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  • 1
    In: Diabetes Care, American Diabetes Association, Vol. 43, No. 4 ( 2020-04-01), p. 806-812
    Abstract: To evaluate the contemporary prevalence of diabetic peripheral neuropathy (DPN) in participants with type 1 diabetes in the T1D Exchange Clinic Registry throughout the U.S. RESEARCH DESIGN AND METHODS DPN was assessed with the Michigan Neuropathy Screening Instrument Questionnaire (MNSIQ) in adults with ≥5 years of type 1 diabetes duration. A score of ≥4 defined DPN. Associations of demographic, clinical, and laboratory factors with DPN were assessed. RESULTS Among 5,936 T1D Exchange participants (mean ± SD age 39 ± 18 years, median type 1 diabetes duration 18 years [interquartile range 11, 31], 55% female, 88% non-Hispanic white, mean glycated hemoglobin [HbA1c] 8.1 ± 1.6% [65.3 ± 17.5 mmol/mol]), DPN prevalence was 11%. Compared with those without DPN, DPN participants were older, had higher HbA1c, had longer duration of diabetes, were more likely to be female, and were less likely to have a college education and private insurance (all P & lt; 0.001). DPN participants also were more likely to have cardiovascular disease (CVD) (P & lt; 0.001), worse CVD risk factors of smoking (P = 0.008), hypertriglyceridemia (P = 0.002), higher BMI (P = 0.009), retinopathy (P = 0.004), reduced estimated glomerular filtration rate (P = 0.02), and Charcot neuroarthropathy (P = 0.002). There were no differences in insulin pump or continuous glucose monitor use, although DPN participants were more likely to have had severe hypoglycemia (P = 0.04) and/or diabetic ketoacidosis (P & lt; 0.001) in the past 3 months. CONCLUSIONS The prevalence of DPN in this national cohort with type 1 diabetes is lower than in prior published reports but is reflective of current clinical care practices. These data also highlight that nonglycemic risk factors, such as CVD risk factors, severe hypoglycemia, diabetic ketoacidosis, and lower socioeconomic status, may also play a role in DPN development.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2020
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  • 2
    In: Diabetes Care, American Diabetes Association, Vol. 43, No. 1 ( 2020-01-01), p. e1-e2
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2020
    detail.hit.zdb_id: 1490520-6
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  • 3
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 9, No. 1 ( 2019-08-01)
    Abstract: Although 70–80% of newly diagnosed ovarian cancer patients respond to first-line therapy, almost all relapse and five-year survival remains below 50%. One strategy to increase five-year survival is prolonging time to relapse by improving first-line therapy response. However, no biomarker today can accurately predict individual response to therapy. In this study, we present analytical and prospective clinical validation of a new test that utilizes primary patient tissue in 3D cell culture to make patient-specific response predictions prior to initiation of treatment in the clinic. Test results were generated within seven days of tissue receipt from newly diagnosed ovarian cancer patients obtained at standard surgical debulking or laparoscopic biopsy. Patients were followed for clinical response to chemotherapy. In a study population of 44, the 32 test-predicted Responders had a clinical response rate of 100% across both adjuvant and neoadjuvant treated populations with an overall prediction accuracy of 89% (39 of 44, p  〈  0.0001). The test also functioned as a prognostic readout with test-predicted Responders having a significantly increased progression-free survival compared to test-predicted Non-Responders, p = 0.01. This correlative accuracy establishes the test’s potential to benefit ovarian cancer patients through accurate prediction of patient-specific response before treatment.
