Research Spotlight

Posted November 15th 2016

Clinical Evaluation of Protective Garments with Respect to Garment Characteristics and Manufacturer Label Information.

Chet R. Rees M.D.

Chet R. Rees M.D.

Lichliter, A., V. Weir, R. E. Heithaus, S. Gipson, A. Syed, J. West and C. Rees (2016). “Clinical evaluation of protective garments with respect to garment characteristics and manufacturer label information.” J Vasc Interv Radiol: 2016 Oct [Epub ahead of print].

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PURPOSE: To test operator exposures inside radiation protection garments in a simulated clinical setup, examining trends related to multiple characteristics. MATERIALS AND METHODS: Sixteen garment models containing lead or nonlead materials and a suspended device (Zero-Gravity) were tested for operator exposure from X rays scattered from an acrylic patient phantom. Weight and surface area were determined. The operator phantom was a wooden frame containing a dosimeter in its cavity. Garments were draped over the frame, and the setup was placed in a typical working position. RESULTS: There was substantial variability in exposures for all garments, ranging from 0.52 to 13.8 microSv/h (mean, 5.39 microSv/h +/- 3.82), with a 12-fold difference for garments labeled 0.5 mm Pb equivalent. Most of the especially poor protectors were nonlead, even when not lightweight. Nonlead models were not more protective per weight overall. For closed-back garments labeled 0.5 mm Pb equivalent, mean exposures were lower for lead than for nonlead materials (mean, 1.48 microSv/h +/- 0.434 vs 6.26 microSv/h +/- 5.13, respectively). Density per exposure-1 was lower for lead than nonlead materials in the 0.5-mm Pb equivalent group, counter to advertised claims. Open-back configurations were lighter than closed (3.3 kg vs 6.0 kg, respectively), with similar mean exposures (5.30 microSv/h vs 5.39 microSv/h, respectively). The lowest exposure was 0.52 microSv/h (9.8% of the mean of all garments) for the suspended device. CONCLUSIONS: Operator exposure in a realistic interventional setup is highly variable for similarly labeled protective garments, highlighting the necessity of internal validation when considering nonlead and lightweight models.


Posted November 15th 2016

Personalized Treatment for a Patient With a BRAF V600E Mutation Using Dabrafenib and a Tumor Treatment Fields Device in a High-Grade Glioma Arising From Ganglioglioma.

George J. Snipes M.D.

George J. Snipes M.D.

Meletath, S. K., D. Pavlick, T. Brennan, R. Hamilton, J. Chmielecki, J. A. Elvin, N. Palma, J. S. Ross, V. A. Miller, P. J. Stephens, G. Snipes, V. Rajaram, S. M. Ali and I. Melguizo-Gavilanes (2016). “Personalized treatment for a patient with a braf v600e mutation using dabrafenib and a tumor treatment fields device in a high-grade glioma arising from ganglioglioma.” J Natl Compr Canc Netw 14(11): 1345-1350.

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BACKGROUND: Gangliogliomas are slow-growing, low-grade central nervous system tumors affecting children and young adults. However, some patients will experience tumor recurrence and/or malignant progression. This article reports on the clinical history, molecular findings, and treatment response in a patient with BRAF V600-mutated high-grade glioma arising from ganglioglioma. METHODS: Hematoxylin-eosin staining and comprehensive genomic profiling via Foundation One were performed on the tumor sample from a male patient undergoing treatment at the Department of Neuro-Oncology at Baylor University Medical Center. RESULTS: The patient was eligible for participation in a clinical trial (ClinicalTrials.gov identifier: NCT00916409) of a tumor treatment fields (TTFields) device, NovoTTF-100A, with concurrent radiation and chemotherapy (CCRT). His disease relapsed 4 months after completion of his CCRT, with MRI showing areas of enhancement. Temozolomide was discontinued and he was offered dabrafenib, an oral selective inhibitor of BRAF V600E, with continued use of NovoTTF. At the time of this report, after 2 years of treatment with dabrafenib and TTFields, the patient shows a durable complete response in all areas with no active lesions or new areas of enhancement. CONCLUSIONS: This report suggests that TTFields delivered in combination with targeted therapy dabrafenib yielded a remarkable clinical and radiologic response in this recurrent high-grade glioma. Targeted therapy matched to genomic alterations combined with TTFields treatment could provide clinical benefit and should be prospectively explored in the near future.


Posted November 15th 2016

Together We Can Do Much: Message from the President.

Marygrace Hernandez-Leveille Ph.D.

Marygrace Hernandez-Leveille Ph.D.

Smith-Blair, N., M. Hernandez-Leveille and L. L. Lefler (2016). “Together we can do much: Message from the president.” Res Nurs Health 39(6): 396-398.

