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Siguier M, Mera R, Pialoux G, Ohayon M, Cotte L, Valin N, Ghosn J, Cua E, Pintado C, Chas J, Barriere G, Durand F, Molina JM. First year of pre-exposure prophylaxis implementation in France with daily or on-demand tenofovir disoproxil fumarate/emtricitabine. J Antimicrob Chemother 2020; 74:2752-2758. [PMID: 31219561 DOI: 10.1093/jac/dkz220] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/18/2019] [Accepted: 04/23/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In January 2016, the French Medicine Agency initiated a Temporary Recommendation for Use (TRU) to allow the use of oral intake of tenofovir disoproxil fumarate and emtricitabine for pre-exposure prophylaxis (PrEP) in adults at high risk of HIV. We report the results of the first year of PrEP implementation in France. METHODS Data were collected by physicians using a secured web subject-monitoring interface, with two forms: an initiation form, with patients' baseline characteristics, and an HIV seroconversion form. Univariate and adjusted multivariate analysis using a logistic regression model were performed to identify baseline factors associated with on-demand PrEP regimen prescription. RESULTS From 4 January 2016 to 28 February 2017, 3405 subjects were enrolled, with 2774 initiation forms completed; 98.1% were male and 96.9% were MSM. An on-demand regimen was prescribed to 57% of subjects. Older age (OR for participants older than 50 years = 1.76, 95% CI 1.35-2.3, P < 0.001) and site of prescription (OR of former IPERGAY sites = 2.28, 95% CI 1.84-2.83, P < 0.001) were associated with on-demand prescription. Those reporting sexually transmitted infection (STI) and condomless anal sex with at least two different partners were less likely to receive on-demand PrEP (OR = 0.68, 95% CI 0.57-0.82 and 0.75, 95% CI 0.57-0.98, respectively; P < 0.05 for all). Four breakthrough HIV infections were reported during the study, in the context of PrEP interruption or acute infection at the time of PrEP initiation. CONCLUSIONS In a real-life setting in France, PrEP was used, either daily or on-demand, mostly by MSM, with breakthrough infections being rare.
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Affiliation(s)
- M Siguier
- Hôpital Saint-Louis, Department of Infectious Diseases and University Paris Diderot, Paris, France
| | - R Mera
- Gilead Sciences, Epidemiology, Foster City, CA, USA
| | - G Pialoux
- Hôpital Tenon, Department of Infectious Diseases, Paris, France
| | | | - L Cotte
- Hôpital Croix Rousse, Department of Infectious Diseases, Lyon, France
| | - N Valin
- Hôpital Saint-Antoine, Department of Infectious Diseases, Paris, France
| | - J Ghosn
- Hôtel Dieu, Department of Infectious Diseases, Paris, France
| | - E Cua
- Hôpital L'Archet, Department of Infectious Diseases, Nice, France
| | - C Pintado
- Hôpital Saint-Louis, Department of Infectious Diseases and University Paris Diderot, Paris, France
| | - J Chas
- Hôpital Tenon, Department of Infectious Diseases, Paris, France
| | - G Barriere
- Gilead Sciences S.A.S., Boulogne-Billancourt, France
| | - F Durand
- Gilead Sciences S.A.S., Boulogne-Billancourt, France
| | - J M Molina
- Hôpital Saint-Louis, Department of Infectious Diseases and University Paris Diderot, Paris, France
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Jackson W, Desai N, Tumati V, Lee J, Dess R, Soni P, Abugharib A, Hamstra D, Hearn J, Sandler H, Zumsteg Z, Montgomery J, Hollenbeck B, Palapattu G, Tomlins S, Mera R, Morgan T, Feng F, Spratt D. Anatomic Patterns of Recurrence Following Biochemical Relapse After Postprostatectomy Radiation Therapy: A Multi-institutional Study. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Jackson W, Desai N, Tumati V, Lee J, Dess R, Soni P, Abugharib A, Hamstra D, Hearn J, Sandler H, Zumsteg Z, Montgomery J, Hollenbeck B, Miller D, Palapattu G, Tomlins S, Mera R, Morgan T, Feng F, Spratt D. Predictors of Rapid Treatment Failure After Postoperative Radiation Therapy: A Multicenter Study. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Soni P, Moraes F, Jackson W, Gadia R, Dess R, Lee J, Palapattu G, Tomlins S, Mera R, Morgan T, Hearn J, Sandler H, Hamstra D, Leite E, Zumsteg Z, Feng F, Spratt D. Multicenter Independent Validation of the Zumsteg-Spratt Risk Classification System of Intermediate- and High-Risk Men Treated With Dose-Escalated Radiation Therapy Without Androgen Deprivation Therapy. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mera R, Thompson HW, Prasad C. Analysis of Data that is in the Form of Categories Part II: Beyond the 2*2 Contingency Table-Partitioning Chi-Square Tests. Nutr Neurosci 2016; 3:143-9. [PMID: 27416372 DOI: 10.1080/1028415x.2000.11747311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This article extends the analysis of 2*2 tables considered in the preceding paper of this three-part series. The methods described in the previous paper for analysis of frequency counts of categorical variables in 2*2 tables, including overall tests, partitioned tests, odds ratios, and estimation of required sample size, are applied to tables with multiple levels, such as those with more than two response factors and/or more than two levels for each factor.
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Affiliation(s)
- R Mera
- a LSU Medical Center , New Orleans , LA 70112 , USA
| | - H W Thompson
- b Clinical Trials and Biometry Unit, LSU Eye Center , New Orleans , LA 70112 , USA
| | - C Prasad
- c Section of Endocrinology, Department of Medicine, LSU Medical Center , New Orleans , LA 70112 , USA
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Abstract
This is the third in a series of articles devoted to a simplified description of experimental design, statistical analysis, and interpretation. The present article deals with an overview of time to event methods, the importance of censored information, and the utilization of survival methods with three concrete examples. These methods can be used to design experiments with increased power to detect significant differences. Experiments planned with time to event methods usually have reduced sample size requirements.
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Affiliation(s)
- R Mera
- a Section of Biostatistics , 1901 Perdido Street, Box P5-1, Stanley S. Scott Cancer Center , New Orleans , LA 70112 , USA
| | - H W Thompson
- b Clinical Trials and Biometry Unit, LSU Eye Center , New Orleans , LA 70112 , USA
| | - C Prasad
- c Section of Endocrinology, Department of Medicine, LSU Medical Center , New Orleans , LA 70112 , USA
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Abstract
This is the fifth installment in a series of articles devoted to a simplified description of statistical techniques. Here we are concerned with the analysis of nominal and ordinal categorical variables where the outcomes are counts or frequencies of events that are observed in an experiment. Examples are given for chi-square analysis of 2 * 2 tables, for the calculation and interpretation of odds ratios, and for the estimation of sample sizes in experiments where outcomes are categorical.
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Affiliation(s)
- R Mera
- a LSU Medical Center New Orleans , LA 70112 , USA
| | - H W Thompson
- b Clinical Trials and Biometry Unit , LSU Eye Center , New Orleans , LA 70112 , USA
| | - C Prasad
- c Section of Endocrinology, Department of Medicine , LSU Medical Center , New Orleans , LA 70112 , USA
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Abstract
This is the fourth in a series of articles devoted to a simplified description of experimental design, statistical analysis and interpretation. This article deals with a basic description of the analysis of variance (ANOVA) and its methods of computation and hypothesis testing. Examples are provided in which a one-way ANOVA is analyzed; methods for post-ANOVA pair-wise comparisons of treatment means are also discussed.