    Type of Medium: Online Resource
    ISSN: 2045-2322
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2019
    detail.hit.zdb_id: 2615211-3
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  • 4
    In: The Journal of Pediatrics, Elsevier BV, Vol. 167, No. 3 ( 2015-09), p. 627-632.e4
    Type of Medium: Online Resource
    ISSN: 0022-3476
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2015
    detail.hit.zdb_id: 2005245-5
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  • 5
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 40, No. 28_suppl ( 2022-10-01), p. 9-9
    Abstract: 9 Background: Clinical efficiency is a key component of value-based healthcare, patient satisfaction, staff burnout, and institutional operational capacity. The objective of this study was to identify clinic inefficiencies using time driven activity-based costing (TDABC) and evaluate the implementation of a new clinical workflow in high volume, outpatient radiation oncology clinics. Methods: We conducted an IRB-approved quality improvement study in the Gastrointestinal (GI), Genitourinary (GU), and Thoracic Radiation (TRO) Oncology departments at a large academic cancer center and four additional network sites (HALs). TDABC methodology was used to create process maps and optimize consult workflow. Patient encounter metrics were captured utilizing a real-time status function in the electronic medical record (Epic Systems). Anonymous patient satisfaction telephone surveys were administered to patients at the HALs. Hourly wages were determined based on 2021 U.S. Bureau of Labor Statistics. Pre- vs post-implementation metrics were compared using the Mann-Whitney U test. Results: Consult data for 1328 patients pre-intervention and 1234 post-intervention across all sections was included. Median overall cycle time was reduced by 21% in GI (19 min, p 〈 0.001), 18% in GU (16 min, p 〈 0.001), and 12% in HALs (9 min, p 〈 0.001). The median interval between rooming and being seen by the attending physician decreased by 13% in GI (7 min, p 〈 0.001), 16% in GU (9 min, p 〈 0.001), 21% in TRO (10 min, p 〈 0.001), and 9% in HALS (4 min, p 〈 0.005). For each consult, there was a median financial savings of $29 for GI, $24 for GU, $5 for TRO, and $14 for HALs per consult. From patient satisfaction surveys (95/177), 99% of patients reported their providers spent adequate time with them, 85% reported their appointment began on time, and 91% reported being seen by a care provider in a timely manner. Conclusions: TDABC is a successful method to identify opportunities to improve clinical efficiency. Implementing workflow changes based upon these findings led to substantial reduction in overall encounter cycle times and patient wait times across multiple departments. Furthermore, patient satisfaction was high and there were significant financial savings with the new workflow. These findings may also have implications for reducing staff burnout and expanding clinical capacity across the magnitude of clinical enterprise.[Table: see text]
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2022
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  • 6
    In: Military Medicine, Oxford University Press (OUP), Vol. 188, No. 7-8 ( 2023-07-22), p. e2772-e2777
    Abstract: The only commercially available ankle-foot prosthesis with powered propulsion lacks ruggedization and other capabilities for service members seeking to return to duty and/or other physically demanding activities. Here, we evaluated a ruggedized powered ankle-foot prosthesis with electromyographic control (“Warrior Ankle”; WA) in an experienced male user of the predicate (Empower) prosthesis. The participant (age = 56 years, mass = 86.8 kg, stature = 173 cm) completed a 650 m simulated hike with varying terrain at a fixed, self-selected speed in the WA and predicate prosthesis, with and without a 22.8 kg weighted vest (“loaded” and “unloaded,” respectively). Peak dorsiflexion and plantarflexion angles were extracted from each gait cycle throughout the simulated hike (∼500 prosthetic-side steps). The participant walked faster with the WA (1.15 m/s) compared to predicate (0.80 m/s) prosthesis. On the prosthetic side, peak dorsiflexion angles were larger for the WA (loaded: 27.9°; unloaded: 26.9°) compared to the predicate (loaded: 19.4°; unloaded: 21.3°); peak plantarflexion angles were similar between prostheses and loading conditions [WA (loaded: 15.5°; unloaded: 14.9°), predicate (loaded: 16.9°; unloaded: 14.8°). The WA better accommodated the varying terrain profile, evidenced by greater peak dorsiflexion angles, as well as dorsiflexion and plantarflexion angles that more closely matched or exceeded those of the innate ankle [dorsiflexion (WA: 31.6°, predicate: 27.5°); plantarflexion (WA: 20.7°, predicate: 20.5°)]. Furthermore, the WA facilitated a faster walking speed, suggesting a greater functional capacity with the WA prosthesis. Although further design enhancements are needed, this case study demonstrated feasibility of a proof-of-concept, ruggedized powered ankle-foot prosthesis with electromyographic control.
