Proc Amer Assoc Cancer Res, Volume 47, 2006 4559 Air pollution particulate matter (PM) is associa... more Proc Amer Assoc Cancer Res, Volume 47, 2006 4559 Air pollution particulate matter (PM) is associated with lung cancer risk. Copper, iron, nickel, vanadium, and zinc are in airborne PM, and cadmium, nickel, and zinc are in tobacco smoke. Cadmium and nickel, as well as several other metals released into air by industry are human lung carcinogens. We conducted an ecological study to examine the association of industrial air releases for metals with lung cancer incidence in Texas. During 1995-2000, 81,132 lung cancer cases were reported in Texas. We identified metals that: (1) are in airborne PM or tobacco smoke, or are human lung carcinogens, and (2) had consistent Environmental Protection Agency reporting for air releases for multiple counties during 1988-2000. We examined the association of metal air releases with average annual age-adjusted rates for lung and non-small cell lung cancer, and lung adenocarcinoma at the county level. Univariate analysis indicated the following positive associations: (1) zinc with the lung cancer ( p = 0.02), non-small cell lung cancer (p < 0.01), and lung adenocarcinoma rates ( p = 0.04), (2) chromium ( p = 0.01) and copper ( p = 0.01) with the non-small cell lung cancer rate, and (3) chromium ( p < 0.01), nickel ( p = 0.01), and vanadium ( p = 0.01) with the lung adenocarcinoma rate. In the multivariate analyses, risk adjusted for sex, race and ethnicity, zinc was positively associated with the non-small lung cancer rate (β = 0.12, p = 0.03), and vanadium (β = 0.10, p = 0.03) was positively associated with the lung adenocarcinoma rate. The study provides new information suggesting that metals, including those that are nutritionally required, play an important role in lung carcinogenesis, particularly for the non-small cell and adenocarcinoma pathologic subtypes. Thus, since metals can be inhaled in substantial quantities, especially in urban environments due to industrial air releases, emissions of PM air pollutants, and tobacco smoke exposure, it will be important to conduct future studies to determine the role of metals in lung carcinogenesis.
BackgroundCurrent evidence is inconsistent on the benefits of aerobic exercise training for preve... more BackgroundCurrent evidence is inconsistent on the benefits of aerobic exercise training for preventing or attenuating age‐related cognitive decline in older adults.ObjectiveTo investigate the effects of a 1‐year progressive, moderate‐to‐high intensity aerobic exercise intervention on cognitive function, brain volume, and cortical thickness in sedentary but otherwise healthy older adults.MethodsWe randomized 73 older adults to a 1‐year aerobic exercise or stretching‐and‐toning (active control) program. The primary outcome was a cognitive composite score calculated from eight neuropsychological tests encompassing inductive reasoning, long‐term and working memory, executive function, and processing speed. Secondary outcomes were brain volume and cortical thickness assessed by MRI, and cardiorespiratory fitness measured by peak oxygen uptake (VO2).ResultsOne‐year aerobic exercise increased peak VO2 by ∼10% (p &lt; 0.001) while it did not change with stretching (p = 0.241). Cognitive composite scores increased in both the aerobic and stretching groups (p &lt; 0.001 for time effect), although no group difference was observed. Total brain volume (p &lt; 0.001) and mean cortical thickness (p = 0.001) decreased in both groups over time, while the reduction in hippocampal volume was smaller in the stretching group compared with the aerobic group (p = 0.040 for interaction). Across all participants, improvement in peak VO2 was positively correlated with increases in cognitive composite score (r = 0.282, p = 0.042) and regional cortical thickness at the inferior parietal lobe (p = 0.016).ConclusionsOne‐year aerobic exercise and stretching interventions improved cognitive performance but did not prevent age‐related brain volume loss in sedentary healthy older adults. Cardiorespiratory fitness gain was positively correlated with cognitive performance and regional cortical thickness.
The validity of the Rorschach as an instrument to assess impulsivity was examined in a sample of ... more The validity of the Rorschach as an instrument to assess impulsivity was examined in a sample of 55 adolescent psychiatric inpatients. The Rorschach variables considered to be related to impulsivity (D, Adjusted D, M, Afr, X + %, FC:CF+C, and L) were used to predict performance on the Gordon Diagnostic System (GDS). Only the discriminant function for the GDS Delay Task (which assesses the ability to formulate response strategies and to benefit from feedback) was statistically significant, with a 76.36% correct classification of subjects. The Rorschach variables with the highest correlations within the discriminant function were D, FC:CF+C, and M. The results of this study appeared to provide some support for the utility of the Rorschach in the assessment of impulsivity.