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Affiliation(s)
- H W Thompson
- a Clinical Trials and Biometry Unit , LSU Eye Center , 2020 Gravier Street, Suite B, New Orleans , LA 70112 , USA
| | - R Mera
- b Section of Biostatistics, Stanley S. Scott Cancer Center , New Orleans
| | - C Prasad
- c Section of Endocrinology, Department of Medicine , LSU Medical Center , New Orleans
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Dean G, McCartney L, Mera R, Urquhart J. Modeling nonlinear viscoelasticity in polymers for design using finite element analysis. POLYM ENG SCI 2011. [DOI: 10.1002/pen.21993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Sicinschi LA, Correa P, Peek RM, Camargo MC, Piazuelo MB, Romero-Gallo J, Hobbs SS, Krishna U, Delgado A, Mera R, Bravo LE, Schneider BG. CagA C-terminal variations in Helicobacter pylori strains from Colombian patients with gastric precancerous lesions. Clin Microbiol Infect 2009; 16:369-78. [PMID: 19456839 DOI: 10.1111/j.1469-0691.2009.02811.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The C-terminus of the Helicobacter pylori CagA protein is polymorphic, bearing different EPIYA sequences (EPIYA-A, B, C or D), and one or more CagA multimerization (CM) motifs. The number of EPIYA-C motifs is associated with precancerous lesions and gastric cancer (GC). The relationship between EPIYA, CM motifs and gastric lesions was examined in H. pylori-infected Colombian patients from areas of high and low risk for GC. Genomic DNA was extracted from H. pylori strains cultured from gastric biopsies from 80 adults with dyspeptic symptoms. Sixty-seven (83.8%) of 80 strains were cagA positive. The 3' region of cagA was sequenced, and EPIYA and CM motifs were identified. CagA proteins contained one (64.2%), two (34.3%) or three EPIYA-C motifs (1.5%), all with Western type CagA-specific sequences. Strains with one EPIYA-C motif were associated with less severe gastric lesions (non-atrophic and multifocal atrophic gastritis), whereas strains with multiple EPIYA-C motifs were associated with more severe lesions (intestinal metaplasia and dysplasia) (p <0.001). In 54 strains, the CM motifs were identical to those common in Western strains. Thirteen strains from the low-risk area contained two different CM motifs: one of Western type located within the EPIYA-C segment and another following the EPIYA-C segment and resembling the CM motif found in East Asian strains. These strains induced significantly shorter projections in AGS cells and an attenuated reduction in levels of CagA upon immunodepletion of SHP-2 than strains possessing Western/Western motifs. This novel finding may partially explain the difference in GC incidence in these populations.
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Affiliation(s)
- L A Sicinschi
- Division of Gastroenterology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
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Gallardo-Wong I, Morán S, Rodríguez-Leal G, Castañeda-Romero B, Mera R, Poo J, Uribe M, Dehesa M. Prognostic value of 13C-phenylalanine breath test on predicting survival in patients with chronic liver failure. World J Gastroenterol 2007; 13:4579-85. [PMID: 17729409 PMCID: PMC4611830 DOI: 10.3748/wjg.v13.i34.4579] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the prognostic value of percentage of 13C-phenylalanine oxidation (13C-PheOx) obtained by 13C-phenylalanine breath test (13C-PheBT) on the survival of patients with chronic liver failure.
METHODS: The hepatic function was determined by standard liver blood tests and the percentage of 13C-PheOx in 118 chronic liver failure patients. The follow-up period was of 64 mo. Survival analysis was performed by the Kaplan-Meier method and variables that were significant (P < 0.10) in univariate analysis and subsequently introduced in a multivariate analysis according to the hazard model proposed by Cox.
RESULTS: Forty-one patients died due to progressive liver failure during the follow-up period. The probability of survival at 12, 24, 36, 48 and 64 mo was 0.88, 0.78, 0.66, 0.57 and 0.19, respectively. Multivariate analysis demonstrated that Child-Pugh classes, age, creatinine and the percentage of 13C-PheOx (HR 0.338, 95% CI: 0.150-0.762, P = 0.009) were independent predictors of survival. When Child-Pugh classes were replaced by all the parameters of the score, only albumin, bilirubin, creatinine, age and the percentage of 13C-PheOx (HR 0.449, 95% CI: 0.206-0.979, P = 0.034) were found to be independent predictors of survival.
CONCLUSION: Percentage of 13C-PheOx obtained by 13C-PheBT is a strong predictor of survival in patients with chronic liver disease.
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Affiliation(s)
- I Gallardo-Wong
- Laboratory of Gastrohepatology Research, Hospital de Pediatria, CMN, Siglo XXI, IMSS. Av Cuauhtemoc 330, Colonia Doctores, Delegacion Cuauhtemoc, Mexico
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Camargo MC, Mera R, Correa P, Peek Jr RM, Fontham E, Goodman K, Piazuelo MB, Sicinschi L, Zabaleta J, Schneider BG. Interleukin-1B-511 Polymorphism and Gastric Cancer: A Meta-Analysis. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s128-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mera R. Pneumococcal Conjugate Vaccine Effect On Streptococcus Pneumoniae Serotype Carriage And Multiple Drug Resistance In The United States. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s203-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Mera R, Fontham ETH, Bravo LE, Bravo JC, Piazuelo MB, Camargo MC, Correa P. Long term follow up of patients treated for Helicobacter pylori infection. Gut 2005; 54:1536-40. [PMID: 15985559 PMCID: PMC1462952 DOI: 10.1136/gut.2005.072009] [Citation(s) in RCA: 259] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 06/06/2005] [Accepted: 06/08/2005] [Indexed: 12/11/2022]
Abstract
BACKGROUND Helicobacter pylori infection induces progressive inflammatory changes in the gastric mucosa that may lead to gastric cancer. Understanding long term effects resulting from the cure of this infection is needed to design cancer prevention strategies. METHODS A cohort of 795 adults with preneoplastic gastric lesions was randomised to receive anti-H pylori treatment and/or antioxidants. At the end of six years of intervention, those who did not receive anti-H pylori treatment were offered it. Gastric biopsies were obtained at baseline, and at 3, 6, and 12 years. A histopathology score was utilised to document changes in gastric lesions. Non-linear mixed models were used to estimate the cumulative effect of H pylori clearance on histopathology scores adjusted for follow up time, interventions, and confounders. RESULTS Ninety seven per cent of subjects were H pylori positive at baseline, and 53% were positive at 12 years. Subjects accumulated 1703 person years free of infection. A multivariate model showed a significant regression in histopathology score as a function of the square of H pylori negative time. Subjects who were H pylori negative had 14.8% more regression and 13.7% less progression than patients who were positive at 12 years (p = 0.001). The rate of healing of gastric lesions occurred more rapidly as years free of infection accumulated, and was more pronounced in less advanced lesions. CONCLUSIONS Preneoplastic gastric lesions regress at a rate equal to the square of time in patients rendered free of H pylori infection. Our findings suggest that patients with preneoplastic gastric lesions should be treated and cured of their H pylori infection.
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Affiliation(s)
- R Mera
- Department of Pathology, Louisiana State University Health Sciences Center, 1901 Perdido St, New Orleans, LA 70112, USA
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Mera R, Correa P, Fontham E, Bravo L, Camargo C. 139: Long-Term Effect of Clearing H. Pylori on Histopathological Lesions of the Stomach. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s35b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R Mera
- Louisiana State University Health Sciences Center, New Orleans, LA, 70112
| | - P Correa
- Louisiana State University Health Sciences Center, New Orleans, LA, 70112
| | - E Fontham
- Louisiana State University Health Sciences Center, New Orleans, LA, 70112
| | - L Bravo
- Louisiana State University Health Sciences Center, New Orleans, LA, 70112
| | - C Camargo
- Louisiana State University Health Sciences Center, New Orleans, LA, 70112
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Schneider BG, Rha SY, Chung HC, Bravo JC, Mera R, Torres JC, Plaisance KT, Schlegel R, McBride CM, Reveles XT, Leach RJ. Regions of allelic imbalance in the distal portion of chromosome 12q in gastric cancer. Mol Pathol 2003; 56:141-9. [PMID: 12782760 PMCID: PMC1187309 DOI: 10.1136/mp.56.3.141] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2003] [Indexed: 11/04/2022]
Abstract
AIMS To define regions of loss on the distal portion of chromosome 12q in gastric adenocarcinoma. METHODS Microsatellite analysis on chromosome 12 was performed on 19 human gastric cancer cell lines using 77 markers, 71 of which were within or distal to 12q21; some portions of this region showed extended regions of homozygosity (ERHs) in 10 of 19 gastric cancer cell lines. In addition, microdissected tumour cells from 76 primary gastric adenocarcinomas were examined using 13 markers of interest implicated by the cell line data; 70% of these showed allelic imbalance (AI) at one or more markers in or distal to 12q21. RESULTS Mapping ERHs in the cell lines and sites of AI in the tumours identified three regions that contain putative tumour suppressor genes: region A is located within 2.8 Mb between markers D12S1667 and D12S88; region B, within 1.9 Mb between markers D12S1607 and D12S78; and region C, in 0.74 Mb between markers D12S342 and D12S324. Fluorescence in situ hybridisation (FISH) analysis in two cell lines confirmed that two of the ERHs reflected deletions, not amplifications, of D12S81 in region A and D12S340 in region C. FISH analysis of marker D12S1075 within an ERH containing region B in one cell line showed neither amplification nor deletion. AI on 12q was not associated with prognosis, but was associated with ethnicity of the patient. CONCLUSIONS These results identify regions on chromosome 12 that appear to contain tumour suppressor genes important in the development of gastric cancer.
