Serial evaluation of tumor morphology index (MI) differentiates between malignant and benign ovar... more Serial evaluation of tumor morphology index (MI) differentiates between malignant and benign ovarian tumors. • Utilization of delta MI allows clinicians to avoid unnecessary surgical evaluations of ovarian tumors.
Thirty-three large felids belonging to six different species were exposed to catnip and catnip ex... more Thirty-three large felids belonging to six different species were exposed to catnip and catnip extract. The species-characteristic response to catnip and the sensitivity of the response to various concentrations of catnip were examined. Putative relationships between catnip sensitivity, species range, age, estrous cycle, and behavioral complexity are discussed. The behavioral response to catnip shown by the domestic cat is seen in several different large felids. Lions and jaguars were extremely sensitive to catnip compared to tigers, cougars, and bobcats, who gave little or no response. Both males and females of the same species tested alike. Reproductive-age adults were more sensitive than either aged or immature animals. It was quantitatively demonstrated that catnip responsiveness is not limited to the domestic cat, that it is not limited to the female, and that it varies dramatically between species and age of felids.
... This work was conducted in the laboratory of Dr. Benita S. Katzenellenbogen whose support and... more ... This work was conducted in the laboratory of Dr. Benita S. Katzenellenbogen whose support and encourage ment is gratefully appreciated. ... 246 (1971) 41884197. 17. Buller RE. Toft D. 0..Schrader WT and O'Malley BW : Progesteronebinding components of chick ovi duct. VIII. ...
Objective.The aim of this study was to document the survival advantage of lowering stage at detec... more Objective.The aim of this study was to document the survival advantage of lowering stage at detection from Stage IIIC to Stage IIIA epithelial ovarian cancer.Methods.Treatment outcomes and survival were evaluated in patients with Stage IIIA and Stage IIIC epithelial ovarian cancer treated from 2000 to 2009 at the University of Kentucky Markey Cancer Center (UKMCC) and SEER institutions.Results.Cytoreduction to no visible disease (P<0.0001) and complete response to platinum-based chemotherapy (P<0.025) occurred more frequently in Stage IIIA than in Stage IIIC cases. Time to progression was shorter in patients with Stage IIIC ovarian cancer (17±1months) than in those with Stage II1A disease (36±8months). Five-year overall survival (OS) improved from 41% in Stage IIIC patients to 60% in Stage IIIA patients treated at UKMCC and from 37% to 56% in patients treated at SEER institutions for a survival advantage of 19% in both data sets. 53% of Stage IIIA and 14% of Stage IIIC patient...
To estimate the effect of ultrasonographic screening on stage at detection and long-term diseases... more To estimate the effect of ultrasonographic screening on stage at detection and long-term diseasespecific survival of women with epithelial ovarian cancer. METHODS: Eligibility included all asymptomatic women aged 50 years and older and women aged 25 years and older with a documented family history of ovarian cancer. From 1987 to 2011, 37,293 women received annual ultrasonographic screening. Women with abnormal screens underwent tumor morphology indexing, serum biomarker analysis, and surgery. RESULTS: Forty-seven invasive epithelial ovarian cancers and 15 epithelial ovarian tumors of low malignant potential were detected. No women with low malignant potential tumors experienced recurrent disease. Stage distribution for invasive epithelial cancers was: stage I, 22 (47%); stage II, 11 (23%); stage III, 14 (30%), and stage IV, 0 (0%). Follow-up varied from 2 months to 20.1 years (mean, 5.8 years). The 5-year survival rate for invasive epithelial ovarian cancers detected by screening was: stage I, 95%؎4.8%; stage II, 77.1%؎14.5%; and stage III, 76.2%؎12.1%. The 5-year survival rate for all women with invasive epithelial ovarian cancer detected by screening as well as interval cancers was 74.8%؎6.6% compared with 53.7%؎2.3% for unscreened women with ovarian cancer from the same institution treated by the same surgical and chemotherapeutic protocols (P<.001). CONCLUSION: Annual ultrasonographic screening of asymptomatic women achieved increased detection of earlystage ovarian cancer cases and an increase in 5-year diseasespecific survival rate for women with ovarian cancer.
