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Mosca, Paul Joseph

Overview:

My research focuses on three areas. One is the development of more effective and entirely novel treatments for melanoma. I have a special interest in immunotherapy, novel targeted molecular therapies, and regional chemotherapy for advanced melanoma of the arm or leg. Another area of interest is palliative surgery for cancer with an emphasis on understanding the optimal role and application of this type of surgery in the care of advanced malignancy. A third area of interest is quality and patient safety with an emphasis on communication and work culture.

Positions:

Associate Professor of Surgery

Surgery, Advanced Oncologic and Gastrointestinal Surgery
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

Ph.D. 1994

Ph.D. — University of Virginia

M.D. 1995

M.D. — University of Virginia

M.B.A. 2011

M.B.A. — Desales University

Intern, Surgery

Duke University

Junior Assistant Resident, Surgery

Duke University

Senior Assistant Resident, Surgery

Duke University

Surgical Research Fellow, Surgery

Duke University

2nd Year Sar, Surgery

Duke University

Chief Resident, Surgery

Duke University

Assistant Professor, Surgery

Duke University School of Medicine

Assistant Professor, Surgery

Lehigh Valley Health Network

Grants:

Improving Melanoma Diagnosis with Pump-Probe Optical Imaging

Administered By
Chemistry
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
January 02, 2013
End Date
December 31, 2017

Dendritic Cell Immunotherapy For Breast Cancer

AwardedBy
National Institutes of Health
Role
PI-Fellow
Start Date
July 01, 1998
End Date
June 30, 2000

Publications:

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science (September 11, 2017). (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science (September 11, 2017). (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science (September 11, 2017). (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science (September 11, 2017). (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science 32.8 (November 2017): 1935-1939. (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science 32.8 (November 2017): 1935-1939. (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science 32.8 (November 2017): 1935-1939. (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science 32.8 (November 2017): 1935-1939. (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science (September 11, 2017). (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science (September 11, 2017). (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science (September 11, 2017). (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science (September 11, 2017). (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science 32.8 (November 2017): 1935-1939. (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science 32.8 (November 2017): 1935-1939. (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science 32.8 (November 2017): 1935-1939. (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science 32.8 (November 2017): 1935-1939. (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

Correction to: The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

The published online version contains mistake. Warren S. Warren was not included in the author group section. Corrected author group section is shown above.

Authors
Puza, CJ; Warren, WS; Mosca, PJ
MLA Citation
Puza, CJ, Warren, WS, and Mosca, PJ. "Correction to: The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science (October 5, 2017).
PMID
28980190
Source
epmc
Published In
Lasers in Medical Science
Publish Date
2017
DOI
10.1007/s10103-017-2339-y

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science (September 11, 2017). (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science (September 11, 2017). (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science (September 11, 2017). (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science (September 11, 2017). (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science 32.8 (November 2017): 1935-1939. (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science 32.8 (November 2017): 1935-1939. (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science 32.8 (November 2017): 1935-1939. (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science 32.8 (November 2017): 1935-1939. (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science (September 11, 2017). (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science (September 11, 2017). (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science (September 11, 2017). (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science (September 11, 2017). (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science 32.8 (November 2017): 1935-1939. (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science 32.8 (November 2017): 1935-1939. (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science 32.8 (November 2017): 1935-1939. (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy.

To present current melanoma diagnosis, staging, prognosis, and treatment algorithms and how recent advances in laser pump-probe microscopy will fill in the gaps in our clinical understanding. Expert opinion and significantly cited articles identified in SCOPUS were used in conjunction with a pubmed database search on Melanoma practice guidelines from the last 10 years. Significant advances in melanoma treatment have been made over the last decade. However, proper treatment algorithm and prognostic information per melanoma stage remain controversial. The next step for providers will involve the identification of patient population(s) that can benefit from recent advances. One method of identifying potential patients is through new laser imaging techniques. Pump-probe laser microscopy has been shown to correctly identify nevi from melanoma and furthermore stratify melanoma by aggressiveness. The recent development of effective adjuvant therapies for melanoma is promising and should be utilized on appropriate patient populations that can potentially be identified using pump-probe laser microscopy.

Authors
Puza, CJ; Mosca, PJ
MLA Citation
Puza, CJ, and Mosca, PJ. "The changing landscape of dermatology practice: melanoma and pump-probe laser microscopy." Lasers in medical science 32.8 (November 2017): 1935-1939. (Review)
PMID
28890988
Source
epmc
Published In
Lasers in Medical Science
Volume
32
Issue
8
Publish Date
2017
Start Page
1935
End Page
1939
DOI
10.1007/s10103-017-2319-2

Management of a cutaneous squamous cell carcinoma overlying an AV fistula.

Cutaneous squamous cell carcinoma (cSCC) currently affects over 700 000 patients per year in the USA alone, and its incidence continues to rise in recent years. A known risk factor for cSCC is chronic inflammation; a cSCC that develops at a site of chronic inflammation is known as Marjolin's ulcer. We present the case of a 76-year-old man with end-stage renal disease requiring chronic haemodialysis who developed an invasive cSCC at the cannulation site of an underlying arteriovenous (AV) fistula. In this instance, treatment with standard surgical excision or Mohs surgery would pose unique risks associated with injury to an otherwise functional AV fistula. Thus, the lesion was treated with electron beam radiation therapy, which offers a similar efficacy to surgery while minimising risk to the fistula. This resulted in a successful oncological outcome with no complications.

Authors
Nath, NS; Gilmore, BF; McCann, RK; Mosca, PJ
MLA Citation
Nath, NS, Gilmore, BF, McCann, RK, and Mosca, PJ. "Management of a cutaneous squamous cell carcinoma overlying an AV fistula." BMJ case reports 2017 (May 6, 2017).
PMID
28478388
Source
epmc
Published In
BMJ Case Reports
Volume
2017
Publish Date
2017
DOI
10.1136/bcr-2016-218932

Clinical Acuity Shorthand System: a standardized classification tool to facilitate handoffs.

The handoff of medical information from one provider to another can be inefficient and error prone, potentially undermining patient safety. Although several tools for structuring handoffs exist, none provide a brief, standardized framework for ensuring that patient acuity is efficiently and reliably communicated. We aim to introduce and perform initial testing of the Clinical Acuity Shorthand System (CLASS) (Copyright 2015, Duke University. All rights reserved.) for surgery, a patient classification tool intended to facilitate efficient communication of key patient information during handoffs.Surgical trainees at a single center were asked to perform an exercise involving application of CLASS to 10 theoretical patient scenarios and to then complete a brief survey. Responses were scored based on similarity to target answers. Performance was evaluated overall and between groups of trainees. Time required to complete the exercise was also determined and perceived utility of the system was assessed based on survey responses.The study task was completed by 17 participants. Mean time to task completion was 10.3 ± 8.4 min. Accuracy was not decreased, and was in fact superior, in junior trainees. Most respondents indicated that such a system would be feasible and could prevent medical errors.CLASS is a novel system that can be learned quickly and implemented readily by trainees and can be used to convey patient information concisely and with acceptable fidelity regardless of level of training. Further study examining application of this system on clinical surgical services is warranted.

Authors
Gilmore, BF; Brys, AK; Nath, NS; Barfield, M; Rialon, KL; Truong, T; Pomann, G-M; Migaly, J; Mosca, PJ
MLA Citation
Gilmore, BF, Brys, AK, Nath, NS, Barfield, M, Rialon, KL, Truong, T, Pomann, G-M, Migaly, J, and Mosca, PJ. "Clinical Acuity Shorthand System: a standardized classification tool to facilitate handoffs." The Journal of surgical research 211 (May 2017): 163-171.
PMID
28501113
Source
epmc
Published In
Journal of Surgical Research
Volume
211
Publish Date
2017
Start Page
163
End Page
171
DOI
10.1016/j.jss.2016.10.033

Isolated Limb Infusion as a Limb Salvage Strategy for Locally Advanced Extremity Sarcoma.

Treatment-resistant, locally advanced soft tissue sarcomas often require amputation for complete tumor extirpation. Isolated limb infusion (ILI) selectively delivers high-dose chemotherapy to the extremity in an attempt to achieve limb salvage. The aim of this study was to report perioperative and oncologic outcomes after ILI in patients with extremity soft tissue sarcomas.From 1994 to 2016, 77 patients underwent 84 ILIs at a total of 5 institutions. Melphalan and actinomycin D were circulated for 30 minutes after complete tourniquet occlusion of the limb, then actively washed out to prevent systemic exposure.The procedure was performed in an upper extremity on 19 patients (21 infusions) and in a lower extremity on 58 patients (63 infusions). The 3-month overall response rate (ORR) for the entire cohort was 58%, and there was a statistically significant difference (p = 0.03) between upper (37%) and lower extremity (66%) ORR. With median follow-up of 20.6 months (range 0.6 to 146.1 months), the overall limb salvage rate was 77.9%. For those who underwent amputation due to progression of disease, the median time to amputation was 4.5 months. With a median follow-up of 20.6 months, the median overall survival for the entire cohort was 44.3 months. The distant metastatic-free survival was longer for responders than nonresponders (p = 0.01), though the disease-specific survival was not different for the same groups (p = 0.2).Isolated limb infusion for extremity soft tissue sarcoma results in an objective response for half of the patients who are otherwise facing amputation, and offers prolonged limb salvage for the vast majority of patients. The procedure is well tolerated without serious complications.

Authors
Mullinax, JE; Kroon, HM; Thompson, JF; Nath, N; Mosca, PJ; Farma, JM; Bhati, R; Hardmann, D; Sileno, S; O'Donoghue, C; Perez, M; Naqvi, SMH; Chen, YA; Gonzalez, RJ; Zager, JS
MLA Citation
Mullinax, JE, Kroon, HM, Thompson, JF, Nath, N, Mosca, PJ, Farma, JM, Bhati, R, Hardmann, D, Sileno, S, O'Donoghue, C, Perez, M, Naqvi, SMH, Chen, YA, Gonzalez, RJ, and Zager, JS. "Isolated Limb Infusion as a Limb Salvage Strategy for Locally Advanced Extremity Sarcoma." Journal of the American College of Surgeons 224.4 (April 2017): 635-642.
PMID
28214556
Source
epmc
Published In
Journal of The American College of Surgeons
Volume
224
Issue
4
Publish Date
2017
Start Page
635
End Page
642
DOI
10.1016/j.jamcollsurg.2016.12.035

A multidisciplinary approach to toxicity management of modern immune checkpoint inhibitors in cancer therapy

Authors
Kottschade, L; Brys, A; Peikert, T; Ryder, M; Raffals, L; Brewer, J; Mosca, P; Markovic, S
MLA Citation
Kottschade, L, Brys, A, Peikert, T, Ryder, M, Raffals, L, Brewer, J, Mosca, P, and Markovic, S. "A multidisciplinary approach to toxicity management of modern immune checkpoint inhibitors in cancer therapy." Melanoma Research 26.5 (October 2016): 469-480.
Source
crossref
Published In
Melanoma Research
Volume
26
Issue
5
Publish Date
2016
Start Page
469
End Page
480
DOI
10.1097/CMR.0000000000000273

Nanotechnology-based strategies for combating toxicity and resistance in melanoma therapy.

Drug toxicity and resistance remain formidable challenges in cancer treatment and represent an area of increasing attention in the case of melanoma. Nanotechnology represents a paradigm-shifting field with the potential to mitigate drug resistance while improving drug delivery and minimizing toxicity. Recent clinical and pre-clinical studies have demonstrated how a diverse array of nanoparticles may be harnessed to circumvent known mechanisms of drug resistance in melanoma to improve therapeutic efficacy. In this review, we discuss known mechanisms of resistance to various melanoma therapies and possible nanotechnology-based strategies that could be used to overcome these barriers and improve the pharmacologic arsenal available to combat advanced stage melanoma.

Authors
Brys, AK; Gowda, R; Loriaux, DB; Robertson, GP; Mosca, PJ
MLA Citation
Brys, AK, Gowda, R, Loriaux, DB, Robertson, GP, and Mosca, PJ. "Nanotechnology-based strategies for combating toxicity and resistance in melanoma therapy." Biotechnology advances 34.5 (September 2016): 565-577. (Review)
PMID
26826558
Source
epmc
Published In
Biotechnology Advances
Volume
34
Issue
5
Publish Date
2016
Start Page
565
End Page
577
DOI
10.1016/j.biotechadv.2016.01.004

Sentinel lymph node biopsy is a prognostic measure in pediatric melanoma.

Sentinel lymph node biopsy (SLNB)-based management has been shown to improve disease-free survival in adult melanoma, but there is scant evidence regarding the utility of SLNB in pediatric melanoma.The 2004-2011 Surveillance, Epidemiology, and End Results database was queried for patients with primary cutaneous melanoma of Breslow depth>0.75mm and clinically negative nodes. Pediatric patients, defined as less than 20years of age, were grouped by whether they underwent SLNB or not. Kaplan-Meier analysis was performed to compare melanoma-specific survival (MSS) in propensity-matched groups.310 pediatric patients met study criteria: 261 (84%) underwent SLNB, while 49 (16%) did not. There was no difference in MSS between matched children who received SLNB and those who did not (p=0.36). Among children who received SLNB, a positive SLNB was associated with worse MSS compared to a negative SLNB (89% vs. 100% at 84months, p=0.04). However, children with a positive SLNB had more favorable survival compared to patients >20years of age (88% vs. 66% at 84months, p=0.02).SLNB does not confer a survival benefit to children with melanoma, but it provides valuable prognostic information regarding MSS.

Authors
Kim, J; Sun, Z; Gulack, BC; Adam, MA; Mosca, PJ; Rice, HE; Tracy, ET
MLA Citation
Kim, J, Sun, Z, Gulack, BC, Adam, MA, Mosca, PJ, Rice, HE, and Tracy, ET. "Sentinel lymph node biopsy is a prognostic measure in pediatric melanoma." Journal of pediatric surgery 51.6 (June 2016): 986-990.
PMID
27041229
Source
epmc
Published In
Journal of Pediatric Surgery
Volume
51
Issue
6
Publish Date
2016
Start Page
986
End Page
990
DOI
10.1016/j.jpedsurg.2016.02.067

Computed Tomography-Based Limb Volume Measurements for Isolated Limb Infusion in Melanoma.

Despite advances in cross-sectional imaging, chemotherapeutic dosing for isolated limb infusion (ILI) in melanoma is currently calculated through cumbersome and potentially imprecise manual measurements. The primary objective of this study was to examine the feasibility of using computed tomography (CT) to calculate limb volume, its concordance with manual measurement, and its ability to predict clinical response and toxicity in patients undergoing ILI.A retrospective analysis of all patients undergoing lower extremity ILI at Duke University Medical Center between 2003 and 2014 was performed. Data pertaining to manually measured limb volume, chemotherapeutic dosing, and patient outcome was obtained. CT-based measurements of limb volume were performed in all patients for whom imaging was available and subsequently compared with manually measured values.CT data were sufficient for measurement in 73 patients. The mean measurement time was 4.61 ± 2.13 min. Although average CT-based measurements were 1.20 L higher in the case of lower limbs, they correlated well with those obtained manually (r (2) = 0.90). Unlike manual measurement, patients with complete responses to chemotherapy had smaller limb volumes than those with disease progression as measured by CT (9.3 vs. 10.7 L; p = .038). Patients suffering grade 3 and 4 toxicities also had statistically lower limb volumes as measured by CT than those who did not (p < .05).CT-based limb volume measurement is feasible for chemotherapy dosing in patients undergoing ILI for melanoma and has predictive value with respect to clinical response and toxicity.

Authors
Brys, AK; Bhatti, L; Bashir, MR; Jaffe, TA; Beasley, GM; Nath, NS; Salama, AKS; Tyler, DS; Mosca, PJ
MLA Citation
Brys, AK, Bhatti, L, Bashir, MR, Jaffe, TA, Beasley, GM, Nath, NS, Salama, AKS, Tyler, DS, and Mosca, PJ. "Computed Tomography-Based Limb Volume Measurements for Isolated Limb Infusion in Melanoma." Annals of surgical oncology 23.4 (April 2016): 1090-1095.
PMID
26572755
Source
epmc
Published In
Annals of Surgical Oncology
Volume
23
Issue
4
Publish Date
2016
Start Page
1090
End Page
1095
DOI
10.1245/s10434-015-4972-7

A mouse-human phase 1 co-clinical trial of a protease-activated fluorescent probe for imaging cancer.

Local recurrence is a common cause of treatment failure for patients with solid tumors. Intraoperative detection of microscopic residual cancer in the tumor bed could be used to decrease the risk of a positive surgical margin, reduce rates of reexcision, and tailor adjuvant therapy. We used a protease-activated fluorescent imaging probe, LUM015, to detect cancer in vivo in a mouse model of soft tissue sarcoma (STS) and ex vivo in a first-in-human phase 1 clinical trial. In mice, intravenous injection of LUM015 labeled tumor cells, and residual fluorescence within the tumor bed predicted local recurrence. In 15 patients with STS or breast cancer, intravenous injection of LUM015 before surgery was well tolerated. Imaging of resected human tissues showed that fluorescence from tumor was significantly higher than fluorescence from normal tissues. LUM015 biodistribution, pharmacokinetic profiles, and metabolism were similar in mouse and human subjects. Tissue concentrations of LUM015 and its metabolites, including fluorescently labeled lysine, demonstrated that LUM015 is selectively distributed to tumors where it is activated by proteases. Experiments in mice with a constitutively active PEGylated fluorescent imaging probe support a model where tumor-selective probe distribution is a determinant of increased fluorescence in cancer. These co-clinical studies suggest that the tumor specificity of protease-activated imaging probes, such as LUM015, is dependent on both biodistribution and enzyme activity. Our first-in-human data support future clinical trials of LUM015 and other protease-sensitive probes.

