Medical Specialties Commons^™

Heavy Metals In Four Marine Fish And Shrimp Species From A Subtropical Coastal Area: Accumulation And Consumer Health Risk Assessment, Mohammad Belal Hossain, Nurer Zaman Bhuiyan, Abul Kasem, Md Kamal Hossain, Salma Sultana, As-Ad Ujjaman Nur, Jimmy Yu, Mohammed Fahad Albeshr, Takaomi Arai

Faculty, Staff and Student Publications

Trace-element or heavy-metal pollution has emerged as a serious concern in terms of both environmental and human health issues. This study measured six trace and toxic heavy metals (Pb, Cd, Cr, Ni, Cu, and Zn) in four marine fish and shrimp species to assess their accumulation levels and evaluate the risks to human health. The mean concentrations of the metals in fish and shrimp species (Labeo bata, Sillaginopsis panijus, Platycepalus fuscus, and Penaeus monodon) followed the decreasing order of Zn (40.8 ± 9.7 μg/g) > Cu (17.8 ± 7.1 μg/g) > Pb (6.2 ± 1.8 μg/g) > Ni (0.4 ± 0.3 μg/g) > Cd …

Notch Signaling Pathway: A Comprehensive Prognostic And Gene Expression Profile Analysis In Breast Cancer, Hassan Yousefi, Afshin Bahramy, Narges Zafari, Mahsa Rostamian Delavar, Khoa Nguyen, Atousa Haghi, Tahmineh Kandelouei, Cecilia Vittori, Parham Jazireian, Sajad Maleki, Danyal Imani, Amin Moshksar, Amirreza Bitaraf, Sadegh Babashah

School of Medicine Faculty Publications

Breast cancer is a complex disease exhibiting a great degree of heterogeneity due to different molecular subtypes. Notch signaling regulates the differentiation of breast epithelial cells during normal development and plays a crucial role in breast cancer progression through the abnormal expression of the Notch up-and down-stream effectors. To date, there are only a few patient-centered clinical studies using datasets characterizing the role of Notch signaling pathway regulators in breast cancer; thus, we investigate the role and functionality of these factors in different subtypes using publicly available databases containing records from large studies. High-throughput genomic data and clinical information extracted …

Prognostic Significance Of P16 And Its Relationship With Human Papillomavirus Status In Patients With Penile Squamous Cell Carcinoma: Results Of 5 Years Follow-Up, Jad Chahoud, Niki M Zacharias, Rachel Pham, Wei Qiao, Ming Guo, Xin Lu, Angelita Alaniz, Luis Segarra, Magaly Martinez-Ferrer, Frederico Omar Gleber-Netto, Curtis R Pickering, Priya Rao, Curtis A Pettaway

Faculty, Staff and Student Publications

Penile Squamous Cell Carcinoma (PSCC) is associated with high-risk human papillomavirus (HR-HPV). The immunohistochemical (IHC) test for p16INK4a (p16) is highly correlated with HR-HPV expression in other SCCs. To investigate whether the expression of p16 IHC or HR-HPV is associated with survival in PSCC, we conducted a single institution analysis of 143 patients with a diagnosis of PSCC and, available tissue were tested for p16 IHC staining patterns, histological subtype, tumor grade, and lymphovascular invasion (LVI) by an experienced pathologist. HR-HPV status using the Cobas PCR Assay or the RNAScope high-risk HPV in situ hybridization kit were also assessed. Patient …

Transient Receptor Potential Channels In Cardiovascular And Renal Diseases, Shuangtao Ma, Michael X Zhu

Faculty, Staff and Student Publications

Transient receptor potential (TRP) channels belong to a superfamily of integral membrane proteins with diverse functions in sensory perception and cellular physiology [...].