Cloud computing is the latest answer of technology to meet the computational requirements of user... more Cloud computing is the latest answer of technology to meet the computational requirements of users. The notable point in complicated computational works is energy consumption. The integration is one of the elements in the cloud system which can reduce the energy consumption and coordinate the software products. In this article, some solutions have been considered for determining the upper bound threshold of utilization for doing migration in order to reduce the power consumption. Also, it has been tried to use a solution to diagnose the overloaded host and eliminate it from the host as it can amend the efficiency as well as improve the host performance. All these will eventually reduce the power consumption. The results of evaluation show that the presented model has better efficiency in reducing the power consumption as well as decreasing the number of the migrations in comparison with the other models.
The goal of this study was to determine the clinical implications of a progressively rising serum... more The goal of this study was to determine the clinical implications of a progressively rising serum CA-125 level in the normal (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 35 U/ml) range in ovarian cancer patients with complete response to therapy. A multi-institutional investigation was undertaken to identify patients with CA-125-producing epithelial ovarian cancers who experienced progressively rising antigen levels in the normal (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;35 U/ml) range after completion of therapy. All patients had (1) histologic documentation of epithelial ovarian cancer and (2) complete clinical remission (CR) as defined by negative imaging studies, normal clinical examination, and a normal (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;35 U/ml) serum CA-125 value. All patients had serum CA-125 determinations at 1- to 3-month intervals after treatment. A rising serum CA-125 level was defined as a progressive increase in at least three CA-125 values above the coefficient of variation (CV) for the assay. No patient had a known episode of pelvic or gastrointestinal inflammatory disease during the period when the progressive rise in serum CA-125 took place. Eleven patients with rising serum CA-125 levels in the normal range were identified. Original stage of disease was as follows: stage IIA, 1; stage IIIC, 10. Cell type was as follows: endometrioid adenocarcinoma, 4; serous adenocarcinoma, 6; clear cell carcinoma, 1. Of the 11 patients identified, all developed recurrent ovarian cancer. Tumor recurrence was documented either by new lesions appearing on imaging studies (6/11) or by histologic confirmation (5/11). The mean time from CR to recurrence was 21 months (median = 22, range = 12-33). The mean time from the third early rising serum CA 125 value to clinical or radiographic confirmation of recurrence was 189 days (range = 84-518). All recurrences were intraabdominal with the exception of one axillary recurrence. In patients with a history of ovarian cancer, three progressively rising serum CA-125 values in the normal range (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 35 U/ml) at 1- to 3-month intervals are associated with a high likelihood of tumor recurrence. Patients with such a pattern should undergo immediate investigation to rule out and/or identify recurrent cancer.
