Cathepsin D is a lysosomal hydrolase involved in intra- and extracellular proteolysis. This enzyme is aberrantly produced and processed in malignancy, and most notably is over-secreted into the tumor cell microenvironment. This hyper-secretion may lead to excessive degradation of the extracellular matrix, and contribute to tumor progression and metastases. These phenomena have been established in vitro, and there is evidence that Cathepsin D is similarly dysregulated in human breast cancer patients. Because breast cancer lacks an effective screening or surveillance biomarker, here we address the hypothesis that serum Cathepsin D activity may be useful to assess the presence or progression of breast cancer in females. While representative histologic sections from various disease-specific cohorts confirm previous findings that increased Cathepsin D production and secretion correlate with tumor progression, we report no difference in serum Cathepsin D activity between patients who are disease free, patients with pre-invasive or limited invasive disease, and patients with metastatic disease. Furthermore, in patients with known metastatic disease, there were no clinical variables associated with significantly different serum Cathepsin D activity. However, the immunohistochemical localization of Cathepsin D expression in histopathologic sections from breast cancer patients correlates with disease progression. Based on the serum results, and in contradistinction to Cathepsin D localization in breast cancer tissues, our findings support using Cathepsin D as a reliable histopathology biomarker for disease progression, but not for serum screening. Abbott, D. E. Margaryan, N. V. Jeruss, J. S. Khan, S. Kaklamani, V. Winchester, D. Hansen, N. Rademaker, A. Khalkhali-Ellis, Z. Hendrix, M. J. 0 2009-11-21T07:19:50Z 2010-01-15 2009-11-20 %0 Journal Article %A Abbott, D. E. %A Margaryan, N. V. %A Jeruss, J. S. %A Khan, S. %A Kaklamani, V. %A Winchester, D. %A Hansen, N. %A Rademaker, A. %A Khalkhali-Ellis, Z. %A Hendrix, M. J. %D 2010 %T Reevaluating cathepsin D as a biomarker for breast cancer: Serum activity levels versus histopathology. %J Cancer Biol Ther %V 9 %N 1 %M 19923884 %U http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19923884 %X Cathepsin D is a lysosomal hydrolase involved in intra- and extracellular proteolysis. This enzyme is aberrantly produced and processed in malignancy, and most notably is over-secreted into the tumor cell microenvironment. This hyper-secretion may lead to excessive degradation of the extracellular matrix, and contribute to tumor progression and metastases. These phenomena have been established in vitro, and there is evidence that Cathepsin D is similarly dysregulated in human breast cancer patients. Because breast cancer lacks an effective screening or surveillance biomarker, here we address the hypothesis that serum Cathepsin D activity may be useful to assess the presence or progression of breast cancer in females. While representative histologic sections from various disease-specific cohorts confirm previous findings that increased Cathepsin D production and secretion correlate with tumor progression, we report no difference in serum Cathepsin D activity between patients who are disease free, patients with pre-invasive or limited invasive disease, and patients with metastatic disease. Furthermore, in patients with known metastatic disease, there were no clinical variables associated with significantly different serum Cathepsin D activity. However, the immunohistochemical localization of Cathepsin D expression in histopathologic sections from breast cancer patients correlates with disease progression. Based on the serum results, and in contradistinction to Cathepsin D localization in breast cancer tissues, our findings support using Cathepsin D as a reliable histopathology biomarker for disease progression, but not for serum screening. %+ Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 8611 false false 1 Cancer biology & therapy Cancer Biol Ther 2010-01-15 aheadofprint JOURNAL ARTICLE 19923884 Publisher 2009-11-21T07:19:50Z http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19923884 9 2010 Background: Free radical Injury is associated with cancer, but how the extent of oxidative stress correlates with the FIGO (International Federation of Gynecology and Obstetrics) stage in Carcinoma Cervix (Ca Cx), and its significance as a prognostic marker, is not clear and needs an in-depth study. Aim: To correlate the blood levels of Lipid Peroxidation (LPO), Reduced Glutathione (GSH), Superoxide Dismutase (SOD), and Vitamin A and E levels with the clinical stage in Ca Cx. Settings and Design: This is a Prospective Case Control Study. Materials and Methods: LPO, SOD, reduced GSH were estimated by Bio Chemical Assays and Vitamins by High Performance Liquid Chromatography (HPLC). Statistical Analysis: The cases and controls were compared using One Way ANOVA and different stages over different time periods were individually compared by Repeated Measure Analysis of Variance. Results: The results indicated a statistically significant increase of LPO vis-a-vis the FIGO stage of Ca Cx and control, while the antioxidant status as depicted by GSH and SOD decreased. Vitamin A and E levels were significantly lower in cancer cases as compared to the control. Conclusion: Increased LPO and reduced antioxidant levels may be taken as associated predictive markers, thus suggesting that Ca Cx cases should get nutritive supplements to contain the blood LPO level and maintain a positive balance of antioxidants for a better outcome in terms of delayed recurrence and better Quality of Life (QOL). Srivastava, S. Natu, S. M. Gupta, A. Pal, K. A. Singh, U. Agarwal, G. G. Singh, U. Goel, M. M. Srivastava, A. N. 0 2009-09-23T06:13:24Z 2009-09-15 %0 Journal Article %A Srivastava, S. %A Natu, S. M. %A Gupta, A. %A Pal, K. A. %A Singh, U. %A Agarwal, G. G. %A Singh, U. %A Goel, M. M. %A Srivastava, A. N. %D 2009 %T Lipid peroxidation and antioxidants in different stages of cervical cancer: Prognostic significance. %J Indian J Cancer %V 46 %N 4 %P 297-302 %M 19749459 %U http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19749459 %X BACKGROUND: Free radical Injury is associated with cancer, but how the extent of oxidative stress correlates with the FIGO (International Federation of Gynecology and Obstetrics) stage in Carcinoma Cervix (Ca Cx), and its significance as a prognostic marker, is not clear and needs an in-depth study. AIM: To correlate the blood levels of Lipid Peroxidation (LPO), Reduced Glutathione (GSH), Superoxide Dismutase (SOD), and Vitamin A and E levels with the clinical stage in Ca Cx. SETTINGS AND DESIGN: This is a Prospective Case Control Study. MATERIALS AND METHODS: LPO, SOD, reduced GSH were estimated by Bio Chemical Assays and Vitamins by High Performance Liquid Chromatography (HPLC). STATISTICAL ANALYSIS: The cases and controls were compared using One Way ANOVA and different stages over different time periods were individually compared by Repeated Measure Analysis of Variance. RESULTS: The results indicated a statistically significant increase of LPO vis-a-vis the FIGO stage of Ca Cx and control, while the antioxidant status as depicted by GSH and SOD decreased. Vitamin A and E