Justin Dvorak

The pro-inflammatory effect of obesity on high grade serous ovarian cancer

INTRODUCTION Obesity is a known generator of chronic inflammation but has an uncertain role in ovarian carcinogenesis and survival. Pro-inflammatory cytokines have previously been associated with poor outcomes. Given the established links, we sought to determine whether obesity and pro-inflammatory cytokines affect platinum sensitivity. METHODS A retrospective review was performed of patients undergoing primary debulking surgery (PDS) for high grade serous ovarian cancer (HGSC) who had available pre-operative serum. Oncologic and treatment characteristics were recorded and analyzed using SAS version 9.3. Bioplex reagent kit was used to measure serum cytokine concentrations. RESULTS 86 patients met study criteria. Most were Caucasian (88%) and non-diabetic (92%). All patients had advanced stage (III/IV) disease and received chemotherapy after PDS. In univariate analysis, lower VEGF (p=0.013) was associated with longer overall survival (OS). Low IL-8 level (p=0.053) was marginally associated with platinum resistant disease. After adjusting for covariates including residual disease and maintenance therapy, IL-8 was no longer associated with platinum sensitive status (p=0.13), VEGF remained associated with OS (low vs. high HR 0.3, 95% CI 0.1-0.8, p=0.018), and higher IL-12 was associated with longer PFS (HR 0.4, 95% CI 0.2-0.9, p=0.031). CONCLUSION In HGSC, pro-inflammatory cytokines are influenced by obesity, as differing inter-cytokine correlations were observed based on BMI, possibly due to dysregulation between cytokines in the setting of obesity. Differences in survival and platinum sensitivity were not noted. Future studies are warranted to determine whether obesity may be a modifiable risk factor for poorer outcomes due to differing immune response.

Global public awareness about atrial fibrillation

Essentials Early recognition of atrial fibrillation helps in stroke prevention. Survey in 10 countries to assess public awareness of atrial fibrillation. Overall global awareness of atrial fibrillation was 48%. Less than 46% of participants were aware atrial fibrillation leads to stroke.

Choctaw Nation Youth Sun Exposure Survey

The incidence of skin cancer is rising among American Indians (AI) but the prevalence of harmful ultraviolet light (UVL) exposures among AI youth is unknown. In 2013, UVL exposures, protective behaviors, and attitudes toward tanning were assessed among 129 AI and Non-Hispanic (NHW) students in grades 8–12 in Southeastern Oklahoma. Sunburn was reported by more than half the AI students and most of the NHW students. One-third of AI students reported never using sunscreen, compared to less than one-fifth of NHW students, but racial differences were mitigated by propensity to burn. Less than 10% of students never covered their shoulders when outside. Girls, regardless of race, wore hats much less often than boys. Regardless of race or sex, more than one-fourth of students never stayed in the shade, and more than one-tenth never wore sunglasses. The prevalence of outdoor tanning did not differ by race, but more than three-fourths of girls engaged in this activity compared to less than half the boys. Indoor tanning was reported by 45% of the girls, compared to 20% of girls nationwide, with no difference by race. Nearly 10% of boys tanned indoors. Among girls, 18% reported more than ten indoor tanning sessions. Over one-quarter of participants agreed that tanning makes people look more attractive, with no significant difference by race or sex. Investigations of UVL exposures should include AI youth, who have not been represented in previous studies but whose harmful UVL exposures, including indoor tanning, may place them at risk of skin cancer.

An Analysis of 3-Year Outcomes Following Canaloplasty for the Treatment of Open-Angle Glaucoma

Purpose To report 3-year results investigating the safety and efficacy of canaloplasty for open-angle glaucoma. Setting University of Oklahoma, Dean McGee Eye Institute, Oklahoma, United States of America. Design Nonrandomized single-center retrospective chart review. Methods Adult open-angle glaucoma eyes underwent canaloplasty or combined cataract-canaloplasty surgery. A tensioning suture was placed into Schlemms canal in all eyes. Primary endpoints included the mean IOP and mean number of glaucoma medications at each follow-up visit. Secondary endpoints included visual acuity and surgical/postsurgical complications. Results The study cohort included 277 eyes (mean age, 72.8 years). Overall, the mean baseline IOP of 19.7 mmHg was reduced to 14.3 mmHg,14.0 mmHg, and 15.2 mmHg at 1, 2, and 3 years, respectively (p < 0.001). The average medicine use was reduced from 2.1 preoperatively to 0.4 at 12 months, and 0.5 and 0.6 at two and three years, respectively (p < 0.001). The frequency of surgical and postsurgical complications was low with no serious adverse events recorded. Conclusion Canaloplasty was safe and effective in achieving long-term IOP reductions and reduced dependence on antiglaucoma medications.

