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Los Angeles, CA, United States

Pomykala K.L.,University of California at Los Angeles | Ganz P.A.,University of California at Los Angeles | Bower J.E.,University of California at Los Angeles | Bower J.E.,Semel Institute for Neuroscience | And 11 more authors.
Brain Imaging and Behavior

To examine relationships following adjuvant chemotherapy between circulating pro-inflammatory cytokines, regional cerebral metabolism, and cognitive complaints in early stage breast cancer patients. 33 breast cancer patients who had completed initial treatment (surgery, ± radiation, 23 chemotherapy, 10 no chemotherapy) obtained resting (18)FFDG PET/CT brain imaging at baseline and 1 year later. Proinflammatory cytokine markers (IL-1ra, sTNF-RII, CRP, and IL-6) and cognitive complaints were also assessed at both time points. At baseline, consistent correlations were seen between the left medial frontal and right inferior lateral anterior temporal cortices and inflammatory markers within the chemotherapy group, and not in the no chemotherapy group. After 1 year, correlations persisted in the medial frontal cortex and the temporal cortex, the latter shifting superiorly. Both of these regional correlations demonstrated the highest levels of significance when looking across the 1 year time frame (IL-1ra: peak voxel p<0.0005; cluster size p<0.0005, p=0.001 after correction (medial prefrontal), p<0.0005; cluster size p=0.001, p=0.029 corr. (anterior temporal), sTNF-RII: p<0.0005; cluster size p=0.001, p=0.040 corr. (medial prefrontal)). Positive correlations were also seen within the chemotherapy group between baseline memory complaints and the medial frontal (p<0.0005; cluster size p<0.0005, p<0.0005 corr.) and anterior temporal (p<0.0005; cluster size p<0.0005, p=0.002 corr.) cortices at baseline and 1 year later. Metabolism in the medial prefrontal cortex and anterior temporal cortex was found to correlate with both memory complaints and cytokine marker levels in chemotherapy patients. © Springer Science+Business Media New York 2012. Source

Maier M.M.,Health-U | Ross D.B.,VA Washington DC Health Care System | Chartier M.,Office of Public Health HIV | Belperio P.S.,VA Greater Los Angeles Health Care System | Backus L.I.,Office of Public Health Population Health
American Journal of Public Health

Objectives. We measured the quality of HCV care using a cascade of HCV care model. Methods.We estimated the number of patients diagnosed with chronic HCV, linked to HCV care, treated with HCV antivirals, and having achieved a sustained virologic response (SVR) in the electronic medical record data from the Veterans Health Administration's Corporate Data Warehouse and the HCV Clinical Case Registry in 2013. Results. Of the estimated 233 898 patients with chronic HCV, 77% (181 168) were diagnosed, 69% (160 794) were linked to HCV care, 17% (39 388) were treated with HCV antivirals, and 7% (15 983) had achieved SVR. Conclusions. This Cascade of HCV Care provides a clinically relevant model to measure the quality of HCV care within a health care system and to compare HCV care across health systems. Source

Ganz P.A.,University of California at Los Angeles | Petersen L.,University of California at Los Angeles | Castellon S.A.,VA Greater Los Angeles Health Care System | Castellon S.A.,University of California at Los Angeles | And 5 more authors.
Journal of Clinical Oncology