Journal of Diabetes and Its Complications, Dec 1, 2019
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Platelets, like neurons, contain 120-to 130-and 110-kd amyloid precursor proteins (APPs). Their r... more Platelets, like neurons, contain 120-to 130-and 110-kd amyloid precursor proteins (APPs). Their ratio is reduced in AD, further reductions correlating with reduced Mini-Mental Status Examination scores [r(11) ϭ 0.69, p Ͻ 0.05]. As statins alter APP processing, platelet APPs were analyzed in patients with AD given anticholesterol drugs for 6 weeks. APP ratios increased [t(37) ϭ Ϫ3.888, p ϭ 0.0004], proportionally with reduced cholesterol [r(36) ϭ Ϫ0.45, p ϭ 0.005]. Longer trials may reveal slowed cognitive loss, validating this index.
The purpose of this study was to identify factors predictive of shuntdependent hydrocephalus amon... more The purpose of this study was to identify factors predictive of shuntdependent hydrocephalus among patients with aneurysmal subarachnoid hemorrhage. The data can be used to predict which patients in this group have a high probability of requiring permanent cerebrospinal fluid diversion. METHODS: Seven hundred eighteen patients with aneurysmal subarachnoid hemorrhage who were treated between 1990 and 1999 were retrospectively studied, to identify factors contributing to shunt-dependent hydrocephalus. With these data, a stepwise logistic regression procedure was used to determine the effect of each variable on the development of hydrocephalus and to create a scoring system. RESULTS: Overall, 152 of the 718 patients (21.2%) underwent shunting procedures for treatment of hydrocephalus. Four hundred seventy-nine of the patients (66.7%) were female. Of the factors investigated, the following were associated with shuntdependent hydrocephalus, as determined with a variety of statistical methods: 1) increasing age (P Ͻ 0.001), 2) female sex (P ϭ 0.015), 3) poor admission Hunt and Hess grade (P Ͻ 0.001), 4) thick subarachnoid hemorrhage on admission computed tomographic scans (P Ͻ 0.001), 5) intraventricular hemorrhage (P Ͻ 0.001), 6) radiological hydrocephalus at the time of admission (P Ͻ 0.001), 7) distal posterior circulation location of the ruptured aneurysm (P ϭ 0.046), 8) clinical vasospasm (P Ͻ 0.001), and 9) endovascular treatment (P ϭ 0.013). The presence of intracerebral hematomas, giant aneurysms, or multiple aneurysms did not influence the development of shunt-dependent hydrocephalus. The results of this study can help identify patients with a high risk of developing shunt-dependent hydrocephalus. This may help neurosurgeons expedite treatment, may decrease the cost and length of hospital stays, and may result in improved outcomes.
Patients with systemic lupus erythematosus (SLE) harbor an increased risk for developing addition... more Patients with systemic lupus erythematosus (SLE) harbor an increased risk for developing additional autoimmune diseases. A recent cross-sectional study reported that cutaneous lupus erythematosus (CLE) patients without SLE also had significantly elevated rates of co-existing autoimmune disease(s). In a case-control study, we characterized the timing and prevalence of autoimmune diseases in a group of 122 CLE patients in relation to their CLE diagnosis and identified demographic and clinical factors associated with the presence of additional autoimmune diagnosis. 117 patients with SLE were used as controls. At the time of lupus diagnosis, 12.3% of CLE and 16.2% of SLE patients had a prior-onset autoimmune disease (P=0.383). After lupus diagnosis, 19.7% of CLE and 17.95% of SLE patients had a new-onset autoimmune disease (P=0.687). For CLE patients, the most common prior-onset and new-onset diagnoses were autoimmune thyroid disease and SLE, respectively. Univariate analysis showed that patients with prior-onset disease were older (P=0.019) and more likely to be antinuclear antibody (ANA) positive (P<0.001) at CLE diagnosis. Patients with new-onset autoimmune disease were more likely to be ANA positive at any point during follow-up (P=0.001). Multivariate analyses showed that positive ANA was significantly associated with prior-onset [odds ratio (OR) 6.95, P=0.001] and new-onset autoimmune diagnosis (OR 5.65, P=0.003). These results demonstrated an elevated and persistent risk for acquiring autoimmune diseases in CLE patients similar to that seen for SLE patients. CLE patients with positive ANA histories have an even greater risk for additional autoimmune conditions, which may help providers focus their screenings.