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Affiliation(s)
- B G Schneider
- Louisiana State University Health Sciences Center, Department of Pathology and Stanley Scott Cancer Center, New Orleans, LA 70112, USA.
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Ruiz B, Garay J, Correa P, Fontham ET, Bravo JC, Bravo LE, Realpe JL, Mera R. Morphometric evaluation of gastric antral atrophy: improvement after cure of Helicobacter pylori infection. Am J Gastroenterol 2001; 96:3281-7. [PMID: 11774937 DOI: 10.1111/j.1572-0241.2001.05326.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Our purpose was to find out if morphometric techniques can document long term changes in gastric antral atrophy after curing Helicobacter pylori infection with or without dietary supplementation with antioxidant micronutrients. METHODS Study subjects were 132 adult volunteers from a Colombian region with high gastric cancer rates. Participants were randomly assigned to ascorbic acid, beta-carotene, and anti-H. pylori treatment, following a factorial design. Gastric biopsies were obtained at baseline and after 72 months of intervention. Atrophy was evaluated by a standard visual analog scale and by morphometry. RESULTS Statistically significant changes in antral atrophy were detected with morphometric techniques after intervention in subjects who received anti-H. pylori treatment. A nonsignificant trend was also observed with visual scores. This effect was greater among those who were free of infection at the end of the trial. After accounting for the effect of anti-H. pylori treatment, no significant effect was noted for dietary supplementation with ascorbic acid and/or beta-carotene. CONCLUSIONS We conclude that gastric atrophy improves significantly after long term control of H. pylori infection. This effect can be demonstrated both by conventional histological grading and by morphometry.
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Affiliation(s)
- B Ruiz
- Department of Pathology, Louisiana State University Medical Center, New Orleans 70112, USA
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Vendrell R, Iñesta M, Mera R, Iturrino J, Soto A, Mas M, Lojo JJ, Torres EA. Ileal pouch-anal anastomosis for ulcerative colitis: the University of Puerto Rico experience. P R Health Sci J 2001; 20:221-4. [PMID: 11776722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVE To review the experience with ileal pouch-anal anastomosis surgery for ulcerative colitis at the University Hospital. BACKGROUND As many as 40% of patients with ulcerative colitis (UC) and 75% with Crohn's disease (CD) require some surgery for their disease. The number of patients referred to our clinics for evaluation and management of Inflammatory Bowel Disease (IBD) has risen in the past seven years. A multidisciplinary IBD service has been created at the University Hospital for the care of these patients, leading to a dramatic increase in the number of surgeries performed for IBD. Over the past decade the ileal pouch-anal anastomosis (IPAA) has emerged as the procedure of choice in most patients with ulcerative colitis requiring total colectomy for management of their disease. Even though the procedure is associated with a considerable morbidity rate, it has become very popular since it avoids the need for a permanent stoma and presumably rids the patient of disease and subsequent cancer risk. RESULTS Twenty-five patients were identified as having IPAA for ulcerative colitis between 1993-2000. Indications for surgery were intractability and toxic megacolon. Complications were pouchitis in 11/25 (44%), anastomotic stricture in 6/25 (24%), small bowel obstruction in 4/25 (16%), and pouch failure in 2/25 (8%). Other complications included wound abscess in 1/25 (4%), and sexual dysfunction in 1/25 (4%) patients. There was no mortality; the patients' quality of life was rated as greatly improved in 14 of 17 patients interviewed (82.4%) and 16 of 17 said they would recommend the surgery to others (94.1%). CONCLUSIONS The results of IPAA surgery, morbidity, mortality, and patient satisfaction in our series were similar to other centers around the world.
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Affiliation(s)
- R Vendrell
- Inflammatory Bowel Disease Service, Department of Medicine, University of Puerto Rico School of Medicine, Medical Sciences Campus
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Oberhelman RA, Flores-Abuxapqui J, Suarez-Hoil G, Puc-Franco M, Heredia-Navarrete M, Vivas-Rosel M, Mera R, Gutierrez-Cogco L. Asymptomatic salmonellosis among children in day-care centers in Mérida, Yucatan, Mexico. Pediatr Infect Dis J 2001; 20:792-7. [PMID: 11734743 DOI: 10.1097/00006454-200108000-00014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Child day-care centers (DCC) have become common in many lower and middle income countries, presenting new problems that may differ from those of DCC in more developed countries. Diarrhea is a common problem in DCC in the United States, but information on the prevalence of diarrhea or specific enteropathogens among children in DCC in tropical and developing countries is limited. METHODS Because of preliminary data from newborns and DCC attendees in Mérida, Mexico, with high rates of Salmonella infection, we conducted a 12-month longitudinal surveillance study of enteropathogens in two Mérida DCC. Seventy-eight children ages 2 months to 4 years were evaluated with demographic and clinical data, and stools were cultured monthly. RESULTS Salmonella sp. was the most common enteropathogen detected (46 of 683 specimens, 6.7%), with higher rates in children younger than 18 months (P < 0.02), but it was found in only 1 of 10 diarrhea episodes that coincided with sampling. Other common organisms identified included Giardia lamblia (21 of 683, 3.0%) and LT-producing enterotoxigenic Escherichia coli (16 of 683, 2.3%). Salmonella was recovered from as many as 19% of children in a single month, but the large multiplicity of serotypes recovered suggested multiple sources rather than a common source outbreak. Children with Salmonella tended to have more liquid stools during the preceding 2 weeks. Salmonella was also isolated from the stool of teachers in 1 of the 2 DCC in 10 of 94 specimens (10.6%), and again multiple serotypes were represented. CONCLUSION These data indicate the presence of multiple sources of Salmonella infection in the DCC, posing a complex situation for infection control.
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Affiliation(s)
- R A Oberhelman
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA.
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Correa P, Fontham ETH, Bravo JC, Bravo LE, Ruiz B, Zarama G, Realpe JL, Malcom GT, Li D, Johnson WD, Mera R. RESPONSE: Re: Chemoprevention of Gastric Dysplasia: Randomized Trial of Antioxidant Supplements and Anti-Helicobacter pylori Therapy. J Natl Cancer Inst 2001. [DOI: 10.1093/jnci/93.7.559-a] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hunt JD, Mera R, Strimas A, Gillespie AT, Ruiz B, Correa P, Fontham ET. KRAS mutations are not predictive for progression of preneoplastic gastric lesions. Cancer Epidemiol Biomarkers Prev 2001; 10:79-80. [PMID: 11205494] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
Individuals with atrophic gastritis (n = 863) were recruited to participate in a chemoprevention trial in Nariño, Columbia. The volunteers were randomly assigned to intervention therapies, which included antibiotic treatment for Helicobacter pylori infection, and then daily dietary supplementation with antioxidant micronutrients in a 2(3) factorial design. Biopsies were obtained according to a specified protocol from designated areas in the stomach for each individual at baseline (before intervention therapy), at year 3, and at year 6. A systematic sample of 160 participants was selected from each of the eight treatment combinations, and the first exon of KRAS was examined for mutations. At year 3, the data indicated that individuals with KRAS mutations in their baseline premalignant stomach biopsies were 3.74 times as likely to progress to a higher premalignant stage than those who lacked baseline mutations (P = 0.04; C. Gong et al., Cancer Epidemiol. Biomark. Prevy. 8:167-171, 1999). However, after 6 years, baseline KRAS mutations failed to predict histological progression. Also, KRAS mutation in 72-month biopsies did not predict histological progression.
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Affiliation(s)
- J D Hunt
- Department of Biochemistry and Molecular Biology, Louisiana State University Health Sciences Center, New Orleans 70112, USA.