Authors
Whitley, MJ; Cardona, DM; Lazarides, AL; Spasojevic, I; Ferrer, JM; Cahill, J; Lee, C-L; Snuderl, M; Blazer, DG; Hwang, ES; Greenup, RA; Mosca, PJ; Mito, JK; Cuneo, KC; Larrier, NA; O'Reilly, EK; Riedel, RF; Eward, WC; Strasfeld, DB; Fukumura, D; Jain, RK; Lee, WD; Griffith, LG; Bawendi, MG; Kirsch, DG; Brigman, BE
MLA Citation
Whitley, MJ, Cardona, DM, Lazarides, AL, Spasojevic, I, Ferrer, JM, Cahill, J, Lee, C-L, Snuderl, M, Blazer, DG, Hwang, ES, Greenup, RA, Mosca, PJ, Mito, JK, Cuneo, KC, Larrier, NA, O'Reilly, EK, Riedel, RF, Eward, WC, Strasfeld, DB, Fukumura, D, Jain, RK, Lee, WD, Griffith, LG, Bawendi, MG, Kirsch, DG, and Brigman, BE. "A mouse-human phase 1 co-clinical trial of a protease-activated fluorescent probe for imaging cancer." Science translational medicine 8.320 (January 2016): 320ra4-.
PMID
26738797
Source
epmc
Published In
Science Translational Medicine
Volume
8
Issue
320
Publish Date
2016
Start Page
320ra4
DOI
10.1126/scitranslmed.aad0293

Pump-probe imaging of pigmented cutaneous melanoma primary lesions gives insight into metastatic potential.

Metastatic melanoma is associated with a poor prognosis, but no method reliably predicts which melanomas of a given stage will ultimately metastasize and which will not. While sentinel lymph node biopsy (SLNB) has emerged as the most powerful predictor of metastatic disease, the majority of people dying from metastatic melanoma still have a negative SLNB. Here we analyze pump-probe microscopy images of thin biopsy slides of primary melanomas to assess their metastatic potential. Pump-probe microscopy reveals detailed chemical information of melanin with subcellular spatial resolution. Quantification of the molecular signatures without reference standards is achieved using a geometrical representation of principal component analysis. Melanin structure is analyzed in unison with the chemical information by applying principles of mathematical morphology. Results show that melanin in metastatic primary lesions has lower chemical diversity than non-metastatic primary lesions, and contains two distinct phenotypes that are indicative of aggressive disease. Further, the mathematical morphology analysis reveals melanin in metastatic primary lesions has a distinct "dusty" quality. Finally, a statistical analysis shows that the combination of the chemical information with spatial structures predicts metastatic potential with much better sensitivity than SLNB and high specificity, suggesting pump-probe microscopy can be an important tool to help predict the metastatic potential of melanomas.

Authors
Robles, FE; Deb, S; Wilson, JW; Gainey, CS; Selim, MA; Mosca, PJ; Tyler, DS; Fischer, MC; Warren, WS
MLA Citation
Robles, FE, Deb, S, Wilson, JW, Gainey, CS, Selim, MA, Mosca, PJ, Tyler, DS, Fischer, MC, and Warren, WS. "Pump-probe imaging of pigmented cutaneous melanoma primary lesions gives insight into metastatic potential." Biomedical optics express 6.9 (September 2015): 3631-3645.
PMID
26417529
Source
epmc
Published In
Biomedical Optics Express
Volume
6
Issue
9
Publish Date
2015
Start Page
3631
End Page
3645
DOI
10.1364/boe.6.003631

Abstract SY36-03: Intraoperative molecular imaging with protease-activated fluorescent imaging agents

Authors
Whitley, MJ; Cardona, DM; Blazer, DG; Hwang, S; Greenup, RA; Mosca, PJ; Cahill, J; Mito, JK; Cuneo, KC; Larrier, N; O'Reilly, E; Spasojevic, I; Riedel, RF; Eward, WC; Griffith, LG; Bawendi, MG; Ferrer, J; Strasfeld, DB; Lee, WD; Brigman, B; Kirsch, DG
MLA Citation
Whitley, MJ, Cardona, DM, Blazer, DG, Hwang, S, Greenup, RA, Mosca, PJ, Cahill, J, Mito, JK, Cuneo, KC, Larrier, N, O'Reilly, E, Spasojevic, I, Riedel, RF, Eward, WC, Griffith, LG, Bawendi, MG, Ferrer, J, Strasfeld, DB, Lee, WD, Brigman, B, and Kirsch, DG. "Abstract SY36-03: Intraoperative molecular imaging with protease-activated fluorescent imaging agents." August 1, 2015.
Source
crossref
Published In
Cancer Research
Volume
75
Issue
15 Supplement
Publish Date
2015
Start Page
SY36-03
End Page
SY36-03
DOI
10.1158/1538-7445.AM2015-SY36-03

Sentinel lymph node biopsy following a rotational flap.

Sentinel lymph node biopsy (SLNB) is a critical component of melanoma management. Extensive prior surgery at the site of a primary melanoma is considered a relative contraindication for SLNB. While evidence suggests that SLNB may be performed accurately even in those patients who have undergone prior wide local excision, it is less clear whether patients who have undergone more extensive surgical procedures, particularly flap reconstructions, can benefit from this procedure. We report a case of a patient who had undergone surgical removal of a primary melanoma and subsequent reconstruction with a rotational flap in whom a SLNB was performed successfully, which revealed nodal metastasis, suggesting that SLNB may remain an appropriate option in carefully selected patients who have previously undergone extensive surgery at site of primary disease.

Authors
Brys, AK; Schneider, MM; Selim, MA; Mosca, PJ
MLA Citation
Brys, AK, Schneider, MM, Selim, MA, and Mosca, PJ. "Sentinel lymph node biopsy following a rotational flap." BMJ case reports 2015 (July 14, 2015).
PMID
26174732
Source
epmc
Published In
BMJ Case Reports
Volume
2015
Publish Date
2015
DOI
10.1136/bcr-2015-210762

Quality of life after isolated limb infusion for in-transit melanoma of the extremity.

Isolated limb infusion (ILI) has been associated with persistent edema, numbness, pain, and functional impairment of the treated limb. However, health-related quality of life (HRQOL) has not yet been assessed using a validated questionnaire.Functional Assessment of Cancer Therapy-Melanoma (FACT-M) questionnaires were collected from subjects enrolled a phase I ILI trial with temozolomide at baseline and 2, 6 weeks, and 3 months post-ILI. Of 28 enrolled patients, 19 patients received maximum tolerated dose of temozolomide and are included in the HRQOL analysis. Clinical and operative variables and treatment response data also were collected.HRQOL scores showed a trend of improvement from baseline through 3-months post-ILI as measured by FACT-M and the melanoma surgery scores. There were no differences in HRQOL when patients were stratified by disease burden, clinical toxicity level, and 3-month disease response. Additionally, fewer patients complained of pain, numbness, and swelling of the affected limb at 3 months post-ILI compared to baseline, and also these symptoms were improved at the immediate postoperative visit compared with baseline.Despite the known morbidity of ILI, we have demonstrated with a validated HRQOL questionnaire that HRQOL is not adversely impacted at therapeutic doses of temozolomide delivered intra-arterially from baseline through 3 months posttreatment. Patient centered-outcomes should be evaluated as a standard part of all future regional therapy trials using standardized melanoma-specific HRQOL questionnaires to more completely evaluate the utility of this type of treatment strategy.

Authors
Jiang, BS; Speicher, PJ; Thomas, S; Mosca, PJ; Abernethy, AP; Tyler, DS
MLA Citation
Jiang, BS, Speicher, PJ, Thomas, S, Mosca, PJ, Abernethy, AP, and Tyler, DS. "Quality of life after isolated limb infusion for in-transit melanoma of the extremity." Annals of surgical oncology 22.5 (May 2015): 1694-1700.
PMID
25120251
Source
epmc
Published In
Annals of Surgical Oncology
Volume
22
Issue
5
Publish Date
2015
Start Page
1694
End Page
1700
DOI
10.1245/s10434-014-3979-9

A Phase I Clinical Trial of LUM015: A Protease-activated Fluorescent Imaging Agent to Detect Cancer during Surgery

Authors
Whitley, MJ; Cardona, DM; Blazer, DG; Hwang, E; Greenup, RA; Mosca, PJ; Cahill, J; Mito, JK; Cuneo, KC; Larrier, N; O'Reilly, E; Spasojevic, I; Riedel, RF; Eward, WC; Griffith, LG; Bawendi, MG; Kirsch, DG; Brigman, BE
MLA Citation
Whitley, MJ, Cardona, DM, Blazer, DG, Hwang, E, Greenup, RA, Mosca, PJ, Cahill, J, Mito, JK, Cuneo, KC, Larrier, N, O'Reilly, E, Spasojevic, I, Riedel, RF, Eward, WC, Griffith, LG, Bawendi, MG, Kirsch, DG, and Brigman, BE. "A Phase I Clinical Trial of LUM015: A Protease-activated Fluorescent Imaging Agent to Detect Cancer during Surgery." February 2015.
Source
wos-lite
Published In
Annals of Surgical Oncology
Volume
22
Publish Date
2015
Start Page
S11
End Page
S12

Rhabdomyosarcomatous Transformation of a Gastrointestinal Stromal Tumor following Treatment with Imatinib.

Rhabdomyosarcomatous dedifferentiation of GIST following tyrosine kinase inhibitor (TKI) therapy is rare, with only a handful of cases previously reported in the literature. Herein we present a case of metastatic GIST initially treated with imatinib that developed radiographic evidence of progression after 8 months of standard dose therapy with continued progression despite attempts at using dose-escalated imatinib 400 mg bid. Due to the patient's worsening clinical symptoms and radiographic concerns for colonic thickening, abscess, and extraluminal air, the patient underwent a palliative resection of a large heterogeneous mass arising from the posterior stomach and several metastatic foci. Pathology revealed a dedifferentiated GIST with rhabdomyosarcomatous features. This report will highlight the unique features of this case and review the existing literature.

Authors
Jiang, X; Anderson, HB; Guy, CD; Mosca, PJ; Riedel, RF; Cardona, DM
MLA Citation
Jiang, X, Anderson, HB, Guy, CD, Mosca, PJ, Riedel, RF, and Cardona, DM. "Rhabdomyosarcomatous Transformation of a Gastrointestinal Stromal Tumor following Treatment with Imatinib." Case reports in oncological medicine 2015 (January 28, 2015): 317493-.
PMID
25694839
Source
epmc
Published In
Case Reports in Oncological Medicine
Volume
2015
Publish Date
2015
Start Page
317493
DOI
10.1155/2015/317493

A Multicenter Phase I Dose Escalation Trial to Evaluate Safety and Tolerability of Intra-arterial Temozolomide for Patients with Advanced Extremity Melanoma Using Normothermic Isolated Limb Infusion

© 2014, Society of Surgical Oncology. Background: l-phenylalanine mustard (LPAM) has been the standard for use in regional chemotherapy (RC) for unresectable in-transit melanoma. Preclinical data demonstrated that regional temozolomide (TMZ) may be more effective. Methods: Patients with AJCC Stage IIIB or IIIC extremity melanoma who failed previous LPAM-based RC were treated with TMZ via isolated limb infusion (ILI) according to a modified accelerated titration design. Drug pharmacokinetic (PK) analysis, tumor gene expression, methylation status of the O 6 -methylguanine methyltransferase (MGMT) promoter, and MGMT expression were evaluated. Primary objectives were to (1) determine dose-limiting toxicities (DLTs) and maximum tolerated dose (MTD) of TMZ via ILI and (2) explore biomarker correlates of response. Results: 28 patients completed treatment over 2.5 years at 3 institutions. 19 patients were treated at the MTD defined as 3,200 mg/m 2 [multiplied by 0.09 (arm), 0.18 (leg)]. Two of five patients had DLTs at the 3,600 mg/m 2 level while only grade 1 (n=15) and grade 2 (n=4) clinical toxicities occurred at the MTD. At 3-month post-ILI, 10.5% (2/19) had CR, 5.3% (1/19) had PR, 15.8% (3/19) had SD, and 68.4% (13/19) had PD. Neither PK parameters of TMZ nor MGMT levels were associated with response or toxicity. Conclusion: In this first ever use of intra-arterial TMZ in ILI for melanoma, the MTD was determined. While we could not define a marker for TMZ response, the minimal toxicity of TMZ ILI may allow for repeated treatments to increase the response rate as well as clarify the role of MGMT expression.

Authors
Beasley, GM; Speicher, P; Augustine, CK; Dolber, PC; Peterson, BL; Sharma, K; Mosca, PJ; Royal, R; Ross, M; Zager, JS; Tyler, DS
MLA Citation
Beasley, GM, Speicher, P, Augustine, CK, Dolber, PC, Peterson, BL, Sharma, K, Mosca, PJ, Royal, R, Ross, M, Zager, JS, and Tyler, DS. "A Multicenter Phase I Dose Escalation Trial to Evaluate Safety and Tolerability of Intra-arterial Temozolomide for Patients with Advanced Extremity Melanoma Using Normothermic Isolated Limb Infusion." Annals of Surgical Oncology 22.1 (January 1, 2015): 287-294.
Source
scopus
Published In
Annals of Surgical Oncology
Volume
22
Issue
1
Publish Date
2015
Start Page
287
End Page
294
DOI
10.1245/s10434-014-3887-z

A multicenter phase I dose escalation trial to evaluate safety and tolerability of intra-arterial temozolomide for patients with advanced extremity melanoma using normothermic isolated limb infusion.

L-phenylalanine mustard (LPAM) has been the standard for use in regional chemotherapy (RC) for unresectable in-transit melanoma. Preclinical data demonstrated that regional temozolomide (TMZ) may be more effective.Patients with AJCC Stage IIIB or IIIC extremity melanoma who failed previous LPAM-based RC were treated with TMZ via isolated limb infusion (ILI) according to a modified accelerated titration design. Drug pharmacokinetic (PK) analysis, tumor gene expression, methylation status of the O6-methylguanine methyltransferase (MGMT) promoter, and MGMT expression were evaluated. Primary objectives were to (1) determine dose-limiting toxicities (DLTs) and maximum tolerated dose (MTD) of TMZ via ILI and (2) explore biomarker correlates of response.28 patients completed treatment over 2.5 years at 3 institutions. 19 patients were treated at the MTD defined as 3,200 mg/m(2) [multiplied by 0.09 (arm), 0.18 (leg)]. Two of five patients had DLTs at the 3,600 mg/m(2) level while only grade 1 (n = 15) and grade 2 (n = 4) clinical toxicities occurred at the MTD. At 3-month post-ILI, 10.5 % (2/19) had CR, 5.3 % (1/19) had PR, 15.8 % (3/19) had SD, and 68.4 % (13/19) had PD. Neither PK parameters of TMZ nor MGMT levels were associated with response or toxicity.In this first ever use of intra-arterial TMZ in ILI for melanoma, the MTD was determined. While we could not define a marker for TMZ response, the minimal toxicity of TMZ ILI may allow for repeated treatments to increase the response rate as well as clarify the role of MGMT expression.

Authors
Beasley, GM; Speicher, P; Augustine, CK; Dolber, PC; Peterson, BL; Sharma, K; Mosca, PJ; Royal, R; Ross, M; Zager, JS; Tyler, DS
MLA Citation
Beasley, GM, Speicher, P, Augustine, CK, Dolber, PC, Peterson, BL, Sharma, K, Mosca, PJ, Royal, R, Ross, M, Zager, JS, and Tyler, DS. "A multicenter phase I dose escalation trial to evaluate safety and tolerability of intra-arterial temozolomide for patients with advanced extremity melanoma using normothermic isolated limb infusion." January 2015.
PMID
25145500
Source
epmc
Published In
Annals of Surgical Oncology
Volume
22
Issue
1
Publish Date
2015
Start Page
287
End Page
294
DOI
10.1245/s10434-014-3887-z

Defining the learning curve for team-based laparoscopic pancreaticoduodenectomy.

BACKGROUND: The purpose of this study was to define the learning curves for laparoscopic pancreaticoduodenectomy (LPD) with and without laparoscopic reconstruction, using paired surgical teams consisting of advanced laparoscopic-trained surgeons and advanced oncologic-trained surgeons. METHODS: All patients undergoing PD without vein resection at a single institution were retrospectively analyzed. LPD was introduced by initially focusing on laparoscopic resection followed by open reconstruction (hybrid) for 18 months prior to attempting a totally LPD (TLPD) approach. Cases were compared with Chi square, Fisher's exact test, and Kruskal-Wallis analysis of variance (ANOVA). RESULTS: Between March 2010 and June 2013, 140 PDs were completed at our institution, of which 56 (40 %) were attempted laparoscopically. In 31/56 procedures we planned to perform only the resection laparoscopically (hybrid), of which 7 (23 %) required premature conversion before completion of resection. Following the first 23 of these hybrid cases, a total of 25 TLPDs have been performed, of which there were no conversions to open. For all LPD, a significant reduction in operative times was identified following the first 10 patients (median 478.5 vs. 430.5 min; p = 0.01), approaching open PD levels. After approximately 50 cases, operative times and estimated blood loss were consistently lower than those for open PD. CONCLUSIONS: In our experience of building an LPD program, the initial ten cases represent the biggest hurdle with respect to operative times. For an experienced teaching center using a staged and team-based approach, LPD appears to offer meaningful reductions in operative time and blood loss within the first 50 cases.