levels were significantly lower in cancer cases as compared to the control. CONCLUSION: Increased LPO and reduced antioxidant levels may be taken as associated predictive markers, thus suggesting that Ca Cx cases should get nutritive supplements to contain the blood LPO level and maintain a positive balance of antioxidants for a better outcome in terms of delayed recurrence and better Quality of Life (QOL). %+ Department of Pathology, Lucknow University, India. Srivastava, S Natu, S M Gupta, A Pal, K A Singh, U Agarwal, G G Singh, Uma Goel, M M Srivastava, A N 8306 false false 4 Indian journal of cancer Indian J Cancer 297-302 ppublish Journal Article 19749459 In-Process 2009-09-30T06:14:27Z http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19749459 46 2009 AIM: To examine the potential clinical implications of the recalibration of total prostate-specific antigen (PSA) and free PSA (fPSA) assays to the World Health Organization (WHO) standard materials. MATERIAL AND METHODS: Data from 1098 patients with or without clinically detected prostate cancer (PCa) from four independent cohort studies were compared using commercial assays calibrated to the traditional Hybritech PSA (PSA-Hyb) and fPSA (fPSA-Hyb) standards and to the WHO 96/670 (PSA-WHO) and 96/668 (fPSA-WHO) standards. The Access Immunoassay System (Beckman Coulter, Inc.) was used in all studies. RESULTS: All studies showed 20% to 25% lower PSA and fPSA test results with the WHO-standardized assays. No significant change in %fPSA (fPSA/PSA x 100) was observed. Continuing to use the traditional clinical PSA cutoffs obtained with the Hybritech standard after changing to the PSA-WHO standard could result in up to one-third of prostate cancer cases being missed. CONCLUSIONS: Manufacturers should fully inform laboratories about a calibration change and its clinical impact. Laboratory reports for PSA measurements should indicate the assay's manufacturer and which calibration standard was used to avoid misleading information concerning PCa risk. Stephan, C. Bangma, C. Vignati, G. Bartsch, G. Lein, M. Jung, K. Philippe, M. Semjonow, A. Catalona, W. J. 0 2009-09-06T11:54:53Z 2009-07-28 %0 Journal Article %A Stephan, C. %A Bangma, C. %A Vignati, G. %A Bartsch, G. %A Lein, M. %A Jung, K. %A Philippe, M. %A Semjonow, A. %A Catalona, W. J. %D 2009 %T 20-25% lower concentrations of total and free prostate-specific antigen (PSA) after calibration of PSA assays to the WHO reference materials--analysis of 1098 patients in four centers. %J Int J Biol Markers %V 24 %N 2 %P 65-69 %M 19634108 %U http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19634108 %X AIM: To examine the potential clinical implications of the recalibration of total prostate-specific antigen (PSA) and free PSA (fPSA) assays to the World Health Organization (WHO) standard materials. MATERIAL AND METHODS: Data from 1098 patients with or without clinically detected prostate cancer (PCa) from four independent cohort studies were compared using commercial assays calibrated to the traditional Hybritech PSA (PSA-Hyb) and fPSA (fPSA-Hyb) standards and to the WHO 96/670 (PSA-WHO) and 96/668 (fPSA-WHO) standards. The Access Immunoassay System (Beckman Coulter, Inc.) was used in all studies. RESULTS: All studies showed 20% to 25% lower PSA and fPSA test results with the WHO-standardized assays. No significant change in %fPSA (fPSA/PSA x 100) was observed. Continuing to use the traditional clinical PSA cutoffs obtained with the Hybritech standard after changing to the PSA-WHO standard could result in up to one-third of prostate cancer cases being missed. CONCLUSIONS: Manufacturers should fully inform laboratories about a calibration change and its clinical impact. Laboratory reports for PSA measurements should indicate the assay's manufacturer and which calibration standard was used to avoid misleading information concerning PCa risk. %K Calibration %K Chemistry, Clinical/methods %K Cohort Studies %K Early Detection of Cancer %K Humans %K Laboratory Techniques and Procedures/standards %K Male %K Prostate-Specific Antigen/*biosynthesis %K Prostatic Neoplasms/*blood/metabolism %K Reference Standards %K Reference Values %K Reproducibility of Results %K World Health Organization %+ Department of Urology, Charite - Universitatsmedizin Berlin, Germany. carsten.stephan@charite.de Stephan, Carsten Bangma, Chris Vignati, Giulio Bartsch, Georg Lein, Michael Jung, Klaus Philippe, Marianne Semjonow, Axel Catalona, William J 691 false false 2 The International journal of biological markers Int J Biol Markers Calibration; Chemistry, Clinical/methods; Cohort Studies; Early Detection of Cancer; Humans; Laboratory Techniques and Procedures/standards; Male; Prostate-Specific Antigen/*biosynthesis; Prostatic Neoplasms/*blood/metabolism; Reference Standards; Reference Values; Reproducibility of Results; World Health Organization 65-69 ppublish Journal Article 19634108 MEDLINE 2009-10-09T06:13:23Z http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19634108 24 2009 In July of 2008, the National Heart, Lung, and Blood Institute convened experts in noninvasive cardiovascular imaging, outcomes research, statistics, and clinical trials to develop recommendations for future randomized controlled trials of the use of imaging in: 1) screening the asymptomatic patient for coronary artery disease; 2) assessment of patients with stable angina; 3) identification of acute coronary syndromes in the emergency room; and 4) assessment of heart failure patients with chronic coronary artery disease with reduced left ventricular ejection fraction. This study highlights several possible trial designs for each clinical situation. Douglas, P. S. Taylor, A. Bild, D. Bonow, R. Greenland, P. Lauer, M. Peacock, F. Udelson, J. 0 2009-09-06T12:00:19Z 2009-06-06 2009-07-07 %0 Journal Article %A Douglas, P. S. %A Taylor, A. %A Bild, D. %A Bonow, R. %A Greenland, P. %A Lauer, M. %A Peacock, F. %A Udelson, J. %D 2009 %T Outcomes research in cardiovascular imaging: report of a workshop sponsored by the National Heart, Lung, and Blood Institute. %J J Cardiovasc Comput Tomogr %V 3 %N 4 %P 212-223 %M 19577208 %U http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19577208 %X In July of 2008, the National Heart, Lung, and Blood Institute convened experts in noninvasive cardiovascular imaging, outcomes research, statistics, and clinical trials to develop recommendations for future randomized controlled trials of the use of imaging in: 1) screening the asymptomatic patient for coronary artery disease; 2) assessment of patients with stable angina; 3) identification of acute coronary syndromes in the emergency room; and 4) assessment of heart failure patients with chronic coronary artery disease with reduced left ventricular ejection fraction. This study highlights several possible trial designs for each clinical situation. %K Biomedical Research/*trends %K Cardiology/*standards %K Cardiovascular Diseases/*diagnosis %K Consensus Development Conferences as Topic %K Diagnostic Imaging/*standards %K Endpoint Determination %K Humans %K *National Heart, Lung, and Blood Institute (U.S.) %K Outcome Assessment (Health Care)/*standards %K *Practice Guidelines as Topic %K United States %+ Division of Cardiovascular Medicine, Duke University Medical Center, 7022 North