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Correa P, Fontham ET, Bravo JC, Bravo LE, Ruiz B, Zarama G, Realpe JL, Malcom GT, Li D, Johnson WD, Mera R. Chemoprevention of gastric dysplasia: randomized trial of antioxidant supplements and anti-helicobacter pylori therapy. J Natl Cancer Inst 2000; 92:1881-8. [PMID: 11106679 DOI: 10.1093/jnci/92.23.1881] [Citation(s) in RCA: 454] [Impact Index Per Article: 18.9] [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: 12/11/2022] Open
Abstract
BACKGROUND Previous research has identified a high risk of gastric carcinoma as well as a high prevalence of cancer precursor lesions in rural populations living in the province of Nariño, Colombia, in the Andes Mountains. METHODS A randomized, controlled chemoprevention trial was conducted in subjects with confirmed histologic diagnoses of multifocal nonmetaplastic atrophy and/or intestinal metaplasia, two precancerous lesions. Individuals were assigned to receive anti-Helicobacter pylori triple therapy and/or dietary supplementation with ascorbic acid, beta-carotene, or their corresponding placebos. Gastric biopsy specimens taken at baseline were compared with those taken at 72 months. Relative risks of progression, no change, and regression from multifocal nonmetaplastic atrophy and intestinal metaplasia were analyzed with multivariate polytomous logistic regression models to estimate treatment effects. All statistical tests were two-sided. RESULTS All three basic interventions resulted in statistically significant increases in the rates of regression: Relative risks were 4.8 (95% confidence interval [CI] = 1.6-14.2) for anti-H. pylori treatment, 5. 1 (95% CI = 1.7-15.0) for beta-carotene treatment, and 5.0 (95% CI = 1.7-14.4) for ascorbic acid treatment in subjects with atrophy. Corresponding relative risks of regression in subjects with intestinal metaplasia were 3.1 (95% CI = 1.0-9.3), 3.4 (95% CI = 1.1-9.8), and 3.3 (95% CI = 1.1-9.5). Combinations of treatments did not statistically significantly increase the regression rates. Curing the H. pylori infection (which occurred in 74% of the treated subjects) produced a marked and statistically significant increase in the rate of regression of the precursor lesions (relative risks = 8.7 [95% CI = 2.7-28.2] for subjects with atrophy and 5.4 [95% CI = 1.7-17.6] for subjects with intestinal metaplasia). CONCLUSIONS In the very high-risk population studied, effective anti-H. pylori treatment and dietary supplementation with antioxidant micronutrients may interfere with the precancerous process, mostly by increasing the rate of regression of cancer precursor lesions, and may be an effective strategy to prevent gastric carcinoma.
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Affiliation(s)
- P Correa
- Department of Pathology, Louisiana State University Health Sciences Center, New Orleans, LA 70112-1393, USA.
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Schneider BG, Bravo JC, Roa JC, Roa I, Kim MC, Lee KM, Plaisance KT, McBride CM, Mera R. Microsatellite instability, prognosis and metastasis in gastric cancers from a low-risk population. Int J Cancer 2000. [PMID: 11008207 DOI: 10.1002/1097-0215(20000920)89:5<444::aid-ijc8>3.0.co;2-f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We examined 169 cases of gastric adenocarcinoma for microsatellite instability (MSI), using a panel of 8 microsatellite markers. Of these cases, 142 were from the United States, a country of relatively low risk for gastric cancer. Comparing microdissected tumors to normal cells from the same patient, we classified tumors as being microsatellite-stable (MSS) or having a low frequency of MSI (MSI-L, up to 30% of markers different in the tumor) or a high frequency of MSI (MSI-H, 30% or more of markers different). Among our American cases, we identified 26 (18.2%) showing MSI-H and 15 (10.6%) showing MSI-L. Twenty cases were from Korean patients, and they showed no significant differences in proportions of MSI-H and MSI-L from the American cases. MSI-H tumors in the American patients were characterized by elevated frequencies of band shifts in repeat sequences of the BAX (50%), transforming growth factor-beta receptor type II (TGFbetaRII, 68.9%), beta(2)-microglobulin (21.4%) and E2F4 (51.7%) genes. Alterations in E2F4 in MSI-H tumors were always integral multiples of 3 nucleotides lost or gained, which would not cause a frameshift mutation, and within the range of normal polymorphisms for this sequence. North American patients (n = 127) with MSI-H and MSI-L tumors had a longer median survival of 541 days and 587 days, respectively, compared to 265 days for patients with MSS tumors (p = 0.027). This survival difference may result from a significantly greater tendency for metastases in the MSS group (p = 0.031).
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Affiliation(s)
- B G Schneider
- Louisiana State University Health Sciences Center and Stanley Scott Cancer Center, New Orleans, LA 70112, USA.
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24
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Schneider BG, Bravo JC, Roa JC, Roa I, Kim MC, Lee KM, Plaisance KT, McBride CM, Mera R. Microsatellite instability, prognosis and metastasis in gastric cancers from a low-risk population. Int J Cancer 2000; 89:444-52. [PMID: 11008207 DOI: 10.1002/1097-0215(20000920)89:5<444::aid-ijc8>3.0.co;2-f] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We examined 169 cases of gastric adenocarcinoma for microsatellite instability (MSI), using a panel of 8 microsatellite markers. Of these cases, 142 were from the United States, a country of relatively low risk for gastric cancer. Comparing microdissected tumors to normal cells from the same patient, we classified tumors as being microsatellite-stable (MSS) or having a low frequency of MSI (MSI-L, up to 30% of markers different in the tumor) or a high frequency of MSI (MSI-H, 30% or more of markers different). Among our American cases, we identified 26 (18.2%) showing MSI-H and 15 (10.6%) showing MSI-L. Twenty cases were from Korean patients, and they showed no significant differences in proportions of MSI-H and MSI-L from the American cases. MSI-H tumors in the American patients were characterized by elevated frequencies of band shifts in repeat sequences of the BAX (50%), transforming growth factor-beta receptor type II (TGFbetaRII, 68.9%), beta(2)-microglobulin (21.4%) and E2F4 (51.7%) genes. Alterations in E2F4 in MSI-H tumors were always integral multiples of 3 nucleotides lost or gained, which would not cause a frameshift mutation, and within the range of normal polymorphisms for this sequence. North American patients (n = 127) with MSI-H and MSI-L tumors had a longer median survival of 541 days and 587 days, respectively, compared to 265 days for patients with MSS tumors (p = 0.027). This survival difference may result from a significantly greater tendency for metastases in the MSS group (p = 0.031).
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Affiliation(s)
- B G Schneider
- Louisiana State University Health Sciences Center and Stanley Scott Cancer Center, New Orleans, LA 70112, USA.
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25
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Schneider BG, Gulley ML, Eagan P, Bravo JC, Mera R, Geradts J. Loss of p16/CDKN2A tumor suppressor protein in gastric adenocarcinoma is associated with Epstein-Barr virus and anatomic location in the body of the stomach. Hum Pathol 2000; 31:45-50. [PMID: 10665912 DOI: 10.1016/s0046-8177(00)80197-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Gastric adenocarcinomas (n = 125) were analyzed by immunohistochemistry for the presence of p16, the CDKN2A gene product. This protein was lost in 31 of 125 cases (25%), and loss was associated with location of the tumor in the body of the stomach (P = .001). Loss of p16 was also associated with the presence of Epstein-Barr virus (EBV) in tumor cells as determined by in situ hybridization (P = .022). This effect may relate to anatomic site, because EBV-associated tumors originate more frequently in the body of the stomach. When p16 status was evaluated for ethnic origin of the patient (non-Hispanic white, Hispanic, or black), a strong trend (P = .057) was found for African-American patients to have fewer p16-negative tumors than other patients. This also may relate to anatomic location, because fewer tumors from black patients arose in the body of the stomach (P = .022). No significant associations were detected between p16 status and histological subtype (intestinal v diffuse), the presence of microsatellite instability, grade or stage of the tumor, or age, gender, or survival of the patient. In conclusion, p16 loss is quite common in gastric adenocarcinoma, and such loss is more common in EBV-infected tumors arising in the body of the stomach.