Can Non-Pharmacological Interventions Effectively Reduce Anxiety And Pain In Chronic Pediatric Patients?, Kiara Harvey

Symposium of Student Scholars

Abstract

Pediatric anxiety and pain have been historically poorly managed. The failure of providers to adequately address medically-induced anxiety and pain in pediatric patients has been shown to prevent them from proactively seeking medical care in the future and has been linked with both altered brain development and increased risk of opioid abuse. Furthermore, poorly managed pain leads to sustained levels of cortisol and exposes patients to several long-term health risks like hypertension. Because non-pharmacological interventions are often preferred by providers, patients, and their caregivers, this research question poses an exploration of the efficacy of non-traditional methods in alleviating procedure-related …

Protocols For Postpartum Hemorrhage, Jackleen Chambers

Symposium of Student Scholars

The occurrence of postpartum hemorrhages (PH) within the healthcare system are on the rise. The detrimental effects that can occur are extremely serious and require an intervention of education and proper training. Labor and delivery units experience traumatic PHs due to lack of proper training regarding early warning signs and correct technical interventions needed for a quick turnaround. This project will use research from scholarly articles to take a closer look at statistical evidence based on the outcomes of being prepared versus underprepared. The project will discuss various methods on how to better prepare nurses to care for hemorrhagic situations. …

Postpartum Depression For Mothers With Early Fetal Death Or Stillbirths, Callie Goldman

Symposium of Student Scholars

Background: Many times, prevention of early fetus death and stillbirths is possible; however, some mortality events are spontaneous or unavoidable. While existing research reveals the likelihood of postpartum depression for mothers following birth, few studies address the potential for postpartum depression of mothers of stillbirth or demised fetuses. The purpose of this study is to determine how mothers can be better prepared for the hardship of losing a baby during childbirth, while going through common difficulties, such as postpartum depression, following birth. Methods: A mixed method approach will be conducted to gather qualitative (interview) and quantitative (Edinburgh Postnatal Depression Scale …

Reducing The Risk Of Chemotherapy Exposure, Miranda Susman

Symposium of Student Scholars

Concerns about antineoplastic drugs (ANPDs), also known as chemotherapy, began in the early 1970s by the National Institute for Occupational Safety and Health. Although ANPDs are used as a standard treatment for cancer, these drugs are considered hazardous due to their adverse health effects. About eight million healthcare workers are exposed to ANPDs and therefore essential that we continue to educate on ways to reduce the risk of exposure to occupational and home health hazards. The overall purpose of this study is to determine if additional education and use of surface wipe samplings reduce the risk of exposure. A literature …

Alternative Precautionary Measures Yielding Lower C. Diff Infection Rates In Healthcare Facilities, Matthew Kramer

Symposium of Student Scholars

Background: An international healthcare concern is the persistent spread of Clostridium difficile, a Gram-positive spore forming bacterium that is responsible for the most common hospital-acquired infection, amongst patients.

Objective: A systematic review was performed to summarize evidence that the interventions utilized in healthcare facilities which indicate a patient’s precautionary status are insufficient, outdated, and commonly lead to infection in neighboring patient rooms. Databases such as PubMed, NCBI, Google Scholar, and APHA’s Medical Care were searched, covering the period from 2017-2022. Studies were included if their focus concentrated on C. diff and the precautionary measures taken by employees at healthcare …

Effectiveness Of Distraction Techniques In Reducing Pain And Anxiety During Pediatric Venipuncture, Gina Hernandez

Symposium of Student Scholars

Abstract

Venipuncture is consistently identified as one of the most painful and feared experiences of hospitalized children, often resulting in traumatic memories and resistance to future procedures. Currently, standard practice for pediatric venipuncture involves physical restraint, either by another person or by utilizing a restrictive tool. This proposal will explore the efficacy of various distraction techniques in mitigating pain and anxiety experienced by pediatric patients undergoing venipuncture. Current research shows that procedural pain and anxiety can be significantly reduced by implementing distraction techniques such as bubble-blowing, deep breathing, audiovisual distraction, and immersive virtual reality. Effectiveness of each technique varies based …

Partial Outpatient Oral Antibiotic Treatment Of Infective Endocarditis Is Non-Inferior To Inpatient Intravenous Antibiotic Therapy, Nicholas J. Murphy

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Iversen K, Ihlemann N, Gill SU, et al. Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis. N Engl J Med. 2019; 380:415-424. https://doi.org/10.1056/NEJMoa1808312

for a patient with infective endocarditis and intravenous drug use with desire to leave the hospital.

Pregabalin May Reduce Neuropathic Pain In Burn Victims, Caroline Nikolaidis

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Gray P, Kirby J, Smith MT, et al. Pregabalin in severe burn injury pain: a double-blind, randomized placebo-controlled trial. Pain. 2011;152(6):1279-1288. https://doi.org/10.1016/j.pain.2011.01.055

for a patient with burn injury pain.

