Saint Francis Medical Center College of Nursing
Peoria, IL, United States
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Atienza J.A.S.,University of Connecticut | Dasanu C.A.,Saint Francis Medical Center College of Nursing
Current Medical Research and Opinion | Year: 2012

Background: Increased incidence of a second primary aero-digestive malignancy after an index head and neck cancer (HNC) is well-documented. Furthermore, a clear set of surveillance strategies for second primary aero-digestive cancers in these patients exists. Methods: The goal of this article is to review the published literature on risk of second primary malignancies (SPMs) (including aero-digestive malignancies) after a treated index HNC as well as its associated predictors, prognosis and surveillance. Most relevant publications were identified through searching the PubMed database for articles published up to July 2012; epidemiologic evidence was synthesized and thoroughly analyzed. Findings: Data from randomized controlled trials, meta-analyses, population-based and cohort group studies, prior reviews, and case reports indicate an increased incidence of various SPMs after occurrence of a HNC. These cancers are not limited to upper aero-digestive sites. Common risk factors including environmental, genetic and immune factors may explain the increased incidence of second cancers in this patient population. In addition, site of the index HNC may predict the site of a future SPM. Conclusions: As a general rule, oral cavity and oropharyngeal squamous cell cancers are associated more with head and neck region SPM, while laryngeal and hypopharyngeal cancers-with that of the lung. As these cancers confer dismal prognosis and shorter survival in patients with HNCs, several literature sources recommend close surveillance for and an aggressive therapy of SPM. Notwithstanding, their optimal management and follow-up schedule remains to be established. © 2013 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.

Shimanovsky A.,University of Connecticut | Jethava A.,Saint Francis Medical Center College of Nursing | Dasanu C.A.,Saint Francis Medical Center College of Nursing
Expert Opinion on Biological Therapy | Year: 2013

Introduction: Malignant melanoma is a highly aggressive, immunogenic tumor that has the ability to modulate the immune system to its own advantage. Patients with melanoma present numerous cellular immune defects and cytokine abnormalities, all leading to suppression of the host anti-tumor immune response. Innovative treatment strategies can be achieved through employing our knowledge of the melanoma-induced immune alterations. Areas covered: The authors review comprehensively the immune abnormalities in individuals with melanoma, and provide a summary of currently available melanoma immunotherapy agents that are currently on the market or undergoing clinical trials. Expert opinion: Ipilimumab, a monoclonal antibody directed against the CTLA-4, is one of the current forefront treatment strategies in malignant melanoma. Novel immunomodulating agents have shown clear activity in patients with malignant melanoma. These include anti-PD-1 and anti-PD-1 ligand antibodies that may soon become important items in the anti-melanoma armamentarium. Combinations of different immunotherapy agents, between themselves or with other agents, are currently being studied in an attempt to further enhance the antineoplastic effect in patients with malignant melanoma. © 2013 Informa UK, Ltd.

Canalis E.,Saint Francis Medical Center College of Nursing | Canalis E.,University of Connecticut
Journal of Clinical Endocrinology and Metabolism | Year: 2010

Skeletal anabolic agents enhance bone formation, which is determined by the number and function of osteoblasts. Cell number is controlled by factors that regulate the replication, differentiation, and death of cells of the osteoblastic lineage, whereas cell function is controlled by signals acting on the mature osteoblast. Bone morphogenetic proteins (BMP) and Wnt induce the differentiation of mesenchymal cells toward osteoblasts, and IGF-I enhances the function of mature osteoblasts. The activity of BMP, Wnt, and IGF-I is controlled by proteins that, by binding to the growth factor or to its receptors, can antagonize its effects. Changes in the expression or binding affinity of these extracellular antagonists can be associated with increased or decreased bone formation and bone mass. Novel approaches to anabolic therapies for osteoporosis may include the use of factors with anabolic properties, or the neutralization of a growth factor antagonist. Selected approaches include the use of neutralizing antibodies to Wnt antagonists, the enhancement of BMP signaling by proteasome inhibitors, or the use of activin soluble receptors, IGF-I, or PTH analogs. An anabolic agent needs to be targeted specifically to the skeleton to avoid unwanted non-skeletal effects and ensure safety. Clinical trials are being conducted to test the long-term effectiveness and safety of novel bone anabolic agents. Copyright © 2010 by The Endocrine Society.