Authors
Speicher, PJ; Nussbaum, DP; White, RR; Zani, S; Mosca, PJ; Blazer, DG; Clary, BM; Pappas, TN; Tyler, DS; Perez, A
MLA Citation
Speicher, PJ, Nussbaum, DP, White, RR, Zani, S, Mosca, PJ, Blazer, DG, Clary, BM, Pappas, TN, Tyler, DS, and Perez, A. "Defining the learning curve for team-based laparoscopic pancreaticoduodenectomy." November 2014.
PMID
24923222
Source
epmc
Published In
Annals of Surgical Oncology
Volume
21
Issue
12
Publish Date
2014
Start Page
4014
End Page
4019
DOI
10.1245/s10434-014-3839-7

Surgical interventions in cancer patients at the end of life: Experiences at an academic medical center.

281 Background: Surgical quality measures look to reduce variation and improve outcomes. Procedure goals can range from cure to symptom improvement. Knowledge of procedures used in this population can inform quality metrics, ensure palliation is included and that metrics do not discourage interventions where benefits are other than traditional measures like mortality.Clinical and administrative data from 1,343 patients treated at an academic medical center from 2006 to 2013 were obtained. Using CPT codes, procedures were identified. Patients who underwent surgical procedures within 180 days of their death were then evaluated to determine the demographic, clinical and surgical characteristics of these cases. Patients <18 years of age and those with missing data were excluded from the analysis. Descriptive statistics were used to describe interventions among patients in the cohort.From 2006 to 2010, 761 patients with cancer treated at an academic medical center had surgical procedures performed within the last 180 days of life. 38.8% of these patients were female, 82% were Caucasian, 15% were African-American, and 3% were other race. Median age was 67.9 years (interquartile range: 58.1 - 78.1). 158 had procedures performed ≤30 days of death, 295 ≤60 days of death, and 530 ≤120 days of death. The most frequent type of procedure performed ≤30 days from death were thoracic procedures including bronchoscopy, thoracentesis, mediastinoscopy and catheter placement for pleural fluid drainage (20.8%), ≤60 days of death 30.3% underwent thoracic procedures, and ≤120 days of death 24.5% underwent similar thoracic procedures.Surgical quality measures are thought to improve surgical outcomes. Evaluation of surgical data from a academic medical center demonstrates continued use interventional procedures in cancer patients within the last 6 months of life. This may in part be due to the symptom burden associated with these diseases. Further evaluation about the goals of interventional procedures in this patient population can inform the outcomes of primary interest in this population of patients who have high mortality due to their advanced disease.

Authors
Kamal, A; Bhavsar, NA; Power, S; Mosca, PJ
MLA Citation
Kamal, A, Bhavsar, NA, Power, S, and Mosca, PJ. "Surgical interventions in cancer patients at the end of life: Experiences at an academic medical center." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 32.30_suppl (October 2014): 281-.
PMID
28141243
Source
epmc
Published In
Journal of Clinical Oncology
Volume
32
Issue
30_suppl
Publish Date
2014
Start Page
281

Immunotherapy following regional chemotherapy treatment of advanced extremity melanoma.

Following regional chemotherapy (RC) for melanoma, approximately 75 % of patients will progress. The role of immunotherapy after RC has not been well established.A prospective, single-institution database of 243 patients with in-transit melanoma (1995-2013) was queried for patients who had progression of disease after RC with melphalan and subsequently received systemic immunotherapy. Fifteen patients received IL-2 only, 12 received ipilimumab only, and 6 received IL-2 followed by ipilimumab. Fisher's exact test was used to determine if there was a difference in number of complete responders after immunotherapy.With IL-2 alone, all patients progressed. After ipilimumab alone, three patients had a complete response and nine had progressive disease. Six additional patients received IL-2 first then ipilimumab. All six progressed on IL-2 but three went on to have a complete response to ipilimumab while three progressed. The use of ipilimumab at any time in patients who progressed after RC was associated with higher rate of complete response compared to use of IL-2 alone (33 vs. 0 %; p = 0.021).Patients with progression after regional therapy for melanoma may benefit from immunologic therapy. In this group of patients, immune checkpoint blockade with ipilimumab has a higher complete response rate than T cell stimulation with IL-2, with no complete responders in the IL-2 only group. Furthermore, the complete response rate for ipilimumab in our cohort is higher than reported response rates in the literature for ipilimumab alone, suggesting that the effects of immunotherapy may be bolstered by previous regional treatment.

Authors
Jiang, BS; Beasley, GM; Speicher, PJ; Mosca, PJ; Morse, MA; Hanks, B; Salama, A; Tyler, DS
MLA Citation
Jiang, BS, Beasley, GM, Speicher, PJ, Mosca, PJ, Morse, MA, Hanks, B, Salama, A, and Tyler, DS. "Immunotherapy following regional chemotherapy treatment of advanced extremity melanoma." Annals of surgical oncology 21.8 (August 2014): 2525-2531.
PMID
24700302
Source
epmc
Published In
Annals of Surgical Oncology
Volume
21
Issue
8
Publish Date
2014
Start Page
2525
End Page
2531
DOI
10.1245/s10434-014-3671-0

Two-day lymphoscintigraphic imaging for melanoma.

OBJECTIVES: Sentinel lymph node mapping has a long history of successful use in the staging and management of cutaneous melanoma. Most practitioners inject the primary site with radiocolloid the evening before or on the day of lymphoscintigraphy. We have found that imaging the day after lymphoscintigraphic injection is quite feasible; it decreases background radioactivity and makes scheduling easier. We aimed to determine whether 2-day lymphoscintigraphy is as effective at defining nodes as 1-day lymphoscintigraphy. MATERIALS AND METHODS: We reviewed the records of 172 patients who underwent lymphoscintigraphy over a 6-year period, all of whom had a diagnosis of melanoma and had undergone 2-day lymphoscintigraphy with imaging on both the day of injection and the day immediately after. The number of basins and the basin pattern were then examined when a discrepancy was seen in the reports in order to decide whether an actual discrepancy between images was present. The number of nodes on same-day and next-day imaging was then evaluated as well. RESULTS: On same-day imaging, the number of basins identified was three node basins (NBs) in five patients, two NBs in 42 patients, one NB in 123 patients and no NB in two patients. On next-day imaging, the number of basins identified was three NBs in five patients, two NBs in 36 patients, one NB in 129 patients and no NB in two patients. The difference in the number of basins between same-day and next-day imaging was not significant once cases such as iliac, para-aortic and pelvic nodes, which do not affect surgical planning, were excluded (P=0.08). The pattern of nodes within the basin was also examined, and the presence or disappearance of disappearing nodes correlated with timing of the next-day images. All cases of disappearing nodes occurred at least 19 h after injection, and cases of disappearance of significant nodes occurred at at least 22 h. The absolute number of nodes declined in 45 cases, remained the same in 124 and increased in three. CONCLUSION: Overall, the same number of basins and, usually, nodes can be detected on the day after injection, as long as the time after injection does not significantly exceed 19 h.

Authors
Oldan, JD; James, OG; Mosca, PJ; Tyler, DS; Borges-Neto, S
MLA Citation
Oldan, JD, James, OG, Mosca, PJ, Tyler, DS, and Borges-Neto, S. "Two-day lymphoscintigraphic imaging for melanoma." Nuclear medicine communications 35.8 (August 2014): 870-875.
PMID
24781011
Source
epmc
Published In
Nuclear Medicine Communications
Volume
35
Issue
8
Publish Date
2014
Start Page
870
End Page
875
DOI
10.1097/mnm.0000000000000136

A phase I study of the safety and activation of a cathepsin-activalable fluorescent cancer-specific probe LUM015.

Authors
Whitley, MJ; Cardona, DM; Blazer, DG; Hwang, SE; Mosca, PJ; Cahill, J; Ferrer, JM; Strasfeld, DB; Mlto, JK; Cuneo, KC; Lanier, N; Williams, O; Spasojevic, I; Riedel, RF; Eward, W; Lee, WD; Griffith, LG; Bawendi, M; Kirsch, DG; Brigman, BE
MLA Citation
Whitley, MJ, Cardona, DM, Blazer, DG, Hwang, SE, Mosca, PJ, Cahill, J, Ferrer, JM, Strasfeld, DB, Mlto, JK, Cuneo, KC, Lanier, N, Williams, O, Spasojevic, I, Riedel, RF, Eward, W, Lee, WD, Griffith, LG, Bawendi, M, Kirsch, DG, and Brigman, BE. "A phase I study of the safety and activation of a cathepsin-activalable fluorescent cancer-specific probe LUM015." May 20, 2014.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
32
Issue
15
Publish Date
2014

Hypoxia in melanoma: using optical spectroscopy and EF5 to assess tumor oxygenation before and during regional chemotherapy for melanoma.

BACKGROUND: There is increasing evidence that tumor hypoxia plays a significant role in the chemoresistance of melanoma, but to our knowledge, real-time tumor oxygenation during isolated limb infusion (ILI) has not been studied. We sought to demonstrate the feasibility of measuring real-time alterations in tissue oxygenation. METHODS: Consecutive patients with histologically confirmed in-transit melanoma were enrolled onto a prospective single-arm pilot study and administered the hypoxia marker drug EF5. All patients were treated with ILI. Optical spectroscopy readings were obtained at three locations: two discrete target lesions and one normal skin control. Measurements were taken at 11 predefined time points during ILI. RESULTS: A total of six patients were enrolled onto this pilot study. Intratumor and normal skin optical spectroscopy readings were found to have discrete inflection points throughout the duration of therapy, corresponding with established time points. Baseline hypoxia as measured by both optical spectroscopy and EF5 immunofluorescence was variable, but on the basis of optical spectra, tumors appeared to become more hypoxic compared to normal skin after tourniquet application. The optical hypoxia signature was variable between patients while hemoglobin absorption increased. CONCLUSIONS: To our knowledge, this is the first use of real-time optical spectroscopy to evaluate oxygenation and perfusion within melanoma lesions during regional chemotherapy. We report our development of this new noninvasive means of assessing tumor vascular function, which has the potential to be a powerful tool for noninvasive examination of the melanoma tumor microenvironment.

Authors
Speicher, PJ; Beasley, GM; Jiang, B; Lidsky, ME; Palmer, GM; Scarbrough, PM; Mosca, PJ; Dewhirst, MW; Tyler, DS
MLA Citation
Speicher, PJ, Beasley, GM, Jiang, B, Lidsky, ME, Palmer, GM, Scarbrough, PM, Mosca, PJ, Dewhirst, MW, and Tyler, DS. "Hypoxia in melanoma: using optical spectroscopy and EF5 to assess tumor oxygenation before and during regional chemotherapy for melanoma." Ann Surg Oncol 21.5 (May 2014): 1435-1440.
PMID
23982250
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
21
Issue
5
Publish Date
2014
Start Page
1435
End Page
1440
DOI
10.1245/s10434-013-3222-0

Efficacy of repeat sentinel lymph node biopsy in patients who develop recurrent melanoma.

Even after negative sentinel lymph node biopsy (SLNB) for primary melanoma, patients who develop in-transit (IT) melanoma or local recurrences (LR) can have subclinical regional lymph node involvement.A prospective database identified 33 patients with IT melanoma/LR who underwent technetium 99m sulfur colloid lymphoscintigraphy alone (n = 15) or in conjunction with lymphazurin dye (n = 18) administered only if the IT melanoma/LR was concurrently excised.Seventy-nine percent (26 of 33) of patients undergoing SLNB in this study had earlier removal of lymph nodes in the same lymph node basin as the expected drainage of the IT melanoma or LR at the time of diagnosis of their primary melanoma. Lymphoscintography at time of presentation with IT melanoma/LR was successful in 94% (31 of 33) cases, and at least 1 sentinel lymph node was found intraoperatively in 97% (30 of 31) cases. The SLNB was positive in 33% (10 of 30) of these cases. Completion lymph node dissection was performed in 90% (9 of 10) of patients. Nine patients with negative SLNB and IT melanoma underwent regional chemotherapy. Patients in this study with a positive sentinel lymph node at the time the IT/LR was mapped had a considerably shorter time to development of distant metastatic disease compared with those with negative sentinel lymph nodes.In this study, we demonstrate the technical feasibility and clinical use of repeat SLNB for recurrent melanoma. Performing SLNB cannot only optimize local, regional, and systemic treatment strategies for patients with LR or IT melanoma, but also appears to provide important prognostic information.

Authors
Beasley, GM; Speicher, P; Sharma, K; Seigler, H; Salama, A; Mosca, P; Tyler, DS
MLA Citation
Beasley, GM, Speicher, P, Sharma, K, Seigler, H, Salama, A, Mosca, P, and Tyler, DS. "Efficacy of repeat sentinel lymph node biopsy in patients who develop recurrent melanoma." Journal of the American College of Surgeons 218.4 (April 2014): 686-692.
PMID
24529806
Source
epmc
Published In
Journal of The American College of Surgeons
Volume
218
Issue
4
Publish Date
2014
Start Page
686
End Page
692
DOI
10.1016/j.jamcollsurg.2013.12.025

Immunotherapy Following Disease Progression after Regional Treatment of Melanoma

Authors
Jiang, BS; Beasley, GM; Speicher, PJ; Hanks, B; Mosca, PJ; Salama, A; Tyler, DS
MLA Citation
Jiang, BS, Beasley, GM, Speicher, PJ, Hanks, B, Mosca, PJ, Salama, A, and Tyler, DS. "Immunotherapy Following Disease Progression after Regional Treatment of Melanoma." Journal of Surgical Research 186.2 (February 2014): 682-682.
Source
crossref
Published In
Journal of Surgical Research
Volume
186
Issue
2
Publish Date
2014
Start Page
682
End Page
682
DOI
10.1016/j.jss.2013.11.925

Defining the Learning Curve for Team-Based Laparoscopic Pancreaticoduodenectomy

© 2014, Society of Surgical Oncology. Background: The purpose of this study was to define the learning curves for laparoscopic pancreaticoduodenectomy (LPD) with and without laparoscopic reconstruction, using paired surgical teams consisting of advanced laparoscopic-trained surgeons and advanced oncologic-trained surgeons. Methods: All patients undergoing PD without vein resection at a single institution were retrospectively analyzed. LPD was introduced by initially focusing on laparoscopic resection followed by open reconstruction (hybrid) for 18 months prior to attempting a totally LPD (TLPD) approach. Cases were compared with Chi square, Fisher’s exact test, and Kruskal–Wallis analysis of variance (ANOVA). Results: Between March 2010 and June 2013, 140 PDs were completed at our institution, of which 56 (40 %) were attempted laparoscopically. In 31/56 procedures we planned to perform only the resection laparoscopically (hybrid), of which 7 (23 %) required premature conversion before completion of resection. Following the first 23 of these hybrid cases, a total of 25 TLPDs have been performed, of which there were no conversions to open. For all LPD, a significant reduction in operative times was identified following the first 10 patients (median 478.5 vs. 430.5 min; p = 0.01), approaching open PD levels. After approximately 50 cases, operative times and estimated blood loss were consistently lower than those for open PD. Conclusions: In our experience of building an LPD program, the initial ten cases represent the biggest hurdle with respect to operative times. For an experienced teaching center using a staged and team-based approach, LPD appears to offer meaningful reductions in operative time and blood loss within the first 50 cases.

Authors
Speicher, PJ; Nussbaum, DP; White, RR; Zani, S; Mosca, PJ; Blazer, DG; Clary, BM; Pappas, TN; Tyler, DS; Perez, A
MLA Citation
Speicher, PJ, Nussbaum, DP, White, RR, Zani, S, Mosca, PJ, Blazer, DG, Clary, BM, Pappas, TN, Tyler, DS, and Perez, A. "Defining the Learning Curve for Team-Based Laparoscopic Pancreaticoduodenectomy." Annals of Surgical Oncology 21.12 (January 1, 2014): 4014-4019.
Source
scopus
Published In
Annals of Surgical Oncology
Volume
21
Issue
12
Publish Date
2014
Start Page
4014
End Page
4019
DOI
10.1245/s10434-014-3839-7

Plasma cytokine analysis in patients with advanced extremity melanoma undergoing isolated limb infusion.