Objective: Chronic stress may promote ovarian cancer progression through autonomic nervous system... more Objective: Chronic stress may promote ovarian cancer progression through autonomic nervous system mediators such as norepinephrine and epinephrine. Beta blockers, commonly used to manage hypertension, block the production of these adrenergic hormones and may prolong survival in breast and prostate cancers. We sought to determine the association between use of beta blockers and epithelial ovarian cancer (EOC) disease progression and survival. After institutional review board approval, we performed a retrospective review of all patients with EOC treated between 1996 and 2006 at our institution. All patients underwent cytoreductive surgery followed by platinum-based chemotherapy. Women were considered beta blocker users if these medications were documented on at least two records more than six months apart. Statistical tests included Fisher's exact, Kaplan-Meier, and Cox regression analyses. Results: Two hundred forty-six patients met criteria for inclusion. Sixty-eight patients were on antihypertensive medications, 23 of whom (9% of the entire cohort) were on beta blockers. Mean ages of hypertensive patients were the same as those on beta-blockers compared with those on other antihypertensive medications (67 years), but were statistically greater compared with ages of nonhypertensive patients (58 years, P < 0.0001). We did not observe differences in the incidence of diabetes or coronary artery disease between the groups. In the entire cohort, 26 (11%) were suboptimally cytoreduced and beta blocker use did not correlate with debulking status. Median progression-free survival for beta blocker users was 27 months, compared with 17 months for non-users (P = 0.05). Similarly, overall disease-specific survival was longer for beta blocker users (56 months) compared with non-users (48 months, P = 0.02, HR = 0.56). Multivariate analysis identified beta blocker use as an independent positive prognostic factor, after controlling for age, stage, grade and cytoreduction status (P = 0.03). In a separate analysis, overall survival remained longer for patients using beta blockers (56 months) when compared with hypertensive patients on other medications (34 months) and patients without hypertension (51 months) (P = 0.007). Conclusions: In this cohort of patients with EOC, beta blocker use reduced the chance of death by 56% compared with that of non-users. A potential suppressive impact of beta blockers on tumor biology should be confirmed in larger prospective trials and correlative translational studies.
To determine the risk of malignancy in septated cystic ovarian tumors. 1319 (4.4%) of 29,829 wome... more To determine the risk of malignancy in septated cystic ovarian tumors. 1319 (4.4%) of 29,829 women were identified by transvaginal sonography (TVS) as having a complex cystic ovarian tumor with septations without solid areas or papillary projections and were placed on long-term ultrasound surveillance for ovarian malignancy. These 1319 patients had a total of 2870 septated cystic ovarian tumors. 2288 tumors (79.7%) had a septal width &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;2 mm and 582 (20.3%) had a septal width &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or=2 mm. 2286 tumors (79.6%) were &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;5 cm in diameter and 584 (20.4%) were&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or=5 cm in diameter. 1114 septated cystic tumors (38.8%) resolved spontaneously (mean duration to resolution-12 months) and 1756 (61.2%) tumors persisted. 128 patients underwent surgical tumor removal within 3 months of ultrasound. Most common histopathology was: serous cystadenoma (75), mucinous cystadenoma (13), and endometrioma (10). One patient had an ovarian tumor of borderline malignancy (Stage IB). There were no cases of ovarian cancer. Patients were followed from 4 to 252 months (mean-77 months). One patient developed papillary morphology in the contralateral ovary 3.2 years after detection of a septated ovarian cyst and had epithelial ovarian cancer in that ovary and in the omentum (Stage IIIC disease). The remaining patients are all free of ovarian neoplasia after a total of 7642 follow-up years. Septated cystic ovarian tumors without solid areas or papillary projections have a low risk of malignancy and can be followed sonographically without surgery.
The lowest premiums at age 50 years were higher in rural areas in contrast to the highest premium... more The lowest premiums at age 50 years were higher in rural areas in contrast to the highest premiums that were less expensive rurally. At age 64 years, the lowest premiums were 9-12.6% of a US$50,000 income, while the most expensive varied between 16.5 and 39%. Access to gynecologic oncologists was variable in different networks. Medicaid enrollment nationally was ∼6× higher than paid enrollment. Eligible participation in Affordable Care Act coverage exceeded expectations by >190%. Performance of four healthcare exchange traded funds indicated that investor confidence is high in the American healthcare sector.
After exposing urological tumor cells to anticancer agents in vitro, cellular esterase activity a... more After exposing urological tumor cells to anticancer agents in vitro, cellular esterase activity and the ability to exclude propidium iodide (PI) were examined as dual indicators of functionality or "viability." High esterase activity/PI exclusion was observed in assays in which anticancer agents failed to inhibit cellular proliferation, while low esterase activity/PI exclusion was often observed when proliferation had been significantly inhibited. In a number of instances, exposure to anticancer agents did produce significant inhibition of proliferation without lowering viability. In this setting, the recovery of proliferative capacity could be demonstrated with several transitional cell carcinoma cell lines, and this recovery was always associated with high esterase activity/PI exclusion. When the proliferation of primary urological tumor preparations was inhibited by drug exposure, estimates of elevated viability were obtained in 27 per cent of the determinations. Thus, ...
