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PubMed | Wheaton Franciscan Healthcare, Aurora Research Institute, Marquette University and Aurora Health Care
Type: | Journal: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer | Year: 2016

: Exercise can improve quality of life (QOL) in breast cancer survivors. In contrast to many group or home-based exercise programs, little is known about the effectiveness of goal-oriented recreational activities.The purpose of this study was to evaluate a clinically overseen team triathlon training program on improving physiological and psychosocial health-related measures in female breast cancer survivors.Twenty-three participants (age=48 (8), BMI=25 (1), mean (SE)) were recruited from a 14-week sprint triathlon (800-m swim, 20-km bike, 5-km run) team training program for women breast cancer survivors (4 (3)years post-surgery, chemo-, or radiation-therapy). Training included two supervised group and three home-based individual sessions per week. Pre- and post-training outcomes included isokinetic knee extensor strength (60, 180, and 300sData are mean (SD) from 21 complete data sets. Knee extensor peak torque significantly improved only at 300sTeam triathlon training in breast cancer survivors can increase aerobic capacity and improve QOL which may contribute to healthier lifestyles in breast cancer survivors.


Raff H.,Medical College of Wisconsin | Raff H.,Aurora Research Institute
Endocrinology and Metabolism Clinics of North America | Year: 2015

Endogenous hypercortisolism (Cushing syndrome) is one of the most enigmatic diseases in clinical medicine. The diagnosis and differential diagnosis of Cushing syndrome depend on proper laboratory evaluation. In this review, an update is provided on selected critical issues in the diagnosis and differential diagnosis of Cushing syndrome: the use of late-night salivary cortisol in initial diagnosis and for postoperative surveillance, and the use of prolactin measurement to improve the performance of inferior petrosal sinus sampling to distinguish Cushing disease from ectopic adrenocorticotropic hormone (ACTH) syndrome during differential diagnosis of ACTH-dependent Cushing syndrome. © 2015 Elsevier Inc.


Trivedi H.,Medical College of Wisconsin | Szabo A.,Medical College of Wisconsin | Zhao S.,Medical College of Wisconsin | Cantor T.,Scantibodies Laboratory Inc. | And 2 more authors.
Journal of Nephrology | Year: 2015

Background: Mineral and bone parameters are actively managed in end-stage renal disease (ESRD). However, whether these undergo circadian variation is not known. We investigated the circadian variation of mineral and bone parameters in patients on long-term hemodialysis. Methods: Seventeen ESRD patients on long-term hemodialysis and eight volunteers without kidney disease were enrolled. Subjects had all medications that affect calcium–phosphate–parathyroid hormone balance (phosphate binders, vitamin D analogues, and calcimimetics) discontinued. Thereafter, for a period of 5 days, subjects consumed a diet controlled in calcium (1,200 mg per day) and phosphorus (1,000 mg per day) content. On the sixth day (a non-dialysis day for the ESRD patients), enrollees underwent twelve 2-h blood draws for phosphate, ionized calcium, parathyroid hormone (PTH), total 25-hydroxy vitamin D (25OHD), and fibroblast growth factor-23 (FGF-23). Results: In the ESRD patients plasma phosphate demonstrated significant circadian variation (P < 0.00001). The peak occurred around 3:30 am and nadir occurred around 11:00 am. Ionized calcium (P = 0.0036), PTH (P = 0.0004) and 25OHD (P = 0.009) also varied significantly during the circadian period; for ionized calcium peak and nadir occurred around 12:15 pm and 8:00 pm, parathyroid hormone 5:45 pm and 10:15 am, and 25OHD 9:45 am and 4:00 pm respectively. FGF-23 did not show a significant circadian variation. Only phosphate (P < 0.0001) and PTH (P = 0.00008) demonstrated circadian variation in the control group. Conclusions: Blood concentrations of phosphate, calcium, PTH and 25-hydroxy vitamin D, exhibit a circadian variation in patients with ESRD. Knowledge of these phenomena is pertinent for the interpretation of clinical testing. © 2014, Italian Society of Nephrology.