Indwelling Pleural Catheterization Maximizes Functionality And Quality Of Life In Management Of Recurrent Malignant Pleural Effusions, Avinash Ramkissoon

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Davies HE, Mishra EK, Kahan BC, et al. Effect of an indwelling pleural catheter vs chest tube and talc pleurodesis for relieving dyspnea in patients with malignant pleural effusion: The TIME2 randomized controlled trial. J Am Med Assoc. 2012;307(22):2383-2389. https://doi.org/10.1001/jama.2012.5535

for the management of recurrent malignant pleural effusions in a patient with metastatic renal cell carcinoma.

Exploring Alternative Treatment Options For A Patient With Heavy Menstrual Bleeding And Mistrust Of The Healthcare System, Rachel A. O'Dell

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Tinelli A, Gustapane S, D’Oria O, Licchelli M, Panese G. Nutraceuticals in fibroid management after ulipristal acetate administration: An observational study on patients’ compliance. International Journal of Gynecology and Obstetrics; 2022;156(1):133-138. https://doi.org/10.1002/ijgo.13692

for a patient with chronic, symptomatic anemia with menorrhagia and uterine fibroid.

Prevalence And Effect Of Cannabis Use In Acute Pancreatitis Of Unknown Etiology, Hanna Tran

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Simons-Linares CR, Barkin JA, Wang Y, et al. Is There an Effect of Cannabis Consumption on Acute Pancreatitis?. Dig Dis Sci. 2018;63(10):2786-2791. https://doi.org/10.1007/s10620-018-5169-2

for a patient with cannabis-associated acute pancreatitis.

The Importance Of Stigma Theory For Clinical Decisions Related To Diabetic Foot Amputations, Rachael Garcia, Callie Bartkowiak, Alison Nesbitt Do

Clinical Research in Practice: The Journal of Team Hippocrates

The authors examine the unconsidered impact of social stigma theory on the shared clinical decision-making process for a patient with foot osteomyelitis and MRSA bacteremia facing the prospect of an amputation.

Unfavorable Social Determinants Of Health Are Associated With Higher Burden Of Financial Toxicity Among Patients With Atherosclerotic Cardiovascular Disease In The Us: Findings From The National Health Interview Survey, Javier Valero-Elizondo, Zulqarnain Javed, Rohan Khera, Mauricio E. Tano, Ramzi Dudum, Isaac Acquah, Adnan A. Hyder, Julia Andrieni, Garima Sharma, Salim S. Virani

Office of the Provost

Background: Atherosclerotic cardiovascular disease (ASCVD) is a major cause of financial toxicity, defined as excess financial strain from healthcare, in the US. Identifying factors that put patients at greatest risk can help inform more targeted and cost-effective interventions. Specific social determinants of health (SDOH) such as income are associated with a higher risk of experiencing financial toxicity from healthcare, however, the associations between more comprehensive measures of cumulative social disadvantage and financial toxicity from healthcare are poorly understood.
Methods: Using the National Health Interview Survey (2013-17), we assessed patients with self-reported ASCVD. We identified 34 discrete SDOH items, across 6 …

Glucocentric Drugs In Cardiovascular Disease Protection And Heart Failure, Khawaja M. Talha, Gregg C. Fonarow, Salim S. Virani, Javed Butler

Office of the Provost

Evidence for cardiovascular outcomes with older-generation antihyperglycemic drugs in the management of type 2 diabetes is based on aggregated data from prior randomized controlled trials and observational studies that were not focused on prespecified cardiovascular end points. Newer antihyperglycemic medications have undergone a rigorous evaluation of cardiovascular outcomes through randomized controlled trials since the US Food and Drug Administration imposed a mandatory requirement for all glucose-lowering drugs in 2008. The three classes of drugs that have been most extensively studied are dipeptidyl peptidase 4 inhibitors, glucagon-like peptide 1 receptor agonists, and sodium-glucose cotransporter-2 (SGLT2) inhibitors, the latter two reporting significant …