Pavilion DUMC, PO Box 17969, Durham, North Carolina 27715, USA. pamela.douglas@duke.edu Douglas, Pamela S Taylor, Allen Bild, Diane Bonow, Robert Greenland, Philip Lauer, Michael Peacock, Frank Udelson, James 7448 false false 4 Journal of cardiovascular computed tomography J Cardiovasc Comput Tomogr Biomedical Research/*trends; Cardiology/*standards; Cardiovascular Diseases/*diagnosis; Consensus Development Conferences as Topic; Diagnostic Imaging/*standards; Endpoint Determination; Humans; *National Heart, Lung, and Blood Institute (U.S.); Outcome Assessment (Health Care)/*standards; *Practice Guidelines as Topic; United States 212-223 ppublish Journal Article 19577208 MEDLINE 2009-09-16T06:16:17Z http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19577208 3 2009 Simon, M. A. Dong, X. Bennett, C. L. 0 2009-09-06T11:54:45Z 2009-06-12 %0 Journal Article %A Simon, M. A. %A Dong, X. %A Bennett, C. L. %D 2009 %T Partnering to promote equality in cancer care. %J Soc Work Public Health %V 24 %N 4 %P 355-359 %M 19517300 %U http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19517300 %+ Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. m-simon2@md.northwestern.edu Simon, Melissa A Dong, Xinqi Bennett, Charles L 236 false false 4 Social work in public health Soc Work Public Health 355-359 ppublish Journal Article 19517300 In-Process 2009-09-06T11:54:45Z http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19517300 24 2009 Coronary artery calcium (CAC), carotid intima-media thickness (CIMT), and reduced ankle brachial indices (ABI) are markers of subclinical vascular disease strongly associated with aging. The authors identified factors associated with low levels of subclinical vascular disease in 1824 participants 70 years and older in the Multi-Ethnic Study of Atherosclerosis. A total of 452 had low CAC (<25th percentile), 441 had low CIMT (<25th percentile), 1636 had normal ABI (>0.9), and 165 had a combination index indicating favorable values for all 3 parameters. This combination index was independently associated with younger age (odds ratio [OR] 2.5 per 1 SD [95% confidence interval (CI), 1.8-3.6]), female sex (OR 3.0 [95% CI, 1.9-4.8]), lower body mass index (OR 1.6 per 1 SD [95% CI, 1.2-2.0]), absence of hypertension (OR 1.8 [95% CI, 1.2-2.6]), absence of dyslipidemia (OR 1.6 [95% CI, 1.04-2.4]), and never-smoking (OR 1.7 [95% CI, 1.1-2.6]). No significant associations were observed for C-reactive protein, education, diet, or physical activity. Favorable levels of multiple traditional risk factors, but not several novel risk factors, were associated with subclinical markers of successful cardiovascular aging. Michos, E. D. Rice, K. M. Szklo, M. Burke, G. L. Siscovick, D. S. Tracy, R. P. Graham Barr, R. Nettleton, J. A. Greenland, P. Jacobs, D. R. Jr Post, W. 0 2009-09-06T12:00:20Z 2009-05-30 %0 Journal Article %A Michos, E. D. %A Rice, K. M. %A Szklo, M. %A Burke, G. L. %A Siscovick, D. S. %A Tracy, R. P. %A Graham Barr, R. %A Nettleton, J. A. %A Greenland, P. %A Jacobs, D. R. Jr %A Post, W. %D 2009 %T Factors associated with low levels of subclinical vascular disease in older adults: multi-ethnic study of atherosclerosis. %J Prev Cardiol %V 12 %N 2 %P 72-79 %M 19476580 %U http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19476580 %X Coronary artery calcium (CAC), carotid intima-media thickness (CIMT), and reduced ankle brachial indices (ABI) are markers of subclinical vascular disease strongly associated with aging. The authors identified factors associated with low levels of subclinical vascular disease in 1824 participants 70 years and older in the Multi-Ethnic Study of Atherosclerosis. A total of 452 had low CAC (<25th percentile), 441 had low CIMT (<25th percentile), 1636 had normal ABI (>0.9), and 165 had a combination index indicating favorable values for all 3 parameters. This combination index was independently associated with younger age (odds ratio [OR] 2.5 per 1 SD [95% confidence interval (CI), 1.8-3.6]), female sex (OR 3.0 [95% CI, 1.9-4.8]), lower body mass index (OR 1.6 per 1 SD [95% CI, 1.2-2.0]), absence of hypertension (OR 1.8 [95% CI, 1.2-2.6]), absence of dyslipidemia (OR 1.6 [95% CI, 1.04-2.4]), and never-smoking (OR 1.7 [95% CI, 1.1-2.6]). No significant associations were observed for C-reactive protein, education, diet, or physical activity. Favorable levels of multiple traditional risk factors, but not several novel risk factors, were associated with subclinical markers of successful cardiovascular aging. %K Aged %K Aged, 80 and over %K Angiography %K Atherosclerosis/blood/diagnosis/*ethnology %K Body Mass Index %K C-Reactive Protein/metabolism %K Cholesterol/blood %K Confidence Intervals %K *Ethnic Groups %K Female %K Follow-Up Studies %K Humans %K Male %K Middle Aged %K Odds Ratio %K Prognosis %K Prospective Studies %K Risk Assessment/*methods %K Risk Factors %K Severity of Illness Index %K Sex Distribution %K Ultrasonography, Doppler %K United States/epidemiology %+ Division of Cardiology, Johns Hopkins University, Carnegie 568, 600 North Wolfe Street, Baltimore, MD 21287, USA. edonnell@jhmi.edu Michos, Erin D Rice, Kenneth M Szklo, Moyses Burke, Gregory L Siscovick, David S Tracy, Russell P Graham Barr, R Nettleton, Jennifer A Greenland, Philip Jacobs, David R Jr Post, Wendy 7451 false false 2 Preventive cardiology Prev Cardiol Aged; Aged, 80 and over; Angiography; Atherosclerosis/blood/diagnosis/*ethnology; Body Mass Index; C-Reactive Protein/metabolism; Cholesterol/blood; Confidence Intervals; *Ethnic Groups; Female; Follow-Up Studies; Humans; Male; Middle Aged; Odds Ratio; Prognosis; Prospective Studies; Risk Assessment/*methods; Risk Factors; Severity of Illness Index; Sex Distribution; Ultrasonography, Doppler; United States/epidemiology 72-79 ppublish Comparative Study 19476580 MEDLINE 2009-09-06T12:00:20Z http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19476580 12 2009 BACKGROUND: There is a paucity of research assessing the potential benefits of mannequin trainers when preparing students to interact with teaching associates. PURPOSE: The goal of this study was to better understand the effects of mannequin-based simulators on student comfort toward learning specific aspects of the clinical female pelvic exam. METHODS: First-year medical students (N = 344) were surveyed before and after a mannequin-based simulation curriculum to assess their comfort levels toward learning the female pelvic exam. RESULTS: Causing harm was the top cause of student anxiety toward learning the pelvic exam. Although the mannequin-based simulation curriculum was effective in significantly increasing (p < .001) student comfort levels toward learning the pelvic exam, the majority of students progressed from being "very uncomfortable" with the exam to being "somewhat comfortable." CONCLUSION: We suggest that mannequin-based simulators be used prior to students' learning experience with pelvic exam teaching associates. Pugh, C. M. Obadina, E. T. Aidoo, K. A. 0 2009-09-06T11:57:22Z 2009-03-31 %0 Journal Article %A Pugh, C. M. %A Obadina, E. T. %A Aidoo, K. A. %D 2009 %T Fear of causing harm: use of mannequin-based simulation to decrease student anxiety prior to interacting with female teaching associates. %J Teach Learn Med %V 21 %N 2 %P 116-120 %M 19330689 %U