    Type of Medium: Online Resource
    ISSN: 0026-4075 , 1930-613X
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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  • 7
    Online Resource
    Online Resource
    American Association for Cancer Research (AACR) ; 2022
    In:  Cancer Research Vol. 82, No. 12_Supplement ( 2022-06-15), p. 3086-3086
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 82, No. 12_Supplement ( 2022-06-15), p. 3086-3086
    Abstract: Unlike cell lines, organoids maintain most of the biological properties of the parental tissue from which the starting cells were isolated including the histology and gene expression. When organoids include clinical annotation, they become a useful, renewable tool for clinical correlation studies, but to be truly predictive the drug profiling assays utilized to screen organoid response must have measurable correlation with patient response. 3D Predict™ is a highly accurate assay that is 89% and 85% predictive of response in first-line ovarian cancer and high-grade gliomas (HGG) respectively. We have developed a panel of organoids that are clinically annotated, include correlative primary tissue 3D Predict™ drug response data, and have been assessed for the recapitulation of primary tissue histology and genomics. Additionally, our organoid models incorporate matched immune cells, a key component of the tumor microenvironment, making them an ideal model for immune-oncology studies. Here we present data on 15 available organoid models across HGG, breast, colorectal and bladder cancer. We have applied these models to drug response studies, including checkpoint inhibitors and shown correlation to primary patient response. The assurance of predictive capacity is unique to KIYATEC’s organoids and is significant because it avoids the pitfalls of comparing drug responses across non-concordant assay platforms while providing assurance that the models are reflective of individual patient response and outcomes. Citation Format: Melissa Millard, Natalie A. Williams, Ashley K. Elrod, Teresa M. DesRochers. Organoids standardized to a clinically validated drug response assay for truly predictive in vitro drug response profiling [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3086.
    Type of Medium: Online Resource
    ISSN: 1538-7445
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2022
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  • 8
    Online Resource
    Online Resource
    American Association for Cancer Research (AACR) ; 2020
    In:  Cancer Research Vol. 80, No. 16_Supplement ( 2020-08-15), p. 2244-2244
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 80, No. 16_Supplement ( 2020-08-15), p. 2244-2244
    Abstract: Poly(ADP-ribose) polymerase (PARP) inhibitors have shown impressive clinical activities for ovarian cancer patients with BRCA mutations and have altered the paradigm for ovarian cancer treatment. Despite the utility that PARP inhibitors provide, intrinsic and acquired resistance often limit their effectiveness as a monotherapy, and therefore combination treatment is an attractive alternative for more durable responses. Checkpoint inhibitors have shown impressive efficacy in numerous solid tumor types, but have failed to show meaningful response in ovarian cancer. The role PARP inhibitors play as immune modulators to enhance checkpoint blockade efficacy has just recently emerged indicating that their combination with checkpoint inhibitors may be beneficial over either single agent. A recent phase I/II clinical trial by researchers at the Dana-Farber Cancer Institute demonstrated niraparib in combination with pembrolizumab produced complete or partial responses in 18% of patients with recurrent platinum-resistant ovarian cancer compared to less than a 5% response rate with PARP inhibitors alone (JAMA Oncol. 2019;5(8):1141-1149). Further understanding of the immune modulatory capacity of PARP inhibitors alone and in combination with checkpoint blockade will aid in the prediction of patient response or resistance to therapy. To address this lack in knowledge, we evaluated therapeutic responses to PARP inhibitors, checkpoint inhibitors, and combinations using ovarian cancer patient-derived 3D tumor spheroids. Primary tumor samples were evaluated for PD-L1 and EpCAM expression, and tumor infiltrating lymphocyte (TILs) populations were assessed for T-cell activation and CD8+:Treg ratios. Immune-mediated antitumor activity was investigated by monitoring changes in PD-L1 and MHC class-I expression in the tumor cell populations following PARP inhibition, pembrolizumab treatment, and in combination. The effects of pembrolizumab alone and in combination for enhanced T-cell mediated tumor cell killing were also tested. PD-L1 expression was associated with response to pembrolizumab, and pembrolizumab induced tumor cell killing was T-cell dependent. Despite detection of cytotoxic activity by olaparib and pembrolizumab as single agents, increased tumor cell killing was detected when olaparib and pembrolizumab were used in combination. In summary, we detected therapy related modulation of tumor cells as well as the immune composition which results in decreased tumor spheroid viability in the presence of PARP inhibition in combination with checkpoint blockade. These results highlight the potential benefit of PARP/checkpoint inhibitor combination therapy and of patient-derived 3D spheroids as a platform to help identify subsets of cancer patients who would likely respond to immunotherapies as single agents or in combination with other approved agents. Citation Format: Kathryn M. Appleton, Ashley Elrod, Stephen Shuford, Teresa M. DesRochers. PARP inhibition in combination with pembrolizumab enhances cytotoxicity in ovarian cancer patient-derived 3D spheroids [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2244.