Purpose: This report examines cognitive complaints and neuropsychological (NP) testing outcomes in patients with early-stage breast cancer after the initiation of endocrine therapy (ET) to determine whether this therapy plays any role in post-treatment cognitive complaints.Patients and Methods: One hundred seventy-three participants from the Mind Body Study (MBS) observational cohort provided data from self-report questionnaires and NP testing obtained at enrollment (T1, before nitiation of ET), and 6 months later (T2). Bivariate analyses compared demographic and treatment variables, cognitive complaints, depressive symptoms, quality of life, and NP functioning between those who received ET versus not. Multivariable linear regression models examined predictors of cognitive complaints at T2, including selected demographic variables, depressive symptoms, ET use, and other medical variables, along with NP domains that were identified in bivariate analyses.Results: Seventy percent of the 173 MBS participants initiated ET, evenly distributed between tamoxifen or aromatase inhibitors. ET-treated participants reported significantly increased language and communication (LC) cognitive complaints at T2 (P =. 003), but no significant differences in NP test performance. Multivariable regression on LC at T2 found higher LC complaints significantly associated with T1 LC score (P <. 001), ET at T2 (P =. 004), interaction between ET and past hormone therapy (HT) (P <. 001), and diminished improvement in NP psychomotor function (P = 05). Depressive symptoms were not significant (P =. 10).Conclusion: Higher LC complaints are significantly associated with ET 6 months after starting treatment and reflect diminished improvements in some NP tests. Past HT is a significant predictor of higher LC complaints after initiation of ET. © 2014 by American Society of Clinical Oncology. Source

Alici Y.,Geriatric Services Unit | Smith D.,University of Pennsylvania | Lu H.L.,University of Pennsylvania | Bailey A.,Birmingham Medical Center | And 4 more authors.
Journal of Pain and Symptom Management

Objectives: To define the frequency of post-traumatic stress disorder (PTSD)-related symptoms among veterans who are near the end of life and to describe the impact that these symptoms have on patients and their families. Methods: Patients had received inpatient or outpatient care from a participating VA facility in the last month of life, and one family member per patient was selected using predefined eligibility criteria. Family members then completed a telephone survey, The Family Assessment of Treatment at End-of-Life, which assessed their perceptions of the quality of the care that the patients and they themselves received during the patients' last month of life. Results: Seventeen percent of patients (89 of 524) were reported to have had PTSD-related symptoms in the last month of life. PTSD-related symptoms caused discomfort less often than pain did (mean frequency score 1.79 vs. 1.93; Wilcoxon sign rank test, P < 0.001) but more often than dyspnea did (mean severity score 1.79 vs. 1.73; Wilcoxon sign rank test, P < 0.001). Family members of patients with PTSD-related symptoms reported less satisfaction overall with the care the patient received (mean score 48 vs. 62; rank sum test, P < 0.001). Patients who received a palliative care consult (n = 49) had lower ratings of discomfort attributed to PTSD-related symptoms (mean 1.55 vs. 2.07; rank sum test, P = 0.007). Conclusion: PTSD-related symptoms may be common and severe among veterans near the end of life and may have a negative effect on families' perceptions of the quality of care that the veteran received. © 2010 U.S. Cancer Pain Relief Committee. Source

Vianna V.F.,National Institute of Traumatology and Orthopaedics | Vianna V.F.,Federal University of Rio de Janeiro | Bonfim D.C.,National Institute of Traumatology and Orthopaedics | Bonfim D.C.,Federal University of Rio de Janeiro | And 11 more authors.
BioMed Research International

Bone marrow stromal cells (BMSCs) are a valuable resource for skeletal regenerative medicine because of their osteogenic potential. In spite of the very general term "stem cell," this population of cells is far from homogeneous, and different BMSCs clones have greatly different phenotypic properties and, therefore, potentially different therapeutic potential. Adherence to a culture flask surface is a primary defining characteristic of BMSCs. We hypothesized that based on the adherence time we could obtain an enriched population of cells with a greater therapeutic potential. We characterized two populations of bone marrow-derived cells, those that adhered by three days (R-cells) and those that did not adhere by three days but did by six days (L-cells). Clones derived from L-cells could be induced into adipogenic, chondrogenic, and osteogenic differentiation in vitro. L-cells appeared to have greater proliferative capacity, as manifested by larger colony diameter and clones with higher CD146 expression. Only clones from L-cells developed bone marrow stroma in vivo. We conclude that the use of late adherence of BMSCs is one parameter that can be used to enrich for cells that will constitute a superior final product for cell therapy in orthopedics. © 2013 Verônica Fernandes Vianna et al. Source

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