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Affiliation(s)
- B G Schneider
- Department of Pathology and Stanley Scott Cancer Center, Louisiana State University Health Sciences Center, New Orleans, USA
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26
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Oberhelman RA, Guerrero SE, Mercado D, Fernandez ML, Mera R. Observations on the impact of breast-feeding and of intestinal helminthiasis on a rapid agglutination assay for fecal lactoferrin in Nicaraguan children with diarrhea. Pediatr Infect Dis J 1999; 18:944-6. [PMID: 10530599 DOI: 10.1097/00006454-199910000-00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- R A Oberhelman
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA.
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27
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Bravo LE, Realpe JL, Campo C, Mera R, Correa P. Effects of acid suppression and bismuth medications on the performance of diagnostic tests for Helicobacter pylori infection. Am J Gastroenterol 1999; 94:2380-3. [PMID: 10483995 DOI: 10.1111/j.1572-0241.1999.01361.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study was designed to investigate whether acid suppression and bismuth medications interfere with the performance of diagnostic tests for Helicobacter pylori (H. pylori) infection. METHODS Sixty patients with previous diagnoses of atrophic gastritis and H. pylori infection made in gastric biopsies taken at Hospital Departmental, Pasto, Colombia, were enrolled in the study. 13C breath urea test (UBT) and stool antigen test (HpSA) were performed simultaneously. Two baseline tests were performed: one 7 days before and another the day before starting medications. A total of 20 patients received for 2 wk one of the following treatments: a) ranitidine; b) lansoprazole; or c) bismuth subsalicylate. The tests were repeated while the patients were on the prescribed medication on days 7 and 14 and then 2 wk after finishing the medication. RESULTS AND CONCLUSIONS Utilizing standard cut-off values for the tests, our results indicate that in the case of the 13C UBT test, ranitidine does not interfere with the results, whereas lansoprazole and bismuth may be expected to yield a significant proportion of false negative results (30-40% for lansoprazole and 45-55% for bismuth). In the case of the HpSA test, ranitidine does not interfere, whereas lansoprazole and bismuth may be expected to yield a nonsignificant proportion of false negative results (15-25% for lansoprazole and 10-15% for bismuth). Absolute values for both tests may be used to study the effects of the pharmacological agents on the characteristics of the infection.
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Affiliation(s)
- L E Bravo
- Department of Pathology, Universidad del Valle, Cali, Colombia
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28
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Mera R, Realpe JL, Bravo LE, DeLany JP, Correa P. Eradication of Helicobacter pylori infection with proton pump-based triple therapy in patients in whom bismuth-based triple therapy failed. J Clin Gastroenterol 1999; 29:51-5. [PMID: 10405232 DOI: 10.1097/00004836-199907000-00013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
To study the effects of treatment of Helicobacter pylori infection in a hyperendemic population, 143 infected patients from the region of Nariño, Colombia, were treated for 2 weeks with clarithromycin (500 mg twice a day), amoxicillin (1 g twice a day), and either lansoprazole (30 mg twice a day) or omeprazole (30 mg twice a day). All patients belong to a low socioeconomic strata, had multifocal atrophic gastritis documented by gastric biopsies, and had been treated previously and unsuccessfully for 2 weeks with bismuth subsalicylate (262 mg four times a day), amoxicillin (500 mg three times a day), and metronidazole (400 mg three times a day). 13C-urea breath tests were performed 6, 12, 24, and 60 weeks after completing therapy. The 13C-urea breath test was negative in 79.7% of patients 1 month after finishing therapy, and in 69.2% of patients 1 year after finishing treatment. There were no differences in eradication rates between patients treated with omeprazole versus lansoprazole. Dyspepsia symptoms decreased from 74% in patients at baseline to 19% at the time of finishing treatment. In low-socioeconomic status populations with hyperendemic infection, triple therapy using omeprazole or lansoprazole plus clarithromycin and amoxicillin is an effective alternative when previous standard bismuth-based triple therapy has failed.
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Affiliation(s)
- R Mera
- Stanley S. Scott Cancer Center, Louisiana State University Medical Center, New Orleans, USA
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29
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Cuntz MC, Levine EA, O'Dorisio TM, Watson JC, Wray DA, Espenan GD, McKnight C, Meier JR, Weber LJ, Mera R, O'Dorisio MS, Woltering EA. Intraoperative gamma detection of 125I-lanreotide in women with primary breast cancer. Ann Surg Oncol 1999; 6:367-72. [PMID: 10379857 DOI: 10.1007/s10434-999-0367-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Somatostatin receptors are present in most human breast cancers. We performed a pilot trial of intraoperative tumor-gamma detection using the radiolabeled somatostatin analog 125I-lanreotide in 13 women with 14 primary breast carcinomas. METHODS All patients were given 125I-lanreotide intravenously before surgery. Patients underwent lumpectomy, and postresection margins were evaluated with the gamma probe. Axillary dissection specimens were evaluated ex vivo. RESULTS Seven of 13 women had gamma probe-positive or clinically suspicious margins re-excised at the time of lumpectomy. Four of six probe-positive margins were histologically positive, and two of six probe-positive margins were histologically negative; a single clinically suspicious margin was histologically positive. A total of 270 axillary lymph nodes were evaluated ex vivo by gamma probe and histology. McNemar's contingency tests demonstrated a highly statistical correlation between histology and gamma probe counts (P < .0001). CONCLUSIONS The overall accuracy of nodal evaluation with 125I-lanreotide/intraoperative gamma detection was 77%; the negative predictive value of this technique was 97%, however. This technique predicted the presence of tumor in 20% of axillary lymph nodes that were negative by routine histology. This technique appears safe and is able to detect positive tumor resection margins and accurately predict axillary lymph node negativity. Further trials of this technique are required to validate its utility.
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Affiliation(s)
- M C Cuntz
- Department of Surgery, Louisiana State University Medical Center, New Orleans 70112, USA
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30
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Gong C, Mera R, Bravo JC, Ruiz B, Diaz-Escamilla R, Fontham ET, Correa P, Hunt JD. KRAS mutations predict progression of preneoplastic gastric lesions. Cancer Epidemiol Biomarkers Prev 1999; 8:167-71. [PMID: 10067815] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Eight hundred sixty-three subjects with atrophic gastritis were recruited to participate in an ongoing chemoprevention trial in Nariño, Colombia. The participants were randomly assigned to intervention therapies, which included treatment to eradicate Helicobacter pylori infection followed by daily dietary supplementation with antioxidant micronutrients in a 2 x 2 x 2 factorial design. A series of biopsies of gastric mucosa were obtained according to a specified protocol from designated locations in the stomach for each participant at baseline (before intervention therapy) and at year three. A systematic sample of 160 participants was selected from each of the eight treatment combinations. DNA was isolated from each of these biopsies (n = 320), and the first exon of KRAS was amplified using PCR. Mutations in the KRAS gene were detected using denaturing gradient gel electrophoresis and confirmed by sequence analysis. Of all baseline biopsies, 14.4% (23 of 160) contained KRAS mutations. Among those participants with atrophic gastritis without metaplasia, 19.4% (6 of 25) contained KRAS mutations, indicating that mutation of this important gene is likely an early event in the etiology of gastric carcinoma. An important association was found between the presence of KRAS mutations in baseline biopsies and the progression of preneoplastic lesions. Only 14.6% (20 of 137) of participants without baseline KRAS mutations progressed from atrophic gastritis to intestinal metaplasia or from small intestinal metaplasia to colonic metaplasia; however, 39.1% (9 of 23) with baseline KRAS mutations progressed to a more advanced lesion after 3 years [univariate odds ratio (OR), 3.76 (P = 0.05); multivariate OR adjusted for treatment, 3.74 (P = 0.04)]. In addition, the specificity of the KRAS mutation predicted progression. For those participants with G-->T transversions at position 1 of codon 12 (GGT-->TGT), 19.4% (5 of 17) progressed (univariate OR, 2.4); however, 60.0% (3 of 5) of participants with G-->A transitions at position 1 of codon 12 (GGT-->AGT) progressed (univariate OR, 8.7; P = 0.004 using chi2 test).
