Medical Specialties Commons^™

The Quest For Sustained Multiple Morbidity Reduction In Very Low-Birth-Weight Infants: The Antifragility Project., Joseph Kaempf, N M Schmidt, S Rogers, C Novack, M Friant, L Wang, N Tipping

Articles, Abstracts, and Reports

OBJECTIVE: Can a comprehensive, explicitly directive evidence-based guideline for all therapies that might affect the major morbidities of very low-birth-weight (VLBW) infants help a neonatal intensive care unit (NICU) further improve generally favorable morbidity rates? Can Antifragility principles of provider adaptive growth from stressors, enhanced infant risk assessment and adherence to effective therapies minimize unproven treatments and reduce all morbidities?

STUDY DESIGN: Prospectively planned observational trial in VLBW infants: control group born October 2011 to September 2013 and study group October 2013 to September 2015. Multi-disciplinary evidence-based review assigned all NICU treatments into one of four distinct categories: (1) always …

Does The Spine Surgeon’S Experience Affect Fracture Classification, Assessment Of Stability, And Treatment Plan In Thoracolumbar Injuries?, Shanmuganathan Rajasekaran, Rishimugesh Kanna, Gregory D. Schroeder, Frank C. Oner, Luiz Vialle, Jens R. Chapman, Marcel Dvorak, Michael Fehlings, Ajoy P. Shetty, Klaus J. Schnake, Frank M. Kandziora, Alex R. Vaccaro

Rothman Institute Papers

Study Design: Prospective survey-based study. Objectives: The AO Spine thoracolumbar injury classification has been shown to have good reproducibility among clinicians. However, the influence of spine surgeons’ clinical experience on fracture classification, stability assessment, and decision on management based on this classification has not been studied. Furthermore, the usefulness of varying imaging modalities including radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) in the decision process was also studied. Methods: Forty-one spine surgeons from different regions, acquainted with the AOSpine classification system, were provided with 30 thoracolumbar fractures in a 3-step assessment: first radiographs, followed by CT and MRI. …

Risk Of Incident Clinical Diagnosis Of Alzheimer's Disease-Type Dementia Attributable To Pathology-Confirmed Vascular Disease, Hiroko H. Dodge, Jian Zhu, Randy Woltjer, Peter T. Nelson, David A. Bennett, Nigel J. Cairns, David W. Fardo, Jeffrey A. Kaye, Deniz-Erten Lyons, Nora Mattek, Julie A. Schneider, Lisa C. Silbert, Chengjie Xiong, Lei Yu, Frederick A. Schmitt, Richard J. Kryscio, Erin L. Abner, Smart Data Consortium

Sanders-Brown Center on Aging Faculty Publications

INTRODUCTION: The presence of cerebrovascular pathology may increase the risk of clinical diagnosis of Alzheimer's disease (AD).

METHODS: We examined excess risk of incident clinical diagnosis of AD (probable and possible AD) posed by the presence of lacunes and large infarcts beyond AD pathology using data from the Statistical Modeling of Aging and Risk of Transition study, a consortium of longitudinal cohort studies with more than 2000 autopsies. We created six mutually exclusive pathology patterns combining three levels of AD pathology (low, moderate, or high AD pathology) and two levels of vascular pathology (without lacunes and large infarcts or with …

Clinical Application Of Ceramics In Anterior Cervical Discectomy And Fusion: A Review And Update, Shayan A. Zadegan, Aidin Abedi, Seyed B. Jazayeri, Hirbod Bonaki, Alex R. Vaccaro, Vafa Rahimi-Movaghar

Rothman Institute Papers

Study Design: Narrative review. Objectives: Anterior cervical discectomy and fusion (ACDF) is a reliable procedure, commonly used for cervical degenerative disc disease. For interbody fusions, autograft was the gold standard for decades; however, limited availability and donor site morbidities have led to a constant search for new materials. Clinically, it has been shown that calcium phosphate ceramics, including hydroxyapatite (HA) and tricalcium phosphate (TCP), are effective as osteoconductive materials and bone grafts. In this review, we present the current findings regarding the use of ceramics in ACDF. Methods: A review of the relevant literature examining the clinical use of ceramics …

Faculty Perceptions Of Readiness To Implement Interprofessional Education In Athletic Training, Meredith M. Parry