Raff H.,Medical College of Wisconsin | Raff H.,Aurora Research Institute | Carroll T.,Medical College of Wisconsin
Journal of Physiology | Year: 2015

The physiological control of cortisol synthesis in the adrenal cortex involves stimulation of adrenocorticotrophic hormone (ACTH) by hypothalamic corticotrophin-releasing hormone (CRH) and then stimulation of the adrenal by ACTH. The control loop of the hypothalamic-pituitary-adrenal (HPA) axis is closed by negative feedback of cortisol on the hypothalamus and pituitary. Understanding this system is required to master the diagnosis, differential diagnosis and treatment of endogenous hypercortisolism - Cushing's syndrome. Endogenous Cushing's syndrome is caused either by excess ACTH secretion or by autonomous cortisol release from the adrenal cortex. Diagnosis of cortisol excess exploits three physiological principles: failure to achieve the normal nadir in the cortisol diurnal rhythm, loss of sensitivity of ACTH-secreting tumours to cortisol negative feedback, and increased excretion of free cortisol in the urine. Differentiating a pituitary source of excess ACTH (Cushing's disease) from an ectopic source is accomplished by imaging the pituitary and sampling for ACTH in the venous drainage of the pituitary. With surgical removal of ACTH or cortisol-secreting tumours, secondary adrenal insufficiency ensues because of the prior suppression of the HPA axis by glucocorticoid negative feedback. Medical therapy is targeted to the anatomical location of the dysregulated component of the HPA axis. Future research will focus on new diagnostics and treatments of Cushing's syndrome. These are elegant examples of translational research: understanding basic physiology informs the development of new approaches to diagnosis and treatment. Appreciating pathophysiology generates new areas for inquiry of basic physiological and biochemical mechanisms. © 2014 The Physiological Society.


Zhang H.,Medical College of Wisconsin | Xu H.,Medical College of Wisconsin | Weihrauch D.,Medical College of Wisconsin | Jones D.W.,Medical College of Wisconsin | And 8 more authors.
Journal of Lipid Research | Year: 2013

Activated leukocytes and polymorphonuclear neutrophils (PMN) release myeloperoxidase (MPO), which binds to endothelial cells (EC), is translocated, and generates oxidants that scavenge nitric oxide (NO) and impair EC function. To determine whether MPO impairs EC function in sickle cell disease (SCD), control (AA) and SCD mice were treated with N-acetyl-lysyltyrosylcysteine-amide (KYC). SCD humans and mice have high plasma MPO and soluble L-selectin (sL-selectin). KYC had no effect on MPO but decreased plasma sL-selectin and malondialdehyde in SCD mice. MPO and 3-chlorotyrosine (3-ClTyr) were increased in SCD aortas. KYC decreased MPO and 3-ClTyr in SCD aortas to the levels in AA aortas. Vasodilatation in SCD mice was impaired. KYC increased vasodilatation in SCD mice more than 2-fold, to ∼60% of levels in AA mice. KYC inhibited MPO-dependent 3-ClTyr formation in EC proteins. SCD mice had high plasma alanine transaminase (ALT), which tended to decrease in KYC-treated SCD mice (P = 0.07). KYC increased MPO and XO/XDH and decreased 3-ClTyr and 3-nitrotyrosine (3-NO2Tyr) in SCD livers. These data support the hypothesis that SCD increases release of MPO, which generates oxidants that impair EC function and injure livers. Inhibiting MPO is an effective strategy for decreasing oxidative stress and liver injury and restoring EC function in SCD. Copyright © 2013 by the American Society for Biochemistry and Molecular Biology, Inc.