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The Southern Nursing Research Society has been instrumental in the promotion of nursing research that addresses health promotion, symptom management,quality of care, and quality of life, not only in the Southern region but nationally and internationally. Our country is witness to mounting rates of obesity and chronic illness and large gaps in healthcare provision and outcomes among racial and ethnic group s. Strains are mounting onthe healthcare syste m to provide cost effective care w ithli mited res ources. This is particularly true in the states ofthe Southern region.


Posted November 15th 2016

Serum APE1 as a predictive marker for platinum-based chemotherapy of non-small cell lung cancer patients.

Laura Baugh, D.O.

Laura Baugh, D.O.

Zhang, S., L. He, N. Dai, W. Guan, J. Shan, X. Yang, Z. Zhong, Y. Qing, F. Jin, C. Chen, Y. Yang, H. Wang, L. Baugh, G. Tell, D. M. Wilson Iii, M. Li and D. Wang (2016). “Serum ape1 as a predictive marker for platinum-based chemotherapy of non-small cell lung cancer patients.” Oncotarget: 2016 Nov [Epub ahead of print].

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PURPOSE: To define the role of the DNA repair protein apurinic/apyrimidinic endonuclease 1 (APE1) in predicting the prognosis and chemotherapeutic response of non-small cell lung cancer patients receiving platinum-containing chemotherapy. RESULTS: Our investigations found that serum APE1 level was significantly elevated in 229 of 412 NSCLC patients and correlated with its level in tissue (r2 = 0.639, p < 0.001). The elevated APE1 level in both tissue and serum of patients prior to chemotherapy was associated with worse progression-free survival (HR: 2.165, p < 0.001, HR: 1.421, p = 0.012), but not with overall survival. After 6 cycles of chemotherapy, a low APE1 serum level was associated with better overall survival (HR: 0.497, p = 0.010). EXPERIMENTAL DESIGN: We measured APE1 protein levels in biopsy tissue from 172 NSCLC patients and sera of 412 NSCLC patients receiving platinum-based chemotherapy by immunohistochemistry and a newly established sensitive and specific enzyme-linked immunosorbent assay, respectively. APE1 levels in sera of 523 healthy donors were also determined as control. CONCLUSIONS: Our studies indicate that APE1 is a biomarker for predicting prognosis and therapeutic efficacy in NSCLC. The chemotherapy-naive serum APE1 level, which correlated with its tissue level inversely associated with progression-free survival of platinum-containing doublet chemotherapy, whereas post-treatment serum APE1 level was inversely associated with overall survival.


Posted November 15th 2016

Variations in Inpatient Rehabilitation Functional Outcomes Across Centers in the Traumatic Brain Injury Model Systems Study and the Influence of Demographics and Injury Severity on Patient Outcomes.

Shahid Shafi M.D.

Shahid Shafi M.D.

Dahdah, M. N., S. Barnes, A. Buros, R. Dubiel, C. Dunklin, L. Callender, C. Harper, A. Wilson, R. Diaz-Arrastia, T. Bergquist, M. Sherer, G. Whiteneck, C. Pretz, R. D. Vanderploeg and S. Shafi (2016). “Variations in inpatient rehabilitation functional outcomes across centers in the traumatic brain injury model systems study and the influence of demographics and injury severity on patient outcomes.” Arch Phys Med Rehabil 97(11): 1821-1831.

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OBJECTIVE: To compare patient functional outcomes across Traumatic Brain Injury Model Systems (TBIMS) rehabilitation centers using an enhanced statistical model and to determine factors that influence those outcomes. DESIGN: Multicenter observational cohort study. SETTING: TBIMS centers. PARTICIPANTS: Patients with traumatic brain injury (TBI) admitted to 19 TBIMS rehabilitation centers from 2003-2012 (N=5505). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Functional outcomes of patients with TBI. RESULTS: Individuals with lower functional status at the time of admission, longer duration of posttraumatic amnesia, and higher burden of medical comorbidities continued to have worse functional outcomes at discharge from inpatient rehabilitation and at the 1-year follow-up, whereas those who were employed at the time of injury had better outcomes at both time periods. Risk-adjusted patient functional outcomes for patients in most TBIMS centers were consistent with previous research. However, there were wide performance differences for a few centers even after using more recently collected data, improving on the regression models by adding predictors known to influence functional outcomes, and using bootstrapping to eliminate confounds. CONCLUSIONS: Specific patient, injury, and clinical factors are associated with differences in functional outcomes within and across TBIMS rehabilitation centers. However, these factors did not explain all the variance in patient outcomes, suggesting a role of some other predictors that remain unknown.