Breast, Cervical, and Colorectal Cancer Education and Navigation: Results of a Community Health Worker Intervention.

Now that cancer has surpassed heart disease as the top cause of death for Hispanics in the United States, it is even more critical to focus on early detection of cancer in this population. We report the results of a theory-driven education-plus-navigation pilot intervention delivered by bilingual, bicultural community health workers (CHWs) with the goal of increasing cancer screening rates and knowledge among low-income Latinas. CHWs enrolled 691 eligible women, ages 18 to 75 years, considered rarely or never screened for breast, cervical, and colorectal cancer. Eligible women were scheduled for an education session and offered health care navigation support with appointment scheduling and reminder/follow-up calls. CHWs provided education to 535 (77%) eligible women, and arranged mammograms, Pap tests, or stool blood tests for 174 (25%) participants, with another 94 (14%) placed on a waiting list at a local health center. Statistically significant positive changes on knowledge of screening guidelines for breast, cervical, and colorectal cancer, and beliefs/attitudes regarding early detection were observed from pre- to posttest among eligible women who attended an educational session. Results highlight the effectiveness of CHW-directed interventions in recruiting individuals for programs, educating them, and influencing cancer knowledge and screening behavior.

An adaptive Src-PDGFRA-Raf axis in rhabdomyosarcoma.

Alveolar rhabdomyosarcoma (aRMS) is a very aggressive sarcoma of children and young adults. Our previous studies have shown that small molecule inhibition of Pdgfra is initially very effective in an aRMS mouse model. However, slowly evolving, acquired resistance to a narrow-spectrum kinase inhibitor (imatinib) was common. We identified Src family kinases (SFKs) to be potentiators of Pdgfra in murine aRMS primary cell cultures from mouse tumors with evolved resistance in vivo in comparison to untreated cultures. Treating the resistant primary cell cultures with a combination of Pdgfra and Src inhibitors had a strong additive effect on cell viability. In Pdgfra knockout tumors, however, the Src inhibitor had no effect on tumor cell viability. Sorafenib, whose targets include not only PDGFRA but also the Src downstream target Raf, was effective at inhibiting mouse and human tumor cell growth and halted progression of mouse aRMS tumors in vivo. These results suggest that an adaptive Src-Pdgfra-Raf-Mapk axis is relevant to PDGFRA inhibition in rhabdomyosarcoma.

Promoting Weight Maintenance among Overweight and Obese Hispanic Children in a Rural Practice.

BACKGROUND: US Hispanic children experience a disproportionate burden of overweight and obesity. Comprehensive high-intensity behavioral programs have demonstrated effectiveness in improving weight status among obese children. However, there remains a need to develop more efficient interventions that are feasible in primary care and demonstrate effectiveness in Hispanic children. METHODS: The pilot study used a two-group randomized design. Eligible overweight (BMI between the 85th and 94th percentile for age and gender) or obese (BMI ≥95th percentile) Hispanic children and their parents (N=118 child/parent dyads) were recruited from a rural pediatric clinic and randomized to: standard care (SC; n=61 dyads) or behavioral intervention (INT; n=57 dyads). The primary outcomes-weight, waist circumference, and zBMI-were measured at baseline, 2, 6, and 18 weeks. Multivariate logistic regression was used to examine the effect of INT on the likelihood of weight maintenance adjusting for potential confounding variables. RESULTS: Significantly fewer INT children (68.5%) experienced weight gain, compared to SC children (89.7%; p=0.009). The same pattern was observed for waist circumference, where fewer INT children (44%) experienced an increase in waist circumference, compared to SC children (68.6%; p=0.02). Although a trend of improvement in favor of the INT was observed for zBMI, it was not significant. CONCLUSIONS: This study provides preliminary evidence for the feasibility of a primary-care-based approach to promoting weight maintenance among a high-risk population.

Intravascular optical coherence tomography light scattering artifacts: merry-go-rounding, blooming, and ghost struts.