Student Dissertations

As the athletic training profession takes steps towards the next level as an allied health care profession, advocates for the profession are positioning athletic trainers as key players in the interprofessional health care team. Recently, the CAATE has pronounced a move for athletic training education to transition all entry-level education to professional master’s degree programs. CAATE is also requesting that athletic training education programs find means to align with other healthcare profession education programs within their institution and actively engage in planned and continuous interprofessional learning activities. This study explored the gap in knowledge regarding athletic training faculty perceptions on …

Lisinopril Or Coreg Cr In Reducing Cardiotoxicity In Women With Breast Cancer Receiving Trastuzumab: A Rationale And Design Of A Randomized Clinical Trial, Maya Guglin, Pamela Munster, Angelina Fink, Jeffrey Krischer

Internal Medicine Faculty Publications

Background—Trastuzumab (TZB) is an established therapy for HER2 positive breast cancer. The use of TZB is commonly associated with cardiotoxicity manifesting as asymptomatic decrease in left ventricular ejection fraction (LVEF) or overt heart failure. Several studies demonstrated favorable effects of angiotensin converting enzyme (ACE) inhibitors and beta blockers (BB) in the prevention of chemotherapy-induced cardiotoxicity. We hypothesize that patients, randomized to receive an ACE inhibitor or a beta-blocker during trastuzumab therapy for breast cancer, will maintain a higher LVEF than patients randomized to placebo.

Methods and Results—We designed a prospective, multicenter, randomized, phase II placebo-controlled clinical trial to …

Effects Of Kdt501 On Metabolic Parameters In Insulin-Resistant Prediabetic Humans, Philip A. Kern, Brian S. Finlin, Dorothy Ross, Tania Boyechko, Beibei Zhu, Neile Grayson, Robert Sims, Jeffrey S. Bland

Internal Medicine Faculty Publications

Context: KDT501 is an isohumulone drug that has demonstrated beneficial effects on metabolic parameters in mice.

Objective: This study was intended to examine potential improvements in metabolism in humans.

Design and Setting: Changes in carbohydrate and lipid metabolism, along with inflammatory markers, were evaluated in prediabetic humans in a clinical research center.

Participants: Nine obese patients participated. All had prediabetes or normal glucose tolerance plus three features of metabolic syndrome.

Intervention: All participants were treated with escalating doses of KDT501 to a maximum dose of 1000 mg every 12 hours for a total of 28 days.

Outcome Measures: Changes in …

Bioactivity Of Oral Linaclotide In Human Colorectum For Cancer Chemoprevention., David S. Weinberg, Jieru E. Lin, Nathan R. Foster, Gary Della'zanna, Asad Umar, Drew Seisler, Walter K. Kraft, David M. Kastenberg, Leo C. Katz, Paul J. Limburg, Scott A. Waldman

Department of Pharmacology and Experimental Therapeutics Faculty Papers

Guanylate cyclase C (GUCY2C) is a tumor-suppressing receptor silenced by loss of expression of its luminocrine hormones guanylin and uroguanylin early in colorectal carcinogenesis. This observation suggests oral replacement with a GUCY2C agonist may be an effective targeted chemoprevention agent. Linaclotide is an FDA-approved oral GUCY2C agonist formulated for gastric release, inducing fluid secretion into the small bowel to treat chronic idiopathic constipation. The ability of oral linaclotide to induce a pharmacodynamic response in epithelial cells of the colorectum in humans remains undefined. Here, we demonstrate that administration of 0.87 mg of oral linaclotide daily for 7 days to healthy …

Clinicians’ Perspectives On Adopting A Lung Cancer Palliative Care Intervention, Shaunna Siler

Loma Linda University Electronic Theses, Dissertations & Projects

Despite the significant progress in implementing palliative care interventions for cancer patients, few intervention studies seek healthcare clinicians’ input prior to implementation. The purpose of this research was then to explore palliative care and oncology clinicians’ (e.g., physicians, nurses, social workers, and chaplains) perspectives on current challenges and useful practices in meeting the quality of life needs of lung cancer patients and family caregivers, and to increase the likelihood of the adoption of a palliative care intervention based on understanding current trends in palliative care delivery at three outpatient oncology sites. The conceptual framework used for this study was the …

Crispr Knockout Of The Hur Gene Causes A Xenograft Lethal Phenotype., Shruti Lal, Edwin C, Cheung, Mahsa Zarei, Ranjan Preet, Saswati N. Chand, Nicole C. Mambelli-Lisboa, Carmella Romeo, Matthew C. Stout, Eric Londin, Austin Goetz, Cinthya Y. Lowder, Avinoam Nevler, Charles Yeo, Paul M. Campbell, Jordan M. Winter, Dan A. Dixon, Jonathan Brody