Female pelvic medicine & reconstructive surgery, 2021
Objectives To provide the rationale and design for a randomized, double-blind clinical trial of c... more Objectives To provide the rationale and design for a randomized, double-blind clinical trial of conjugated estrogen vaginal cream (applied for at least 5 weeks preoperatively and continued twice-weekly through 12 months postoperatively) compared with placebo in postmenopausal women with symptomatic pelvic organ prolapse undergoing a standardized transvaginal native tissue apical repair. Methods Study population, randomization process, study cream intervention, masking of participants and evaluators, placebo cream manufacture, standardized surgical intervention, and collection of adverse events are described. The primary outcome of surgical success is a composite of objectively no prolapse beyond the hymen and the vaginal cuff descending no more than one third the vaginal length; subjectively, no sense of vaginal pressure or bulging; and no retreatment for prolapse at 12 months. Time-to-failure postoperatively will be compared in the 2 groups with continued surveillance to 36 months. Secondary outcomes assessed at baseline, preoperatively (ie, after at least 5 weeks of study cream), and postoperatively at 6 month intervals include validated condition-specific and general quality-of-life metrics, overall impression of improvement, sexual function, vaginal atrophy symptoms, and body image. Challenges unique to this study include design and manufacture of placebo and defining and measuring study drug adherence. Results Recruitment of 204 women is complete with 197 randomized. There have been 174 surgeries completed with 15 more pending; 111 have completed their 12 month postoperative visit. Conclusions This trial will contribute evidence-based information regarding the effect of perioperative vaginal estrogen as an adjunct therapy to standardized transvaginal native tissue prolapse surgical repair.
Importance Increased rates of autoimmune conditions have been reported in association with system... more Importance Increased rates of autoimmune conditions have been reported in association with systemic lupus erythematosus (SLE). Little is known about coexisting autoimmune conditions in patients with cutaneous lupus erythematosus (CLE) without SLE. Objective To determine the prevalence and risk factors of having coexisting autoimmune conditions in patients with CLE. Design, Setting, and Participants This cross-sectional study was performed from November 2008 to February 2017 at the University of Texas Southwestern Medical Center (UTSW) and Parkland Health and Hospital System, Dallas, Texas. Participants were identified through the UTSW Cutaneous Lupus Registry. All participants had a dermatologist-confirmed diagnosis of CLE using clinicopathological correlation. Exclusion criteria included age younger than 18 years, and meeting at least 4 American College of Rheumatology diagnostic criteria for SLE. Participants with CLE and without concomitant autoimmune diseases were compared by demographic and disease characteristics. Main Outcomes and Measures The primary and secondary outcomes were presence of coexisting autoimmune condition(s) and individual autoimmune diseases, respectively. Predictor variables significantly associated with coexisting autoimmune diseases were identified by univariate and multivariable logistic regression analyses. Results Among the 285 participants initially screened, 129 participants with CLE were included (102 [79.1%] female; median age, 49 years [interquartile range, 38.3-57.1 years]). Coexisting autoimmune conditions were found in 23 (17.8%). Autoimmune thyroid disease had the highest frequency at 4.7% (n = 6). Multivariable logistic regression analyses showed that patients with CLE who were white (odds ratio [OR], 2.88; 95% CI, 1.00-8.29; P = .0498), never smokers (OR, 3.28; 95% CI, 1.14-9.39; P = .03), had family history of autoimmune disease (OR, 3.54; 95% CI, 1.21-10.39; P = .02), and history of positive antinuclear antibody test result (OR, 4.87; 95% CI, 1.69-14.03; P = .003) had a significant association with having coexisting autoimmune conditions. Conclusions and Relevance This study suggests that patients with CLE without concurrent SLE can have increased rates of coexisting autoimmune conditions. Collecting a thorough review of systems can prompt clinicians to pursue further testing and evaluation by other specialists. Future studies investigating development of coexisting autoimmune conditions over time in the CLE population are necessary to confirm these findings.