Detection Of Progression Or Regression Of Breast Cancer By Circulating Tumor Dna (Ctdna), Ujjwal Karki, Bipin Ghimire, Emma Herrman, Siddhartha Yadav, Mohammad Muhsin Chisti

Conference Presentation Abstracts

Circulating tumor DNA (ctDNA) are short DNA sequences shed by tumor cells into the systemic circulation. Studies have shown potential utility of the test to predict relapse or recurrence following treatment in solid tumors, but sensitivity and specificity have varied widely, ranging from 19-100% and 80-100% respectively, in breast cancer specifically. Moreover, literature describing the utility of monitoring dynamic changes in ctDNA trends is limited. We aim to evaluate the correlation between ctDNA test, both single test as well as dynamic trends in value over time, with imaging findings.

Isolation And Characterization Of Chi-Like Salmonella Bacteriophages Infecting Two Salmonella Enterica Serovars, Typhimurium And Enteritidis, Addisu D. Teklemariam, Mona G. Alharbi, Rashad R. Al-Hindi, Ibrahim Alotibi, Abdullah A. Aljaddawi, Sheren A. Azhari, Ahmed Esmael

Nebraska Center for Virology: Faculty Publications

Salmonella enterica Serovar Typhimurium and Salmonella enterica Serovar Enteritidis are well-known pathogens that cause foodborne diseases in humans. The emergence of antibiotic-resistant Salmonella serovars has caused serious public health problems worldwide. In this study, two lysogenic phages, STP11 and SEP13, were isolated from a wastewater treatment plant in Jeddah, KSA. Transmission electron microscopic images revealed that both phages are new members of the genus “Chivirus” within the family Siphoviridae. Both STP11 and SEP13 had a lysis time of 90 min with burst sizes of 176 and 170 PFU/cell, respectively. The two phages were thermostable (0 ^◦C …

The Rheumatoid Arthritis Drug Auranofin Lowers Leptin Levels And Exerts Antidiabetic Effects In Obese Mice, Aaron R Cox, Peter M Masschelin, Pradip K Saha, Jessica B Felix, Robert Sharp, Zeqin Lian, Yan Xia, Natasha Chernis, David A Bader, Kang Ho Kim, Xin Li, Jun Yoshino, Xin Li, Gang Li, Zheng Sun, Huaizhu Wu, Cristian Coarfa, David D Moore, Samuel Klein, Kai Sun, Sean M Hartig

Faculty, Staff and Student Publications

Low-grade, sustained inflammation in white adipose tissue (WAT) characterizes obesity and coincides with type 2 diabetes mellitus (T2DM). However, pharmacological targeting of inflammation lacks durable therapeutic effects in insulin-resistant conditions. Through a computational screen, we discovered that the FDA-approved rheumatoid arthritis drug auranofin improved insulin sensitivity and normalized obesity-associated abnormalities, including hepatic steatosis and hyperinsulinemia in mouse models of T2DM. We also discovered that auranofin accumulation in WAT depleted inflammatory responses to a high-fat diet without altering body composition in obese wild-type mice. Surprisingly, elevated leptin levels and blunted beta-adrenergic receptor activity achieved by leptin receptor deletion abolished the antidiabetic …

Mechanisms Of Irf2bpl-Related Disorders And Identification Of A Potential Therapeutic Strategy, Shrestha Sinha Ray, Debdeep Dutta, Cassandra Dennys, Samantha Powers, Florence Roussel, Pawel Lisowski, Petar Glažar, Xiaojin Zhang, Pipasha Biswas, Joseph R Caporale, Nikolaus Rajewsky, Marc Bickle, Nicolas Wein, Hugo J Bellen, Shibi Likhite, Paul C Marcogliese, Kathrin C Meyer

Faculty, Staff and Students Publications

The recently discovered neurological disorder NEDAMSS is caused by heterozygous truncations in the transcriptional regulator IRF2BPL. Here, we reprogram patient skin fibroblasts to astrocytes and neurons to study mechanisms of this newly described disease. While full-length IRF2BPL primarily localizes to the nucleus, truncated patient variants sequester the wild-type protein to the cytoplasm and cause aggregation. Moreover, patient astrocytes fail to support neuronal survival in coculture and exhibit aberrant mitochondria and respiratory dysfunction. Treatment with the small molecule copper ATSM (CuATSM) rescues neuronal survival and restores mitochondrial function. Importantly, the in vitro findings are recapitulated in vivo, where co-expression of full-length …