BACKGROUND: Preprocedure clinical and pathologic factors have failed to consistently differentiate complete response (CR) from progressive disease (PD) in patients after isolated limb infusion (ILI) with melphalan for unresectable in-transit extremity melanoma. METHODS: Multiplex immunobead assay technology (Milliplex MAP Human Cytokine/Chemokine Magnetic Bead Panel, Millipore Corp., Billerica, MA; and Magpix analytical test instrument, Luminex Corp., Austin, TX) was performed on pre-ILI plasma to determine concentrations of selected cytokines (MIP-1α, IL-1Rα, IP-10, IL-1β, IL-1α, MCP-1, IL-6, IL-17, EGF, IL-12p40, VEGF, GM-CSF, and MIP-1β) on a subset of patients (n = 180) who experienced CR (n = 23) or PD (n = 24) after ILI. Plasma from normal donors (n = 12) was also evaluated. RESULTS: Of 180 ILIs performed, 28 % (95 % confidence interval 22-35, n = 50) experienced a CR, 14 % (n = 25) experienced a partial response, 11 % (n = 21) had stable disease, 34 % (n = 61) had PD, and 13 % (n = 23) were not evaluable for response. Tumor characteristics and pharmacokinetics appeared similar between CR (n = 23) and PD (n = 24) patients who underwent cytokine analysis. Although there were no differences in cytokine levels between CR and PD patients, there were differences between the melanoma patients and controls. MIP-1α, IL-1Rα, IL-1β, IL-1α, IL-17, EGF, IL-12p40, VEGF, GM-CSF, and MIP-1β were significantly higher in normal controls compared to melanoma patients, while IP-10 was lower (p < 0.001) in controls compared to melanoma patients. CONCLUSIONS: Patients with unresectable in-transit melanoma appear to have markedly decreased levels of immune activating cytokines compared to normal healthy controls. This further supports a potential role for immune-targeted therapies and immune monitoring in patients with regionally advanced melanoma.

Authors
Shetty, G; Beasley, GM; Sparks, S; Barfield, M; Masoud, M; Mosca, PJ; Pruitt, SK; Salama, AKS; Chan, C; Tyler, DS; Weinhold, KJ
MLA Citation
Shetty, G, Beasley, GM, Sparks, S, Barfield, M, Masoud, M, Mosca, PJ, Pruitt, SK, Salama, AKS, Chan, C, Tyler, DS, and Weinhold, KJ. "Plasma cytokine analysis in patients with advanced extremity melanoma undergoing isolated limb infusion." Ann Surg Oncol 20.4 (April 2013): 1128-1135.
PMID
23456379
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
20
Issue
4
Publish Date
2013
Start Page
1128
End Page
1135
DOI
10.1245/s10434-012-2785-5

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2013
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Integration of Palliative Surgery into the Palliative Care Delivery Team

Authors
Rialon, KL; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Abernethy, AP, and Mosca, PJ. "Integration of Palliative Surgery into the Palliative Care Delivery Team." Journal of Palliative Care & Medicine 02.02 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
02
Publish Date
2013
DOI
10.4172/2165-7386.1000e115

Melanoma immunotherapy using mature DCs expressing the constitutive proteasome

Background. Many cancers, including melanoma, exclusively express constitutive proteasomes (cPs) and are unable to express immunoproteasomes (iPs). In contrast, mature DCs used for immunotherapy exclusively express iPs. Since proteasomes generate peptides presented by HLA class I molecules, we hypothesized that mature melanoma antigen-loaded DCs engineered to process antigens through cPs would be superior inducers of antimelanoma immunity in vivo. Methods. Subjects with metastatic melanoma were vaccinated with mature DCs transfected with RNAs encoding melanoma antigens MART1, MAGE-3, gp100, and tyrosinase. These DCs were derived from monocytes that were untransfected (Arm A; n = 4), transfected with control siRNA (Arm B; n = 3), or transfected with siRNAs targeting the 3 inducible iP subunits (Arm C; n = 5). Results. Vaccination stimulated antigen-specific T cell responses in all subjects, which peaked after 3-4 vaccinations, but remained elevated in Arm C subjects. Also in Arm C, circulating melanoma cell levels (as detected by quantitative PCR) fell, and T cell lytic activity against autologous melanoma was induced. In HLA-A2+ subjects, CD8+ T cells that bound tetramers loaded with cP-derived melanoma antigenic peptides were found in the peripheral blood only in Arm C subjects. Of 2 subjects with active disease (both in Arm C), one had a partial clinical response, while the other, who exhibited diffuse dermal and soft tissue metastases, had a complete response. Conclusion. These results suggest that the efficacy of melanoma DC-based immunotherapy is enhanced when tumor antigen-loaded DCs used for vaccination express cPs. Trial registration. Clinicaltrials.gov NCT00672542.

Authors
Dannull, J; Haley, NR; Archer, G; Nair, S; Boczkowski, D; Harper, M; Rosa, ND; Pickett, N; Mosca, PJ; Burchette, J; Selim, MA; Mitchell, DA; Sampson, J; Tyler, DS; Pruitt, SK
MLA Citation
Dannull, J, Haley, NR, Archer, G, Nair, S, Boczkowski, D, Harper, M, Rosa, ND, Pickett, N, Mosca, PJ, Burchette, J, Selim, MA, Mitchell, DA, Sampson, J, Tyler, DS, and Pruitt, SK. "Melanoma immunotherapy using mature DCs expressing the constitutive proteasome." Journal of Clinical Investigation 123.7 (2013): 3135-3145.
PMID
23934126
Source
scival
Published In
Journal of Clinical Investigation
Volume
123
Issue
7
Publish Date
2013
Start Page
3135
End Page
3145
DOI
10.1172/JCI67544

A multi-institution experience comparing the clinical and physiologic differences between upper extremity and lower extremity melphalan-based isolated limb infusion.

BACKGROUND: Although studies of melphalan-based isolated limb infusion (ILI) combine data from upper extremity (UE) treatments with those from lower extremity (LE) treatments, differences between the 2 may be clinically important. METHODS: Candidates for UE ILI (n = 51) and LE ILI (n = 192) were identified from prospective databases at 2 institutions. The Response Evaluation Criteria in Solid Tumors and Wieberdink toxicity scale were used as appropriate. RESULTS: The following patients had indications for UE ILI: melanoma, 36 of 47 patients (77%); sarcoma, 5 of 47 patients (11%); Merkel cell sarcoma, 3 of 47 patients (6%), and squamous cell carcinoma, 3 of 47 patients (6%). The patients who underwent UE ILI, as expected, had lower limb volumes (mean, 2.5 L vs 8.6 L; P < .001) and lower mean melphalan doses (20.7 mg vs 49.5 mg; P < .001). On perfusate blood gas analysis, the mean base excess at 30 minutes (-13.9 vs -9.1; P < .001) and the mean pH at 30 minutes (7.06 vs 7.15; P < .001) were lower for UE procedures than for LE procedures, although the mean ischemic time was longer in LE procedures (67.2 minutes) than in UE procedures (61.6 minutes; P = .03). The rate of regional toxicity grade ≥3 for UE ILI was 7% compared with 24% (P = .005) for LE ILI. There was no difference in the complete response rate for melanoma UE procedures (28%; 95% confidence interval, 16%-44%) compared with LE ILI procedures (32%; 95% confidence interval, 25%-39%). CONCLUSIONS: ILI for UE disease was associated with similar complete response rates but lower toxicity than ILI for LE disease and with different physiologic sequelae despite comparable methods. The UE appears relatively resistant to toxic effects of melphalan-based ILI as currently performed, which suggests a potential for further optimization of drug dosing for UE ILI.

Authors
Beasley, GM; Sharma, K; Wong, J; Miller, M; Turley, RS; Lidsky, M; Masoud, M; Dewhirst, MW; Mosca, PJ; Zager, JS; Tyler, DS
MLA Citation
Beasley, GM, Sharma, K, Wong, J, Miller, M, Turley, RS, Lidsky, M, Masoud, M, Dewhirst, MW, Mosca, PJ, Zager, JS, and Tyler, DS. "A multi-institution experience comparing the clinical and physiologic differences between upper extremity and lower extremity melphalan-based isolated limb infusion." Cancer 118.24 (December 15, 2012): 6136-6143.
PMID
22674423
Source
pubmed
Published In
Cancer
Volume
118
Issue
24
Publish Date
2012
Start Page
6136
End Page
6143
DOI
10.1002/cncr.27676

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, K
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, K. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (2013).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J, Blazer, DG, and Mosca, PJ. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J; Blazer, DG; Mosca, PJ
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Patterns of recurrence following complete response to regional chemotherapy for in-transit melanoma

Background: Even after complete response (CR) to regional chemotherapy for in-transit melanoma, many patients develop recurrence. Understanding the probability, location, and timing of recurrences can optimize management strategies for this patient population. Methods: A prospective database identified patients who underwent 81 first-time hyperthermic isolated limb perfusions (HILPs) and 133 first-time isolated limb infusions (ILIs). Response was defined using the response evaluation criteria in solid tumors; recurrence was defined as development of new disease after in-field CR. Results: HILP exhibited a significantly higher CR rate than ILI (44 vs. 28 %, p = .01). Among 36 HILP-CRs and 37 ILI-CRs, the 3-year recurrence rate was 65 % (95 % confidence interval [95 % CI]: 43-79 %) and 85 % (95 % CI: 63-94%), respectively. Median time to first recurrence was longer for HILP-CR than ILI-CR (23 vs. 8 months, p = .02). There was no statistically significant difference in median time to in-field recurrence between HILP-CR and ILI-CR (46 vs. 25 months, p = .15), but HILP-CR showed a longer median time to out-of-field recurrence (42 vs. 14 months, p = .02). Finally, the overall survival (OS) difference between HILP-CR and ILI-CR (3-year survival: 77 vs. 54 %) did not achieve statistical significance (p = .10). Conclusions: In the largest series comparing patterns of recurrence, we demonstrate that out-of-field recurrence after CR to HILP occurs later than after CR to ILI, though control of in-field disease remains similar. There remains no statistically significant difference in overall survival after CR to the 2 procedures. © 2012 Society of Surgical Oncology.

Authors
Sharma, K; Beasley, G; Turley, R; Raymond, AK; Broadwater, G; Peterson, B; Mosca, P; Tyler, D
MLA Citation
Sharma, K, Beasley, G, Turley, R, Raymond, AK, Broadwater, G, Peterson, B, Mosca, P, and Tyler, D. "Patterns of recurrence following complete response to regional chemotherapy for in-transit melanoma." Annals of Surgical Oncology 19.8 (2012): 2563-2571.
PMID
22476748
Source
scival
Published In
Annals of Surgical Oncology
Volume
19
Issue
8
Publish Date
2012
Start Page
2563
End Page
2571
DOI
10.1245/s10434-012-2315-5

Circulating tumor cells in melanoma patients.

Circulating tumor cells (CTCs) are of recognized importance for diagnosis and prognosis of cancer patients. With melanoma, most studies do not show any clear relationship between CTC levels and stage of disease. Here, CTCs were enriched (∼400X) from blood of melanoma patients using a simple centrifugation device (OncoQuick), and 4 melanocyte target RNAs (TYR, MLANA, MITF, and MIF) were quantified using QPCR. Approximately one-third of melanoma patients had elevated MIF and MLANA transcripts (p<0.0001 and p<0.001, respectively) compared with healthy controls. In contrast, healthy controls had uniformly higher levels of TYR and MITF than melanoma patients (p<0.0001). There was a marked shift of leukocytes into the CTC-enriched fractions (a 430% increase in RNA recovery, p<0.001), and no relationship between CTC levels and stage of disease was found. CTCs were captured on microfabricated filters and cultured. Captured melanoma CTCs were large cells, and consisted of 2 subpopulations, based on immunoreactivity. One subpopulation (∼50%) stained for both pan-cytokeratin (KRT) markers and the common leukocyte marker CD-45, whereas the second subpopulation stained for only KRT. Since similar cells are described in many cancers, we also examined blood from colorectal and pancreatic cancer patients. We observed analogous results, with most captured CTCs staining for both CD-45/KRT markers (and for the monocyte differentiation marker CD-14). Our results suggest that immature melanocyte-related cells (expressing TYR and MITF RNA) may circulate in healthy controls, although they are not readily detectable without considerable enrichment. Further, as early-stage melanomas develop, immature melanocyte migration into the blood is somehow curtailed, whereas a significant proportion of patients develop elevated CTC levels (based on MIF and MLANA RNAs). The nature of the captured CTCs is consistent with literature describing leukocyte/macrophage-tumor cell fusion hybrids, and their role in metastatic progression.

Authors
Clawson, GA; Kimchi, E; Patrick, SD; Xin, P; Harouaka, R; Zheng, S; Berg, A; Schell, T; Staveley-O'Carroll, KF; Neves, RI; Mosca, PJ; Thiboutot, D
MLA Citation
Clawson, GA, Kimchi, E, Patrick, SD, Xin, P, Harouaka, R, Zheng, S, Berg, A, Schell, T, Staveley-O'Carroll, KF, Neves, RI, Mosca, PJ, and Thiboutot, D. "Circulating tumor cells in melanoma patients." PLoS One 7.7 (2012): e41052-.
PMID
22829910
Source
pubmed
Published In
PloS one
Volume
7
Issue
7
Publish Date
2012
Start Page
e41052
DOI
10.1371/journal.pone.0041052

The Akt signaling pathway: an emerging therapeutic target in malignant melanoma.

Studies using cultured melanoma cells and patient tumor biopsies have demonstrated deregulated PI3 kinase-Akt3 pathway activity in ~70% of melanomas. Furthermore, targeting Akt3 and downstream PRAS40 has been shown to inhibit melanoma tumor development in mice. Although these preclinical studies and several other reports using small interfering RNAs and pharmacological agents targeting key members of this pathway have been shown to retard melanoma development, analysis of early Phase I and Phase II clinical trials using pharmacological agents to target this pathway demonstrate the need for (1) selection of patients whose tumors have PI3 kinase-Akt pathway deregulation, (2) further optimization of therapeutic agents for increased potency and reduced toxicity, (3) the identification of additional targets in the same pathway or in other signaling cascades that synergistically inhibit the growth and progression of melanoma, and (4) better methods for targeted delivery of pharmaceutical agents inhibiting this pathway. In this review we discuss key potential targets in PI3K-Akt3 signaling, the status of pharmacological agents targeting these proteins, drugs under clinical development, and strategies to improve the efficacy of therapeutic agents targeting this pathway.

Authors
Madhunapantula, SV; Mosca, PJ; Robertson, GP
MLA Citation
Madhunapantula, SV, Mosca, PJ, and Robertson, GP. "The Akt signaling pathway: an emerging therapeutic target in malignant melanoma." Cancer Biol Ther 12.12 (December 15, 2011): 1032-1049. (Review)
PMID
22157148
Source
pubmed
Published In
Cancer Biology and Therapy
Volume
12
Issue
12
Publish Date
2011
Start Page
1032
End Page
1049
DOI
10.4161/cbt.12.12.18442

When a chance to cut is not a chance to cure: a future for palliative surgery?

In the context of healthcare reform, Surgery stands at a critical juncture. Attempting to rein in healthcare spending, legislators and payers can be expected to closely examine the legitimacy and necessity of a variety of medical treatments, including surgical procedures. Among these procedures, the most at risk for dismissal based on perceived ineffectiveness or lack of need may be those performed near the end of life, when the potential benefit of surgical intervention may seem negligible. While procedures may be performed for a variety of reasons toward the end of life--some indeed being inappropriate and/or unnecessary--palliative surgery plays an important role in the management of incurable disease. The purposes of this article are to: describe the place for palliative surgery in the armamentarium of palliative care; discuss potential challenges to patients' access to palliative surgery that may arise from health policy or quality initiatives based on poor evidence; and outline a strategy for (a) systematically differentiating palliative surgeries from other, potentially expendable surgeries performed near the end of life, and (b) defining a plan for generating the evidence base to support best practice.

Authors
Mosca, PJ; Blazer, DG; Wheeler, JL; Abernethy, AP
MLA Citation
Mosca, PJ, Blazer, DG, Wheeler, JL, and Abernethy, AP. "When a chance to cut is not a chance to cure: a future for palliative surgery?." Ann Surg Oncol 18.12 (November 2011): 3235-3239.
PMID
21584829
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
18
Issue
12
Publish Date
2011
Start Page
3235
End Page
3239
DOI
10.1245/s10434-011-1787-z

Augmentation of tumor-specific immunity by upregulation of apoptotic melanoma cell calreticulin expression.

Authors
Mosca, PJ; Robertson, GP
MLA Citation
Mosca, PJ, and Robertson, GP. "Augmentation of tumor-specific immunity by upregulation of apoptotic melanoma cell calreticulin expression." Cancer Biol Ther 11.6 (March 15, 2011): 581-583.
PMID
21282973
Source
pubmed
Published In
Cancer Biology and Therapy
Volume
11
Issue
6
Publish Date
2011
Start Page
581
End Page
583

Steroid hormones drive cancer development

Authors
Madhunapantula, SV; Mosca, P; Robertson, GP
MLA Citation
Madhunapantula, SV, Mosca, P, and Robertson, GP. "Steroid hormones drive cancer development." Cancer Biology and Therapy 10.8 (2010): 765-766.
PMID
20935464
Source
scival
Published In
Cancer Biology and Therapy
Volume
10
Issue
8
Publish Date
2010
Start Page
765
End Page
766
DOI
10.4161/cbt.10.8.13531

Predictive factors of regional toxicity and serum creatine phosphokinase levels after isolated limb infusion for melanoma: a multi-institutional analysis.