The effect of ovarian cancer screening on survival is enabled by women who continue to actively p... more The effect of ovarian cancer screening on survival is enabled by women who continue to actively participate in screening. In this report, factors that affect participation are examined. Participants included 13 963 Kentucky women who received 56 392 screens accounting for a 46 113 screening year experience. Background, health history and reasons for participating in transvaginal sonographic screening were collected via a self-reported questionnaire. Screening participants were characterized as. 50 years old, mostly married, well educated, medically insured, health conscious women, living in the vicinity of the screening centre or 51±150 miles away. Approximately 70% of the participants can be considered active in the study based upon a screening visit during the 1997±1998 2-year period. The probabilities of a return screen at 1, 2, 5 and 7.5 years were 77.8%, 72.0%, 58.7% and 50.6%, respectively. A total of 96% of return visits occurred within 2 years, with 33.7% having intervals of , 1 year. Perceived family history was not observed to affect continuation. However, abnormal findings were associated with a shortened participation. These high levels of continuation in ultrasound screening indicate that women take this disease seriously and demonstrate that this disease is of consequence to them.
The use of VisiCalc and VisiPlot software routines for performing calculations and graphing of da... more The use of VisiCalc and VisiPlot software routines for performing calculations and graphing of data commonly encountered in steroid biochemistry is described. These software routines have utility and are relatively easy to use, requiring little or no programming experience. Use of these routines is demonstrated in terms of data processing associated with chromatography of receptor preparations and equilibrium binding analyses. The execution of these software routines is rapid and can result in a considerable savings of time and personnel. These and other generically similar software routines should have the greatest utility in laboratories where the experimental design is subject to on-going change.
Serial evaluation of tumor morphology index (MI) differentiates between malignant and benign ovar... more Serial evaluation of tumor morphology index (MI) differentiates between malignant and benign ovarian tumors. • Utilization of delta MI allows clinicians to avoid unnecessary surgical evaluations of ovarian tumors.
Thirty-three large felids belonging to six different species were exposed to catnip and catnip ex... more Thirty-three large felids belonging to six different species were exposed to catnip and catnip extract. The species-characteristic response to catnip and the sensitivity of the response to various concentrations of catnip were examined. Putative relationships between catnip sensitivity, species range, age, estrous cycle, and behavioral complexity are discussed. The behavioral response to catnip shown by the domestic cat is seen in several different large felids. Lions and jaguars were extremely sensitive to catnip compared to tigers, cougars, and bobcats, who gave little or no response. Both males and females of the same species tested alike. Reproductive-age adults were more sensitive than either aged or immature animals. It was quantitatively demonstrated that catnip responsiveness is not limited to the domestic cat, that it is not limited to the female, and that it varies dramatically between species and age of felids.
... This work was conducted in the laboratory of Dr. Benita S. Katzenellenbogen whose support and... more ... This work was conducted in the laboratory of Dr. Benita S. Katzenellenbogen whose support and encourage ment is gratefully appreciated. ... 246 (1971) 41884197. 17. Buller RE. Toft D. 0..Schrader WT and O'Malley BW : Progesteronebinding components of chick ovi duct. VIII. ...