Tele-Medicine Based And Self-Administered Interactive Exercise Program (Tele-Exergame) To Improve Cognition In Older Adults With Mild Cognitive Impairment Or Dementia: A Feasibility, Acceptability, And Proof-Of-Concept Study, Catherine Park, Ram Kinker Mishra, Michele K York, Ana Enriquez, Abigail Lindsay, Gregory Barchard, Ashkan Vaziri, Bijan Najafi

Center on Aging Staff Publications

Improved life expectancy is increasing the number of older adults who suffer from motor-cognitive decline. Unfortunately, conventional balance exercise programs are not tailored to patients with cognitive impairments, and exercise adherence is often poor due to unsupervised settings. This study describes the acceptability and feasibility of a sensor-based in-home interactive exercise system, called tele-Exergame, used by older adults with mild cognitive impairment (MCI) or dementia. Our tele-Exergame is specifically designed to improve balance and cognition during distractive conditioning while a telemedicine interface remotely supervises the exercise, and its exercises are gamified balance tasks with explicit augmented visual feedback. Fourteen adults …

The Integrative Conjugative Element Icespym92 Contributes To Pathogenicity Of Emergent Antimicrobial-Resistant Emm92 Group A Streptococcus, Ji-Sun Lee, Michael W Lero, Jose Mercado-Matos, Sha Zhu, Minjeong Jo, Claire E Tocheny, Jennifer S Morgan, Leslie M Shaw

Faculty, Staff and Student Publications

Despite the strong association of the insulin/insulin-like growth factor (IGF) signaling (IIS) pathway with tumor initiation, recurrence, and metastasis, the mechanism by which this pathway regulates cancer progression is not well understood. Here, we report that IIS supports breast cancer stem cell (CSC) self-renewal in an IRS2-phosphatidylinositol 3-kinase (PI3K)-dependent manner that involves the activation and stabilization of MYC. IRS2-PI3K signaling enhances MYC expression through the inhibition of GSK3β activity and suppression of MYC phosphorylation on threonine 58, thus reducing proteasome-mediated degradation of MYC and sustaining active pS62-MYC function. A stable T58A-Myc mutant rescues CSC function in Irs2−/− cells, supporting …

Unfavorable Social Determinants Of Health Are Associated With Higher Burden Of Financial Toxicity Among Patients With Atherosclerotic Cardiovascular Disease In The Us: Findings From The National Health Interview Survey, Javier Valero-Elizondo, Zulqarnain Javed, Rohan Khera, Mauricio E Tano, Ramzi Dudum, Isaac Acquah, Adnan A Hyder, Julia Andrieni, Garima Sharma, Michael J Blaha, Salim S Virani, Ron Blankstein, Miguel Cainzos-Achirica, Khurram Nasir

Faculty, Staff and Students Publications

• D: PMC9727868

Expression Of P-Stat3 And C-Myc Correlates With P2-Hnf4Α Expression In Nonalcoholic Fatty Liver Disease (Nafld), Mamoun Younes, Lin Zhang, Baharan Fekry, Kristin Eckel-Mahan

Faculty, Staff and Student Publications

We studied the expression of two hepatocyte nuclear factor 4 alpha (HNF4α) isoforms, p-STAT3. and c-Myc in 49 consecutive liver biopsies with nonalcoholic fatty liver disease (NAFLD) using immunohistochemistry. All 49 biopsies (100%) were positive for nuclear expression of P1-HNF4α. Twenty-eight (57%) cases were positive for P2-HNF4α, 6 (12%) were positive for p-STAT3 and 5 (10%) were positive for c-Myc. All 6 (100%) p-STAT3-positive cases were also positive for P2-HNF4α (p = 0.03). p-STAT3-positive cases were more likely to be positive for c-Myc (67% vs. 2%, p = 0.0003). Four cases were positive for P2-HNF4α, p-STAT3 and c-Myc. p-STAT3 …