BACKGROUND: Isolated limb infusion (ILI) is a minimally invasive technique delivering regional chemotherapy to treat in-transit extremity melanoma. Determining perioperative factors that could predict toxicity is important to optimize strategies to improve clinical outcomes after regional chemotherapy in melanoma. METHODS: Perioperative factors from 171 ILI patients performed at eight centers from 2001 to 2008 were reviewed. The Wieberdink limb toxicity scale and creatine phosphokinase (CK) levels were used to measure toxicity. Logistic regression analysis was used to estimate the association between toxicity and perioperative parameters. RESULTS: Mild (grades I-II) and severe (grades >or=III) limb toxicity developed in 68% and 32% of patients, respectively. Melphalan adjusted for ideal body weight (aIBW) and papaverine were used in 47% and 63% of patients, respectively. Median peak CK for all patients was 563 U/l, and median peak occurred at postoperative day 4. On univariate analysis, papaverine and high CK levels (>563 U/l) were significantly associated with higher toxicity. On the contrary, aIBW was significantly associated with a lower risk of severe toxicity. Perfusate blood gas at 30 min [pH, PaO(2), and base excess (BE) ], limb temperature, and ischemia time were not predictive of limb toxicity. On multivariate analysis, severe toxicity was associated with female sex (P = 0.01), papaverine (P = 0.01), and high peak CK levels (P < 0.01). Independent predictors of high CK levels included younger age, unadjusted melphalan dose, and low PaO(2) at 30 min. CONCLUSIONS: ILI can be performed with an acceptable morbidity. Papaverine use, female gender, and high peak CK were associated with higher limb toxicity. CK levels can be diminished significantly with aIBW.

Authors
Santillan, AA; Delman, KA; Beasley, GM; Mosca, PJ; Hochwald, SN; Grobmyer, SR; Andtbacka, RH; Noyes, RD; Kane, JM; Ross, MI; Tyler, DS; Zager, JS
MLA Citation
Santillan, AA, Delman, KA, Beasley, GM, Mosca, PJ, Hochwald, SN, Grobmyer, SR, Andtbacka, RH, Noyes, RD, Kane, JM, Ross, MI, Tyler, DS, and Zager, JS. "Predictive factors of regional toxicity and serum creatine phosphokinase levels after isolated limb infusion for melanoma: a multi-institutional analysis." Ann Surg Oncol 16.9 (September 2009): 2570-2578.
PMID
19543771
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
16
Issue
9
Publish Date
2009
Start Page
2570
End Page
2578
DOI
10.1245/s10434-009-0563-9

A multi-institutional experience of isolated limb infusion: defining response and toxicity in the US.

BACKGROUND: Isolated limb infusion (ILI) is a minimally invasive approach for treating in-transit extremity melanoma, with only two US single-center studies reported. Establishing response and toxicity to ILI as compared with hyperthermic isolated limb perfusion is important for optimizing future regional chemotherapeutic strategies in melanoma. STUDY DESIGN: Patient characteristics and procedural variables were collected retrospectively from 162 ILIs performed at 8 institutions (2001 to 2008) and compared using chi-square and Student's t-test. ILIs were performed for 30 minutes in patients with in-transit melanoma. Melphalan dose was corrected for ideal body weight (IBW) in 42% (n = 68) of procedures. Response was determined at 3 months by Response Evaluation Criteria in Solid Tumors; toxicity was assessed using the Wieberdink Limb Toxicity Scale. RESULTS: In 128 evaluable patients, complete response rate was 31%, partial response rate was 33%, and there was no response in 36% of patients. For all patients (n = 162), 36% had Wieberdink toxicity grade >or=3 with one toxicity-related amputation. On multivariate analysis, smaller limb volumes were associated with better overall response (p = 0.021). Use of papaverine in the circuit to achieve cutaneous vasodilation was associated with better response (p < 0.001) but higher risk of grade >or=3 toxicity (p = 0.001). Correction of melphalan dose for ideal body weight did not alter complete response (p = 0.345), but did lead to marked reduction in toxicity (p < 0.001). CONCLUSIONS: In the first multi-institutional analysis of ILI, a complete response rate of 31% was achieved with acceptable toxicity demonstrating this procedure to be a reasonable alternative to hyperthermic isolated limb perfusion in the management of advanced extremity melanoma.

Authors
Beasley, GM; Caudle, A; Petersen, RP; McMahon, NS; Padussis, J; Mosca, PJ; Zager, JS; Hochwald, SN; Grobmyer, SR; Delman, KA; Andtbacka, RH; Noyes, RD; Kane, JM; Seigler, H; Pruitt, SK; Ross, MI; Tyler, DS
MLA Citation
Beasley, GM, Caudle, A, Petersen, RP, McMahon, NS, Padussis, J, Mosca, PJ, Zager, JS, Hochwald, SN, Grobmyer, SR, Delman, KA, Andtbacka, RH, Noyes, RD, Kane, JM, Seigler, H, Pruitt, SK, Ross, MI, and Tyler, DS. "A multi-institutional experience of isolated limb infusion: defining response and toxicity in the US." J Am Coll Surg 208.5 (May 2009): 706-715.
PMID
19476821
Source
pubmed
Published In
Journal of the American College of Surgeons
Volume
208
Issue
5
Publish Date
2009
Start Page
706
End Page
715
DOI
10.1016/j.jamcollsurg.2008.12.019

Targeting Akt3 signaling in malignant melanoma using isoselenocyanates

Purpose: Melanoma is the most invasive and deadly form of skin cancer. Few agents are available for treating advanced disease to enable long-term patient survival, which is driving the search for new compounds inhibiting deregulated pathways causing melanoma. Akt3 is an important target in melanomas because its activity is increased in ∼70% of tumors, decreasing apoptosis in order to promote tumorigenesis. Experimental Design: Because naturally occurring products can be effective anticancer agents, a library was screened to identify Akt3 pathway inhibitors. Isothiocyanates were identified as candidates, but low potency requiring high concentrations for therapeutic efficacy made them unsuitable. Therefore, more potent analogs called isoselenocyanates were created using the isothiocyanate backbone but increasing the alkyl chain length and replacing sulfur with selenium. Efficacy was measured on cultured cells and tumors by quantifying proliferation, apoptosis, toxicity, and Akt3 pathway inhibition. Results: Isoselenocyanates significantly decreased Akt3 signaling in cultured melanoma cells and tumors. Compounds having 4 to 6carbon alkyl side chains with selenium substituted for sulfur, called ISC-4 and ISC-6, respectively, decreased tumor development by ∼ 60% compared with the corresponding isothiocyanates, which had no effect. No changes in animal body weight or in blood parameters indicative of liver-, kidney-, or cardiac-related toxicity were observed with isoselenocyanates. Mechanistically, isoselenocyanates ISC-4 and ISC-6decreased melanoma tumorigenesis by causing an ~ 3-fold increase in apoptosis. Conclusions: Synthetic isoselenocyanates are therapeutically effective for inhibiting melanoma tumor development by targeting Akt3 signaling to increase apoptosis in melanoma cells with negligible associated systemic toxicity. © 2009 American Association for Cancer Research.

Authors
Sharma, A; Sharma, AK; Madhunapantula, SV; Desai, D; Huh, SJ; Mosca, P; Amin, S; Robertson, GP
MLA Citation
Sharma, A, Sharma, AK, Madhunapantula, SV, Desai, D, Huh, SJ, Mosca, P, Amin, S, and Robertson, GP. "Targeting Akt3 signaling in malignant melanoma using isoselenocyanates." Clinical Cancer Research 15.5 (2009): 1674-1685.
PMID
19208796
Source
scival
Published In
Clinical cancer research : an official journal of the American Association for Cancer Research
Volume
15
Issue
5
Publish Date
2009
Start Page
1674
End Page
1685
DOI
10.1158/1078-0432.CCR-08-2214

Pharmacokinetics & drug resistance of melphalan in regional chemotherapy: ILP versus ILI.

Two forms of regional chemotherapy for the treatment of advanced melanoma or sarcoma of the extremity are isolated limb perfusion (ILP) and the more recently described isolated limb infusion (ILI). Melphalan is the most commonly employed agent in both ILP and ILI, although it is often used in conjunction with other cytotoxic and/or biologic therapies. While ILP and ILI are far more effective for the treatment of extremity disease than is systemic therapy, there is still significant room for improvement in outcomes, from the standpoint of both response rate and toxicity. An understanding of the pharmacokinetics of regional chemotherapy would allow for the prediction of tumor response and toxicity and therefore patient outcomes. In addition, elucidating the mechanisms of drug resistance would lead to opportunities to develop effective chemo-modulators that enhance the effectiveness of ILP and ILI. This paper reviews progress in these two key areas of active investigation.

Authors
Padussis, JC; Steerman, SN; Tyler, DS; Mosca, PJ
MLA Citation
Padussis, JC, Steerman, SN, Tyler, DS, and Mosca, PJ. "Pharmacokinetics & drug resistance of melphalan in regional chemotherapy: ILP versus ILI." Int J Hyperthermia 24.3 (May 2008): 239-249. (Review)
PMID
18393002
Source
pubmed
Published In
International Journal of Hyperthermia (Informa)
Volume
24
Issue
3
Publish Date
2008
Start Page
239
End Page
249
DOI
10.1080/02656730701816410

Can surgeons improve survival in stage IV melanoma?

Successful systemic management of stage IV melanoma continues to be elusive because of the paucity of effective therapies. This has fueled the continued interest in surgical resection. Several single-institution studies and a current, large, multi-institutional phase III trial have demonstrated a survival benefit for patients who underwent surgical resection for melanoma metastases. Incorporating these results into new approaches using multimodality treatment may enhance survival in patients with stage IV melanoma.

Authors
Mosca, PJ; Teicher, E; Nair, SP; Pockaj, BA
MLA Citation
Mosca, PJ, Teicher, E, Nair, SP, and Pockaj, BA. "Can surgeons improve survival in stage IV melanoma?." J Surg Oncol 97.5 (April 1, 2008): 462-468. (Review)
PMID
18270974
Source
pubmed
Published In
Journal of Surgical Oncology
Volume
97
Issue
5
Publish Date
2008
Start Page
462
End Page
468
DOI
10.1002/jso.20950

Current immunotherapeutic strategies in malignant melanoma.

The basis of immunotherapy for melanoma is the existence of melanoma-associated antigens that can be targeted by the immune system. Identification of many of these antigens has enabled investigators to develop a wide array of immunotherapy strategies for the treatment of melanoma. Although several of these strategies have been shown to induce antitumor immune responses in some patients, robust clinical responses have been observed less frequently. With exciting recent advancements in this field, however, there is promise of generating potent immunologic responses and translating them more consistently into durable clinical responses. This article reviews several current approaches to immunotherapy for melanoma and describes the key role that surgeons play in advancing this area of oncology.

Authors
Agostino, NM; Ali, A; Nair, SG; Mosca, PJ
MLA Citation
Agostino, NM, Ali, A, Nair, SG, and Mosca, PJ. "Current immunotherapeutic strategies in malignant melanoma." Surg Oncol Clin N Am 16.4 (October 2007): 945-xi. (Review)
PMID
18022553
Source
pubmed
Published In
Surgical Oncology Clinics of North America
Volume
16
Issue
4
Publish Date
2007
Start Page
945
End Page
xi
DOI
10.1016/j.soc.2007.07.010

Dendritic cell vaccines.

Dendritic cells are antigen-presenting cells that have been shown to stimulate tumor antigen-specific T cell responses in preclinical studies. Consequently, there has been intense interest in developing dendritic cell based cancer vaccines. A variety of methods for generating dendritic cells, loading them with tumor antigens, and administering them to patients have been described. In recent years, a number of early phase clinical trials have been performed and have demonstrated the safety and feasibility of dendritic cell immunotherapies. A number of these trials have generated valuable preliminary data regarding the clinical and immunologic response to DC-based immunotherapy. The emphasis of dendritic cell immunotherapy research is increasingly shifting toward the development of strategies to increase the potency of dendritic cell vaccine preparations.

Authors
Mosca, PJ; Lyerly, HK; Clay, TM; Morse, MA; Lyerly, HK
MLA Citation
Mosca, PJ, Lyerly, HK, Clay, TM, Morse, MA, and Lyerly, HK. "Dendritic cell vaccines. (Published online)" Front Biosci 12 (May 1, 2007): 4050-4060. (Review)
PMID
17485358
Source
pubmed
Published In
Frontiers in bioscience : a journal and virtual library
Volume
12
Publish Date
2007
Start Page
4050
End Page
4060

Histopathologic characteristics, recurrence patterns, and survival of 129 patients with desmoplastic melanoma.

BACKGROUND: Desmoplastic melanoma (DM) has been associated with higher local recurrence rates than other types of cutaneous melanoma. Current controversies regarding locoregional treatment strategies warrant further investigation. METHODS: Retrospective review of a prospectively maintained melanoma database identified 129 patients with DM out of >12,500 melanoma patients referred for treatment from 1980 to 2003. Clinical and histopathologic characteristics, recurrence, and survival were analyzed. RESULTS: The median follow-up was 4.0 years. Of the 129 patients identified, 82 (63.6%) were male, and the median age was 55.2 years. American Joint Committee on Cancer staging was I, II, and III in 25.6%, 68.0%, and 6.4% of patients, respectively, and the mean tumor thickness was 4.42 mm. Overall survival was 76% at 5 years and 64% at 10 years; median survival was 13.0 years. A total of 51 patients (39.5%) experienced disease recurrence, with a median time to recurrence of 1.3 years. The first recurrence was local in 18 patients (14.0%), nodal in 18 patients (14.0%), and distant in 15 patients (11.6%), with median survivals of 6.7, 7.8, and 1.8 years, respectively. Statistically significant predictors of recurrence were a final positive margin status and stage, and predictors of overall survival were patient age and stage. CONCLUSIONS: Compared with other types of melanoma, DMs do demonstrate a tendency toward local recurrence, thus suggesting that narrower excision margins may not be appropriate in this population. Scrutiny of final surgical margins is critical to the local management of DM. In addition, the potential for regional nodal involvement must be considered at the time of diagnosis and during surveillance for disease recurrence.

Authors
Posther, KE; Selim, MA; Mosca, PJ; Stanley, WE; Johnson, JL; Tyler, DS; Seigler, HF
MLA Citation
Posther, KE, Selim, MA, Mosca, PJ, Stanley, WE, Johnson, JL, Tyler, DS, and Seigler, HF. "Histopathologic characteristics, recurrence patterns, and survival of 129 patients with desmoplastic melanoma." Ann Surg Oncol 13.5 (May 2006): 728-739.
PMID
16538415
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
13
Issue
5
Publish Date
2006
Start Page
728
End Page
739
DOI
10.1245/ASO.2006.03.091

Predictors of outcome after hyperthermic isolated limb perfusion: role of tumor response.

HYPOTHESIS: Analysis of multiple clinical and pathological factors in patients undergoing therapeutic hyperthermic isolated limb perfusion for extremity melanoma can identify variables with prognostic significance. DESIGN: Retrospective review of a prospectively collected limb perfusion database with a median follow-up interval of 32.2 months. SETTING: Single-institution tertiary care surgical oncology unit. PATIENTS: We report a series of 59 consecutive therapeutic hyperthermic isolated limb perfusion treatments (14 upper extremity and 45 lower extremity) in 54 patients with melanoma from January 1, 1995, through December 31, 2002, using a standard melphalan dosing protocol. At the time of perfusion, 31 cases had fewer than 10 lesions, with none greater than 3 cm in diameter. The remaining 28 cases had 10 or more lesions or at least 1 lesion greater than 3 cm in diameter. MAIN OUTCOME MEASURES: Response, recurrence, and survival were assessed in relation to multiple demographic, clinical, and technical variables using chi2, log-rank, and Kaplan-Meier survival analyses. RESULTS: The 3-year survival for the entire cohort was 54%. Thirty-three (56%) of the 59 perfusion treatments resulted in a persistent complete response of at least 6 months' duration. Statistical analysis showed that patients with no evidence of regional nodal involvement had a significantly lower incidence of distant recurrence (P = .02). Those patients achieving a complete response to therapy had a survival advantage (P = .03). CONCLUSION: In patients undergoing therapeutic hyperthermic isolated limb perfusion for in-transit melanoma, the ability to achieve a complete response following treatment, independent of regional nodal status, was the strongest predictor of long-term survival.

Authors
Aloia, TA; Grubbs, E; Onaitis, M; Mosca, PJ; Cheng, T-Y; Seigler, H; Tyler, DS
MLA Citation
Aloia, TA, Grubbs, E, Onaitis, M, Mosca, PJ, Cheng, T-Y, Seigler, H, and Tyler, DS. "Predictors of outcome after hyperthermic isolated limb perfusion: role of tumor response." Arch Surg 140.11 (November 2005): 1115-1120.
PMID
16301451
Source
pubmed
Published In
Archives of Surgery
Volume
140
Issue
11
Publish Date
2005
Start Page
1115
End Page
1120
DOI
10.1001/archsurg.140.11.1115

Pneumatosis intestinalis after lung transplant.

Pneumatosis intestinalis may be idiopathic or associated with numerous conditions. Uncommonly, it has been associated with organ transplantation. We report one case of pneumatosis intestinalis after lung transplantation in an adult patient. To our knowledge, this finding has not been reported in the radiology literature.