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
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    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2020
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  • 9
    Online Resource
    Online Resource
    American Association for Cancer Research (AACR) ; 2023
    In:  Cancer Research Vol. 83, No. 7_Supplement ( 2023-04-04), p. 2275-2275
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 83, No. 7_Supplement ( 2023-04-04), p. 2275-2275
    Abstract: Biological therapies for the treatment of cancer are utilized for the same ultimate purpose as chemically derived cancer drugs, to induce tumor cell death. However, the differing mechanisms of action often make the evaluation of biologic drug efficacy more complex, requiring the support and/or recapitulation of functional immune components. Biologics also have different limitations that can govern their efficacy such as their large size potentially impeding sufficient penetration to target sites and in the case of live biotherapeutic products, the need to maintain sustained function, or persistence, by resisting immunosuppression by the tumor microenvironment. Preclinical testing of biologics is often confined to cell lines which lack an immune system and mouse models which are expensive, time consuming, and poor proxies for the human immune system. To address these issues, we have developed ex vivo 3D spheroid platforms to measure the efficacy of three types of biologics: antibody-drug conjugates (ADCs), bispecific antibodies, and chimeric antigen receptor (CAR) T-cells. Primary cells from cancer patients or from patient-derived xenografts were evaluated for the expression of the biologic target molecule then cultured to form 3D spheroids. Spheroid models were validated for the evaluation of antibody-based therapies by determining sufficient diffusion of antibodies to target sites. For ADC testing, cell death was measured in a plate-based read-out following treatment with the ADC trastuzumab deruxtecan, and the cytotoxic efficacy of the ADC was compared to trastuzumab alone or free exatecan. Differences in killing kinetics and the maximum efficacy of the ADC were determined compared to the other tested agents. HER2 inhibition was evaluated through changes in constitutive downstream signaling. Two biologics with the same molecular target, a bispecific antibody targeting carcinoembryonic antigen (CEA) on tumor cells and CD3 on T-cells, as well as a CAR T-cell product targeting CEA were also evaluated. Following treatment with the bispecific, tumor cell viability was detected using flow cytometry and changes in T-cell activation were measured via cytokine secretion using primary colorectal cancer models. Importantly, bispecific antibody efficacy was dependent upon the presence of T-cells. Finally, CAR T-cell mediated tumor cell killing was detected using a fluorescent image-based approach. Collectively, this work establishes a model for testing multiple classes of drugs in a 3D ex vivo model that can be used to advance preclinical drug development and evaluate mechanisms of action of diverse drug classes in a physiologically relevant model. Citation Format: Katy A. Lassahn, Ashley K. Elrod, Aaron L. Carlson, Natalie A. Dance, Melissa Millard, Michael J. Wick, Teresa M. DesRochers, Kathryn M. Appleton. Preclinical testing of therapeutic biologics using patient-derived 3D spheroids [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 2275.
    Type of Medium: Online Resource
    ISSN: 1538-7445
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2023
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    detail.hit.zdb_id: 1432-1
    detail.hit.zdb_id: 410466-3
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  • 10
    In: Clinical Infectious Diseases, Oxford University Press (OUP), ( 2019-04-06)
    Type of Medium: Online Resource
    ISSN: 1058-4838 , 1537-6591
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    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2002229-3
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