Department of Surgery Faculty Papers

Pancreatic ductal adenocarcinoma (PDA) is the third leading cause of cancer-related deaths in the United States, whereas colorectal cancer is the third most common cancer. The RNA-binding protein HuR (ELAVL1) supports a pro-oncogenic network in gastrointestinal (GI) cancer cells through enhanced HuR expression. Using a publically available database, HuR expression levels were determined to be increased in primary PDA and colorectal cancer tumor cohorts as compared with normal pancreas and colon tissues, respectively. CRISPR/Cas9 technology was successfully used to delete the HuR gene in both PDA (MIA PaCa-2 and Hs 766T) and colorectal cancer (HCT116) cell lines. HuR deficiency has …

Human Cytomegalovirus: A Neglected Public Health Area Of Significant Relevance To Women, The Foetus And New Born. Time For Action!, Amna Rehana Siddiqui, Saira Ibrahim, Anwar Ali Siddiqui, Paul Moss, El-Nasir Lalani

Community Health Sciences

No abstract provided.

Multicomponent Intervention Versus Usual Care For Management Of Hypertension In Rural Bangladesh, Pakistan And Sri Lanka: Study Protocol For A Cluster Randomized Controlled Trial., Tazeen H. Jafar, Imtiaz Jehan, H. Asita De Silva, Aliya Naheed, Mihir Gandhi, Pryseley Assam, Eric A. Finkelstein, Helena Legido Quigley, Marcel Bilger, Aamir Hameed, John David Clemens, Shah Ebrahim, Elizabeth L. Turner, Anuradhani Kasturiratne

Community Health Sciences

BACKGROUND:

High blood pressure (BP) is the leading attributable risk for cardiovascular disease (CVD). In rural South Asia, hypertension continues to be a significant public health issue with sub-optimal BP control rates. The goal of the trial is to compare a multicomponent intervention (MCI) to usual care to evaluate the effectiveness and cost-effectiveness of the MCI for lowering BP among adults with hypertension in rural communities in Bangladesh, Pakistan and Sri Lanka.

METHODS/DESIGN:

This study is a stratified, cluster randomized controlled trial with a qualitative component for evaluation of processes and stakeholder feedback. The MCI has five components: (1) home …

Hypertensive Supratentorial Intracerebral Hemorrhage: Early Surgery And Functional Outcome; A Tertiary Care Hospital Experience From Karachi, Pakistan., Muhammad Imran, Atiq Ahmed Khan, Syed Ijlal Ahmed, Shiraz Ahmed Ghouri, Muhammad Osama Farooqi, Alizay Rashid Khan, Majid Chandio

Pakistan Journal of Neurological Sciences (PJNS)

BACKGROUND: Spontaneous supratentorialintracerebral hemorrhage (ICH) has a high morbidity and mortality and places a significant burden on health and social services.The role and timing of operative neurosurgical intervention remain controversial and the practice and timing of surgery continue to be haphazard. METHODOLOGY: Our study was a descriptive study conducted at Civil hospital Karachi, Pakistan. Sample size was calculated. The sampling technique of our study was non probability. The data was collected and analyzed using spssvs 17. Data was observed for any descriptive and inferential statistics. RESULTS: There were 38 males (63.3%) and 22 females (36.7%). The mean age of patients …

Respiratory Distress In Patients Of Guillain-Barre Syndrome With Sensory Manifestations, Maher Bano Malik, Haris Majid Rajput, Jahangir Shoro

Pakistan Journal of Neurological Sciences (PJNS)

Guillain-Barré syndrome (GBS) is one of the most frequent disorder of peripheral nervous system associated with respiratory distress. One clinical parameter that was found significant in heralding the onset of respiratory failure in GBS weresensory manifestations. The aim of the study was to determine the frequency of respiratory distress in patients of GuillainBarresyndrome with or without sensory manifestations in the disease. MATERIALS AND METHODS: This was a descriptive case seriesthat was conducted from January 19, 2013 to July 18, 2013 in Department of Neurology, Pakistan Institute of Medical Sciences, Islamabad. All patients who met the inclusion criteria were selected for …

Advancing Gaming Technology In Neurological Rehabilitation, Samreen Sadiq, Iqra Khan

Pakistan Journal of Neurological Sciences (PJNS)

The consumption of gaming technology has recently gain unexpected significance in medical health care for neurological rehabilitation. With increasing interest in exergames study, numerous definitions and terminology have been introduced to describe this term. Researchers from health-related background acknowledged the fact that engaging in video gaming was not always sedentary and might act as a means to ensure more physical work. Simplifying the terminology exergames are those types of gaming technology or multimedia communications that necessitate the player to perform physical activity during play.