http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19330689 %X BACKGROUND: There is a paucity of research assessing the potential benefits of mannequin trainers when preparing students to interact with teaching associates. PURPOSE: The goal of this study was to better understand the effects of mannequin-based simulators on student comfort toward learning specific aspects of the clinical female pelvic exam. METHODS: First-year medical students (N = 344) were surveyed before and after a mannequin-based simulation curriculum to assess their comfort levels toward learning the female pelvic exam. RESULTS: Causing harm was the top cause of student anxiety toward learning the pelvic exam. Although the mannequin-based simulation curriculum was effective in significantly increasing (p < .001) student comfort levels toward learning the pelvic exam, the majority of students progressed from being "very uncomfortable" with the exam to being "somewhat comfortable." CONCLUSION: We suggest that mannequin-based simulators be used prior to students' learning experience with pelvic exam teaching associates. %+ Department of Surgery, Northwestern University, Feinberg School of Medicine, 201 East Huron Street, Chicago, IL 60611-2908, USA. drpugh@northwestern.edu Pugh, Carla M Obadina, Eniola T Aidoo, Kofi A 4871 false false 2 Teaching and learning in medicine Teach Learn Med 116-120 ppublish Journal Article 19330689 In-Process 2009-09-06T11:57:22Z http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19330689 21 2009 This paper presents Mixed Reality Humans (MRHs), a new type of embodied agent enabling touch-driven communication. Affording touch between human and agent allows MRHs to simulate interpersonal scenarios in which touch is crucial. Two studies provide initial evaluation of user behavior with a MRH patient and the usability and acceptability of a MRH patient for practice and evaluation of medical students' clinical skills. In Study I (n=8) it was observed that students treated MRHs as social actors more than students in prior interactions with virtual human patients (n=27), and used interpersonal touch to comfort and reassure the MRH patient similarly to prior interactions with human patients (n=76). In the within-subjects Study II (n=11), medical students performed a clinical breast exam on each of a MRH and human patient. Participants performed equivalent exams with the MRH and human patients, demonstrating the usability of MRHs to evaluate students' exam skills. The acceptability of the MRH patient for practicing exam skills was high as students rated the experience as believable and educationally beneficial. Acceptability was improved from Study I to Study II due to an increase in the MRH's visual realism, demonstrating that visual realism is critical for simulation of specific interpersonal scenarios. Kotranza, A. Lok, B. Deladisma, A. Pugh, C. M. Lind, D. S. 0 2009-09-06T11:57:22Z 2009-03-14 %0 Journal Article %A Kotranza, A. %A Lok, B. %A Deladisma, A. %A Pugh, C. M. %A Lind, D. S. %D 2009 %T Mixed reality humans: evaluating behavior, usability, and acceptability. %J IEEE Trans Vis Comput Graph %V 15 %N 3 %P 369-382 %M 19282545 %U http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19282545 %X This paper presents Mixed Reality Humans (MRHs), a new type of embodied agent enabling touch-driven communication. Affording touch between human and agent allows MRHs to simulate interpersonal scenarios in which touch is crucial. Two studies provide initial evaluation of user behavior with a MRH patient and the usability and acceptability of a MRH patient for practice and evaluation of medical students' clinical skills. In Study I (n=8) it was observed that students treated MRHs as social actors more than students in prior interactions with virtual human patients (n=27), and used interpersonal touch to comfort and reassure the MRH patient similarly to prior interactions with human patients (n=76). In the within-subjects Study II (n=11), medical students performed a clinical breast exam on each of a MRH and human patient. Participants performed equivalent exams with the MRH and human patients, demonstrating the usability of MRHs to evaluate students' exam skills. The acceptability of the MRH patient for practicing exam skills was high as students rated the experience as believable and educationally beneficial. Acceptability was improved from Study I to Study II due to an increase in the MRH's visual realism, demonstrating that visual realism is critical for simulation of specific interpersonal scenarios. %K Breast/*physiology %K *Computer Graphics %K Computer Simulation %K Consumer Satisfaction %K Diagnosis, Computer-Assisted/*methods %K Humans %K Imaging, Three-Dimensional/methods %K *Models, Biological %K Palpation/*methods %K Task Performance and Analysis %K Touch/*physiology %K *User-Computer Interface %+ University of Florida, Gainesville, FL, USA. akotranz@cise.ufl.edu Kotranza, Aaron Lok, Benjamin Deladisma, Adeline Pugh, Carla M Lind, D Scott 4873 false false 3 IEEE transactions on visualization and computer graphics IEEE Trans Vis Comput Graph Breast/*physiology; *Computer Graphics; Computer Simulation; Consumer Satisfaction; Diagnosis, Computer-Assisted/*methods; Humans; Imaging, Three-Dimensional/methods; *Models, Biological; Palpation/*methods; Task Performance and Analysis; Touch/*physiology; *User-Computer Interface 369-382 ppublish Evaluation Studies 19282545 MEDLINE 2009-09-06T11:57:22Z http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19282545 15 2009 OBJECTIVES: The study examined the relationship between care delivery team effectiveness, management support, organizational culture, and the extent of implementation of a clinical innovation. METHODS: The study involved 6 target clinic areas in 78 Department of Veterans Affairs medical centers that participated in the national implementation of Advanced Clinic Access (ACA). Primary data were collected through staff surveys and structured interviews; secondary analyses were conducted using administrative databases. Hierarchical linear models were used to test the influence of team effectiveness and organizational context on implementation ratings. RESULTS AND CONCLUSIONS: Team effectiveness as measured by team knowledge and skills was significantly associated with the extent of ACA implementation in both primary and specialty care. Team functioning was significant only in primary care. Management support as measured by personal leadership support for quality improvement and the importance of reduced wait times was also significantly associated with ACA implementation, but practical management support and organizational culture were not. Team effectiveness partially mediated the relationship between extent of implementation and personal leadership support. Findings support the underlying theory that implementation of clinical innovations depends on both individual staff and a more complex dynamic of individuals operating within work units in the larger organization. Lukas, C. V. Mohr, D. C. Meterko, M. 0 2009-09-06T11:56:43Z 2009-01-17 %0 Journal Article %A Lukas, C. V. %A Mohr, D. C. %A Meterko, M. %D 2009 %T Team effectiveness and organizational context in the implementation of a clinical innovation. %J Qual Manag Health Care %V 18 %N 1 %P 25-39 %M 