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Affiliation(s)
- C Gong
- Department of Biochemistry and Molecular Biology, Louisiana State University Medical Center, New Orleans 70112, USA
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31
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Oberhelman RA, Laborde D, Mera R, Starszak E, Saunders P, Mirza A, Bessinger GT, Hull A. Colonization with enteroadherent, enterotoxigenic and enterohemorrhagic Escherichia coli among day-care center attendees in New Orleans, Louisiana. Pediatr Infect Dis J 1998; 17:1159-62. [PMID: 9877367 DOI: 10.1097/00006454-199812000-00012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND E. coli strains producing specific virulence factors are frequently cited as causes of pediatric diarrhea in developing areas, although many well children from the same areas are colonized with these organisms. The role of these Escherichia coli in day-care center (DCC)-associated diarrhea in the United States has not been evaluated. METHODS A cohort of 112 DCC attendees from 5 DCC in urban New Orleans were followed longitudinally with demographic data, biweekly routine stool samples and additional stool samples with episodes of diarrhea. E. coli isolates were routinely saved; diarrhea stool samples were tested to detect enterotoxigenic, enterohemorrhagic and enteroadherent strains; and the prevalence of these E. coli in children with and without diarrhea was investigated. RESULTS During 225 child months of observation 21 episodes of diarrhea were documented and microbiologic data were available for 18. HEp-2 cell enteroadherent E. coli [mostly enteroaggregative (EAggEC) pattern] were identified in 6 of 18 (33.3%) diarrhea cases vs. 6 of 36 (16.6%) age-matched controls. However, the prevalence of EAggEC was very DCC-specific, with EAggEC found in 12 of 22 routine specimens from a DCC with recent EAggEC-related diarrhea vs. 0 of 11 routine specimens from age-matched children in another DCC without EAggEC-related diarrhea (P=0.002). Enterotoxigenic E. coli were uncommon in both ill and well children, and no enterohemorrhagic E. coli were detected. CONCLUSION EAggEC were commonly isolated from children with and without diarrhea in certain DCC settings, although we cannot determine whether these strains caused diarrhea. Diarrhea-producing E. coli were not associated with diarrhea in this DCC population.
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Affiliation(s)
- R A Oberhelman
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
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Skrepnik N, Zieske AW, Robert E, Bravo JC, Mera R, Hunt JD. Aggressive administration of recombinant oncotoxin AR209 (anti-ErbB-2) in athymic nude mice implanted with orthotopic human non-small cell lung tumours. Eur J Cancer 1998; 34:1628-33. [PMID: 9893641 DOI: 10.1016/s0959-8049(98)00176-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Lung cancer remains a significant public health problem in the U.S.A. and will result in an estimated 160,400 deaths in 1997. This appalling number is due in large part to the lack of adequate treatment for tumours that are refractory to surgery with curable intent, or of an adequate salvage therapy for those patients who recur after surgical resection. Because non-small cell lung cancer is refractory to traditional chemotherapy, non-traditional therapies have been developed to treat patients with this disease. Recombinant oncotoxins have been designed to target cells that express certain proteins as part of their cellular membrane. One such oncotoxin, AR209 (formerly OLX-209 [e23(Fv)PE38KDEL]), has the specificity of an anti-ErbB-2 antibody contained within a single-chain antibody domain (e23v) coupled to a portion of the Pseudomonas exotoxin A (PE38KDEL). Previous studies demonstrate that this drug is capable of significantly reducing the size of orthotopic lung tumour xenografts. However, most of the treated mice developed tumours once therapy was removed. In this study, mice were treated aggressively using one of four drug treatment schedules. Mice were treated with either intravenous or subcutaneous injections of AR209 over a 2 week period. The data indicate that AR209 significantly reduced the size of tumours and upon microscopic analysis at necropsy, some mice were cured. However, despite the treatment schedule used, many mice contained residual tumour. Residual tumours expressed the ErbB-2 protein, indicating that more aggressive treatment with AR209 may have resulted in higher rates of cure.
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Affiliation(s)
- N Skrepnik
- Department of Biochemistry and Molecular Biology, Louisiana State University Medical Center, New Orleans 70112, USA
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33
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Oberhelman RA, Guerrero ES, Fernandez ML, Silio M, Mercado D, Comiskey N, Ihenacho G, Mera R. Correlations between intestinal parasitosis, physical growth, and psychomotor development among infants and children from rural Nicaragua. Am J Trop Med Hyg 1998; 58:470-5. [PMID: 9574794 DOI: 10.4269/ajtmh.1998.58.470] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The correlations between malnutrition, parasitosis (especially helminth infections), and child development are complex, and studies of these interrelationships will allow health agencies to maximize screening and intervention strategies for developing countries. We examined these correlations in a cross-sectional program in Carazo State, Nicaragua. Nine hundred sixty-one children in two age strata (ages 0-24 months and ages 2-10 years) from one urban and three rural communities were screened for intestinal parasites (direct smear and ZnSO4 flotation), malnutrition, and developmental delays. Nutritional status was determined as weight-for-age (WFA), weight-for-height (WFH), and height-for-age (HFA). Developmental status (normal, suspect) was determined for the four subtests of the Denver II Screening Test. The prevalence of malnutrition was 14.6% (WFA), 8.4% (WFH), and 36.3% (HFA). Parasitosis was more prevalent in children less than 24 months of age with low HFA, whereas in older children low WFA was more closely associated with parasitic infections. Ascaris and Trichuris were more prevalent in malnourished children. On the Denver II, suspect test results in all four categories (language, social, gross motor, and fine motor) were associated with low WFA, and suspect language tests were associated with both intestinal parasites (P = 0.0003) and Ascaris infection in particular (P = 0.044). Developmental disabilities are a significant and frequently undetected health problem in developing countries, and malnutrition associated with intestinal helminth infections may be an important contributory factor for these disabilities.
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Affiliation(s)
- R A Oberhelman
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana 70112, USA
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Cummiskey RD, Mera R, Levine EA. Preoperative chemotherapy for locally advanced breast carcinoma at Charity Hospital, New Orleans, Louisiana. Am Surg 1998; 64:103-6. [PMID: 9486878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Despite increased screening and public education efforts, there continues to be a subset of patients with breast carcinoma who do not seek medical attention until their lesions are locally advanced. Recently, there has been increasing interest in administering preoperative chemotherapy to these patients. The purpose of this study was to evaluate the Charity Hospital experience with preoperative chemotherapy for locally advanced breast carcinoma. Thirty-three poor urban women with T3 or T4 breast lesions were treated with preoperative chemotherapy before surgical resection, between 1987 and 1995. Their charts and pathology were reviewed and analyzed. Local treatment was in the form of radical mastectomy (n = 3), modified radical mastectomy (n = 26), or lumpectomy with axillary dissection (n = 4). After preoperative chemotherapy, 4 patients had a complete histologic response (12%), 19 had a partial response (58%), and 10 had no response (30%). After a mean follow-up of 40.6 months, stage IIIA (n = 16) and stage IIIB (n = 12) patients were found to have 5-year survival rates of 50.2 and 26.7 per cent, respectively. Stage IV (n = 5) patients had a median survival of 23.1 months with no survivors at 3 years. Patients who had a complete or partial response to chemotherapy had a median survival of 43.0 months versus 23.1 months for the nonresponders. We conclude that our response rate, for poor urban women with locally advanced breast carcinoma, to preoperative chemotherapy, is comparable with that found in the literature. Furthermore, the initial response to this chemotherapy may be an important indicator of ultimate prognosis.
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MESH Headings
- Adult
- Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Breast Neoplasms/drug therapy
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/drug therapy
- Carcinoma, Lobular/surgery
- Carcinoma, Medullary/drug therapy
- Carcinoma, Medullary/surgery
- Chemotherapy, Adjuvant
- Disease-Free Survival
- Female
- Humans
- Louisiana
- Mastectomy, Modified Radical
- Mastectomy, Radical
- Mastectomy, Segmental
- Middle Aged
- Preoperative Care
- Prognosis
- Retrospective Studies
- Survival Analysis
- Treatment Outcome
- Urban Population
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Affiliation(s)
- R D Cummiskey
- Department of Surgery, Stanley S. Scott Cancer Center and Louisiana State University, New Orleans, USA
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35
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Stolier AJ, Mera R, Schapira D. The impact of current use of hormone replacement therapy on prognostic factors and surgical treatment of new breast cancers. Oncol Rep 1998; 5:61-4. [PMID: 9458294 DOI: 10.3892/or.5.1.61] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
When postmenopausal women were diagnosed with breast cancer while taking hormone replacement, no adverse effects were noted in either clinical or prognostic factors when compared to a similar group not on hormones. Younger age at diagnosis and an increased chance of carcinoma in situ were noted in those on hormones. A surveillance or observational bias is one explanation for these findings. A promotional effect of hormone replacement therapy could not be eliminated based on this study.