We sought to elucidate the mechanisms underlying two common intravascular optical coherence tomography (IV-OCT) artifacts that occur when imaging metallic stents: "merry-go-rounding" (MGR), which is an increase in strut arc length (SAL), and "blooming," which is an increase in the strut reflection thickness (blooming thickness). Due to uncontrollable variables that occur in vivo, we performed an in vitro assessment of MGR and blooming in stented vessel phantoms. Using Xience V and Driver stents, we examined the effects of catheter offset, intimal strut coverage, and residual blood on SAL and blooming thickness in IV-OCT images. Catheter offset and strut coverage both caused minor MGR, while the greatest MGR effect resulted from light scattering by residual blood in the vessel lumen, with 1% hematocrit (Hct) causing a more than fourfold increase in SAL compared with saline (p<0.001 ). Residual blood also resulted in blooming, with blooming thickness more than doubling when imaged in 0.5% Hct compared with saline (p<0.001 ). We demonstrate that a previously undescribed mechanism, light scattering by residual blood in the imaging field, is the predominant cause of MGR. Light scattering also results in blooming, and a newly described artifact, three-dimensional-MGR, which results in "ghost struts" in B-scans.

Admittance to detect alterations in left ventricular stroke volume.

BACKGROUND: Implantable cardioverter-defibrillators monitor intracardiac electrograms (EGMs) to discriminate between ventricular and supraventricular tachycardias. The incidence of inappropriate shocks remains high because of misclassification of the tachycardia in an otherwise hemodynamically stable individual. Coupling EGMs with an assessment of left ventricular (LV) stroke volume (SV) could help in gauging hemodynamics during an arrhythmia and reducing inappropriate shocks. OBJECTIVE: The purpose of this study was to use the admittance method to accurately derive LV SV. METHODS: Ultrasonic flow probe and LV endocardial crystals were used in canines (n = 12) as the standard for LV SV. Biventricular pacing leads were inserted to obtain admittance measurements. A tetrapolar, complex impedance measurement was made between the Bi-V leads. The real and imaginary components of impedance were used to discard the myocardial component from the blood component to derive instantaneous blood conductance (Gb). Alterations in SV were measured during right ventricular pacing, dopamine infusion, and inferior vena cava occlusion. RESULTS: Gb tracks steady-state changes in SV more accurately than traditional magnitude (ie, |Y|, without removal of the muscle signal) during right ventricular pacing and dopamine infusion (P = .004). Instantaneous LV volume also was tracked more accurately by Gb than ∣Y∣ in the subset of subjects that underwent inferior vena cava occlusions (n = 5, P = .025). Finite element modeling demonstrates that admittance shifts more sensitivity of the measurement to the LV blood chamber as the mechanism for improvement (see Online Appendix). CONCLUSION: Monitoring LV SV is possible using the admittance method with biventricular pacing leads. The technique could be piggybacked to complement EGMs to determine if arrhythmias are hemodynamically unstable.

Safety and efficacy of frequency domain optical coherence tomography in pigs.

AIMS: To determine the safety and efficacy of frequency domain OCT, which can scan at much higher rates and make it possible to avoid an occlusion balloon and image during an angiographic injection through guide catheter. The catheters have diameters ranging from 2.7 to 3.5 Fr. The presence of the imaging catheter increases fluid resistance to the injection of viscous solutions necessary for clearing the blood. METHODS AND RESULTS: The Volcano 3.5 Fr frequency domain OCT catheter system was investigated for safety in (a) n=10 porcine studies using acute and 30-day histology, and (b) for efficacy in n=9 in vivo porcine coronary arteries. We found: (a) frequency domain imaging is safe in the porcine model using histology as an endpoint; (b) the addition of a viscous contrast (iodixonal) to saline is superior for lumen clearance compared to saline alone; (c) hand injection, 4 ml/sec, and 6 ml/sec power injection all provided similar vessel wall clearance; (d) the anticipated loss of vessel wall visualisation with left main injection (due to half the injectate in the non-imaged vessel) was not evident in proximal and middle coronary artery OCT catheter positions. CONCLUSIONS: Frequency domain OCT is safe and efficacious in the porcine model.