Baylor University Medical Center Proceedings, Mar 15, 2018
Psychological distress in cancer is a well-documented phenomenon, but additional information is n... more Psychological distress in cancer is a well-documented phenomenon, but additional information is needed about demographic and disease correlates in diverse populations with different forms of cancer. This study focused on gynecologic cancers. Using the Distress Thermometer and the Hospital Anxiety and Depression Scale, this study examined distress levels in 94 women with gynecologic cancer who were being treated as outpatients at a large urban medical center. The distress levels in this sample were lower than in comparable studies, raising questions about openness to reporting distress. Those who reported higher levels of distress were more likely to also report a mental health diagnosis or psychiatric medication. This suggests that an alternate form for distress screening may involve inquiring about mental health treatment. In this sample, younger women and those with higher educational achievement or private health insurance had higher levels of distress. Conversely, there were no relations between distress levels and disease characteristics, indicating that, for example, women with early stage disease have just as much risk of distress as those with later-stage disease.
3223 Background: Physical activity reduces breast cancer risk by 20-30%. Thus, it would be import... more 3223 Background: Physical activity reduces breast cancer risk by 20-30%. Thus, it would be important to determine if epigenetic markers for breast cancer can be used to monitor the effectiveness of physical activity interventions for breast cancer prevention. Physical activity may lower the cumulative level of lifetime exposure to circulating estrogens as the result of absent or shorter menstrual cycles. Although the relationship between estrogen and the DNA-methylation of promoter regions of genes is unknown, there is evidence in mice that estradiol and diethylstilbestrol elicit DNA methylation changes that results in uterine tumors. Recently, it has been shown that aberrant DNA methylation of tumor suppressor genes (TSGs), RASSF1A and APC, in benign breast tissue is associated with higher breast cancer risk, measured by the Gail model. Methods: We conducted a case-control study in pre- and post-menopausal women without breast cancer to determine the effect of lifetime physical activity on the DNA methylation status of the APC and RASSF1A TSGs in benign breast tissue. Lifetime physical activity for all types (occupation, household, and exercise and sports) was obtained by an interviewer-administered questionnaire, and converted into metabolic equivalent (MET) hrs/wk. Breast cells were obtained using random periareolar fine-needle aspiration. DNA methylation status for the APC and RASSF1A TSGs in genomic DNA derived from breast cells was determined using methylation-specific PCR. Two independent samples t test analyses was performed to determine the difference between MET hrs/wk for lifetime physical activity and its different types with and without aberrant methylation for the APC and RASSF1A TSGs in breast cells. Results: Thirty-one women participated in the study. Aberrant methylation for the APC, RASSF1A, and APC + RASSF1A genes was noted in 9, 13, and 7 study subjects respectively. Lifetime physical activity was inversely associated with aberrant methylation for the APC and APC + RASSF1A genes, with P = 0.22 and P = 0.29 respectively. Lifetime physical activity for sports and exercise as a type had the highest inverse association with aberrant methylation for the APC and APC + RASSF1A genes, with P = 0.07 and P = 0.24 respectively. Also, lifetime physical activity for occupation as a type had a positive association with aberrant methylation for the APC, RASSF1A, and APC + RASSF1A genes, with P = 0.46, P = 0.21, and P = 0.37 respectively. Conclusions: The study, based on the trend in its current sample, suggests that lifetime physical activity, primarily sports and exercise, is inversely associated with aberrant methylation for the APC and RASSF1A genes individually and the APC + RASSF1A genes combined. Also, higher psychological stress levels at work may reduce the cancer protective effect of occupational physical activity, or that those with lower sports and exercise physical activity over-reported for occupational physical activity.
Journal of Autism and Developmental Disorders, Jan 2, 2021
Motor differences are common in Autism Spectrum Disorder (ASD), but rarely evaluated against diag... more Motor differences are common in Autism Spectrum Disorder (ASD), but rarely evaluated against diagnostic criteria for Developmental Coordination Disorder (DCD). We aimed to determine whether motor problems in ASD represent the possible co-occurrence of DCD. We retrospectively reviewed standardized assessments and parent-reports to evaluate motor ability in 43 individuals with ASD against diagnostic criteria for DCD, and compared to 18 individuals with DCD. Over 97% of cases in the ASD group scored below the 16th percentile in motor ability, with most below the 5th percentile. Over 90% of cases in the ASD group met criteria for co-occurring DCD. Motor challenges are a clinically-significant problem in ASD; systematically assessing the prevalence of co-occurring ASD + DCD is necessary to optimize assessment and intervention.