Chintamaneni K.,Aurora Research Institute | Bruder E.D.,Aurora Research Institute | Raff H.,Aurora Research Institute | Raff H.,Medical College of Wisconsin
American Journal of Physiology - Regulatory Integrative and Comparative Physiology | Year: 2013

Apnea, the temporary cessation of respiratory airflow, is a common cause of intermittent hypoxia (IH) in premature infants. We hypothesized that IH elicits a stress response and alters glucose homeostasis in the neonatal rat. Rat pups were studied on postnatal day (PD) 2, 8, 10, 12, and 14. Pups were exposed to normoxia (control) or six cycles consisting of 30-s exposures to hypoxia (FIO2 = 3%) over a 60-min period. Blood samples were obtained at baseline, after the third cycle (~30 min), and after the sixth cycle (~60 min). Tissue samples were collected following the sixth cycle. Plasma ACTH, corticosterone, glucose, and insulin were analyzed at all ages. Hypothalamic, pituitary, and adrenal mRNA expression was evaluated by quantitative PCR in PD2, PD8, and PD12 pups. Exposure to IH elicited significant increases in plasma ACTH and corticosterone at all ages studied. The largest increase in corticosterone occurred in PD2 pups, despite only a very small increase in plasma ACTH. This ACTH-independent increase in corticosterone in PD2 pups was associated with increases in adrenal Ldlr and Star mRNA expression. Additionally, IH caused hyperglycemia and hyperinsulinemia at all ages. We conclude that IH elicits a significant pituitary-adrenal response and significantly alters glucose homeostasis. Furthermore, the quantitative and qualitative characteristics of these responses depend on developmental age. © 2013 the American Physiological Society.


Moffitt P.,Aurora Research Institute | Fikowski H.,Aurora College | Mauricio M.,Aurora College | Mackenzie A.,Aurora College
International Journal of Circumpolar Health | Year: 2013

Introduction. Family violence is a complex, multidimensional and pervasive presence in many Aboriginal communities. Although practitioners acknowledge that intimate partner violence (IPV) is a grave concern in the North, as in other jurisdictions in Canada, there is a paucity of literature about IPV and the local response to that violence. Objective. The purpose of this study is to report on a synthesis of Northern Territorial literature and a 3-year media watch conducted in the Canadian territories. Design. This review is part of a multidisciplinary 5-year study occurring in the Northwest Territories (NT) and northern regions of the Prairie Provinces of Canada. The methods included a review of the literature through CINAHL, PubMed, Academic Search Complete, Social Sciences Index and JSTOR (1990-2012) combined with a media watch from 2009 to 2012. A thematic content analysis was completed. Results. Themes included: colonization; alcohol and substance use; effects of residential schooling; housing inadequacies; help-seeking behaviours; and gaps within the justice system. Identified themes from the media watch were: murders from IPV; reported assaults and criminal charges; emergency protection orders; and awareness campaigns and prevention measures. Conclusion. When synthesized, the results of the literature review and media surveillance depict a starting context and description of IPV in the Canadian territories. There are many questions left unanswered which build support for the necessity of the current research, outline the public outcry for action in local media and identify the current published knowledge about IPV. © 2013 Pertice Moffitt et al.


Pemmaraju N.,University of Texas M. D. Anderson Cancer Center | Gupta V.,Princess Margaret Cancer Center | Thompson M.A.,Aurora Research Institute | Lane A.A.,Dana-Farber Cancer Institute
Current Hematologic Malignancy Reports | Year: 2016

The incorporation of Internet resources and the use of social media among patients, clinicians, advocates, and researchers in the field of hematology and oncology are growing in importance. Utilization of online information sharing is rising, especially among those involved in rare blood cancer fields, which have generally featured a paucity of reliable, updated information. In particular, blastic plasmacytoid dendritic cell neoplasm (BPDCN), an uncommon, but highly aggressive hematologic malignancy, is one example of a cancer with limited information readily available to the general public. The infrequent incidence of BPDCN, the challenges in recognizing the disease and making a clinico-pathologic diagnosis, and the lack of standard therapies are some of the reasons accounting for the dearth of expert opinion, scientific publications and discussion, and accessibility of online information for patients. This article highlights social media and Internet sources available for patients and other healthcare stakeholders in the field of BPDCN and discusses our efforts to increase awareness and propagation of BPDCN electronic resources, including the founding of an online Twitter community, #BPDCN. © 2016 Springer Science+Business Media New York