Objective.The aim of this study was to document the survival advantage of lowering stage at detec... more Objective.The aim of this study was to document the survival advantage of lowering stage at detection from Stage IIIC to Stage IIIA epithelial ovarian cancer.Methods.Treatment outcomes and survival were evaluated in patients with Stage IIIA and Stage IIIC epithelial ovarian cancer treated from 2000 to 2009 at the University of Kentucky Markey Cancer Center (UKMCC) and SEER institutions.Results.Cytoreduction to no visible disease (P<0.0001) and complete response to platinum-based chemotherapy (P<0.025) occurred more frequently in Stage IIIA than in Stage IIIC cases. Time to progression was shorter in patients with Stage IIIC ovarian cancer (17±1months) than in those with Stage II1A disease (36±8months). Five-year overall survival (OS) improved from 41% in Stage IIIC patients to 60% in Stage IIIA patients treated at UKMCC and from 37% to 56% in patients treated at SEER institutions for a survival advantage of 19% in both data sets. 53% of Stage IIIA and 14% of Stage IIIC patient...
To estimate the effect of ultrasonographic screening on stage at detection and long-term diseases... more To estimate the effect of ultrasonographic screening on stage at detection and long-term diseasespecific survival of women with epithelial ovarian cancer. METHODS: Eligibility included all asymptomatic women aged 50 years and older and women aged 25 years and older with a documented family history of ovarian cancer. From 1987 to 2011, 37,293 women received annual ultrasonographic screening. Women with abnormal screens underwent tumor morphology indexing, serum biomarker analysis, and surgery. RESULTS: Forty-seven invasive epithelial ovarian cancers and 15 epithelial ovarian tumors of low malignant potential were detected. No women with low malignant potential tumors experienced recurrent disease. Stage distribution for invasive epithelial cancers was: stage I, 22 (47%); stage II, 11 (23%); stage III, 14 (30%), and stage IV, 0 (0%). Follow-up varied from 2 months to 20.1 years (mean, 5.8 years). The 5-year survival rate for invasive epithelial ovarian cancers detected by screening was: stage I, 95%؎4.8%; stage II, 77.1%؎14.5%; and stage III, 76.2%؎12.1%. The 5-year survival rate for all women with invasive epithelial ovarian cancer detected by screening as well as interval cancers was 74.8%؎6.6% compared with 53.7%؎2.3% for unscreened women with ovarian cancer from the same institution treated by the same surgical and chemotherapeutic protocols (P<.001). CONCLUSION: Annual ultrasonographic screening of asymptomatic women achieved increased detection of earlystage ovarian cancer cases and an increase in 5-year diseasespecific survival rate for women with ovarian cancer.
Cloud computing is the latest answer of technology to meet the computational requirements of user... more Cloud computing is the latest answer of technology to meet the computational requirements of users. The notable point in complicated computational works is energy consumption. The integration is one of the elements in the cloud system which can reduce the energy consumption and coordinate the software products. In this article, some solutions have been considered for determining the upper bound threshold of utilization for doing migration in order to reduce the power consumption. Also, it has been tried to use a solution to diagnose the overloaded host and eliminate it from the host as it can amend the efficiency as well as improve the host performance. All these will eventually reduce the power consumption. The results of evaluation show that the presented model has better efficiency in reducing the power consumption as well as decreasing the number of the migrations in comparison with the other models.
The goal of this study was to determine the clinical implications of a progressively rising serum... more The goal of this study was to determine the clinical implications of a progressively rising serum CA-125 level in the normal (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 35 U/ml) range in ovarian cancer patients with complete response to therapy. A multi-institutional investigation was undertaken to identify patients with CA-125-producing epithelial ovarian cancers who experienced progressively rising antigen levels in the normal (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;35 U/ml) range after completion of therapy. All patients had (1) histologic documentation of epithelial ovarian cancer and (2) complete clinical remission (CR) as defined by negative imaging studies, normal clinical examination, and a normal (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;35 U/ml) serum CA-125 value. All patients had serum CA-125 determinations at 1- to 3-month intervals after treatment. A rising serum CA-125 level was defined as a progressive increase in at least three CA-125 values above the coefficient of variation (CV) for the assay. No patient had a known episode of pelvic or gastrointestinal inflammatory disease during the period when the progressive rise in serum CA-125 took place. Eleven patients with rising serum CA-125 levels in the normal range were identified. Original stage of disease was as follows: stage IIA, 1; stage IIIC, 10. Cell type was as follows: endometrioid adenocarcinoma, 4; serous adenocarcinoma, 6; clear cell carcinoma, 1. Of the 11 patients identified, all developed recurrent ovarian cancer. Tumor recurrence was documented either by new lesions appearing on imaging studies (6/11) or by histologic confirmation (5/11). The mean time from CR to recurrence was 21 months (median = 22, range = 12-33). The mean time from the third early rising serum CA 125 value to clinical or radiographic confirmation of recurrence was 189 days (range = 84-518). All recurrences were intraabdominal with the exception of one axillary recurrence. In patients with a history of ovarian cancer, three progressively rising serum CA-125 values in the normal range (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 35 U/ml) at 1- to 3-month intervals are associated with a high likelihood of tumor recurrence. Patients with such a pattern should undergo immediate investigation to rule out and/or identify recurrent cancer.