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Affiliation(s)
- A J Stolier
- The Breast Center, New Orleans, LA 70115, USA
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36
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Hill MA, Mera R, Levine EA. Leiomyosarcoma: a 45-year review at Charity Hospital, New Orleans. Am Surg 1998; 64:53-60; discussion 60-1. [PMID: 9457038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Approximately 2 to 9% of all soft tissue sarcomas are leiomyosarcomas (LMS). LMS arises nearly exclusively as tumors in adults, with peak incidence occurring in the fifth and sixth decades. The purpose of this study was to analyze disease-specific survival and define prognostic factors in patients with this disease who were treated and followed at a single institution. Fifty-eight cases of LMS were identified in the Tumor Registry of the Medical Center of Louisiana at New Orleans (charity Hospital) from 1950 to 1995. Charts were reviewed and tissue blocks reexamined to confirm the diagnosis. Follow-up information was available for 56 of 58 (96%) patients. Univariate and multivariate analyses were performed to analyze which factors predict outcome. The median survival time was 138 months. Univariate analysis identified age (> 48 years), location (retroperitoneal vs other sites), and extent of disease as prognostic factors. Multivariate analysis revealed that only age and the extent of disease at presentation are independent prognostic indicators. Race, sex, and adjuvant therapy were not significant prognostic factors. Surgical resection remains the therapeutic mainstay for patients with LMS. The value of other treatment modalities is largely limited to surgical failures. The data show that the age of the patient and the extent of disease at presentation are the best predictors of long-term survival. LMS has a good prognosis when complete resection of localized lesions can be achieved.
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Affiliation(s)
- M A Hill
- Section of Surgical Oncology, Louisiana State University Medical Center, New Orleans 70112, USA
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Hill MA, Gong C, Casey TJ, Menon AG, Mera R, Gillespie AT, Giardina JF, Levine EA, Hunt JD. Detection of K-ras mutations in resected primary leiomyosarcoma. Cancer Epidemiol Biomarkers Prev 1997; 6:1095-100. [PMID: 9419409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Mutation of the K-ras oncogene occurs frequently in human malignancy. However, there are few reports concerning K-ras mutations in soft-tissue sarcoma, including leiomyosarcoma. We therefore designed a study to determine the prevalence of mutations in the first exon of K-ras in leiomyosarcoma and to evaluate its prognostic potential. Fifty-one leiomyosarcomas were reviewed, and their diagnoses were confirmed on pathological review. Tissue blocks were retrieved, and new sections were prepared for confirmation of diagnosis. Additional tissue sections were used for DNA isolation. PCR and denaturing gradient gel electrophoresis (DGGE) were used to detect K-ras mutations in the first exon of genomic DNA isolated from the specimens. Seven (14%) K-ras mutations were detected using DGGE. Subsequent sequencing of the K-ras gene from each of the mutated tumors confirmed the DGGE results in each case. The median survival for patients whose tumors did not contain mutations of K-ras was 42 months (n = 42) versus 25 months (n = 7) for those with mutations (P = 0.06). However, patients with stages I and II tumors had a median survival of 82 months (n = 28) compared to 28 months for those with stages III and IV disease (n = 20, P = 0.02). The results suggest that K-ras codon 12 mutations are uncommon in leiomyosarcoma; however, when such mutations are found, there is a trend toward worse survival. Furthermore, the data confirm that stage is a significant prognostic indicator.
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Affiliation(s)
- M A Hill
- Section of Surgical Oncology, Louisiana State University Medical Center, New Orleans 70112, USA
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38
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Siegfried JM, Gillespie AT, Mera R, Casey TJ, Keohavong P, Testa JR, Hunt JD. Prognostic value of specific KRAS mutations in lung adenocarcinomas. Cancer Epidemiol Biomarkers Prev 1997; 6:841-7. [PMID: 9332768] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Adenocarcinomas of the lung remain a significant public health problem. Locally defined (stage I) tumors are considered amenable to resection with curative intent. However, only about 45% of these patients survive for 5 years. The median survival for more advanced tumors is drastically lower. Much research has been focused on identifying a valid genetic biomarker of prognosis. Mutations of the proto-oncogene KRAS have been identified by some groups as being a valid prognostic indicator for adenocarcinoma of the lung. To evaluate the effect of KRAS gene mutation on the survival of patients with lung adenocarcinoma, 181 archival tumors were examined by PCR and denaturing gradient gel electrophoresis. Mutations in either codon 12 or 13 were found in 31.5% of the samples. The most common mutation was a G-->T transversion in codon 12, representing 66.7% of the mutations. No difference was observed in the survival of patients with a KRAS mutation versus those whose tumors contained wild-type KRAS. This lack of difference was also observed when the analysis was restricted to those with stage I tumors or when patients with stage I or II disease were grouped together. However, certain amino acid substitutions, including cysteine, arginine, and aspartate, indicated a significantly poorer prognosis, whereas hydrophobic amino acid substitutions showed a significantly better prognosis than wild-type (P = 0.04). Sample sizes were small for this analysis due to the number of possible mutations. As expected, the stage of tumor at resection was the most significant predictor of outcome. Based on this study of 181 patients from two major medical centers located in different cities, we conclude that KRAS mutation status is not a satisfactory predictor of prognosis in lung adenocarcinoma, but the substitution of a polar or charged amino acid for the wild-type glycine residue may be a negative prognostic indicator.
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Affiliation(s)
- J M Siegfried
- Department of Pharmacology, University of Pittsburgh School of Medicine, University of Pittsburgh Cancer Institute, Pennsylvania 15261, USA
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Levine EA, Holzmayer T, Bacus S, Mechetner E, Mera R, Bolliger C, Roninson IB, Das Gupta TK. Evaluation of newer prognostic markers for adult soft tissue sarcomas. J Clin Oncol 1997; 15:3249-57. [PMID: 9336362 DOI: 10.1200/jco.1997.15.10.3249] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.2] [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: 02/05/2023] Open
Abstract
PURPOSE In addition to tumor size, grade, location, and the presence of metastases, other factors may be useful in prognostication for adults with soft tissue sarcoma (STS). This study examines the relationship of MDR-1 mRNA, p-glycoprotein (P-gp), Ki-67 expression, and DNA content expression to clinical outcome in adults with STS. PATIENTS AND METHODS Snap-frozen STS specimens from 65 patients were analyzed and compared with clinical outcomes. Immunohistochemistry was performed for the Ki-67 antigen and P-gp. DNA content was determined using the Feulgen reaction and quantitated using image analysis. MDR-1 mRNA expression was determined using a reverse-transcriptase polymerase chain reaction (RT-PCR)-based assay. RESULTS P-glycoprotein expression was found by immunohistochemistry in 48% of cases with 5-year overall (54% v 14%, P = .07) and disease-free survival rates (32% v 18%, P = .039) higher in high-grade tumors that did not express P-gp. MDR-1 mRNA was detected in 51% of cases and no patient with high levels of MDR-1 mRNA expression was a long-term survivor. Patients with diploid tumors had significantly better survival than those with nondiploid tumors (51% v 31%, P = .03). High levels of Ki-67 were associated with poorer overall survival (46% v 31%, P = .04). On multivariate analysis, American Joint Committee on Cancer (AJCC) staging, DNA content, Ki-67, and P-gp staining were significant prognostic factors for 5-year overall and disease-free survival. CONCLUSION P-gp expression, high-level Ki-67 expression, and nondiploid DNA content are independent prognostic indicators that correlate with poor outcomes in STS patients. However, MDR-1 mRNA was not found to be predictive of survival. These newer markers are useful additions to AJCC staging for prognostication for patients with STS. Such markers may be useful in selecting high-risk STS patients who could benefit from systemic adjuvant therapy.