Oaks M.,Aurora Research Institute | Taylor S.,Aurora Research Institute | Shaffer J.,Aurora Research Institute
OncoImmunology | Year: 2013

In addition to the well-established effector functions of IgGs, including direct cytotoxicity and antibody-dependent cellular cytotoxicity, some populations of IgGs may exert anti-inflammatory effects. Here, we describea population of antibodies that form in the natural course of metastatic cancer and contain glycans that terminate with sialic acid. We demonstrate that both the titer of these antibodies and their level of sialylation are relatively stable throughout the progression of metastatic melanoma. The sialylation pattern of these antibodies somehow correlates with their specificity for tumor-associated antigens, as IgGs targeting several antigens associated with infectious agents are relatively poor of sialic acid. We also show that some antibodies targeting the melanoma-associated antigen NY-ES O-1 bind to the human C-type lectin CD209 (DC-SIGN). We propose that these antibodies are candidate anti-inflammatory antibodies. The presence of anti-inflammatory antibodies in cancer patients may explain, at least in part, why tumors persist and spread in the host despite strong tumor-specific humoral responses. The elucidation of the cellular and molecular pathways involved in the induction of anti-inflammatory antibodies specific for tumor-associated antigens and their function may yield important insights into howtumors evade immune detection and progress.© 2013 Landes Bioscience.


Haas J.M.,Aurora Health Care | Singh M.,Aurora Research Institute | Vakil N.,University of Wisconsin - Madison
United European Gastroenterology Journal | Year: 2016

Background: The surgical treatment of diverticulitis is in a state of evolution. Clinicians across many disciplines need to counsel patients regarding surgical choices. Objectives: A systematic review and meta-analysis was conducted to determine the mortality and complication rates following surgery for diverticulitis in both the emergent and elective setting. Methods: We searched PubMed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) for relevant articles published from 1980 to 2012. The primary outcome of interest was the point estimate of mortality, following surgery for diverticulitis. Results: Of the 289 citations reviewed, we included 59 studies. Overall, the point estimate for mortality was 3.05%, with a 95% confidence intereval (CI) of 1.73–5.32 and p < 0.001. Mortality following emergent surgery was 10.64% (95% CI 7.95–14.11; p < 0.001), versus 0.50% (95% CI 0.46–0.54; p < 0.001) following elective operations. A laparoscopic approach had an estimated mortality of 0.75% (95% CI 0.35–1.58; p < 0.001), compared to an open surgical approach, which had a mortality of 4.69% (95% CI 2.29–9.36, p < 0.001). The mortality following a resection with primary anastomosis was 1.96% (95% CI 1.22–3.13; p < 0.001) and for the Hartmann’s procedure was 14.18% (95% CI 9.83–20.03; p < 0.001). A comparative analysis found that the risk of post-operative mortality was significantly higher following emergent surgery, compared to elective surgery (odds ratio (OR): 6.12 with 95% CI 1.62–23.10; p = 0.008; Q = 2.56, p = 0.46 and I2= 0); the open approach, compared to a laparoscopic approach (OR: 36.43 with 95% CI 9.94–133.6; p = 0.13; and Q = 2.79, p = 0.25 and I2= 28.26); and for Hartmann’s procedure, compared to primary anastomosis without diversion (OR: 25.45 with 95% CI 15.13–42.81, p < 0.001; and Q = 23.34, p = 0.14 and I2= 27.16). The overall reported post-operative complication rate was 32.64% (95% CI 27.43–38.32; p < 0.00). The overall surgical and medical complication rates were 18.96% and 13.93%, respectively. Conclusions: Urgent surgical treatment of diverticulitis has a significant complication rate. Even elective surgery has a significant complication rate that needs to be considered when doing the clinical decision-making for recurrent diverticulitis. © 2015, © Author(s) 2015.

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