Evaluation of the efficacy and toxicity profile associated with intraperitoneal chemotherapy use in older women

OBJECTIVE Intraperitoneal (IP) chemotherapy (CT) for treatment of epithelial ovarian cancer (EOC) has been shown to provide a substantial OS advantage. This study aims to compare the toxicity and benefits of IP CT in patients ≥70 with those <70. METHODS We performed a single institution retrospective review of patients diagnosed with Stage IIA-IIIC EOC from 2000 to 2013 who received IP CT. Clinicopathologic characteristics were extracted, and survival was calculated. RESULTS 133 patients were included with 100 pts. <70years old and 33 pts. ≥70years old. Clinical trial enrollment was similar despite age. In trial enrolled patients, older patients received statistically fewer cycles of therapy (6.4 vs 5.8, p=0.002) but had similar dose delays (0.9 vs 0.7, p=0.72), and modifications (0.9 vs 0.36, p=0.11). Median PFS (27 vs 31months) and OS (71 and 62months) were not statistically different. Grade 3/4 neutropenia was significantly worse in the older patients (82% vs 100%, p=0.04). Neuropathy grade ≥2 and other non-hematologic toxicities were not different between age groups. CONCLUSIONS Despite completing fewer cycles of IP CT, older EOC patients had comparable survival to younger patients. The population of older patients receiving IP CT in this study were on clinical trial and likely to be heartier than the general older population. IP CT appears well tolerated and effective among select older patients and is likely under-utilized outside of clinical trials.

Diabetes knowledge in young adults: associations with hemoglobin A1C.

The purpose of this study was to quantify associations between hemoglobin A1C (A1C) and diabetes knowledge score using an assessment tool developed to evaluate the level of diabetes knowledge in young adults with Type 1 diabetes (T1DM) and their parent/primary caregiver. Seventy-five participants with T1DM, ages 15-22 years, completed questionnaires. Two 25-item questionnaires were developed: one for patient and one for caregiver. Linear regression quantified associations between correct items on the tools and participant A1C and demographic characteristics. Mean age of participants was 16.7 ± 1.7 years, diabetes duration 5.9 ± 4.2 years, 46.7% male, 74.7% Caucasian, 69.3% on multiple daily injections, and 30.7% on continuous subcutaneous insulin infusion therapy; 78.7% of parents/caregivers completed the questionnaire. A significant interaction was observed between patient and caregiver scores with A1C by diabetes duration. Among patients with diabetes <6 years, higher patient and caregiver scores were associated with lower A1C (-0.25 ± 0.11, p = .03 and -0.59 ± 0.19, p = .005, respectively) accounting for age, gender, race, therapy, and insurance. Neither patient nor caregiver score was associated with A1C in patients with diabetes duration ≥6 years. Better performance on a diabetes knowledge assessment (for both patient and the caregiver) was found to be associated with more favorable levels of glycemic control among young adults with diabetes <6 years. Additional evaluation of these questionnaires and novel interventions to enhance knowledge in this population are needed.

Improving cancer care for American Indians with cervical cancer in the Indian Health Service (IHS) system — Navigation may not be enough

OBJECTIVES Patient navigation programs have been shown to positively impact cancer outcomes for minority populations. Little is known regarding the effects of these programs on American Indian (AI) populations. The purpose of this study is to characterize the impact of a patient navigation program on AI cervical cancer patients at a tertiary care center. METHODS A retrospective review of all AI cervical cancer patients receiving navigation services and a cohort of AI patients treated prior to navigation services was performed. Additional comparisons were made between those with and without Indian Health Service (IHS) funding. Summary statistics were used to describe demographic, clinical characteristics, treatment, and survivorship across groups. RESULTS Of 55 patients identified, 34 received navigation and 21 did not. In navigated patients, median age was 46years (27-80years) compared with 42years (17-68years) in pre-navigation patients (p=0.53). There was no difference between stage at diagnosis (p=0.73). No difference was noted in treatment received between groups (p=0.48). Distance traveled for treatment between groups did not differ (p=0.46). Median time to initiation of treatment was not different between groups, 30.5days vs. 27.5days (p=0.18). Among patients with IHS funding, navigation services did not alter time to initiation of treatment (p=0.57), and there was no difference in completion of prescribed therapy between groups (92% navigated vs 100% pre-navigation). CONCLUSIONS Navigation services for AI cervical cancer patients did not alter initiation or completion of treatment. Navigation programs may provide less tangible benefits to AI cervical cancer patients and further study is warranted.