Authors
Ho, LM; Mosca, PJ; Thompson, WM
MLA Citation
Ho, LM, Mosca, PJ, and Thompson, WM. "Pneumatosis intestinalis after lung transplant." Abdom Imaging 30.5 (September 2005): 598-600.
PMID
16096869
Source
pubmed
Published In
Abdominal Imaging
Volume
30
Issue
5
Publish Date
2005
Start Page
598
End Page
600
DOI
10.1007/s00261-005-0311-y

Melanoma arising in a skin graft.

Cutaneous melanoma remains an ongoing public health threat, and the cornerstone of management continues to be early diagnosis and treatment. Unfortunately, primary melanomas may have atypical presentations, making early diagnosis difficult and causing significant treatment delays. In this report, an unusual case is presented in which a patient experienced the synchronous development of a melanoma in situ within a skin graft donor site and an invasive melanoma within the recipient skin graft site. This exceptional presentation of cutaneous melanoma is discussed to highlight key principles of skin grafting in relation to the management of malignant melanoma.

Authors
Hall, JG; Herman, C; Cook, JL; Tyler, D; Seigler, HF; Mosca, PJ
MLA Citation
Hall, JG, Herman, C, Cook, JL, Tyler, D, Seigler, HF, and Mosca, PJ. "Melanoma arising in a skin graft." Ann Plast Surg 54.1 (January 2005): 92-96.
PMID
15613891
Source
pubmed
Published In
Annals of Plastic Surgery
Volume
54
Issue
1
Publish Date
2005
Start Page
92
End Page
96

Immune monitoring.

A wide array of immunologic tests are available for immune monitoring in cancer vaccine trials, and the number of novel assays and technical modifications continues to burgeon. Because only a small fraction of all proposed vaccine trials tested in phase I-II trials, for practical reasons, will ultimately move forward to be tested in phase III trials, there must be a system of establishing the most promising immunization strategies. This evaluation of cancer vaccine will require standardization of the immune assays and statistical methods used in immunologic monitoring. Furthermore, the use of a systematic approach to evaluating and adopting novel technologies for immunologic assessment would likely lead to timely implementation of more reliable, practical and cost-effective methods of immune. It should be the goal and expectation that this rational approach to immune monitoring will allow the critical appraisal of the most promising vaccine candidates in the context of pivotal, multi-center trials.

Authors
Mosca, PJ; Clay, TM; Morse, MA; Lyerly, HK
MLA Citation
Mosca, PJ, Clay, TM, Morse, MA, and Lyerly, HK. "Immune monitoring." Cancer Treat Res 123 (2005): 369-388. (Review)
PMID
16211879
Source
pubmed
Published In
Cancer Treatment and Research
Volume
123
Publish Date
2005
Start Page
369
End Page
388

Intracellular Cytokine Assays

This chapter provides an overview of intracellular cytokine assays. Intracellular cytokine assays are a relatively new method of identifying cytokine production by individual T cells and have the ability to correlate cytokine expression with cell surface phenotype without cell separation. In addition, this highly sensitive flow cytometric method allows for the rapid detection of low frequency T cells expressing cytokine in response to specific antigen stimulation. The unique capabilities of this method make it a model assay for clinical and research applications. The overall premise of intracellular cytokine assays is direct detection of intracellular cytokine expression in response to antigen stimulation. Intracellular cytokine assays can be performed using various sources of cells and antigen depending on the target(s) of interest. T cell stimulation can be performed directly on whole blood, peripheral blood mononuclear cells, in vitro manipulated lymphocytes, isolated cells, and lymph nodes; although using whole blood for these assays provides a more physiological environment and may have an effect on the T cell response to stimulation. Since these assays are most often used to detect very low frequency events, appropriate control antigens are particularly important to ensure clear antigen specific response. © 2005 Elsevier Ltd. All rights reserved.

Authors
Hobeika, AC; Morse, MA; Clay, TM; Osada, T; Mosca, PJ; Lyerly, HK
MLA Citation
Hobeika, AC, Morse, MA, Clay, TM, Osada, T, Mosca, PJ, and Lyerly, HK. "Intracellular Cytokine Assays." 2005. 336-340.
Source
scival
Publish Date
2005
Start Page
336
End Page
340
DOI
10.1016/B978-012455900-4/50290-7

Histopathologic characteristics, recurrence patterns, and survival of 129 patients with desmoplastic melanoma

Authors
Posther, KE; Mosca, PJ; Selim, MA; Stanley, WE; Johnson, JL; Tyler, DS; Seigler, HF
MLA Citation
Posther, KE, Mosca, PJ, Selim, MA, Stanley, WE, Johnson, JL, Tyler, DS, and Seigler, HF. "Histopathologic characteristics, recurrence patterns, and survival of 129 patients with desmoplastic melanoma." February 2004.
Source
wos-lite
Published In
Annals of Surgical Oncology
Volume
11
Issue
2
Publish Date
2004
Start Page
S78
End Page
S78
DOI
10.1007/BF02524057

Immunotherapy of surgical malignancies.

Authors
Morse, MA; Lyerly, HK; Clay, TM; Abdel-Wahab, O; Chui, SY; Garst, J; Gollob, J; Grossi, PM; Kalady, M; Mosca, PJ; Onaitis, M; Sampson, JH; Seigler, HF; Toloza, EM; Tyler, D; Vieweg, J; Yang, Y
MLA Citation
Morse, MA, Lyerly, HK, Clay, TM, Abdel-Wahab, O, Chui, SY, Garst, J, Gollob, J, Grossi, PM, Kalady, M, Mosca, PJ, Onaitis, M, Sampson, JH, Seigler, HF, Toloza, EM, Tyler, D, Vieweg, J, and Yang, Y. "Immunotherapy of surgical malignancies." Curr Probl Surg 41.1 (January 2004): 15-132. (Review)
PMID
14749625
Source
pubmed
Published In
Current Problems in Surgery
Volume
41
Issue
1
Publish Date
2004
Start Page
15
End Page
132
DOI
10.1016/S0011384003001321

Surgical management of cutaneous melanoma: current practice and impact on prognosis.

Authors
Mosca, PJ; Tyler, DS; Seigler, HF
MLA Citation
Mosca, PJ, Tyler, DS, and Seigler, HF. "Surgical management of cutaneous melanoma: current practice and impact on prognosis." Adv Surg 38 (2004): 85-119. (Review)
PMID
15515616
Source
pubmed
Published In
Advances in Surgery(R)
Volume
38
Publish Date
2004
Start Page
85
End Page
119

How does the immune system attack cancer?

Authors
Morse, MA; Lyerly, HK; Clay, TM; Abdel-Wahab, O; Chui, SY; Garst, J; Gollob, J; Grossi, PM; Kalady, M; Mosca, PJ; Onaitis, M; Sampson, JH; Seigler, HF; Toloza, EM; Tyler, D; Vieweg, J; Yang, Y
MLA Citation
Morse, MA, Lyerly, HK, Clay, TM, Abdel-Wahab, O, Chui, SY, Garst, J, Gollob, J, Grossi, PM, Kalady, M, Mosca, PJ, Onaitis, M, Sampson, JH, Seigler, HF, Toloza, EM, Tyler, D, Vieweg, J, and Yang, Y. "How does the immune system attack cancer?." Current Problems in Surgery 41.1 (2004): 15-132.
Source
scival
Published In
Current Problems in Surgery
Volume
41
Issue
1
Publish Date
2004
Start Page
15
End Page
132
DOI
10.1016/j.cpsurg.2003.08.001

Active immunotherapy with Flt3-ligand mobilized peripheral blood dendritic cells loaded with carcinoembryonic antigen peptide in patients with metastatic malignancies

Background: Dendritic cells (DC) loaded with tumor antigens induce immune responses in some cancer patients. However, the most commonly used method for obtaining clinical grade DC requires in vitro generation over 7 days in media containing cytokine, increasing the complexity and cost of the cellular vaccine product. The cytokine Flt3-ligand (FL) increases peripheral blood DC numbers in humans permitting an alternative approach to obtaining an adequate number of clinical grade DCs. We sought to evaluate the safety and immunogenicity of immunizations with FL-mobilized DC loaded with the tumor antigen CEA. Methods: Patients with CEA-expressing cancers received FL 20 μg/kg/d SQ x 10 d and were then leukapheresed to obtain peripheral blood mononuclear cells enriched for DC (FL-DC). After maturation overnight, FL-DC were coadministered (1 × 107 cells) as a combined ID and SQ injection with a class I peptide fragment of CEA, hepatitis B core antigen, tetanus toxoid or KLH protein every 3 weeks for four immunizations. Results: We found that FL and FL-DC immunizations were well tolerated. Following FL, the CD11c+CD14- DC population within the PBMC increased (1.5 ± 1.4% to 8.5 ± 4.2%). After overnight maturation, 10 to 20% of these DC expressed the maturation marker CD80. Antigen-specific DTH reactivity was observed at injection sites in all but 1 patient. Antigen specific immune responses were detected in the peripheral blood of 4 of 6 patients by intracellular cytokine staining, ELISPOT, proliferation, or tetramer analysis. Among the 6 patients who completed the immunizations, there was 1 with stable disease and 5 with progressive disease. Immunization with mobilized dendritic cells loaded with tumor antigens appears feasible and induces low levels of immune response.

Authors
Morse, MA; Clay, TM; Hobeika, AC; Chui, S; Mosca, PJ; Caron, D; Lyerly, HK
MLA Citation
Morse, MA, Clay, TM, Hobeika, AC, Chui, S, Mosca, PJ, Caron, D, and Lyerly, HK. "Active immunotherapy with Flt3-ligand mobilized peripheral blood dendritic cells loaded with carcinoembryonic antigen peptide in patients with metastatic malignancies." Journal of Applied Research 4.4 (2004): 554-569.
Source
scival
Published In
The journal of applied research
Volume
4
Issue
4
Publish Date
2004
Start Page
554
End Page
569

Flt3-ligand as a vaccine adjuvant: Results in a study of Flt3-ligand plus tetanus toxoid immunization

Dendritic cells (DC) efficiently process and present antigens to the effector arm of the immune system, thereby stimulating immunity against antigens of both foreign and self origin. Administration of Flt3-ligand (FL) has been reported to increase dendritic cell (DC) numbers in mice and humans. As a result, FL has attracted interest as an adjuvant for vaccine immunotherapy. To investigate whether FL might increase the immune response to a model recall antigen, we administered FL 25 μg/kg/d subcutaneously to six healthy volunteers followed by a standard injection of intramuscular tetanus toxoid (TT). A control cohort of six healthy volunteers received tetanus toxoid alone. Compared to subjects who received only TT, subjects who received Flt3L and TT had greater TT-specific DTH reactivity. In contrast, FL did not augment peripheral blood mononuclear cell proliferative responses or antibody responses to TT. FL resulted in inconsistent TT-specific T cell responses as measured by interferon-gamma ELISPOT and cytokine flow cytometry. We conclude that while FL mobilization of DC may enhance in vivo immune responses to a known immunogenic recall antigen, there are inconsistent effects on immune response detected by in vitro assays. Further study will be required to determine which individuals might experience augmentation of the immune response with FL.

Authors
Chui, S; Clay, TM; Mosca, PJ; Hobeika, AC; Osada, T; Galibert, L; Caron, D; Lyerly, HK; Morse, MA
MLA Citation
Chui, S, Clay, TM, Mosca, PJ, Hobeika, AC, Osada, T, Galibert, L, Caron, D, Lyerly, HK, and Morse, MA. "Flt3-ligand as a vaccine adjuvant: Results in a study of Flt3-ligand plus tetanus toxoid immunization." Journal of Applied Research 4.4 (2004): 536-549.
Source
scival
Published In
The journal of applied research
Volume
4
Issue
4
Publish Date
2004
Start Page
536
End Page
549

Immunotherapy with autologous, human dendritic cells transfected with carcinoembryonic antigen mRNA.

Immunizations with dendritic cells (DC) transfected with RNA encoding tumor antigens induce potent tumor antigen-specific immune responses in vitro and in murine models. We performed a phase I study of patients with advanced carcinoembryonic antigen (CEA)-expressing malignancies followed by a phase II study of patients with resected hepatic metastases of colon cancer to assess safety and feasibility of administering autologous DC loaded with CEA mRNA. The immunizations were well tolerated. Of the 24 evaluable patients in the dose-escalation phase, there was 1 complete response (by tumor marker), 2 minor responses, 3 with stable disease, and 18 with progressive disease. In the phase II study, 9 of 13 patients have relapsed at a median of 122 days. Evidence of an immunologic response was demonstrated in biopsies of DC injection sites and peripheral blood of selected patients. We conclude that it is feasible and safe to administer mRNA-loaded DC to patients with advanced malignancies.

Authors
Morse, MA; Nair, SK; Mosca, PJ; Hobeika, AC; Clay, TM; Deng, Y; Boczkowski, D; Proia, A; Neidzwiecki, D; Clavien, P-A; Hurwitz, HI; Schlom, J; Gilboa, E; Lyerly, HK
MLA Citation
Morse, MA, Nair, SK, Mosca, PJ, Hobeika, AC, Clay, TM, Deng, Y, Boczkowski, D, Proia, A, Neidzwiecki, D, Clavien, P-A, Hurwitz, HI, Schlom, J, Gilboa, E, and Lyerly, HK. "Immunotherapy with autologous, human dendritic cells transfected with carcinoembryonic antigen mRNA." Cancer Invest 21.3 (June 2003): 341-349.
PMID
12901279
Source
pubmed
Published In
Cancer Investigation (Informa)
Volume
21
Issue
3
Publish Date
2003
Start Page
341
End Page
349

Current status of dendritic cell immunotherapy of malignancies.

Because dendritic cells (DC) are central to the induction of antigen-specific T cell responses, their use for the active immunotherapy of malignancies has been of considerable interest. Since clinical trials with DC-based vaccines have been initiated, a number of important developmental issues have become apparent. These include the ideal source and type of DC, the form of antigen and method of loading DC, whether to induce maturation, the route and timing of immunization, and the optimal clinical scenario. Clinical responses such as stability of disease and tumor regressions have been reported in some patients, particularly with melanoma, myeloma, and prostate cancer.

Authors
Mosca, PJ; Clay, TM; Kim Lyerly, H; Morse, MA
MLA Citation
Mosca, PJ, Clay, TM, Kim Lyerly, H, and Morse, MA. "Current status of dendritic cell immunotherapy of malignancies." Int Rev Immunol 22.3-4 (May 2003): 255-281. (Review)
PMID
12745642
Source
pubmed
Published In
International Reviews of Immunology (Informa)
Volume
22
Issue
3-4
Publish Date
2003
Start Page
255
End Page
281

Proteomics for monitoring immune responses to cancer vaccines.

Standardized biomarkers for the detection of clinically significant immunological responses would be extremely valuable in immunotherapy trials. Most available assays measure either the frequency or function of antigen-specific T-cells, or the titers of antibodies or immune complexes. These assays have generally exhibited either inadequate sensitivity or too high a signal-to-noise ratio to reliably detect the low-frequency T-cell responses induced by cancer vaccines. In addition, such assays reflect only one aspect of the immune response rather than the complete picture. Proteomics, the study of proteins within a cell or biological sample, may offer a novel approach to immunological monitoring that complements existing immunological assays. By studying the protein content of T-cells responding to a vaccine or in the serum of vaccinated individuals, it may be possible to develop a metric for quantitating the magnitude of immunological responses. Proteomics could also provide a tool for establishing the quality of the immune response and for obtaining valuable information regarding the underlying regulatory mechanisms and pathways. Advances in miniaturization and automation may also permit characterization of the immune response more rapidly and from smaller amounts of biological material than is possible with existing assay systems.

Authors
Mosca, PJ; Lyerly, HK; Ching, CD; Hobeika, AC; Clay, TM; Morse, MA
MLA Citation
Mosca, PJ, Lyerly, HK, Ching, CD, Hobeika, AC, Clay, TM, and Morse, MA. "Proteomics for monitoring immune responses to cancer vaccines." Curr Opin Mol Ther 5.1 (February 2003): 39-43. (Review)
PMID
12669469
Source
pubmed
Published In
Current Opinion in Molecular Therapeutics
Volume
5
Issue
1
Publish Date
2003
Start Page
39
End Page
43

Immunoregulatory T cells in cancer immunotherapy.

Many of the tumour antigens targeted by active immunisation strategies are in fact self-antigens. Successful anticancer immunotherapy will therefore require not only potent methods of T cell activation, but also successful interference with mechanisms of immune tolerance that have evolved to prevent tissue destruction by autoreactive T cells. In addition to thymic deletion, anergy and skewing of T cell cytokine expression, a role for immunoregulatory T cells in the maintenance of self-tolerance has been suggested. Suppression of autoreactive T cells by regulatory T cells has been suggested to occur by both cytokine and cell-contact-dependent mechanisms. In murine models, suppression of auto-reactive T cells mediated by cell contact has been attributed to a population of spontaneously occurring CD4+CD25+ T cells. Cells with similar phenotype and function have been found in healthy humans. In murine models, these cells behave as regulatory T cells, counteracting autoimmune and inflammatory reactions, and have a role in tolerance and in peripheral T cell homeostasis. Of interest for cancer immunotherapy is the fact that depleting these cells results in the induction of antitumour immune responses, particularly after tumour specific vaccination. One hypothesis is that depleting these CD4+CD25+ counter-regulatory T cells in humans with cancer will enhance the efficacy of anticancer immunisations.