Objective: Chronic stress may promote ovarian cancer progression through autonomic nervous system... more Objective: Chronic stress may promote ovarian cancer progression through autonomic nervous system mediators such as norepinephrine and epinephrine. Beta blockers, commonly used to manage hypertension, block the production of these adrenergic hormones and may prolong survival in breast and prostate cancers. We sought to determine the association between use of beta blockers and epithelial ovarian cancer (EOC) disease progression and survival. After institutional review board approval, we performed a retrospective review of all patients with EOC treated between 1996 and 2006 at our institution. All patients underwent cytoreductive surgery followed by platinum-based chemotherapy. Women were considered beta blocker users if these medications were documented on at least two records more than six months apart. Statistical tests included Fisher's exact, Kaplan-Meier, and Cox regression analyses. Results: Two hundred forty-six patients met criteria for inclusion. Sixty-eight patients were on antihypertensive medications, 23 of whom (9% of the entire cohort) were on beta blockers. Mean ages of hypertensive patients were the same as those on beta-blockers compared with those on other antihypertensive medications (67 years), but were statistically greater compared with ages of nonhypertensive patients (58 years, P < 0.0001). We did not observe differences in the incidence of diabetes or coronary artery disease between the groups. In the entire cohort, 26 (11%) were suboptimally cytoreduced and beta blocker use did not correlate with debulking status. Median progression-free survival for beta blocker users was 27 months, compared with 17 months for non-users (P = 0.05). Similarly, overall disease-specific survival was longer for beta blocker users (56 months) compared with non-users (48 months, P = 0.02, HR = 0.56). Multivariate analysis identified beta blocker use as an independent positive prognostic factor, after controlling for age, stage, grade and cytoreduction status (P = 0.03). In a separate analysis, overall survival remained longer for patients using beta blockers (56 months) when compared with hypertensive patients on other medications (34 months) and patients without hypertension (51 months) (P = 0.007). Conclusions: In this cohort of patients with EOC, beta blocker use reduced the chance of death by 56% compared with that of non-users. A potential suppressive impact of beta blockers on tumor biology should be confirmed in larger prospective trials and correlative translational studies.
To determine the risk of malignancy in septated cystic ovarian tumors. 1319 (4.4%) of 29,829 wome... more To determine the risk of malignancy in septated cystic ovarian tumors. 1319 (4.4%) of 29,829 women were identified by transvaginal sonography (TVS) as having a complex cystic ovarian tumor with septations without solid areas or papillary projections and were placed on long-term ultrasound surveillance for ovarian malignancy. These 1319 patients had a total of 2870 septated cystic ovarian tumors. 2288 tumors (79.7%) had a septal width &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;2 mm and 582 (20.3%) had a septal width &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or=2 mm. 2286 tumors (79.6%) were &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;5 cm in diameter and 584 (20.4%) were&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or=5 cm in diameter. 1114 septated cystic tumors (38.8%) resolved spontaneously (mean duration to resolution-12 months) and 1756 (61.2%) tumors persisted. 128 patients underwent surgical tumor removal within 3 months of ultrasound. Most common histopathology was: serous cystadenoma (75), mucinous cystadenoma (13), and endometrioma (10). One patient had an ovarian tumor of borderline malignancy (Stage IB). There were no cases of ovarian cancer. Patients were followed from 4 to 252 months (mean-77 months). One patient developed papillary morphology in the contralateral ovary 3.2 years after detection of a septated ovarian cyst and had epithelial ovarian cancer in that ovary and in the omentum (Stage IIIC disease). The remaining patients are all free of ovarian neoplasia after a total of 7642 follow-up years. Septated cystic ovarian tumors without solid areas or papillary projections have a low risk of malignancy and can be followed sonographically without surgery.