Prosodic Improvement in Persons with Parkinson Disease Receiving SPEAK OUT!® Voice Therapy

Background/Aims: Hypokinetic dysarthria in Parkinson disease (PD) hinders the ability to verbally communicate and interferes with activities of daily living. SPEAK OUT!® is a therapy program designed to improve functional communicative ability. In contrast to the Lee Silverman Voice Treatment program, SPEAK OUT!® promotes speaking with intent to effect loud speech. This study evaluated the efficacy of SPEAK OUT!® in persons with idiopathic PD in 3 domains: self-reported voice handicap, clinical ratings of dysarthria and prosody, and acoustic analysis of prosody. Participants and Methods: Pre-/post-therapy data included PD participants’ scores on the Voice Handicap Index (VHI) and the Voice-Related Quality of Life (V-RQOL) questionnaire, audio recordings, perceptual evaluation scores, and demographic data, such as age, sex, handedness, diagnosis, and onset of PD. Results: Participants achieved a statistically and clinically significant improvement in speech intensity, pitch range, normalized pairwise variability index for pitch, sustained vowel duration, reading intelligibility, and vocal quality after SPEAK OUT!® training, consistent with both of the self-report voice scores, i.e., the VHI and the V-RQOL, and with the perceptual speech evaluation scores. Longer PD duration was associated with lowered efficacy. Conclusions: SPEAK OUT!® is effective and should be administered as early as possible after disease onset.

Altered saccadic targets when processing facial expressions under different attentional and stimulus conditions

HIGHLIGHTSFacial blends occur when different emotions are expressed on the upper and lower face.Perception is biased to lower face; if attention is directed to upper face, left visual field becomes biased to upper face.With no attentional instructions, initial saccades target the lower face equally.If attention is directed to the upper face, saccades target the upper face equally.Initial saccades do not completely explain asymmetric attentional‐perceptual biases. ABSTRACT Depending on a subjects attentional bias, robust changes in emotional perception occur when facial blends (different emotions expressed on upper/lower face) are presented tachistoscopically. If no instructions are given, subjects overwhelmingly identify the lower facial expression when blends are presented to either visual field. If asked to attend to the upper face, subjects overwhelmingly identify the upper facial expression in the left visual field but remain slightly biased to the lower facial expression in the right visual field. The current investigation sought to determine whether differences in initial saccadic targets could help explain the perceptual biases described above. Ten subjects were presented with full and blend facial expressions under different attentional conditions. No saccadic differences were found for left versus right visual field presentations or for full facial versus blend stimuli. When asked to identify the presented emotion, saccades were directed to the lower face. When asked to attend to the upper face, saccades were directed to the upper face. When asked to attend to the upper face and try to identify the emotion, saccades were directed to the upper face but to a lesser degree. Thus, saccadic behavior supports the concept that there are cognitive‐attentional pre‐attunements when subjects visually process facial expressions. However, these pre‐attunements do not fully explain the perceptual superiority of the left visual field for identifying the upper facial expression when facial blends are presented tachistoscopically. Hence other perceptual factors must be in play, such as the phenomenon of virtual scanning.

Acetazolamide: A New Treatment for Visual Vertigo

ABSTRACT Visual vertigo is a disorder characterised by symptoms of dizziness, vertigo, unsteadiness, disorientation, and general discomfort induced by visual triggers. It is currently treated with vestibular rehabilitation therapy, with no effective pharmacotherapy available for treatment-resistant cases. The objective of this study was to evaluate the efficacy of oral acetazolamide in improving symptoms of visual vertigo. A comparative case series of adult patients clinically diagnosed with visual vertigo was conducted from January 1992 to May 2015. Patients without a full neurologic or otorhinolaryngologic work-up, negative magnetic resonance imaging (MRI), and an organic cause for their symptoms were excluded. The identified patients were then contacted by phone to complete a voluntary symptom survey. Main outcome was the subjective reported percentage in symptom improvement. Secondary outcomes were subjective improvement by symptom triggers. The participants were retrospectively divided into three groups based on their treatment with acetazolamide: currently on acetazolamide, terminated acetazolamide, or never initiated acetazolamide. Fifty-seven patients met the inclusion criteria and were willing to complete the phone survey (19 currently on acetazolamide, 27 terminated acetazolamide, and 11 never initiated therapy). Overall symptomatic improvement was reported by 18 (94.7%) patients currently on acetazolamide, 18 (66.7 %) who terminated acetazolamide, and 5 (45.5%) who never initiated therapy, varying significantly by group (p = 0.0061). Greatest improvement was reported in symptoms triggered by being a passenger in a car. These results show that acetazolamide has a positive association with improvement of symptoms of visual vertigo.