19148027 %U http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19148027 %X OBJECTIVES: The study examined the relationship between care delivery team effectiveness, management support, organizational culture, and the extent of implementation of a clinical innovation. METHODS: The study involved 6 target clinic areas in 78 Department of Veterans Affairs medical centers that participated in the national implementation of Advanced Clinic Access (ACA). Primary data were collected through staff surveys and structured interviews; secondary analyses were conducted using administrative databases. Hierarchical linear models were used to test the influence of team effectiveness and organizational context on implementation ratings. RESULTS AND CONCLUSIONS: Team effectiveness as measured by team knowledge and skills was significantly associated with the extent of ACA implementation in both primary and specialty care. Team functioning was significant only in primary care. Management support as measured by personal leadership support for quality improvement and the importance of reduced wait times was also significantly associated with ACA implementation, but practical management support and organizational culture were not. Team effectiveness partially mediated the relationship between extent of implementation and personal leadership support. Findings support the underlying theory that implementation of clinical innovations depends on both individual staff and a more complex dynamic of individuals operating within work units in the larger organization. %K *Cooperative Behavior %K *Diffusion of Innovation %K *Efficiency, Organizational %K Hospitals, Veterans/organization & administration %K Humans %K Interviews as Topic %K Medical Staff, Hospital/psychology %K Organizational Culture %K Quality of Health Care %+ Department of Veterans Affairs, Boston University School of Public Health, Boston, Massachusetts, USA. carol.vandeusenlukas@va.gov Lukas, Carol Vandeusen Mohr, David C Meterko, Mark 4011 false false 1 Quality management in health care Qual Manag Health Care *Cooperative Behavior; *Diffusion of Innovation; *Efficiency, Organizational; Hospitals, Veterans/organization & administration; Humans; Interviews as Topic; Medical Staff, Hospital/psychology; Organizational Culture; Quality of Health Care 25-39 ppublish Journal Article 19148027 MEDLINE 2009-09-06T11:56:43Z http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19148027 18 2009 Prostate inflammation can lead to an elevation in the serum PSA concentration and confound the use of PSA kinetics. This can have considerable clinical consequences, since these measurements form the basis for important clinical decisions. Thus, there has been investigation into ways to decrease the confounding from inflammation, including repeat PSA measurements after a period of observation or a course of empiric antibiotics. This article reviews the evidence about elevations in PSA due to prostatitis and describes the controversy over the optimal approach to reduce its confounding impact on prostate cancer screening. Loeb, S. Gashti, S. N. Catalona, W. J. 0 2009-09-06T11:54:53Z 2008-12-30 %0 Journal Article %A Loeb, S. %A Gashti, S. N. %A Catalona, W. J. %D 2009 %T Exclusion of inflammation in the differential diagnosis of an elevated prostate-specific antigen (PSA). %J Urol Oncol %V 27 %N 1 %P 64-66 %M 19111800 %U http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19111800 %X Prostate inflammation can lead to an elevation in the serum PSA concentration and confound the use of PSA kinetics. This can have considerable clinical consequences, since these measurements form the basis for important clinical decisions. Thus, there has been investigation into ways to decrease the confounding from inflammation, including repeat PSA measurements after a period of observation or a course of empiric antibiotics. This article reviews the evidence about elevations in PSA due to prostatitis and describes the controversy over the optimal approach to reduce its confounding impact on prostate cancer screening. %K Anti-Bacterial Agents/therapeutic use %K Biopsy %K Diagnosis, Differential %K Early Detection of Cancer %K Humans %K Inflammation/blood/*diagnosis %K Male %K Medical Oncology/methods %K Prevalence %K Prostate-Specific Antigen/*biosynthesis %K Prostatic Neoplasms/blood/*diagnosis %K Prostatitis/blood/*diagnosis %K Tumor Markers, Biological/blood %+ James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA. Loeb, Stacy Gashti, Sara N Catalona, William J 703 false false 1 Urologic oncology Urol Oncol Anti-Bacterial Agents/therapeutic use; Biopsy; Diagnosis, Differential; Early Detection of Cancer; Humans; Inflammation/blood/*diagnosis; Male; Medical Oncology/methods; Prevalence; Prostate-Specific Antigen/*biosynthesis; Prostatic Neoplasms/blood/*diagnosis; Prostatitis/blood/*diagnosis; Tumor Markers, Biological/blood 64-66 ppublish Journal Article 19111800 MEDLINE 2009-09-06T11:54:53Z http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19111800 27 2009 Weinberger, A. H. Hitsman, B. Papandonatos, G. D. Sacco, K. A. Vessicchio, J. C. George, T. P. 0 2009-11-18T07:17:20Z 2009-11-17 %0 Journal Article %A Weinberger, A. H. %A Hitsman, B. %A Papandonatos, G. D. %A Sacco, K. A. %A Vessicchio, J. C. %A George, T. P. %D 2009 %T Predictors of abstinence and changes in psychiatric symptoms in a pooled sample of smokers with schizophrenia receiving combination pharmacotherapy and behavioral therapy for smoking cessation. %J J Clin Psychopharmacol %V 29 %N 6 %P 601-603 %M 19910728 %U http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19910728 Weinberger, Andrea H Hitsman, Brian Papandonatos, George D Sacco, Kristi A Vessicchio, Jennifer C George, Tony P 8603 false false 6 Journal of clinical psychopharmacology J Clin Psychopharmacol 601-603 2009-12-01 ppublish Letter 19910728 In-Process 2009-11-18T07:17:20Z http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19910728 29 2009 OBJECTIVES: To evaluate the response rate and toxicity of a regimen comprised of monthly carboplatin and weekly paclitaxel for recurrent ovarian cancer. METHODS: We performed a retrospective chart review of patients with recurrent ovarian cancer treated between 2001 and 2006 at a single institution with carboplatin AUC 5 (day 1), and paclitaxel 80 mg/m(2) (days 1, 8, 15) of a 28-day cycle. Primary endpoints were response rate, progression-free survival and overall survival. RESULTS: Twenty patients were treated with this regimen from 2001 to 2006. Stage ranged from stages IC to IV. All received intravenous platinum and taxane as their initial therapy. Histologic subtypes included papillary serous (17), carcinosarcoma (1), and clear cell (2). The median number of prior regimens was 1 (range 1-3). The overall response rate was 85.0% (15 complete responses, 2 partial responses). Patients with tumors categorized as platinum sensitive had a response rate of 93.3% (14/15) and those with tumors deemed platinum resistant had a response rate of 60.0% (3/5). The median survival has not yet been reached after a median follow-up of 28 months. Neutropenia was the only grade 3/4 toxicity, occurring in 7 patients (35.0%). Platinum hypersensitivity reactions occurred in 5 patients (25.0%) who all successfully continued treatment