Role Of Manual Activities Among Cerebral Palsy Children, Iqra Khan, Samreen Sadiq

Pakistan Journal of Neurological Sciences (PJNS)

Objective: Determine the role of manual activities in children presenting with spastic type of Cerebral Palsy. Methods: AQuasi experimental study was conducted in Children Hospital and Compass. A sample of 30 children with cerebral palsy aged between 6 to 12 years was studied and assessment was made before and after the implementation of treatment through ABILHAND kids Questionnaire. The duration of this study was 6 months from December 2014 to May 2015. The recruiting strategy used was convenience sampling. Intervention was given for a period of 90 hours for 9 weeks. Qualitative variables were expressed as proportions (percentages). Before and …

Histiocyt Ic Sarcoma Of The Flax Cerebri With Distant Metastasis, Ateeque Ahmed Khan, Mahnoor Hafeez

Pakistan Journal of Neurological Sciences (PJNS)

Histiocytic Sarcoma is an extremely rare CNS tumor and to the best of authors' knowledge, the extra-axial CNS histiocytic Sarcoma involving FalxCerebriin the humans has not been described earlier in the literature.We report an unusual case of22 year old male who presented to the Civil Hospital with symptoms of chronic headache and bilateral lower limb weakness. His MRI Brain showed an aggressive heterogeneously enhancing extraaxialfalxtumor with trans-calvarial invasion seen on interim CT scan and demonstration of distant metastases after resection and craniectomy. The immune-histochemical analysis was strongly positive CD68 and S-100 signifying Histiocytic Sarcoma.

Fat Embolism Syndrome, In A Patient With Bilateral Total Knee Replacement, Syeda Saba Zaidi, Noman Ishaque

Pakistan Journal of Neurological Sciences (PJNS)

Fat embolism syndrome is caused by the release of fat globules into the systemic circulation. The presentation varies from mild respiratory distress to a devastating clinical scenario that includes hypoxemia, petechial hemorrhages of the skin, and confusion that may lead to coma or death.It is prevalent in 1-5% of patients after trauma to the pelvis, long bones and rarely described in elective total knee replacement.

Discover The Ibn-E-Sina Within You' Annual Neurology Research Day, May 2017 Shifa International Hospital, Islamabad, Faaraea Haroon

Pakistan Journal of Neurological Sciences (PJNS)

Headaches are the most prevalent neurological disorders and the most frequent symptom seen in general practice. The need to know further of such disorders in medical students is essential to ensure a healthier studying environment, which will ultimately yield better, more capable, health care professionals.

Neurosarcoidosis Presenting As Psychiatric Symptoms: A Diagnostic Challenge, Farheen Niazi, Tariq Hussain

Pakistan Journal of Neurological Sciences (PJNS)

Among patients having neurosarcoidosis, psychiatric manifestations can be seen in 20% of the patients.Sarcoidosis is extremely rare in Asia, being almost unknown in some countries like China and Southeast Asia.Neurosarcoidosis occurs in approximately 5% of patients with sarcoidosis. Neurosarcoidosis presenting as psychiatric manifestations has rarely been reported. We report a case of a young male who presented with psychiatric symptoms,was diagnosed with neurosarcoidosisand responded well to oral steroids.His symptoms were diffuseheadaches, and feelings of movement of fluid on top of headand certain other vague somatic complaints like body aches, vertigo etc. Such patients are difficult to diagnose as sarcoidosis is …

Role Of Early Contrast Enhanced Ct Scan In Severity Prediction Of Acute Pancreatitis, Noman Shahzad, Muhammad Rizwan Khan, K. M. Inam Pal, Dawar Khan, Muhammad Shahrukh Effendi

Department of Surgery Docs

Abstract

Severe pancreatitis occurs in approximately 15-25% of patients with acute pancreatitis. The objective of our study was to compare the CTSeverity Index (CTSI) with a clinical score (BISAP score) to predict severity of acute pancreatitis. Forty-eight consecutive patients with acutepancreatitis who underwent contrast enhanced CT scan within 72 hours of presentation were included. Results of our study showed that both CTSI and BISAP score were reliable predictors of mortality (p value = 0.019 and <0.001 respectively) and need for mechanical ventilation (p value = .002 and .006 respectively). Positive predictive value of CTSI to predict recovery without intervention was 91.4% as compared to 78% for that of BISAP score. Receiver Operating Characteristics (ROC) Curves showed CT scan was superior to BISAP Score in predicting need of percutaneous or surgical intervention. Early CT scan may be utilized for prediction of clinical course of patients with acute pancreatitis.