Proc Amer Assoc Cancer Res, Volume 47, 2006 4559 Air pollution particulate matter (PM) is associa... more Proc Amer Assoc Cancer Res, Volume 47, 2006 4559 Air pollution particulate matter (PM) is associated with lung cancer risk. Copper, iron, nickel, vanadium, and zinc are in airborne PM, and cadmium, nickel, and zinc are in tobacco smoke. Cadmium and nickel, as well as several other metals released into air by industry are human lung carcinogens. We conducted an ecological study to examine the association of industrial air releases for metals with lung cancer incidence in Texas. During 1995-2000, 81,132 lung cancer cases were reported in Texas. We identified metals that: (1) are in airborne PM or tobacco smoke, or are human lung carcinogens, and (2) had consistent Environmental Protection Agency reporting for air releases for multiple counties during 1988-2000. We examined the association of metal air releases with average annual age-adjusted rates for lung and non-small cell lung cancer, and lung adenocarcinoma at the county level. Univariate analysis indicated the following positive associations: (1) zinc with the lung cancer ( p = 0.02), non-small cell lung cancer (p < 0.01), and lung adenocarcinoma rates ( p = 0.04), (2) chromium ( p = 0.01) and copper ( p = 0.01) with the non-small cell lung cancer rate, and (3) chromium ( p < 0.01), nickel ( p = 0.01), and vanadium ( p = 0.01) with the lung adenocarcinoma rate. In the multivariate analyses, risk adjusted for sex, race and ethnicity, zinc was positively associated with the non-small lung cancer rate (β = 0.12, p = 0.03), and vanadium (β = 0.10, p = 0.03) was positively associated with the lung adenocarcinoma rate. The study provides new information suggesting that metals, including those that are nutritionally required, play an important role in lung carcinogenesis, particularly for the non-small cell and adenocarcinoma pathologic subtypes. Thus, since metals can be inhaled in substantial quantities, especially in urban environments due to industrial air releases, emissions of PM air pollutants, and tobacco smoke exposure, it will be important to conduct future studies to determine the role of metals in lung carcinogenesis.
BackgroundCurrent evidence is inconsistent on the benefits of aerobic exercise training for preve... more BackgroundCurrent evidence is inconsistent on the benefits of aerobic exercise training for preventing or attenuating age‐related cognitive decline in older adults.ObjectiveTo investigate the effects of a 1‐year progressive, moderate‐to‐high intensity aerobic exercise intervention on cognitive function, brain volume, and cortical thickness in sedentary but otherwise healthy older adults.MethodsWe randomized 73 older adults to a 1‐year aerobic exercise or stretching‐and‐toning (active control) program. The primary outcome was a cognitive composite score calculated from eight neuropsychological tests encompassing inductive reasoning, long‐term and working memory, executive function, and processing speed. Secondary outcomes were brain volume and cortical thickness assessed by MRI, and cardiorespiratory fitness measured by peak oxygen uptake (VO2).ResultsOne‐year aerobic exercise increased peak VO2 by ∼10% (p &lt; 0.001) while it did not change with stretching (p = 0.241). Cognitive composite scores increased in both the aerobic and stretching groups (p &lt; 0.001 for time effect), although no group difference was observed. Total brain volume (p &lt; 0.001) and mean cortical thickness (p = 0.001) decreased in both groups over time, while the reduction in hippocampal volume was smaller in the stretching group compared with the aerobic group (p = 0.040 for interaction). Across all participants, improvement in peak VO2 was positively correlated with increases in cognitive composite score (r = 0.282, p = 0.042) and regional cortical thickness at the inferior parietal lobe (p = 0.016).ConclusionsOne‐year aerobic exercise and stretching interventions improved cognitive performance but did not prevent age‐related brain volume loss in sedentary healthy older adults. Cardiorespiratory fitness gain was positively correlated with cognitive performance and regional cortical thickness.
The validity of the Rorschach as an instrument to assess impulsivity was examined in a sample of ... more The validity of the Rorschach as an instrument to assess impulsivity was examined in a sample of 55 adolescent psychiatric inpatients. The Rorschach variables considered to be related to impulsivity (D, Adjusted D, M, Afr, X + %, FC:CF+C, and L) were used to predict performance on the Gordon Diagnostic System (GDS). Only the discriminant function for the GDS Delay Task (which assesses the ability to formulate response strategies and to benefit from feedback) was statistically significant, with a 76.36% correct classification of subjects. The Rorschach variables with the highest correlations within the discriminant function were D, FC:CF+C, and M. The results of this study appeared to provide some support for the utility of the Rorschach in the assessment of impulsivity.