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Affiliation(s)
- E A Levine
- Department of Surgical Oncology, University of Illinois at Chicago, USA
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Brainard D, Hyslop NE, Mera R, Churchill J. Long-term outcome of inpatients with tuberculosis assigned to outpatient therapy at a local clinic in New Orleans. J Investig Med 1997; 45:381-7. [PMID: 9291694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND To characterize the New Orleans tuberculosis (TB) patient population and determine what factors might influence outcome, we followed inpatients with active disease at a large, public hospital who then received outpatient treatment at a public clinic. METHODS A total of 61 patients were enrolled from January 1, 1993 through July 1994 and followed until no patients were actively receiving treatment. Demographic and psychosocial data were collected and associated with the number of months of treatment received and final outcome. RESULTS Of the 61 patients, 26 (43%) completed treatment, 15 (25%) were lost to follow-up, 11 (18%) died, and 9 (14%) were referred out of the area during treatment. Among those lost to follow-up, 60% received only one month of treatment. Homelessness was the only factor significantly related to whether or not a patient completed outpatient therapy (p = .02) with almost 60% of all homeless patients becoming lost to follow-up. Assignment to directly observed therapy (DOT) did not significantly raise compliance rates. HIV status did not significantly alter the duration of treatment, but these patients had a mortality rate 3 times that of the other patients. CONCLUSIONS Efforts to improve TB control should focus on increasing compliance, particularly among the homeless. Although expansion of DOT is essential, raising therapy completion rates to acceptable levels may require additional social services, financial incentives and enforceable legal remedies for noncompliance. More rigorous treatment guidelines are needed to assure consistent management of patients who receive interrupted treatment.
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Affiliation(s)
- D Brainard
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA
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Skrepnik N, Araya JC, Qian Z, Xu H, Hamide J, Mera R, Hunt JD. Effects of anti-erbB-2 (HER-2/neu) recombinant oncotoxin AR209 on human non-small cell lung carcinoma grown orthotopically in athymic nude mice. Clin Cancer Res 1996; 2:1851-7. [PMID: 9816140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The recombinant oncotoxin AR209 [e23(Fv)PE38KDEL; formerly OLX-209] was developed to treat neoplasia that expresses the c-erbB-2 (HER-2/neu) protein product p185(erbB-2). The AR209 compound contains a single-chain antibody domain specific for p185(erbB-2), coupled with a portion of the Pseudomonas exotoxin. The drug has been shown to be effective in inhibiting cells that overexpress erbB-2 due to gene amplification and in cells that do not contain amplified erbB-2 but express slightly higher levels of the protein than normal cells do. To test the efficacy of AR209 on human lung tumors, athymic nude mice were inoculated intrathoracically with a cell line derived from a poorly differentiated lung adenocarcinoma. This cell line, termed 201T, expresses moderately elevated levels of p185(erbB-2) 7.6-fold over normal bronchial epithelium. Mice treated with i.v. injections of AR209 for 5 weeks after orthotopic tumor implantation had smaller tumors and in 20% of cases showed no evidence of disease. The data from this study indicate that AR209 may be an effective treatment for patients with non-small cell lung cancers that express p185(erbB-2).
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Affiliation(s)
- N Skrepnik
- Departments of Biochemistry and Molecular Biology, Pathology, and Radiology, New Orleans, Louisiana 70112, USA
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Mannick EE, Bravo LE, Zarama G, Realpe JL, Zhang XJ, Ruiz B, Fontham ET, Mera R, Miller MJ, Correa P. Inducible nitric oxide synthase, nitrotyrosine, and apoptosis in Helicobacter pylori gastritis: effect of antibiotics and antioxidants. Cancer Res 1996; 56:3238-43. [PMID: 8764115] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Helicobacter pylori infection is a known risk factor for gastric cancer. We hypothesized that H. pylori infection would lead to the sustained production of the reactive nitrogen species nitric oxide and peroxynitrite as part of the host immune response. We further hypothesized that H. pylori infection would lead to increased apoptosis of gastric epithelial cells, possibly in response to free radical-mediated DNA damage. Using immunohistochemistry, we stained and scored gastric antral biopsies from 84 Colombian patients with nonatrophic gastritis before and after treatment for H. pylori infection. We examined expression of inducible nitric oxide synthase (iNOS); nitrotyrosine, a marker for peroxynitrite; and DNA fragmentation, a marker for apoptosis. Patients were treated with triple therapy (amoxicillin, 500 mg three times a day for 2 weeks; metronidazole, 400 mg three times a day for 2 weeks; and bismuth subsalicylate, 262 mg four times a day for 2 weeks, followed by 262 mg every day for 4-12 months). Eradication of H. pylori infection resulted in a significant reduction in iNOS and nitrotyrosine staining and a marginally significant reduction in apoptosis. Dietary supplementation with beta-carotene (30 mg every day for 4-12 months) resulted in a significant decrease in iNOS staining. Supplementation with ascorbic acid (1 g twice a day for 4-12 months) led to a significant reduction in nitrotyrosine staining. In patients supplemented with either ascorbic acid or beta-carotene, there was a trend toward a reduction in apoptosis, but this was not statistically significant. We conclude that H. pylori infection is accompanied by the formation of endogenous reactive nitrogen intermediates, which may contribute to DNA damage and apoptosis. In addition to antimicrobial therapy, dietary supplementation with beta-carotene and ascorbic acid may prevent the formation of these potential carcinogens.
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Affiliation(s)
- E E Mannick
- Department of Pediatrics, Stanley Scott Cancer Center, Louisiana State University Medical Center, New Orleans, Louisiana 70112, USA
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Abstract
The goal of this study was to determine the temporal and spatial sequence of events that accompany lung injury and repair after parenteral administration of the Clara cell-specific cytotoxicant, naphthalene. Changes in airway epithelial cells were evaluated by measuring alterations in the expression of markers for differentiated Clara cells (CYPIIF and Clara cell 10-kDa secretory protein, CC10), distal airway/alveolar type II cells (surfactant protein B; SP-B) and for cycling/proliferating cells (cyclin dependent kinase 1;CDK1). Naphthalene-induced Clara cell cytotoxicity resulted in the exfoliation of epithelial cells containing CC10 protein. This was accompanied by a dramatic reduction in the abundance of mRNA for CC10 and CYPIIF. Large numbers of CDK1 mRNA-positive cells were identified in and around bronchioles and terminal bronchioles 48 h after treatment. This cellular proliferation resulted in the population of airways by immature epithelial cells lacking normal levels of CC10 mRNA but overexpressing SP-B mRNA. Seventy-two hours after naphthalene treatment a reduction in CDK1 mRNA-positive cells was noted within bronchioles and terminal bronchioles at all locations, with the exception of airway bifurcations. At airway bifurcations CDK1 mRNA appeared to be more abundant at the 72-h time point than at 48 h. Comparison of these sections with serial sections probed for CC10 mRNA demonstrated a correlation between the expression of CDK1 and CC10 mRNA at bifurcations. Temporal increases in the abundance of CC10 mRNA observed at later time points were largely accounted for by the processive maturation of newly repopulated cells neighboring bifurcations in bronchioles. These studies identify spatially distinct populations of cells that act in concert to repopulate naphthalene-injured airways and support the notion that branch point cells play an important role in the maturation of newly regenerated airway epithelial cells after acute injury.
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Affiliation(s)
- B R Stripp
- Division of Pulmonary Biology, Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA
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Rama BN, Salem BI, Haikal M, Mera R, Ortbals D, Gowda S. Total inferior vena cava thrombosis following coronary artery bypass surgery. Cathet Cardiovasc Diagn 1990; 19:237-9. [PMID: 2334954 DOI: 10.1002/ccd.1810190403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A 44-yr-old male presented with abdominal and back pain following coronary bypass surgery (CABG). Total inferior vena cava (IVC) thrombosis was then documented by computed tomography as well as IVC contrast cineangiography. Furthermore, the patient developed multiple pulmonary emboli. This presentation with severe abdominal and back pain with lack of early peripheral edema without apparent hepatic or renal dysfunction and with extreme elevation of erythrocyte sedimentation rate seems rather unusual. To our knowledge, such massive IVC thrombosis has not been reported following CABG. Thrombolytic and anticoagulant therapy was utilized with good recovery.
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Affiliation(s)
- B N Rama
- Cardiology Division, St. Luke's Hospital, St. Louis, MO 63017
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Aşgian B, Popoviciu L, Mera R, Micu M. [Morphological characteristics and the evolutive electroclinical aspects of pathological biopotentials in subacute sclerosing panencephalitis]. Rev Med Interna Neurol Psihiatr Neurochir Dermatovenerol Neurol Psihiatr Neurochir 1988; 33:23-35. [PMID: 2972046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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