The lowest premiums at age 50 years were higher in rural areas in contrast to the highest premium... more The lowest premiums at age 50 years were higher in rural areas in contrast to the highest premiums that were less expensive rurally. At age 64 years, the lowest premiums were 9-12.6% of a US$50,000 income, while the most expensive varied between 16.5 and 39%. Access to gynecologic oncologists was variable in different networks. Medicaid enrollment nationally was ∼6× higher than paid enrollment. Eligible participation in Affordable Care Act coverage exceeded expectations by >190%. Performance of four healthcare exchange traded funds indicated that investor confidence is high in the American healthcare sector.
After exposing urological tumor cells to anticancer agents in vitro, cellular esterase activity a... more After exposing urological tumor cells to anticancer agents in vitro, cellular esterase activity and the ability to exclude propidium iodide (PI) were examined as dual indicators of functionality or "viability." High esterase activity/PI exclusion was observed in assays in which anticancer agents failed to inhibit cellular proliferation, while low esterase activity/PI exclusion was often observed when proliferation had been significantly inhibited. In a number of instances, exposure to anticancer agents did produce significant inhibition of proliferation without lowering viability. In this setting, the recovery of proliferative capacity could be demonstrated with several transitional cell carcinoma cell lines, and this recovery was always associated with high esterase activity/PI exclusion. When the proliferation of primary urological tumor preparations was inhibited by drug exposure, estimates of elevated viability were obtained in 27 per cent of the determinations. Thus, ...
The effect of ovarian cancer screening on survival is enabled by women who continue to actively p... more The effect of ovarian cancer screening on survival is enabled by women who continue to actively participate in screening. In this report, factors that affect participation are examined. Participants included 13 963 Kentucky women who received 56 392 screens accounting for a 46 113 screening year experience. Background, health history and reasons for participating in transvaginal sonographic screening were collected via a self-reported questionnaire. Screening participants were characterized as. 50 years old, mostly married, well educated, medically insured, health conscious women, living in the vicinity of the screening centre or 51±150 miles away. Approximately 70% of the participants can be considered active in the study based upon a screening visit during the 1997±1998 2-year period. The probabilities of a return screen at 1, 2, 5 and 7.5 years were 77.8%, 72.0%, 58.7% and 50.6%, respectively. A total of 96% of return visits occurred within 2 years, with 33.7% having intervals of , 1 year. Perceived family history was not observed to affect continuation. However, abnormal findings were associated with a shortened participation. These high levels of continuation in ultrasound screening indicate that women take this disease seriously and demonstrate that this disease is of consequence to them.
The use of VisiCalc and VisiPlot software routines for performing calculations and graphing of da... more The use of VisiCalc and VisiPlot software routines for performing calculations and graphing of data commonly encountered in steroid biochemistry is described. These software routines have utility and are relatively easy to use, requiring little or no programming experience. Use of these routines is demonstrated in terms of data processing associated with chromatography of receptor preparations and equilibrium binding analyses. The execution of these software routines is rapid and can result in a considerable savings of time and personnel. These and other generically similar software routines should have the greatest utility in laboratories where the experimental design is subject to on-going change.
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