Authors
Morse, MA; Clay, TM; Mosca, P; Lyerly, HK
MLA Citation
Morse, MA, Clay, TM, Mosca, P, and Lyerly, HK. "Immunoregulatory T cells in cancer immunotherapy." Expert Opin Biol Ther 2.8 (December 2002): 827-834. (Review)
PMID
12517262
Source
pubmed
Published In
Expert Opinion on Biological Therapy
Volume
2
Issue
8
Publish Date
2002
Start Page
827
End Page
834
DOI
10.1517/14712598.2.8.827

Multiple signals are required for maturation of human dendritic cells mobilized in vivo with Flt3 ligand.

The ligand for the receptor tyrosine kinase fms-like tyrosine kinase 3 (Flt3L) is a growth factor for hematopoietic progenitors and induces expansion of the two distinct lineages of dendritic cells (DC) that have been described in humans. These two lineages, DC1 and DC2, have been described according to their ability to induce naive T cell differentiation to T helper cell type 1 (Th1) and Th2 effector cells, respectively. The immunoregulatory potential of DC1 and DC2 depends on their state of maturation and activation, which can be mediated by several molecules. Because monocyte-derived DC1 produce interleukin-12 (IL-12) when stimulated with CD40 ligand (CD40L), we hypothesized that similar results would be obtained with DC1 mobilized by Flt3L. Unexpectedly, we found that immature DC expanded in vivo by Flt3L treatment could not be stimulated to produce IL-12 in vitro using CD40L and/or interferon-gamma (IFN-gamma) alone. Instead, we found that Flt3L-mobilized DC from cancer patients require a sequence of specific signals for maturation, which included initial treatment with granulocyte macrophage-colony stimulating factor followed by a combination of maturation signals such as CD40L and IFN-gamma. Flt3L-mobilized DC matured in this manner possessed greater T cell-stimulatory function than nonmatured DC. The ability to generate phenotypically mature, IL-12-producing DC1 from peripheral blood mononuclear cells mobilized by Flt3L will have important implications for the development of effective cancer immunotherapy strategies.

Authors
Mosca, PJ; Hobeika, AC; Colling, K; Clay, TM; Thomas, EK; Caron, D; Lyerly, HK; Morse, MA
MLA Citation
Mosca, PJ, Hobeika, AC, Colling, K, Clay, TM, Thomas, EK, Caron, D, Lyerly, HK, and Morse, MA. "Multiple signals are required for maturation of human dendritic cells mobilized in vivo with Flt3 ligand." J Leukoc Biol 72.3 (September 2002): 546-553.
PMID
12223523
Source
pubmed
Published In
Journal of leukocyte biology
Volume
72
Issue
3
Publish Date
2002
Start Page
546
End Page
553

Dendritic cell recovery following nonmyeloablative allogeneic stem cell transplants.

Nonmyeloablative allogeneic stem cell transplantation (NMSCT) may destroy some malignancies through a graft-versus-tumor (GVT) effect, but tumor relapse and viral reactivation remain challenges for which immunizations may be helpful. Dendritic cells (DC), particularly DC1 and ex vivo-cultured DC, induce antigen-specific immune responses following viral infections and anti-tumor immunizations. DC2 may be tolerogenic. We hypothesize that successful immunizations following NMSCT will require adequate numbers of functional DC1 or ex vivo-generated DC. We determined the number, phenotype, and function of blood DC1 and DC2 and ex vivo-generated DC obtained from donor-recipient pairs before and up to 90 days after NMSCT. Although the percentage and number of recipient blood Lin(-) HLA-DR(+) CD11c(+) DC1 following NMSCT (median 0.46%, IQR 0.33-0.52%) was lower than donor DC1 (median 0.94%, IQR 0.40-2.2%) this was not significant. In contrast, the percentage and absolute number of blood Lin(-) HLA-DR(+) CD11c(-) CD123(+) DC2 was significantly decreased following the transplant (median 0.01% IQR 0.01-0.01% at day 60 compared with median 0.14%, IQR 0.10-0.38% for the donor before transplantation, p < 0.05). The yield (median 6.0%, IQR 5.5-8.5%) and allostimulatory function of ex vivo-generated DC did not differ significantly at any time point. The donor chimerism of blood and cultured DC reflected that of the overall white blood cells. Ex vivo-generated, donor DC loaded with cytomegalovirus (CMV) antigens were capable of stimulating a CMV-specific immune response in vitro within peripheral blood mononuclear cells of a patient following NMSCT. We conclude that blood DC numbers may be diminished following NMSCT transplant, but that DC1 recovery exceeds DC2 and functional DC may be generated from peripheral blood progenitors at all time points suggesting a possible use in immunization strategies.

Authors
Morse, MA; Rizzieri, D; Stenzel, TT; Hobeika, AC; Vredenburgh, JJ; Chao, NJ; Clay, TM; Mosca, PJ; Lyerly, HK
MLA Citation
Morse, MA, Rizzieri, D, Stenzel, TT, Hobeika, AC, Vredenburgh, JJ, Chao, NJ, Clay, TM, Mosca, PJ, and Lyerly, HK. "Dendritic cell recovery following nonmyeloablative allogeneic stem cell transplants." J Hematother Stem Cell Res 11.4 (August 2002): 659-668.
PMID
12201954
Source
pubmed
Published In
Journal of hematotherapy & stem cell research
Volume
11
Issue
4
Publish Date
2002
Start Page
659
End Page
668
DOI
10.1089/15258160260194802

Dendritic cell maturation in active immunotherapy strategies.

Dendritic cells (DCs) loaded with tumour antigen have become the centrepiece of clinical trials testing active immunotherapy strategies. Important variables include the source of DCs, the choice of antigens, the method of antigen loading and the route and timing of administration. Recently, the requirement for and the method of, DC maturation have been receiving particular attention. This is due to observations from in vitro studies and animal models demonstrating that mature DCs induce more potent antigen-specific T-cells responses than immature DCs. Furthermore, preliminary observations in human studies suggest that immature DCs might actually downregulate antigen-specific T-cell responses but mature DCs may augment them. Current studies are addressing how to define DC maturation, whether the variety of methods for maturation result in DCs with similar T-cell stimulatory capacity, how to maintain the maturational status and whether maturation in vitro before immunisation, or in vivo, after immunisation, results in better DC function.

Authors
Morse, MA; Mosca, PJ; Clay, TM; Lyerly, HK
MLA Citation
Morse, MA, Mosca, PJ, Clay, TM, and Lyerly, HK. "Dendritic cell maturation in active immunotherapy strategies." Expert Opin Biol Ther 2.1 (January 2002): 35-43. (Review)
PMID
11772338
Source
pubmed
Published In
Expert Opinion on Biological Therapy
Volume
2
Issue
1
Publish Date
2002
Start Page
35
End Page
43
DOI
10.1517/14712598.2.1.35

Dendritic cell-based vaccines in cancer: Clinical experience to date

Therapeutic vaccines that can activate the immune system to destroy malignancies hold the promise of a low-toxicity, precisely targeted anticancer treatment modality. Because dendritic cells (DCs) are central to the activation of antigen-specific immune responses, DCs loaded with tumor antigens are of considerable interest as therapeutic vaccines. Preclinical studies have demonstrated the potency of DC-based immunizations in promoting tumor rejection. Continued preclinical and clinical studies are assessing a number of important parameters regarding the formulation and administration regimen of DC-based vaccines and have provided support for phase I and II studies. Thus far, DC-mediated immunizations have been well tolerated, with few toxicities reported. Tumor regression has been reported in up to 30% of patients, particularly with immunologically sensitive tumors such as melanoma. Biologic activity, measured as activation of antigen-specific T cells, is reported in up to 100% of patients immunized against potent recall antigens, such as tetanus toxoid, and up to 30% of those immunized against tumor antigens. Current clinical trials are increasingly testing DC-based vaccines in patients with minimal residual disease, such as following attempted curative surgery or following high-dose chemotherapy and stem-cell support where clinical benefit is likely to be the greatest. Newer strategies are focusing on further modifications to DCs to increase their immunostimulatory potency. These include newer methods of antigen loading, better techniques for DC maturation, strategies to enhance polarization of DCs to ensure the induction of T helper cell type 1 immune responses, and the administration of adjunctive cytokines to augment the immune response following immunization.

Authors
Morse, MA; Mosca, PJ; Clay, TM; Lyerly, HK
MLA Citation
Morse, MA, Mosca, PJ, Clay, TM, and Lyerly, HK. "Dendritic cell-based vaccines in cancer: Clinical experience to date." American Journal of Cancer 1.5 (2002): 313-322.
Source
scival
Published In
American Journal of Cancer
Volume
1
Issue
5
Publish Date
2002
Start Page
313
End Page
322
DOI
10.2165/00024669-200201050-00002

Quantitating antigen specific T cell responses in peripheral blood: A comparison of peptide MHC tetramer, ELISpot and intracellular cytokine analysis.

Authors
Hobeika, AC; Peplinski, S; Morse, MA; Mosca, PJ; Clay, TC; Lyerly, HK
MLA Citation
Hobeika, AC, Peplinski, S, Morse, MA, Mosca, PJ, Clay, TC, and Lyerly, HK. "Quantitating antigen specific T cell responses in peripheral blood: A comparison of peptide MHC tetramer, ELISpot and intracellular cytokine analysis." November 16, 2001.
Source
wos-lite
Published In
Blood
Volume
98
Issue
11
Publish Date
2001
Start Page
23A
End Page
23A

Enumerating functionally mature monocyte-derived dendritic cells for use in cancer immunotherapy.

Authors
Colling, KL; Hobeika, AC; Mosca, PJ; Clay, TM; Lyerly, HK; Morse, MA
MLA Citation
Colling, KL, Hobeika, AC, Mosca, PJ, Clay, TM, Lyerly, HK, and Morse, MA. "Enumerating functionally mature monocyte-derived dendritic cells for use in cancer immunotherapy." November 16, 2001.
Source
wos-lite
Published In
Blood
Volume
98
Issue
11
Publish Date
2001
Start Page
851A
End Page
851A

Assays for monitoring cellular immune responses to active immunotherapy of cancer.

Numerous cancer immunotherapy strategies are currently being tested in clinical trials. Although clinical efficacy will be the final test of these approaches, the long and complicated developmental pathway for these agents necessitates evaluating immunological responses as intermediate markers of the most likely candidates for success. This has emphasized the need for assays that accurately detect and quantitate T cell-mediated, antigen-specific immune responses. This review evaluates the currently used in vivo and in vitro methods of assessing T-cell number and function, including delayed-type hypersensitivity, tetramer analysis, ELISPOT, flow cytometry-based analysis of cytokine expression, and PCR-based detection of T-cell receptor gene usage or cytokine production. We provide examples of how each has been used to monitor recent clinical trials and a discussion of how well each correlates with clinical outcome.

Authors
Clay, TM; Hobeika, AC; Mosca, PJ; Lyerly, HK; Morse, MA
MLA Citation
Clay, TM, Hobeika, AC, Mosca, PJ, Lyerly, HK, and Morse, MA. "Assays for monitoring cellular immune responses to active immunotherapy of cancer." Clin Cancer Res 7.5 (May 2001): 1127-1135. (Review)
PMID
11350875
Source
pubmed
Published In
Clinical cancer research : an official journal of the American Association for Cancer Research
Volume
7
Issue
5
Publish Date
2001
Start Page
1127
End Page
1135

Surrogate markers of response to cancer immunotherapy.

Clinically effective cancer immunotherapy has been sought for more than 100 years and has been recently applied most successfully in strategies that passively deliver immune effectors such as monoclonal antibodies (anti-CD20 for lymphoma and anti-HER2/neu for breast cancer), donor lymphocyte infusions in chronic myelongenous leukemia and non-myeloablative allogeneic peripheral blood progenitor transplants for renal cell carcinoma. There is mounting enthusiasm for strategies employing active stimulation of antitumour immune responses. These include vaccines based on tumour antigen proteins and peptides, autologous, allogeneic or gene-modified tumour cells, dendritic cells and antigen-encoding viral vector constructs. Indeed, randomised Phase III clinical trials of autologous tumour cell vaccines for colorectal cancer demonstrated an improvement in disease free survival and a trend toward improved overall survival [1]. Despite these preliminary successes, it is clear that the many strategies under development cannot all be evaluated for survival benefit in large clinical trials that require many years, patients and resources to complete. This highlights the need to develop intermediate markers to help prioritise which agents to test in prospective randomised Phase III trials.

Authors
Morse, MA; Clay, TM; Hobeika, AC; Mosca, PJ; Lyerly, HK
MLA Citation
Morse, MA, Clay, TM, Hobeika, AC, Mosca, PJ, and Lyerly, HK. "Surrogate markers of response to cancer immunotherapy." Expert Opin Biol Ther 1.2 (March 2001): 153-158.
PMID
11727526
Source
pubmed
Published In
Expert Opinion on Biological Therapy
Volume
1
Issue
2
Publish Date
2001
Start Page
153
End Page
158
DOI
10.1517/14712598.1.2.153

Direct detection of cellular immune responses to cancer vaccines.

The evaluation of cancer immunotherapy is predicated on the hypothesis that markers of tumor antigen-specific T-cell immunity will cone-late with clinical efficacy. Establishing which candidate vaccines should enter large-scale clinical trials will necessitate optimal application of immunologic monitoring assays. Evidence suggests that available techniques are adequate for the direct detection of clinically significant antigen-specific T-cell responses from tissue specimens. To achieve this goal, it is important to have an understanding of individual methods and their limitations, to include appropriate control antigens in the monitoring strategy, and to incorporate statistical considerations into the design and analysis of such studies.

Authors
Mosca, PJ; Hobeika, AC; Clay, TM; Morse, MA; Lyerly, HK
MLA Citation
Mosca, PJ, Hobeika, AC, Clay, TM, Morse, MA, and Lyerly, HK. "Direct detection of cellular immune responses to cancer vaccines." Surgery 129.3 (March 2001): 248-254. (Review)
PMID
11231452
Source
pubmed
Published In
Surgery
Volume
129
Issue
3
Publish Date
2001
Start Page
248
End Page
254
DOI
10.1067/msy.2001.108609

Monitoring cellular immune responses to cancer immunotherapy.

Many clinical trials are testing the feasibility of stimulating the immune system to treat cancer. Although the efficacy of this approach will ultimately be determined by clinically relevant endpoints, detection of the magnitude and activity of the immune response is an important intermediate point in the development of these strategies. Assays that predict clinically relevant endpoints are particularly desirable for helping to determine which strategies should ultimately be tested in larger randomized clinical trials. In this review, we will discuss these cellular immunological assays and the current status of their role in clinical trials of immunotherapy.

Authors
Morse, MA; Clay, TM; Hobeika, AC; Mosca, PJ; Lyerly, HK
MLA Citation
Morse, MA, Clay, TM, Hobeika, AC, Mosca, PJ, and Lyerly, HK. "Monitoring cellular immune responses to cancer immunotherapy." Curr Opin Mol Ther 3.1 (February 2001): 45-52. (Review)
PMID
11249731
Source
pubmed
Published In
Current Opinion in Molecular Therapeutics
Volume
3
Issue
1
Publish Date
2001
Start Page
45
End Page
52

Quantitating therapeutically relevant T-cell responses to cancer vaccines.

Successful application of active immunotherapy to the treatment of cancer will require stimulation of potent antigen-specific T-cell responses. It is not known how numerous or how potent these T cells must be in order to abrogate tumors, but the levels of immunity needed to control chronic viral infections may provide estimates for comparison. Evaluation of the efficacy of a vaccine strategy in attaining these levels of immunity will depend on the use of assays that create a picture of T-cell number and function that correlates with clinical outcomes. We discuss the currently available in vivo and in vitro T-cell assays and their relevance for detecting therapeutic levels of T-cell activity. We also propose a strategy for efficiently evaluating the immunologic efficacy of cancer vaccines so that the most promising candidates can be brought more rapidly into definitive clinical trials.

Authors
Hobeika, AC; Clay, TM; Mosca, PJ; Lyerly, HK; Morse, MA
MLA Citation
Hobeika, AC, Clay, TM, Mosca, PJ, Lyerly, HK, and Morse, MA. "Quantitating therapeutically relevant T-cell responses to cancer vaccines." Crit Rev Immunol 21.1-3 (2001): 287-297. (Review)
PMID
11642610
Source
pubmed
Published In
Critical Reviews in Immunology
Volume
21
Issue
1-3
Publish Date
2001
Start Page
287
End Page
297

Preoperative mobilization of circulating dendritic cells by Flt3 ligand administration to patients with metastatic colon cancer.