Findings Of Cognitive Impairment At High Altitude: Relationships To Acetazolamide Use And Acute Mountain Sickness., Lara Phillips, Buddha Basnyat, Yuchiao Chang, Erik R. Swenson, N. Stuart Harris

Department of Emergency Medicine Faculty Papers

Phillips, Lara, Buddha Basnyat, Yuchiao Chang, Erik R. Swenson, and N. Stuart Harris. Findings of cognitive impairment at high altitude: relationships to acetazolamide use and acute mountain sickness. High Alt Med Biol. 18:121-127, 2017.

OBJECTIVE: Acute mountain sickness (AMS) is defined by patient-reported symptoms using the Lake Louise Score (LLS), which provides limited insight into any possible underlying central nervous system (CNS) dysfunction. Some evidence suggests AMS might coexist with altered neural functioning. Cognitive impairment (CI) may go undetected unless a sensitive test is applied. Our hypothesis was that a standardized test for mild CI would provide an objective measure …

The Exerrt Trial: "Exercise To Regadenoson In Recovery Trial": A Phase 3b, Open-Label, Parallel Group, Randomized, Multicenter Study To Assess Regadenoson Administration Following An Inadequate Exercise Stress Test As Compared To Regadenoson Without Exercise For Myocardial Perfusion Imaging Using A Spect Protocol, G Thomas, S Cullom, T Kitt, K Feaheny, K Ananthasubramaniam, R Gropler, Diwakar Jain, R Thompson

NYMC Faculty Publications

BACKGROUND: This study assessed the non-inferiority and safety of regadenoson administration during recovery from inadequate exercise compared with administration without exercise. METHODS: Patients unable to achieve adequate exercise stress were randomized to regadenoson 0.4 mg either during recovery (Ex-Reg) or 1 hour after inadequate exercise (Regadenoson) (MPI1). All patients also underwent non-exercise regadenoson MPI 1-14 days later (MPI2). The number of segments with reversible perfusion defects (RPDs) detected using single photon emission computerized tomography imaging was categorized. The primary analysis evaluated the majority agreement rate between Ex-Reg and Regadenoson groups. RESULTS: 1,147 patients were randomized. The lower bound of the …

Outcomes Of Spatially Fractionated Radiotherapy (Grid) For Bulky Soft Tissue Sarcomas In A Large Animal Model, Michael W. Nolan, Tracy L. Gieger, Alexander A. Karakashian, Mariana N. Nikolova‑Karakashian, Lysa P. Posner, Donald M. Roback, Judith N. Rivera, Sha Chang

Physiology Faculty Publications

GRID directs alternating regions of high- and low-dose radiation at tumors. A large animal model mimicking the geometries of human treatments is needed to complement existing rodent systems (eg, microbeam) and clarify the physical and biological attributes of GRID. A pilot study was undertaken in pet dogs with spontaneous soft tissue sarcomas to characterize responses to GRID. Subjects were treated with either 20 Gy (3 dogs) or 25 Gy (3 dogs), delivered using 6 MV X-rays and a commercial GRID collimator. Acute toxicity and tumor responses were assessed 2, 4, and 6 weeks later. Acute Radiation Therapy Oncology Group grade …

Serious Fungal Infections In Pakistan, Kauser Jabeen, Joveria Farooqi, Sajjad Mirza, D Denning, Afia Zafar

Department of Pathology and Laboratory Medicine

The true burden of fungal infection in Pakistan is unknown. High-risk populations for fungal infections [tuberculosis (TB), diabetes, chronic respiratory diseases, asthma, cancer, transplant and human immunodeficiency virus (HIV) infection] are numerous. Here, we estimate the burden of fungal infections to highlight their public health significance. Whole and at-risk population estimates were obtained from the WHO (TB), BREATHE study (COPD), UNAIDS (HIV), GLOBOCAN (cancer) and Heartfile (diabetes). Published data from Pakistan reporting fungal infections rates in general and specific populations were reviewed and used when applicable. Estimates were made for the whole population or specific populations at risk, as previously …