using a carboplatin desensitization protocol. CONCLUSIONS: A monthly carboplatin and weekly paclitaxel regimen is highly active for women with recurrent platinum-sensitive and platinum-resistant epithelial ovarian cancer. The regimen is well tolerated. This pilot series demonstrates the potential for this regimen as treatment of choice among doublet first salvage regimens for patients with recurrent epithelial ovarian cancer, thus warranting multi-institutional study. Hoekstra, A. V. Hurteau, J. A. Kirschner, C. V. Rodriguez, G. C. 0 2009-10-07T06:12:54Z 2009-10-01 2009-10-06 %0 Journal Article %A Hoekstra, A. V. %A Hurteau, J. A. %A Kirschner, C. V. %A Rodriguez, G. C. %D 2009 %T The combination of monthly carboplatin and weekly paclitaxel is highly active for the treatment of recurrent ovarian cancer. %J Gynecol Oncol %V 115 %N 3 %P 377-381 %M 19800107 %U http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19800107 %X OBJECTIVES: To evaluate the response rate and toxicity of a regimen comprised of monthly carboplatin and weekly paclitaxel for recurrent ovarian cancer. METHODS: We performed a retrospective chart review of patients with recurrent ovarian cancer treated between 2001 and 2006 at a single institution with carboplatin AUC 5 (day 1), and paclitaxel 80 mg/m(2) (days 1, 8, 15) of a 28-day cycle. Primary endpoints were response rate, progression-free survival and overall survival. RESULTS: Twenty patients were treated with this regimen from 2001 to 2006. Stage ranged from stages IC to IV. All received intravenous platinum and taxane as their initial therapy. Histologic subtypes included papillary serous (17), carcinosarcoma (1), and clear cell (2). The median number of prior regimens was 1 (range 1-3). The overall response rate was 85.0% (15 complete responses, 2 partial responses). Patients with tumors categorized as platinum sensitive had a response rate of 93.3% (14/15) and those with tumors deemed platinum resistant had a response rate of 60.0% (3/5). The median survival has not yet been reached after a median follow-up of 28 months. Neutropenia was the only grade 3/4 toxicity, occurring in 7 patients (35.0%). Platinum hypersensitivity reactions occurred in 5 patients (25.0%) who all successfully continued treatment using a carboplatin desensitization protocol. CONCLUSIONS: A monthly carboplatin and weekly paclitaxel regimen is highly active for women with recurrent platinum-sensitive and platinum-resistant epithelial ovarian cancer. The regimen is well tolerated. This pilot series demonstrates the potential for this regimen as treatment of choice among doublet first salvage regimens for patients with recurrent epithelial ovarian cancer, thus warranting multi-institutional study. %+ Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, NorthShore University HealthSystem, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 8438 false false 3 Gynecologic oncology Gynecol Oncol 377-381 2009-12-01 ppublish JOURNAL ARTICLE 19800107 In-Process 2009-11-05T07:22:56Z http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19800107 115 2009 Khan, S. A. 0 2009-10-16T06:14:43Z 2009-10-13 2009-10-15 %0 Journal Article %A Khan, S. A. %D 2009 %T Axillary Reverse Mapping to Prevent Lymphedema After Breast Cancer Surgery: Defining the Limits of the Concept. %J J Clin Oncol %V 27 %N 33 %P 5494-5496 %M 19826108 %U http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19826108 8483 false false 33 Journal of clinical oncology : official journal of the American Society of Clinical Oncology J Clin Oncol 5494-5496 2009-11-20 ppublish JOURNAL ARTICLE 19826108 Publisher 2009-11-20T07:17:36Z http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19826108 27 2009 OBJECTIVE: MUC1, MUC5AC, and MUC6 are main constituents of the mucus barrier in the stomach, which protects the underlying epithelium from acid, proteases, mechanical trauma, and pathogenic microorganisms. Accumulating evidence implicates potential roles of MUC1, MUC5AC, and MUC6 genetic variation in the development of stomach cancer. METHODS: We evaluated the relationship between common genetic variations in these genes and stomach cancer risk, using an LD-based tagSNP approach in a population-based case-control study conducted in Warsaw, Poland, during 1994-1996. We genotyped 6, 8, and 14 tagSNPs in MUC1, MUC5AC, and MUC6 genes, respectively, among 273 cases newly diagnosed with stomach cancer and 377 controls. RESULTS: Each of the six tagSNPs tested across the MUC1 region showed statistically significant associations with an increased risk of stomach cancer. Carriers of the haplotype ACTAA rare alleles of rs4971052, rs4276913, rs4971088, rs4971092, and rs4072037 had a nearly doubled risk (OR = 1.93, 95% CI = 1.49-2.48) compared to the referent haplotype GTAAG. Out of the eight tagSNPs across MUC5AC region, only minor allele of rs868903 was significantly associated with an increased risk of stomach cancer (OR = 1.80, 95% CI = 1.22-2.63). CONCLUSIONS: Overall, our data provide evidence that some common variations in MUC1 and MUC5AC genes contribute to an elevated risk of stomach cancer. Further studies are needed to confirm these novel findings. Jia, Y. Persson, C. Hou, L. Zheng, Z. Yeager, M. Lissowska, J. Chanock, S. J. Chow, W. H. Ye, W. 0 2009-11-21T07:19:54Z 2009-11-19 2009-11-20 %0 Journal Article %A Jia, Y. %A Persson, C. %A Hou, L. %A Zheng, Z. %A Yeager, M. %A Lissowska, J. %A Chanock, S. J. %A Chow, W. H. %A Ye, W. %D 2009 %T A comprehensive analysis of common genetic variation in MUC1, MUC5AC, MUC6 genes and risk of stomach cancer. %J Cancer Causes Control %M 19924550 %U http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19924550 %X OBJECTIVE: MUC1, MUC5AC, and MUC6 are main constituents of the mucus barrier in the stomach, which protects the underlying epithelium from acid, proteases, mechanical trauma, and pathogenic microorganisms. Accumulating evidence implicates potential roles of MUC1, MUC5AC, and MUC6 genetic variation in the development of stomach cancer. METHODS: We evaluated the relationship between common genetic variations in these genes and stomach cancer risk, using an LD-based tagSNP approach in a population-based case-control study conducted in Warsaw, Poland, during 1994-1996. We genotyped 6, 8, and 14 tagSNPs in MUC1, MUC5AC, and MUC6 genes, respectively, among 273 cases newly diagnosed with stomach cancer and 377 controls. RESULTS: Each of the six tagSNPs tested across the MUC1 region showed statistically significant associations with an increased risk of stomach cancer. Carriers of the haplotype ACTAA rare alleles of rs4971052, rs4276913, rs4971088, rs4971092, and rs4072037 had a nearly doubled risk (OR = 1.93, 95% CI = 1.49-2.48) compared to the referent haplotype GTAAG. Out of the eight tagSNPs across MUC5AC region, only minor allele of rs868903 was significantly associated with an increased risk of stomach cancer (OR = 1.80, 95% CI = 1.22-2.63). CONCLUSIONS: Overall, our data provide evidence that some common variations in MUC1 and MUC5AC genes contribute to an elevated risk of stomach cancer. Further studies are needed to confirm these novel findings. %+ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, 17177, Stockholm, Sweden. 