Journal of Diabetes and Its Complications, Dec 1, 2019
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Platelets, like neurons, contain 120-to 130-and 110-kd amyloid precursor proteins (APPs). Their r... more Platelets, like neurons, contain 120-to 130-and 110-kd amyloid precursor proteins (APPs). Their ratio is reduced in AD, further reductions correlating with reduced Mini-Mental Status Examination scores [r(11) ϭ 0.69, p Ͻ 0.05]. As statins alter APP processing, platelet APPs were analyzed in patients with AD given anticholesterol drugs for 6 weeks. APP ratios increased [t(37) ϭ Ϫ3.888, p ϭ 0.0004], proportionally with reduced cholesterol [r(36) ϭ Ϫ0.45, p ϭ 0.005]. Longer trials may reveal slowed cognitive loss, validating this index.
The purpose of this study was to identify factors predictive of shuntdependent hydrocephalus amon... more The purpose of this study was to identify factors predictive of shuntdependent hydrocephalus among patients with aneurysmal subarachnoid hemorrhage. The data can be used to predict which patients in this group have a high probability of requiring permanent cerebrospinal fluid diversion. METHODS: Seven hundred eighteen patients with aneurysmal subarachnoid hemorrhage who were treated between 1990 and 1999 were retrospectively studied, to identify factors contributing to shunt-dependent hydrocephalus. With these data, a stepwise logistic regression procedure was used to determine the effect of each variable on the development of hydrocephalus and to create a scoring system. RESULTS: Overall, 152 of the 718 patients (21.2%) underwent shunting procedures for treatment of hydrocephalus. Four hundred seventy-nine of the patients (66.7%) were female. Of the factors investigated, the following were associated with shuntdependent hydrocephalus, as determined with a variety of statistical methods: 1) increasing age (P Ͻ 0.001), 2) female sex (P ϭ 0.015), 3) poor admission Hunt and Hess grade (P Ͻ 0.001), 4) thick subarachnoid hemorrhage on admission computed tomographic scans (P Ͻ 0.001), 5) intraventricular hemorrhage (P Ͻ 0.001), 6) radiological hydrocephalus at the time of admission (P Ͻ 0.001), 7) distal posterior circulation location of the ruptured aneurysm (P ϭ 0.046), 8) clinical vasospasm (P Ͻ 0.001), and 9) endovascular treatment (P ϭ 0.013). The presence of intracerebral hematomas, giant aneurysms, or multiple aneurysms did not influence the development of shunt-dependent hydrocephalus. The results of this study can help identify patients with a high risk of developing shunt-dependent hydrocephalus. This may help neurosurgeons expedite treatment, may decrease the cost and length of hospital stays, and may result in improved outcomes.
Patients with systemic lupus erythematosus (SLE) harbor an increased risk for developing addition... more Patients with systemic lupus erythematosus (SLE) harbor an increased risk for developing additional autoimmune diseases. A recent cross-sectional study reported that cutaneous lupus erythematosus (CLE) patients without SLE also had significantly elevated rates of co-existing autoimmune disease(s). In a case-control study, we characterized the timing and prevalence of autoimmune diseases in a group of 122 CLE patients in relation to their CLE diagnosis and identified demographic and clinical factors associated with the presence of additional autoimmune diagnosis. 117 patients with SLE were used as controls. At the time of lupus diagnosis, 12.3% of CLE and 16.2% of SLE patients had a prior-onset autoimmune disease (P=0.383). After lupus diagnosis, 19.7% of CLE and 17.95% of SLE patients had a new-onset autoimmune disease (P=0.687). For CLE patients, the most common prior-onset and new-onset diagnoses were autoimmune thyroid disease and SLE, respectively. Univariate analysis showed that patients with prior-onset disease were older (P=0.019) and more likely to be antinuclear antibody (ANA) positive (P<0.001) at CLE diagnosis. Patients with new-onset autoimmune disease were more likely to be ANA positive at any point during follow-up (P=0.001). Multivariate analyses showed that positive ANA was significantly associated with prior-onset [odds ratio (OR) 6.95, P=0.001] and new-onset autoimmune diagnosis (OR 5.65, P=0.003). These results demonstrated an elevated and persistent risk for acquiring autoimmune diseases in CLE patients similar to that seen for SLE patients. CLE patients with positive ANA histories have an even greater risk for additional autoimmune conditions, which may help providers focus their screenings.