News Article | October 29, 2016

Leading online higher education information provider has announced it’s ranking of the 2016-2017 Best Online Colleges in Illinois. A total of 21 schools were selected for excellence in online education, with the University of Illinois at Springfield, Lincoln Christian University, Aurora University, National Louis University and Governors State University on top for four-year programs and Shawnee Community College and Southeastern Illinois College ranking highest for two-year programs. "Illinois has seen a steady increase in college enrollment since the mid-1990’s,” said Dan Schuessler, CEO and Founder of "These colleges are taking learning to the next level by offering online education options that are affordable and high quality. The flexibility online classes provide is paramount when it comes to helping a growing number of students earn college degrees.” To qualify for a place on the Best Online Colleges in Illinois list, requires schools to hold public or private not-for-profit status. They must also carry accreditation and maintain specific in-state tuition standards; only two-year schools offering in-state tuition under $5,000 annually and four-year schools offering in-state tuition under $25,000 annually are considered. Rankings are assigned based on analysis of a dozen different data points, including variety of online offerings, graduation rates and financial aid statistics. A complete list of schools featured on the 2016-2017 Best Online Colleges in Illinois ranking are included below. Details on each school’s rank, specific data points and methodology used for the comparison can be found at: Aurora University Eastern Illinois University Governors State University Greenville College Illinois State University Lincoln Christian University MacMurray College Methodist College Moody Bible Institute National Louis University National University of Health Sciences North Park University Saint Francis Medical Center College of Nursing Shawnee Community College Southeastern Illinois College Southern Illinois University - Edwardsville St. John's College of Nursing University of Illinois at Chicago University of Illinois at Springfield University of Illinois at Urbana - Champaign Western Illinois University began in 2011 to provide quality data and information about pursuing an affordable higher education. Our free community resource materials and tools span topics such as financial aid and college savings, opportunities for veterans and people with disabilities, and online learning resources. We feature higher education institutions that have developed online learning environments that include highly trained faculty, new technology and resources, and online support services to help students achieve educational and career success. We have been featured by nearly 1,100 postsecondary institutions and nearly 120 government organizations.

Shibli-Rahhal A.,University of Iowa | Paturi B.,Saint Francis Medical Center College of Nursing | Paturi B.,Joslin Diabetes Center
Osteoporosis International | Year: 2014

Although 25 hydroxyvitamin D (25OHD) and parathyroid hormone (PTH) levels are inversely related, less than half of the patients with a low vitamin D level have an elevated PTH, and, in most of these patients, the PTH does not immediately normalize with correction of the vitamin D. Introduction: Despite the inverse relationship between 25OHD and PTH, patients with vitamin D deficiency seen in clinical practice do not always have an elevated PTH, and, in those with secondary hyperparathyroidism, the PTH does not always normalize with correction of vitamin D deficiency. We examined variations in PTH concentrations in patients with low 25OHD and studied changes in the PTH concentration with restoration of vitamin D sufficiency. Methods: This was a retrospective cohort study of patients with a 25OHD∈<∈30 ng/mL and a concomitant PTH measurement seen at the Metabolic Bone Disease Clinic at a tertiary care center between July 1, 2007 and May 31, 2011. Patients with conditions associated with alterations in PTH were excluded. Results: The study population consisted of 104 patients. The mean age was 55.5 years, and 83 % were female. The 25OHD and PTH were negatively correlated, but only 30 % of patients with a 25OHD∈<∈30 ng/mL and 40 % of those with a 25OHD∈<∈20 ng/mL had an elevated PTH. As the 25OHD increased to 30 ng/mL or higher, the PTH decreased significantly in the group of patients who had an elevated PTH at baseline, but only 44 % reached a normal PTH. Of patients with a normal PTH at baseline, 59 % experienced a drop in their PTH while the PTH remained unchanged or increased in 41 %. Conclusions: PTH has a limited role in defining vitamin D status in individual patients and in guiding vitamin D therapy in clinical practice. © 2014 International Osteoporosis Foundation and National Osteoporosis Foundation.

Jethava A.,Saint Francis Medical Center College of Nursing
Connecticut medicine | Year: 2013

Inclusion body myositis features a slowly progressive inflammatory myopathy characterized by progressive proximal muscle weakness in the lower extremities, followed by proximal, upper-extremity weakness and later involvement of distal muscles groups. Although the most severely affected muscles are those of the limbs, the disease can also involve the respiratory, cardiovascular and gastrointestinal system muscles as well. We describe a unique patient who presented with acute hypercapnic hypoxic respiratory failure secondary to inclusion body myositis. Our patient required mechanical ventilation but responded to corticosteroid therapy. The diagnosis was delayed in part because of the slowly progressive course of the disease and the fact that an extensive investigation had not disclosed a cause. We postulate that muscle biopsy may be warranted in select patients suffering from a protracted muscle weakness.