Procedural Outcomes After Percutaneous Coronary Interventions In Focal And Diffuse Coronary Artery Disease, Takuya Mizukami, Jeroen Sonck, Koshiro Sakai, Brian Ko, Michael Maeng, Hiromasa Otake, Bon-Kwon Koo, Sakura Nagumo, Bjarne L Nørgaard, Jonathon Leipsic, Toshiro Shinke, Daniel Munhoz, Niya Mileva, Marta Belmonte, Hirofumi Ohashi, Emanuele Barbato, Nils P Johnson, Bernard De Bruyne, Carlos Collet

Faculty, Staff and Student Publications

Background

Coronary artery disease (CAD) patterns play an essential role in the decision‐making process about revascularization. The pullback pressure gradient (PPG) quantifies CAD patterns as either focal or diffuse based on fractional flow reserve (FFR) pullbacks. The objective of this study was to evaluate the impact of CAD patterns on acute percutaneous coronary intervention (PCI) results considered surrogates of clinical outcomes.

Methods and Results

This was a prospective, multicenter study of patients with hemodynamically significant CAD undergoing PCI. Motorized FFR pullbacks and optical coherence tomography (OCT) were performed before and after PCI. Post‐PCI FFR >0.90 was considered an optimal result. …

Popdc1 Scaffolds A Complex Of Adenylyl Cyclase 9 And The Potassium Channel Trek-1 In Heart, Tanya A Baldwin, Yong Li, Autumn N Marsden, Susanne Rinné, Anibal Garza-Carbajal, Roland F R Schindler, Musi Zhang, Mia A Garcia, Venugopal Reddy Venna, Niels Decher, Thomas Brand, Carmen W Dessauer

Faculty, Staff and Student Publications

The establishment of macromolecular complexes by scaffolding proteins is key to the local production of cAMP by anchored adenylyl cyclase (AC) and the subsequent cAMP signaling necessary for cardiac functions. We identify a novel AC scaffold, the Popeye domain-containing (POPDC) protein. The POPDC family of proteins is important for cardiac pacemaking and conduction, due in part to their cAMP-dependent binding and regulation of TREK-1 potassium channels. We show that TREK-1 binds the AC9:POPDC1 complex and copurifies in a POPDC1-dependent manner with AC9 activity in heart. Although the AC9:POPDC1 interaction is cAMP-independent, TREK-1 association with AC9 and POPDC1 is reduced upon …

A Unified Model Of Age-Related Cardiovascular Disease, Michael Fossel, Joe Bean, Nina Khera, Mikhail G Kolonin

Faculty, Staff and Student Publications

Despite progress in biomedical technologies, cardiovascular disease remains the main cause of mortality. This is at least in part because current clinical interventions do not adequately take into account aging as a driver and are hence aimed at suboptimal targets. To achieve progress, consideration needs to be given to the role of cell aging in disease pathogenesis. We propose a model unifying the fundamental processes underlying most age-associated cardiovascular pathologies. According to this model, cell aging, leading to cell senescence, is responsible for tissue changes leading to age-related cardiovascular disease. This process, occurring due to telomerase inactivation and telomere attrition, …

Plasma Growth Hormone Is A Potential Biomarker Of Response To Atezolizumab And Bevacizumab In Advanced Hepatocellular Carcinoma Patients, Yehia I Mohamed, Dan G Duda, Muhammad O Awiwi, Sunyoung S Lee, Lina Altameemi, Lianchun Xiao, Jeffrey S Morris, Robert A Wolff, Khaled M Elsayes, Rikita I Hatia, Aliya Qayyum, Shadi M Chamseddine, Asif Rashid, James C Yao, Armeen Mahvash, Manal M Hassan, Hesham M Amin, Ahmed Omar Kaseb

Faculty, Staff and Student Publications

INTRODUCTION: Hepatocellular carcinoma (HCC) has limited systemic therapy options when discovered at an advanced stage. Thus, there is a need for accessible and minimally invasive biomarkers of response to guide the selection of patients for treatment. This study investigated the biomarker value of plasma growth hormone (GH) level as a potential biomarker to predict outcome in unresectable HCC patients treated with current standard therapy, atezolizumab plus bevacizumab (Atezo/Bev).

MATERIALS AND METHODS: Study included unresectable HCC patients scheduled to receive Atezo/Bev. Patients were followed to determine progression-free survival (PFS) and overall survival (OS). Plasma GH levels were measured by ELISA and …