Female pelvic medicine & reconstructive surgery, 2021
Objectives To provide the rationale and design for a randomized, double-blind clinical trial of c... more Objectives To provide the rationale and design for a randomized, double-blind clinical trial of conjugated estrogen vaginal cream (applied for at least 5 weeks preoperatively and continued twice-weekly through 12 months postoperatively) compared with placebo in postmenopausal women with symptomatic pelvic organ prolapse undergoing a standardized transvaginal native tissue apical repair. Methods Study population, randomization process, study cream intervention, masking of participants and evaluators, placebo cream manufacture, standardized surgical intervention, and collection of adverse events are described. The primary outcome of surgical success is a composite of objectively no prolapse beyond the hymen and the vaginal cuff descending no more than one third the vaginal length; subjectively, no sense of vaginal pressure or bulging; and no retreatment for prolapse at 12 months. Time-to-failure postoperatively will be compared in the 2 groups with continued surveillance to 36 months. Secondary outcomes assessed at baseline, preoperatively (ie, after at least 5 weeks of study cream), and postoperatively at 6 month intervals include validated condition-specific and general quality-of-life metrics, overall impression of improvement, sexual function, vaginal atrophy symptoms, and body image. Challenges unique to this study include design and manufacture of placebo and defining and measuring study drug adherence. Results Recruitment of 204 women is complete with 197 randomized. There have been 174 surgeries completed with 15 more pending; 111 have completed their 12 month postoperative visit. Conclusions This trial will contribute evidence-based information regarding the effect of perioperative vaginal estrogen as an adjunct therapy to standardized transvaginal native tissue prolapse surgical repair.
Importance Increased rates of autoimmune conditions have been reported in association with system... more Importance Increased rates of autoimmune conditions have been reported in association with systemic lupus erythematosus (SLE). Little is known about coexisting autoimmune conditions in patients with cutaneous lupus erythematosus (CLE) without SLE. Objective To determine the prevalence and risk factors of having coexisting autoimmune conditions in patients with CLE. Design, Setting, and Participants This cross-sectional study was performed from November 2008 to February 2017 at the University of Texas Southwestern Medical Center (UTSW) and Parkland Health and Hospital System, Dallas, Texas. Participants were identified through the UTSW Cutaneous Lupus Registry. All participants had a dermatologist-confirmed diagnosis of CLE using clinicopathological correlation. Exclusion criteria included age younger than 18 years, and meeting at least 4 American College of Rheumatology diagnostic criteria for SLE. Participants with CLE and without concomitant autoimmune diseases were compared by demographic and disease characteristics. Main Outcomes and Measures The primary and secondary outcomes were presence of coexisting autoimmune condition(s) and individual autoimmune diseases, respectively. Predictor variables significantly associated with coexisting autoimmune diseases were identified by univariate and multivariable logistic regression analyses. Results Among the 285 participants initially screened, 129 participants with CLE were included (102 [79.1%] female; median age, 49 years [interquartile range, 38.3-57.1 years]). Coexisting autoimmune conditions were found in 23 (17.8%). Autoimmune thyroid disease had the highest frequency at 4.7% (n = 6). Multivariable logistic regression analyses showed that patients with CLE who were white (odds ratio [OR], 2.88; 95% CI, 1.00-8.29; P = .0498), never smokers (OR, 3.28; 95% CI, 1.14-9.39; P = .03), had family history of autoimmune disease (OR, 3.54; 95% CI, 1.21-10.39; P = .02), and history of positive antinuclear antibody test result (OR, 4.87; 95% CI, 1.69-14.03; P = .003) had a significant association with having coexisting autoimmune conditions. Conclusions and Relevance This study suggests that patients with CLE without concurrent SLE can have increased rates of coexisting autoimmune conditions. Collecting a thorough review of systems can prompt clinicians to pursue further testing and evaluation by other specialists. Future studies investigating development of coexisting autoimmune conditions over time in the CLE population are necessary to confirm these findings.