8612 false false Cancer causes & control : CCC Cancer Causes Control 2009-11-19 aheadofprint JOURNAL ARTICLE 19924550 Publisher 2009-11-21T07:19:54Z http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19924550 2009 Prior research has linked heightened cortisol reactivity to stress with increased food consumption. This pilot study tested corollaries of the hypothesis that cortisol stress reactivity promotes obesity. Thirty-four lean and obese women completed an acute stress task and a non-stressful control task in counterbalanced order. Contrary to expectations, higher post-stress cortisol was associated with decreased post-stress snack intake in obese women but was unrelated to snack intake in lean women. Stress also blunted an expected rise in hunger only among obese women. Findings suggest that some obese women may be more sensitive to short-term anorectic effects of HPA axis activation. Appelhans, B. M. Pagoto, S. L. Peters, E. N. Spring, B. J. 0 2009-11-22T07:25:39Z 2009-11-16 2009-11-21 %0 Journal Article %A Appelhans, B. M. %A Pagoto, S. L. %A Peters, E. N. %A Spring, B. J. %D 2009 %T HPA AXIS RESPONSE TO STRESS PREDICTS SHORT-TERM SNACK INTAKE IN OBESE WOMEN. %J Appetite %M 19925839 %U http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19925839 %X Prior research has linked heightened cortisol reactivity to stress with increased food consumption. This pilot study tested corollaries of the hypothesis that cortisol stress reactivity promotes obesity. Thirty-four lean and obese women completed an acute stress task and a non-stressful control task in counterbalanced order. Contrary to expectations, higher post-stress cortisol was associated with decreased post-stress snack intake in obese women but was unrelated to snack intake in lean women. Stress also blunted an expected rise in hunger only among obese women. Findings suggest that some obese women may be more sensitive to short-term anorectic effects of HPA axis activation. %+ Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680N Lake Shore Dr., Chicago, IL 60611, USA; Department of Preventive Medicine, Rush University Medical Center, 1700W Van Buren St, Ste 470, Chicago, IL 60612, USA. 8616 false false Appetite Appetite 2009-11-16 aheadofprint JOURNAL ARTICLE 19925839 Publisher 2009-11-22T07:25:39Z http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19925839 2009 PURPOSE: A controversy of current prostate specific antigen based prostate cancer screening is the over detection of potentially insignificant prostate cancer. Because PSA kinetics were previously linked to prostate cancer specific mortality, we determined whether prostate specific antigen velocity is associated with clinically significant prostate cancer. MATERIALS AND METHODS: A total of 1,073 men underwent radical prostatectomy from 1992 to 2008 with data available on prostate specific antigen velocity and tumor volume. Insignificant cancer was defined by the Ohori criteria as organ confined, tumor volume 0.5 cc or less and no primary or secondary Gleason pattern 4 or 5. We calculated the proportion of men with pathologically insignificant prostate cancer stratified by prostate specific antigen velocity. RESULTS: Preoperative prostate specific antigen velocity greater than 0.4 ng/ml per year was significantly associated with high grade disease (p = 0.008), positive surgical margins (p = 0.003) and seminal vesicle invasion (p = 0.007) at radical prostatectomy. Median tumor volume was also significantly higher in men with preoperative prostate specific antigen velocity greater than 0.4 ng/ml per year (3.1 vs 2.4 cc, p = 0.0001). Overall 69 men (6%) met the Ohori criteria for insignificant cancer. Patients with preoperative prostate specific antigen velocity greater than 0.4 ng/ml per year were 50% less likely to have insignificant disease (10% vs 5%, p = 0.003). CONCLUSIONS: A prostate specific antigen velocity threshold of 0.4 ng/ml per year was associated with the likelihood of insignificant prostate cancer. This suggests that prostate specific antigen velocity may be a useful adjunct in prostate cancer screening to increase specificity for identifying patients with clinically significant disease. Loeb, S. Roehl, K. A. Helfand, B. T. Kan, D. Catalona, W. J. 0 2009-11-18T07:16:00Z 2009-11-12 2009-11-17 %0 Journal Article %A Loeb, S. %A Roehl, K. A. %A Helfand, B. T. %A Kan, D. %A Catalona, W. J. %D 2009 %T Can Prostate Specific Antigen Velocity Thresholds Decrease Insignificant Prostate Cancer Detection? %J J Urol %M 19913814 %U http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19913814 %X PURPOSE: A controversy of current prostate specific antigen based prostate cancer screening is the over detection of potentially insignificant prostate cancer. Because PSA kinetics were previously linked to prostate cancer specific mortality, we determined whether prostate specific antigen velocity is associated with clinically significant prostate cancer. MATERIALS AND METHODS: A total of 1,073 men underwent radical prostatectomy from 1992 to 2008 with data available on prostate specific antigen velocity and tumor volume. Insignificant cancer was defined by the Ohori criteria as organ confined, tumor volume 0.5 cc or less and no primary or secondary Gleason pattern 4 or 5. We calculated the proportion of men with pathologically insignificant prostate cancer stratified by prostate specific antigen velocity. RESULTS: Preoperative prostate specific antigen velocity greater than 0.4 ng/ml per year was significantly associated with high grade disease (p = 0.008), positive surgical margins (p = 0.003) and seminal vesicle invasion (p = 0.007) at radical prostatectomy. Median tumor volume was also significantly higher in men with preoperative prostate specific antigen velocity greater than 0.4 ng/ml per year (3.1 vs 2.4 cc, p = 0.0001). Overall 69 men (6%) met the Ohori criteria for insignificant cancer. Patients with preoperative prostate specific antigen velocity greater than 0.4 ng/ml per year were 50% less likely to have insignificant disease (10% vs 5%, p = 0.003). CONCLUSIONS: A prostate specific antigen velocity threshold of 0.4 ng/ml per year was associated with the likelihood of insignificant prostate cancer. This suggests that prostate specific antigen velocity may be a useful adjunct in prostate cancer screening to increase specificity for identifying patients with clinically significant disease. %+ Department of Urology, The Johns Hopkins School of Medicine, Baltimore, Maryland. 