Diverse Expression Patterns And Tumorigenic Role Of Neurotensin Signaling Components In Colorectal Cancer Cells, Ji Tae Kim, Heidi L. Weiss, B. Mark Evers

Markey Cancer Center Faculty Publications

Colorectal cancer (CRC), which is one of the most common malignancies worldwide, results from an accumulation of genetic and epigenetic modifications including DNA methylation. Neurotensin (NTS), a hormone localized to the gut and central nervous system, mediates its physiological and pathological effects, including growth stimulation for a variety of cancers, through three distinct NTS receptors (NTSRs). Most NTS functions are mediated through the high-affinity receptor NTSR1, and expression of NTSR1 is increased in many cancers including CRC. In this study, we investigated the expression profiles and cellular functions of the NTSRs, especially NTSR1, in CRC cells. We showed that expression …

Expanding The Genotypic Spectrum Of Bathing Suit Ichthyosis., Nareh V. Marukian, Rong-Hua Hu, Brittany G. Craiglow, Leonard M. Milstone, Jing Zhou, Amy Theos, Hande Kaymakcalan, Deniz A. Akkaya, Jouni J. Uitto, Hassan Vahidnezhad, Leila Youssefian, Susan J. Bayliss, Amy S. Paller, Lynn M. Boyden, Keith A. Choate

Department of Dermatology and Cutaneous Biology Faculty Papers

Importance: Bathing suit ichthyosis (BSI) is a rare congenital disorder of keratinization characterized by restriction of scale to sites of relatively higher temperature such as the trunk, with cooler areas remaining unaffected. Fewer than 40 cases have been reported in the literature. Bathing suit ichthyosis is caused by recessive, temperature-sensitive mutations in the transglutaminase-1 gene (TGM1). Clear genotype-phenotype correlations have been difficult to establish because several of the same TGM1 mutations have been reported in BSI and other forms of congenital ichthyosis. We identify novel and recurrent mutations in 16 participants with BSI.

Objective: To expand the genotypic spectrum of …

Evaluation Of Chest Pain After Implantable Cardioverter-Defibrillator Placement, Amir Gahremanpour, Mohammad Saeed, Yochai Birnbaum

The Texas Heart Institute Journal

No abstract provided.

Primary Lung Carcinoid Metastatic To The Breast, Marianna Zagurovskaya, Karen Tran-Harding, Richard Gibbs

Radiology Faculty Publications

Lung carcinoid tumors account for approximately 2% of lung cancers, with 10% of the tumors represented by the atypical type. While atypical carcinoids are metastatic to intrathoracic lymph nodes in approximately half of the cases on the initial presentation, distant metastases are seen in only 20% of the patients and are found most frequently in bones, liver, adrenal glands, and brain. We present a case of an unusual metastatic disease to the breast in 51-year-old female who developed a new breast mass 2 years after left lower lobectomy due to atypical carcinoid tumor. Atypical pulmonary carcinoid metastases to the breast …

Molecular-Based Recursive Partitioning Analysis Model For Glioblastoma In The Temozolomide Era: A Correlative Analysis Based On Nrg Oncology Rtog 0525., Erica Hlavin Bell, Stephanie L Pugh, Joseph P. Mcelroy, Mark R. Gilbert, Minesh Mehta, Alexander C Klimowicz, Anthony Magliocco, Markus Bredel, Pierre Robe, Anca L. Grosu, Roger Stupp, Walter Curran, Aline P. Becker, Andrea L. Salavaggione, Jill S. Barnholtz-Sloan, Kenneth Aldape, Deborah T. Blumenthal, Paul D. Brown, Jon Glass, Luis Souhami, R. Jeffrey Lee, David Brachman, John Flickinger, Minhee Won, Arnab Chakravarti

Department of Neurosurgery Faculty Papers

Importance: There is a need for a more refined, molecularly based classification model for glioblastoma (GBM) in the temozolomide era.

Objective: To refine the existing clinically based recursive partitioning analysis (RPA) model by incorporating molecular variables.

Design, Setting, and Participants: NRG Oncology RTOG 0525 specimens (n = 452) were analyzed for protein biomarkers representing key pathways in GBM by a quantitative molecular microscopy-based approach with semiquantitative immunohistochemical validation. Prognostic significance of each protein was examined by single-marker and multimarker Cox regression analyses. To reclassify the prognostic risk groups, significant protein biomarkers on single-marker analysis were incorporated into an RPA model …