Baylor University Medical Center Proceedings, Mar 15, 2018
Psychological distress in cancer is a well-documented phenomenon, but additional information is n... more Psychological distress in cancer is a well-documented phenomenon, but additional information is needed about demographic and disease correlates in diverse populations with different forms of cancer. This study focused on gynecologic cancers. Using the Distress Thermometer and the Hospital Anxiety and Depression Scale, this study examined distress levels in 94 women with gynecologic cancer who were being treated as outpatients at a large urban medical center. The distress levels in this sample were lower than in comparable studies, raising questions about openness to reporting distress. Those who reported higher levels of distress were more likely to also report a mental health diagnosis or psychiatric medication. This suggests that an alternate form for distress screening may involve inquiring about mental health treatment. In this sample, younger women and those with higher educational achievement or private health insurance had higher levels of distress. Conversely, there were no relations between distress levels and disease characteristics, indicating that, for example, women with early stage disease have just as much risk of distress as those with later-stage disease.
3223 Background: Physical activity reduces breast cancer risk by 20-30%. Thus, it would be import... more 3223 Background: Physical activity reduces breast cancer risk by 20-30%. Thus, it would be important to determine if epigenetic markers for breast cancer can be used to monitor the effectiveness of physical activity interventions for breast cancer prevention. Physical activity may lower the cumulative level of lifetime exposure to circulating estrogens as the result of absent or shorter menstrual cycles. Although the relationship between estrogen and the DNA-methylation of promoter regions of genes is unknown, there is evidence in mice that estradiol and diethylstilbestrol elicit DNA methylation changes that results in uterine tumors. Recently, it has been shown that aberrant DNA methylation of tumor suppressor genes (TSGs), RASSF1A and APC, in benign breast tissue is associated with higher breast cancer risk, measured by the Gail model. Methods: We conducted a case-control study in pre- and post-menopausal women without breast cancer to determine the effect of lifetime physical activity on the DNA methylation status of the APC and RASSF1A TSGs in benign breast tissue. Lifetime physical activity for all types (occupation, household, and exercise and sports) was obtained by an interviewer-administered questionnaire, and converted into metabolic equivalent (MET) hrs/wk. Breast cells were obtained using random periareolar fine-needle aspiration. DNA methylation status for the APC and RASSF1A TSGs in genomic DNA derived from breast cells was determined using methylation-specific PCR. Two independent samples t test analyses was performed to determine the difference between MET hrs/wk for lifetime physical activity and its different types with and without aberrant methylation for the APC and RASSF1A TSGs in breast cells. Results: Thirty-one women participated in the study. Aberrant methylation for the APC, RASSF1A, and APC + RASSF1A genes was noted in 9, 13, and 7 study subjects respectively. Lifetime physical activity was inversely associated with aberrant methylation for the APC and APC + RASSF1A genes, with P = 0.22 and P = 0.29 respectively. Lifetime physical activity for sports and exercise as a type had the highest inverse association with aberrant methylation for the APC and APC + RASSF1A genes, with P = 0.07 and P = 0.24 respectively. Also, lifetime physical activity for occupation as a type had a positive association with aberrant methylation for the APC, RASSF1A, and APC + RASSF1A genes, with P = 0.46, P = 0.21, and P = 0.37 respectively. Conclusions: The study, based on the trend in its current sample, suggests that lifetime physical activity, primarily sports and exercise, is inversely associated with aberrant methylation for the APC and RASSF1A genes individually and the APC + RASSF1A genes combined. Also, higher psychological stress levels at work may reduce the cancer protective effect of occupational physical activity, or that those with lower sports and exercise physical activity over-reported for occupational physical activity.
Journal of Autism and Developmental Disorders, Jan 2, 2021
Motor differences are common in Autism Spectrum Disorder (ASD), but rarely evaluated against diag... more Motor differences are common in Autism Spectrum Disorder (ASD), but rarely evaluated against diagnostic criteria for Developmental Coordination Disorder (DCD). We aimed to determine whether motor problems in ASD represent the possible co-occurrence of DCD. We retrospectively reviewed standardized assessments and parent-reports to evaluate motor ability in 43 individuals with ASD against diagnostic criteria for DCD, and compared to 18 individuals with DCD. Over 97% of cases in the ASD group scored below the 16th percentile in motor ability, with most below the 5th percentile. Over 90% of cases in the ASD group met criteria for co-occurring DCD. Motor challenges are a clinically-significant problem in ASD; systematically assessing the prevalence of co-occurring ASD + DCD is necessary to optimize assessment and intervention.
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Papers by Linda S Hynan