 and 6 were 6.05%, and treatments 4 and 7 were 7.18%. This represented a 29.89, 60.05, 89.95, 29.63, 60.05, and 89.95% increase in protein for treatment 2 through treatment 7 compared with treatment 1, respectively. Milk protein level influenced ice crystal size; with increased protein, the ice crystal size was favorably reduced in treatments 2, 4, and 5 and was similar in treatments 3, 6, and 7 compared with treatment 1. At 1 wk postmanufacture, overall texture acceptance for all treatments was more desirable compared with treatment 1. When evaluating all parameters, treatment 2 with added whey protein concentrate and treatments 5 and 6 with added milk protein concentrate were similar or improved compared with treatment 1. It is possible to produce acceptable ice cream with higher levels of protein.
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Affiliation(s)
- M R Patel
- Dairy Science Department, South Dakota State University, Brookings 57007-0647, USA
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Abstract
BACKGROUND Reperfusion injury after lung transplantation remains a perplexing and unpredictable problem. Most surgeons preserve the lung inflated, but the amount of inflation that should be used is not well documented. Therefore, we studied the effect of high inflation during organ preservation on lung function during reperfusion. Our hypothesis is that donor lung hyperinflation during storage contributes to early allograft dysfunction during reperfusion. METHODS To test our hypothesis we used an isolated, blood-perfused, ventilated rabbit lung model. Group I lungs (control) underwent immediate reperfusion after harvest. Group II lungs (low-inflation, maintained at 6 mmHg airway pressure) and group III lungs (high-inflation, maintained at 20 mmHg airway pressure) were stored for 4 h in 4 degrees C Euro-Collins solution after harvest. All lungs were then reperfused with whole blood for 1 h, and measurements of arterial oxygenation (PO2, mmHg), pulmonary artery pressure (PAP, mmHg), peak inspiratory pressure (PIP, cm H2O), and wet-to-dry weight ratio (WTD) were obtained. RESULTS Throughout the 1 h reperfusion period group III lungs had significantly lower oxygenation compared to groups I and II. In addition, throughout reperfusion, group III lungs showed significantly higher PAP and PIP compared to group II. WTD did not differ significantly between groups, however, there was a trend toward increased edema in group III. CONCLUSIONS These results indicate that high inflation during cold storage results in acute pulmonary dysfunction. Careful monitoring of airway inflation pressure during storage, especially to prevent hyperinflation, should be maintained in the current practice for lung transplantation.
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Affiliation(s)
- Mayank R Patel
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia 22908, USA
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Patel MR, Bérces A, Kerékgyárto T, Rontó G, Lammer H, Zarnecki JC. Annual solar UV exposure and biological effective dose rates on the Martian surface. Adv Space Res 2004; 33:1247-1252. [PMID: 15803610 DOI: 10.1016/j.asr.2003.08.036] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The ultraviolet (UV) environment of Mars has been investigated to gain an understanding of the variation of exposure throughout a Martian year, and link this flux to biological effects and possible survival of organisms at the Martian surface. To gain an idea of how the solar UV radiation varies between different regions, including planned landing sites of two future Mars surface missions, we modelled the total solar UV surface flux throughout one Martian year for two different dust scenarios. To understand the degree of solar UV stress on micro-organisms and/or molecules essential for life on the surface of Mars, we also calculated the biologically effective dose (BED) for T7 and Uracil in relevant wavelength regions at the Martian surface as a function of season and latitude, and discuss the biological survival rates in the presence of Martian solar UV radiation. High T7/Uracil BED ratios indicate that even at high latitudes where the UV flux is significantly reduced, the radiation environment is still hostile for life due to the persisting UV-C component of the flux.
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Affiliation(s)
- M R Patel
- Planetary and Space Sciences Research Institute, The Open University, Milton Keynes, UK.
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