8597 false false The Journal of urology J Urol 2009-11-12 aheadofprint JOURNAL ARTICLE 19913814 Publisher 2009-11-18T07:16:00Z http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19913814 2009 OBJECTIVE To determine whether the placement of small-calibre, rapidly absorbed prophylactic periprostatic sutures before the mobilization of the prostate could reduce blood loss during open retropubic radical prostatectomy (RRP). PATIENTS AND METHODS In 2007, during open RRP, we began placing prophylactic haemostatic sutures of 4-0 and 3-0 plain catgut in the anterior portions of the distal neurovascular bundles (NVBs) and lateral to the proximal NVBs and prostate pedicles before initiating the nerve-sparing dissection and mobilizing the prostate gland. To evaluate whether this reduced intraoperative blood loss, we compared estimated blood loss (EBL), non-autologous transfusion rates, and postoperative haemoglobin (Hb) levels between 100 consecutive patients treated immediately before and 100 consecutive patients treated immediately after the adoption of the prophylactic periprostatic suture technique. RESULTS Before the use of prophylactic haemostatic sutures, the mean intraoperative blood loss was 1285 mL, and one patient (1%) received an intraoperative non-autologous transfusion. After the adoption of prophylactic sutures, the mean EBL was 700 mL (P < 0.001), and there were no transfusions. The mean Hb concentration the morning after RRP was 10.9 g/dL before and 11.8 g/dL after the initiation of prophylactic haemostatic sutures (P < 0.001). CONCLUSION Prophylactic periprostatic haemostatic sutures significantly reduce intraoperative blood loss during open RRP. Carvalhal, G. F. Griffin, C. R. Kan, D. Loeb, S. Catalona, W. J. 0 2009-11-07T07:16:58Z 2009-11-03 2009-11-06 %0 Journal Article %A Carvalhal, G. F. %A Griffin, C. R. %A Kan, D. %A Loeb, S. %A Catalona, W. J. %D 2009 %T Reducing blood loss in open radical retropubic prostatectomy with prophylactic periprostatic sutures. %J BJU Int %M 19888968 %U http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19888968 %X OBJECTIVE To determine whether the placement of small-calibre, rapidly absorbed prophylactic periprostatic sutures before the mobilization of the prostate could reduce blood loss during open retropubic radical prostatectomy (RRP). PATIENTS AND METHODS In 2007, during open RRP, we began placing prophylactic haemostatic sutures of 4-0 and 3-0 plain catgut in the anterior portions of the distal neurovascular bundles (NVBs) and lateral to the proximal NVBs and prostate pedicles before initiating the nerve-sparing dissection and mobilizing the prostate gland. To evaluate whether this reduced intraoperative blood loss, we compared estimated blood loss (EBL), non-autologous transfusion rates, and postoperative haemoglobin (Hb) levels between 100 consecutive patients treated immediately before and 100 consecutive patients treated immediately after the adoption of the prophylactic periprostatic suture technique. RESULTS Before the use of prophylactic haemostatic sutures, the mean intraoperative blood loss was 1285 mL, and one patient (1%) received an intraoperative non-autologous transfusion. After the adoption of prophylactic sutures, the mean EBL was 700 mL (P < 0.001), and there were no transfusions. The mean Hb concentration the morning after RRP was 10.9 g/dL before and 11.8 g/dL after the initiation of prophylactic haemostatic sutures (P < 0.001). CONCLUSION Prophylactic periprostatic haemostatic sutures significantly reduce intraoperative blood loss during open RRP. %+ Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, and Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins, Baltimore, MD, USA. 8567 false false BJU international BJU Int 2009-11-03 aheadofprint JOURNAL ARTICLE 19888968 Publisher 2009-11-07T07:16:58Z http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19888968 2009 OBJECTIVE To further examine the association between statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) and pathological features in a large group of patients undergoing radical prostatectomy (RP), as epidemiological studies have suggested that statins, in addition to their beneficial cardiovascular effects, might reduce the risk of aggressive prostate cancer. PATIENTS AND METHODS From 2003 to 2009, 1351 men with data on preoperative statin use had RP by one surgeon. The clinical and pathological tumour features were compared between 504 users of statins and 847 who were not users. RESULTS Statin users were significantly older and had a higher mean body mass index than non-users. The preoperative serum prostate-specific antigen levels, tumour volume and percentage of cancer in the RP specimen were significantly lower in patients taking statins. Overall, statin users had a proportionately lower rate of adverse tumour pathology features, including a significantly lower risk of positive (cancerous) surgical margins. CONCLUSION Our results suggest that the use of statins might be associated with more favourable pathological features at RP. The long-term disease-specific outcomes and the underlying link between statins and prostate cancer require further investigation. Loeb, S. Kan, D. Helfand, B. T. Nadler, R. B. Catalona, W. J. 0 2009-11-07T07:16:58Z 2009-11-03 2009-11-06 %0 Journal Article %A Loeb, S. %A Kan, D. %A Helfand, B. T. %A Nadler, R. B. %A Catalona, W. J. %D 2009 %T Is statin use associated with prostate cancer aggressiveness? %J BJU Int %M 19888973 %U http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19888973 %X OBJECTIVE To further examine the association between statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) and pathological features in a large group of patients undergoing radical prostatectomy (RP), as epidemiological studies have suggested that statins, in addition to their beneficial cardiovascular effects, might reduce the risk of aggressive prostate cancer. PATIENTS AND METHODS From 2003 to 2009, 1351 men with data on preoperative statin use had RP by one surgeon. The clinical and pathological tumour features were compared between 504 users of statins and 847 who were not users. RESULTS Statin users were significantly older and had a higher mean body mass index than non-users. The preoperative serum prostate-specific antigen levels, tumour volume and percentage of cancer in the RP specimen were significantly lower in patients taking statins. Overall, statin users had a proportionately lower rate of adverse tumour pathology features, including a significantly lower risk of positive (cancerous) surgical margins. CONCLUSION Our results suggest that the use of statins might be associated with more favourable pathological features at RP. The long-term disease-specific outcomes and the underlying link between statins and prostate cancer require further investigation. %+ Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD, and Department of Urology, Northwestern Feinberg School of Medicine, Chicago, IL, USA. 8566 false false BJU international BJU Int 2009-11-03 aheadofprint JOURNAL ARTICLE 19888973 Publisher 2009-11-07T07:16:58Z http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19888973 2009 Robinson, J. K. 0 2009-11-19T07:22:51Z 2009-11-18 %0 Journal Article %A Robinson, J. K. %D 2009 %T Linking publication about efalizumab effectiveness with safety concerns. %J Arch Dermatol %V 145 %N 11 %P 1338 %M 19917976 %U http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19917976 Robinson, June K 8608 false false 11 Archives of dermatology Arch Dermatol 1338 2009-11-01 ppublish Comment 19917976 In-Process 2009-11-19T07:22:51Z http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19917976 145 2009 Benson, A. B. 0 2009-10-30T06:21:56Z 2009-10-29 %0 Journal Article %A Benson, A. B. %D 2009 %T Chemotherapy: Adding oxaliplatin to the equation. %J Nat Rev Clin Oncol %V 6 %N 11 %P 620-622 %M 19861991 %U http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19861991 Benson, Al B 8537 false false 11 Nature reviews. Clinical oncology Nat Rev Clin Oncol 620-622 2009-11-01 ppublish Journal Article 19861991 In-Process 2009-10-31T06:19:28Z http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19861991 6 2009