Canalis E.,Saint Francis Medical Center College of Nursing
Nature Reviews Endocrinology | Year: 2013

Osteoporosis is a skeletal disorder characterized by bone loss, which results in architectural deterioration of the skeleton, compromised bone strength and an increased risk of fragility fractures. Most current therapies for osteoporosis stabilize the skeleton by inhibiting bone resorption (antiresorptive agents), but the development of anabolic therapies that can increase bone formation and bone mass is of great interest. Wnt signalling induces differentiation of bone-forming cells (osteoblasts) and suppresses the development of bone-resorbing cells (osteoclasts). The Wnt pathway is controlled by antagonists that interact either directly with Wnt proteins or with Wnt co-receptors. The importance of Wnt signalling in bone formation is indicated by skeletal disorders such as sclerosteosis and van Buchem syndrome, which are caused by mutations in the gene encoding the Wnt antagonist sclerostin (SOST). Experiments in mice have shown that downregulation or neutralization of Wnt antagonists enhances bone formation. Phase II clinical trials show that 1-year treatment with antisclerostin antibodies increases bone formation, decreases bone resorption and leads to a substantial increase in BMD. Consequently, Wnt signalling can be targeted by the neutralization of its extracellular antagonists to obtain a skeletal anabolic response. © 2013 Macmillan Publishers Limited. All rights reserved.

Jethava A.,Saint Francis Medical Center College of Nursing
Connecticut medicine | Year: 2013

Pulmonary blastoma is a rare malignant tumor, histologically resembling the fetal lung. Since its first description in 1945, only about 200 cases have been reported worldwide. This tumor predominantly affects children, but has also been reported in adults with a peak incidence in the fourth decade of life. Pulmonary blastoma has a variable clinical course that cannot be determined by its histological appearance. We report a 51-year-old patient with a large biphasic pulmonary blastoma who was treated with surgical excision. The patient remains disease-free eleven months postoperatively. As relapse rates are high in patients with large biphasic (type 2) tumors, the patient is being monitored closely. Although a rare occurrence after the age of 20, pulmonary blastoma should remain in the differential diagnosis of a lung mass in an adult.

Jethava A.,Saint Francis Medical Center College of Nursing
Connecticut medicine | Year: 2012

Health-care professionals must be aware of the mandatory vitamin supplementation in patients status post bariatric surgery. A recent increase in the number of gastric bypass surgeries in US has been associated with a proportional increase in Wernicke encephalopathy reports. Subtle or atypical neurologic features are not uncommon. Our report is of a female patient with acute Wernicke encephalopathy accompanied by sensorineural hearing loss six weeks after bariatric surgery. The patient had only a partial recovery of her neurologic symptoms eightweeks after vigorous therapy for this condition. Symptomatic thiamine (vitamin B1) and vitamin B12 deficiencies are particularly concerning effects of bariatric procedures, as neurologic and cognitive deficits may be long lasting or even permanent despite aggressive replacement therapy.

Zanotti S.,Saint Francis Medical Center College of Nursing | Canalis E.,Saint Francis Medical Center College of Nursing
Endocrinology | Year: 2013

Notch1 to Notch4 transmembrane receptors determine cell fate, and release of the Notch intracellular domain (NICD) in the cytoplasm induces gene expression. Notch regulates endochondral ossification, but it is not clear whether Notch interacts with signals controlling chondrocyte differentiation. Nuclear factor of activated T cells (Nfatc) transcription factors regulate chondrogenesis, and we asked whether Notch modifies Nfat signaling in chondrocytes. Notch was induced in teratocarcinoma ATDC5 chondrogenic cells infected with a retroviral vector, where the cytomegalovirus (CMV) promoter directs NICD expression. NICD suppressed chondrocyte differentiation and inhibited Nfat transactivation and Nfatc1 expression. Notch was activated in chondrocytes from RosaNotch mice, where the Rosa26 promoter is upstream of a loxP-flanked STOP cassette and NICD. To excise the STOP cassette and express NICD, RosaNotch chondrocytes were infected with an adenoviral vector where the CMV promoter directs Cre expression (Ad-CMV-Cre). Notch1 and Notch2 mediate the effects of Notch in skeletal cells, and to inhibit Notch signaling, chondrocytes from mice homozygous for Notch1 and Notch2 alleles targeted with loxP sites were infected with Ad-CMV-Cre. NICD suppressed chondrogenic nodules formation and expression of selected chondrocyte gene markers, induced Col10a1 and Mmp13, and suppressed Nfat transactivation and Nfatc1 expression, whereas inactivation of Notch1 and Notch2 did not affect chondrocyte differentiation. To investigate Nfatc1 function in chondrocytes, Nfatc1 was induced in RosaNotch chondrocytes overexpressing NICD or controls. Nfatc1 suppressed chondrocyte differentiation and opposed Col10a1 induction by Notch. In conclusion, Notch suppresses Nfat transactivation in chondrocytes and Notch and Nfatc1 regulate chondrocyte differentiation. Copyright © 2013 by The Endocrine Society.

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