PURPOSE: To evaluate preoperative dendritic cell (DC) mobilization and tumor infiltration after administration of Flt3 ligand (Flt3L) to patients with metastatic colon cancer. PATIENTS AND METHODS: Twelve patients with colon cancer metastatic to the liver or lung received Flt3L (20 microg/kg/d subcutaneously for 14 days for one to three cycles at monthly intervals) before attempted metastasectomy. The number and phenotype of DCs mobilized into peripheral-blood mononuclear cells (PBMCs) were evaluated by flow cytometry. After surgical resection, metastatic tumor tissue was evaluated for DC infiltration. In vivo immune responses to recall antigens were measured. RESULTS: After Flt3L administration, on average, the total number of leukocytes in the peripheral blood increased from 5.9 +/- 1.0 x 10(3)/mm(3) to 11.2 +/- 3.8 x 10(3)/mm(3) (mean +/- SD, P: =. 0001). The percentage of CD11c(+)CD14(-) DCs in PBMCs increased from 2.4% +/- 1.8% to 8.8% +/- 4.7% (P: =.004). Delayed-type hypersensitivity (DTH) responses to recall antigens (CANDIDA:, mumps, and tetanus) showed marginally significant increases in reactivity after Flt3L administration (P: =.06, P: =.03, and P: =.08, respectively). An increase in the number of DCs was observed at the periphery of the tumors of patients who received Flt3L compared with those of patients who had not. CONCLUSION: Flt3L is capable of mobilizing DCs into the peripheral blood of patients with metastatic colon cancer and may be associated with increases in DC infiltration in the peritumoral regions. Flt3L mobilization is associated with a trend toward increased DTH responses to recall antigens in vivo. The use of Flt3L to increase circulating DCs for cancer immunotherapy should be considered.

Authors
Morse, MA; Nair, S; Fernandez-Casal, M; Deng, Y; St Peter, M; Williams, R; Hobeika, A; Mosca, P; Clay, T; Cumming, RI; Fisher, E; Clavien, P; Proia, AD; Niedzwiecki, D; Caron, D; Lyerly, HK
MLA Citation
Morse, MA, Nair, S, Fernandez-Casal, M, Deng, Y, St Peter, M, Williams, R, Hobeika, A, Mosca, P, Clay, T, Cumming, RI, Fisher, E, Clavien, P, Proia, AD, Niedzwiecki, D, Caron, D, and Lyerly, HK. "Preoperative mobilization of circulating dendritic cells by Flt3 ligand administration to patients with metastatic colon cancer." J Clin Oncol 18.23 (December 1, 2000): 3883-3893.
PMID
11099317
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
18
Issue
23
Publish Date
2000
Start Page
3883
End Page
3893
DOI
10.1200/JCO.2000.18.23.3883

Multiple signals are required for IL-12 production by Flt-3 ligand mobilized dendritic cells.

Authors
Mosca, PJ; Hobeika, AC; Clay, TM; Nair, SK; Thomas, EK; Caron, DA; Lyerly, HK; Morse, MA
MLA Citation
Mosca, PJ, Hobeika, AC, Clay, TM, Nair, SK, Thomas, EK, Caron, DA, Lyerly, HK, and Morse, MA. "Multiple signals are required for IL-12 production by Flt-3 ligand mobilized dendritic cells." November 16, 2000.
Source
wos-lite
Published In
Blood
Volume
96
Issue
11
Publish Date
2000
Start Page
295A
End Page
295A

A subset of human monocyte-derived dendritic cells expresses high levels of interleukin-12 in response to combined CD40 ligand and interferon-gamma treatment.

Dendritic cells (DCs) may arise from multiple lineages and progress through a series of intermediate stages until fully mature, at which time they are capable of optimal antigen presentation and T-cell activation. High cell surface expression of CD83 is presumed to correlate with full maturation of DCs, and a number of agents have been shown to increase CD83 expression on DCs. We hypothesized that interleukin 12 (IL-12) expression would be a more accurate marker of functionally mature DCs capable of activating antigen-specific T cells. We used combinations of signaling through CD40, using CD40 ligand trimer (CD40L), and interferon gamma to demonstrate that CD83 expression is necessary but not sufficient for optimal production of IL-12 by DCs. Phenotypically mature DCs could be induced to produce high levels of IL-12 p70 only when provided 2 simultaneous stimulatory signals. By intracellular cytokine detection, we determined that only a subset of cells that express high levels of CD80 and CD83 generate large amounts of IL-12. DCs matured with both signals are superior to DCs stimulated with the individual agents in activating antigen-specific T cell in vitro. These findings have important implications regarding the identification, characterization, and clinical application of functionally mature DCs.

Authors
Mosca, PJ; Hobeika, AC; Clay, TM; Nair, SK; Thomas, EK; Morse, MA; Lyerly, HK
MLA Citation
Mosca, PJ, Hobeika, AC, Clay, TM, Nair, SK, Thomas, EK, Morse, MA, and Lyerly, HK. "A subset of human monocyte-derived dendritic cells expresses high levels of interleukin-12 in response to combined CD40 ligand and interferon-gamma treatment." Blood 96.10 (November 15, 2000): 3499-3504.
PMID
11071647
Source
pubmed
Published In
Blood
Volume
96
Issue
10
Publish Date
2000
Start Page
3499
End Page
3504

Gene therapy for lung cancer.

Gene therapy is emerging as a promising modality for the treatment of lung cancer. Diverse strategies employing gene therapy for lung cancer have been investigated in vitro and in animal models, and a number of these approaches have met with promising results. Several phase I and II clinical trials have been undertaken, and early results suggest that it may be safe to administer gene therapy to lung cancer patients. It remains to be determined whether this modality will be efficacious as primary or adjunctive therapy in the setting of lung cancer.

Authors
Mosca, PJ; Morse, MA; D'Amico, TA; Crawford, J; Lyerly, HK
MLA Citation
Mosca, PJ, Morse, MA, D'Amico, TA, Crawford, J, and Lyerly, HK. "Gene therapy for lung cancer." Clin Lung Cancer 1.3 (February 2000): 218-226.
PMID
14733649
Source
pubmed
Published In
Clinical lung cancer
Volume
1
Issue
3
Publish Date
2000
Start Page
218
End Page
226

Effects of ThermH2Osorb carbon dioxide absorber on temperature and humidity in the anesthetic circuit.

Authors
Mosca, PJ; Loyd, GE; Tsueda, K
MLA Citation
Mosca, PJ, Loyd, GE, and Tsueda, K. "Effects of ThermH2Osorb carbon dioxide absorber on temperature and humidity in the anesthetic circuit." Anesth Analg 84.5 (May 1997): 1164-1165. (Letter)
PMID
9141956
Source
pubmed
Published In
Anesthesia and Analgesia
Volume
84
Issue
5
Publish Date
1997
Start Page
1164
End Page
1165

Mimosine targets serine hydroxymethyltransferase.

The plant amino acid, mimosine, is an extremely effective inhibitor of DNA replication in mammalian cells (Mosca, P. J., Dijkwel, P. A., and Hamlin, J. L. (1992) Mol. Cell. Biol. 12, 4375-4383). Mimosine appears to prevent the formation of replication forks at early-firing origins when delivered to mammalian cells approaching the G1/S boundary, and blocks DNA replication when added to S phase cells after a lag of approximately 2.5 h. We have shown previously that [3H]mimosine can be specifically photocross-linked both in vivo and in vitro to a 50-kDa polypeptide (p50) in Chinese hamster ovary (CHO) cells. In the present study, six tryptic peptides (58 residues total) from p50 were sequenced by tandem mass spectrometry and their sequences were found to be at least 77.5% identical and 96.5% similar to sequences in rabbit mitochondrial serine hydroxymethyltransferase (mSHMT). This assignment was verified by precipitating the [3H]mimosine-p50 complex with a polyclonal antibody to rabbit cSHMT. The 50-kDa cross-linked product was almost undetectable in a mimosine-resistant CHO cell line and in a CHO gly- cell line that lacks mitochondrial, but not cytosolic, SHMT activity. The gly- cell line is still sensitive to mimosine, suggesting that the drug may inhibit both the mitochondrial and the cytosolic forms. SHMT is involved in the penultimate step of thymidylate biosynthesis in mammalian cells and, as such, is a potential target for chemotherapy in the treatment of cancer.

Authors
Lin, HB; Falchetto, R; Mosca, PJ; Shabanowitz, J; Hunt, DF; Hamlin, JL
MLA Citation
Lin, HB, Falchetto, R, Mosca, PJ, Shabanowitz, J, Hunt, DF, and Hamlin, JL. "Mimosine targets serine hydroxymethyltransferase." J Biol Chem 271.5 (February 2, 1996): 2548-2556.
PMID
8576220
Source
pubmed
Published In
The Journal of biological chemistry
Volume
271
Issue
5
Publish Date
1996
Start Page
2548
End Page
2556

Mimosine, a novel inhibitor of DNA replication, binds to a 50 kDa protein in Chinese hamster cells.

We recently demonstrated that the plant amino acid, mimosine, is an extremely efficacious inhibitor of DNA replication in mammalian cells [P. A. Dijkwel and J. L. Hamlin (1992) Mol. Cell. Biol. 12, 3715-3722; P. J. Mosca et al. (1992) Mol. Cell. Biol. 12, 4375-4383]. Several of its properties further suggested that mimosine might target initiation at origins of replication, which would make it a unique and very useful inhibitor for studying the regulation of DNA synthesis. However, mimosine is known to chelate iron, a cofactor for ribonucleotide reductase. Thus, the possibility arose that mimosine functions in vivo simply by lowering intracellular deoxyribonucleotide pools. In the present study, we show that, in fact, it is possible to override mimosine inhibition in vivo by adding excess iron; however, copper, which is not a substitute for iron in ribonucleotide reductase, is equally effective. Evidence is presented that mimosine functions instead by binding to an intracellular protein. We show that radiolabeled mimosine can be specifically cross-linked to a 50 kDa polypeptide (termed p50) in vitro. Binding to p50 is virtually undetectable in CHO cells selected for resistance to 1 mM mimosine, arguing that p50 is the biologically relevant target. p50 is not associated with the cellular membrane fraction and, hence, is probably not a channel protein. Furthermore, the binding activity does not vary markedly as a function of cell cycle position, arguing that p50 is not a cyclin. Finally, both iron and copper are able to reverse the mimosine-p50 interaction in vitro, probably explaining why both metal ions are able to overcome mimosine's inhibitory effect on DNA synthesis in vivo.

Authors
Mosca, PJ; Lin, HB; Hamlin, JL
MLA Citation
Mosca, PJ, Lin, HB, and Hamlin, JL. "Mimosine, a novel inhibitor of DNA replication, binds to a 50 kDa protein in Chinese hamster cells." Nucleic Acids Res 23.2 (January 25, 1995): 261-268.
PMID
7862531
Source
pubmed
Published In
Nucleic Acids Research
Volume
23
Issue
2
Publish Date
1995
Start Page
261
End Page
268

A Golgi and horseradish peroxidase study of the sonic motor nucleus of the oyster toadfish.

The sonic motor nucleus (SMN) of the oyster toadfish Opsanus tau, a single midline structure in the occipital spinal cord and caudal medulla, contains large electrically-coupled motoneurons. Although interpretation is complicated by multiyear growth in soma size, neurons in males may be either large (L) or small (S), whereas females have exclusively S neurons. Golgi stains have allowed separation of five neuron variants (rostral, dorsal, stellate, ventral and caudal) which differ in location, soma shape and size, and direction and pattern of dendritic branching. All variants are present in L and S males and in females, and retrograde transport of horseradish peroxidase indicates that all variants are motoneurons. The SMN is organized into three horizontal layers with rostral and dorsal neurons forming a rostrocaudally arrayed network across the dorsal-dorsolateral surface. Stellate cells are found in the middle layer, and ventral cells with laterally directed dendrites that exit the SMN line the inferior surface. Caudal neurons with caudally directed exiting dendrites are arranged in parallel rows in the caudal fifth of the SMN. We suggest that variant differences in dendritic orientation relate to different patterns of innervation by multiple afferents to the SMN and function to maximize contacts between neurons as a means of facilitating synchronization within the nucleus. Sexual dimorphism has been demonstrated to a minor degree: all variants have larger somas in L fish than S fish, but no difference has been found in primary dendrite diameter. Larger somas would potentially support the greater amount of sound production by nesting males who produce a mating boatwhistle call. Equivalent dendrite diameter in females, who are just as likely as males to grunt, an agonistic call, suggests that female Opsanus have a well developed sonic circuitry compared to Porichthys, another toadfish in which females are typically silent.

Authors
Fine, ML; Mosca, PJ
MLA Citation
Fine, ML, and Mosca, PJ. "A Golgi and horseradish peroxidase study of the sonic motor nucleus of the oyster toadfish." Brain Behav Evol 45.3 (1995): 123-137.
PMID
7796092
Source
pubmed
Published In
Brain, behavior and evolution
Volume
45
Issue
3
Publish Date
1995
Start Page
123
End Page
137

Defining origins of replication in mammalian cells.

Authors
Hamlin, JL; Mosca, PJ; Levenson, VV
MLA Citation
Hamlin, JL, Mosca, PJ, and Levenson, VV. "Defining origins of replication in mammalian cells." Biochim Biophys Acta 1198.2-3 (December 30, 1994): 85-111. (Review)
PMID
7819277
Source
pubmed
Published In
Biochimica et Biophysica Acta: international journal of biochemistry and biophysics
Volume
1198
Issue
2-3
Publish Date
1994
Start Page
85
End Page
111

THE PLANT AMINO-ACID MIMOSINE MAY INHIBIT INITIATION AT ORIGINS OF REPLICATION IN CHINESE-HAMSTER CELLS (MOLECULAR AND CELLULAR BIOLOGY, VOL 12, PG 4375, 1992)

Authors
MOSCA, PJ; DIJKWEL, PA; HAMLIN, JL
MLA Citation
MOSCA, PJ, DIJKWEL, PA, and HAMLIN, JL. "THE PLANT AMINO-ACID MIMOSINE MAY INHIBIT INITIATION AT ORIGINS OF REPLICATION IN CHINESE-HAMSTER CELLS (MOLECULAR AND CELLULAR BIOLOGY, VOL 12, PG 4375, 1992)." March 1993.
Source
wos-lite
Published In
Molecular and Cellular Biology
Volume
13
Issue
3
Publish Date
1993
Start Page
1981
End Page
1981

Initiation of replication at a mammalian chromosomal origin.

Authors
Hamlin, JL; Mosca, PJ; Dijkwel, PA; Lin, HB
MLA Citation
Hamlin, JL, Mosca, PJ, Dijkwel, PA, and Lin, HB. "Initiation of replication at a mammalian chromosomal origin." Cold Spring Harb Symp Quant Biol 58 (1993): 467-474.
PMID
7956061
Source
pubmed
Published In
Cold Spring Harbor Laboratory: Symposia on Quantitative Biology
Volume
58
Publish Date
1993
Start Page
467
End Page
474

Erratum: The plant amino acid mimosine may inhibit initiation at origins of replication in Chinese hamster cells (Mol. Cell. Biol., Vol. 12, No. 10, p. 4375, (1992))

Authors
Mosca, PJ; Dijkwel, PA; Hamlin, JL
MLA Citation
Mosca, PJ, Dijkwel, PA, and Hamlin, JL. "Erratum: The plant amino acid mimosine may inhibit initiation at origins of replication in Chinese hamster cells (Mol. Cell. Biol., Vol. 12, No. 10, p. 4375, (1992))." Molecular and Cellular Biology 13.3 (1993): 1981--.
Source
scival
Published In
Molecular and Cellular Biology
Volume
13
Issue
3
Publish Date
1993
Start Page
1981-

The plant amino acid mimosine may inhibit initiation at origins of replication in Chinese hamster cells.

An understanding of replication initiation in mammalian cells has been hampered by the lack of mutations and/or inhibitors that arrest cells just prior to entry into the S period. The plant amino acid mimosine has recently been suggested to inhibit cells at a regulatory step in late G1. We have examined the effects of mimosine on cell cycle traverse in the mimosine [corrected]-resistant CHO cell line CHOC 400. When administered to cultures for 14 h after reversal of a G0 block, the drug appears to arrest the population at the G1/S boundary, and upon its removal cells enter the S phase in a synchronous wave. However, when methotrexate is administered to an actively dividing asynchronous culture, cells are arrested not only at the G1/S interface but also in early and middle S phase. Most interestingly, two-dimensional gel analysis of replication intermediates in the initiation locus of the amplified dihydrofolate reductase domain suggests that mimosine may actually inhibit initiation. Thus, this drug represents a new class of inhibitors that may open a window on regulatory events occurring at individual origins of replication.

Authors
Mosca, PJ; Dijkwel, PA; Hamlin, JL
MLA Citation
Mosca, PJ, Dijkwel, PA, and Hamlin, JL. "The plant amino acid mimosine may inhibit initiation at origins of replication in Chinese hamster cells." Mol Cell Biol 12.10 (October 1992): 4375-4383.
PMID
1406627
Source
pubmed
Published In
Molecular and Cellular Biology
Volume
12
Issue
10
Publish Date
1992
Start Page
4375
End Page
4383

Anatomical study of the innervation pattern of the sonic muscle of the oyster toadfish.

The sonic muscle of the oyster toadfish Opsanus tau contracts in almost perfect synchrony along its rostrocaudal extent. We explored some of the anatomical mechanisms underlying this synchronization. Cleared and stained wholemounts demonstrate that axons innervating the rostral portion of the muscle run caudally in the main nerve trunk before branching in the rostral direction, thus increasing their path length and potentially equalizing conduction time to different parts of the muscle. Differential axon diameter is not clearly important for synchronization because the mean diameter of axons innervating the caudal portion is not larger than that of axons from the entire nerve as it enters the muscle. Restricted injections of horseradish peroxidase (HRP) into different regions of the sonic muscle result in similar uniform distributions of labeled motor neurons throughout the ipsilateral sonic motor nucleus (SMN), indicating that the SMN and sonic muscle each form a single compartment. Although there is a tendency for fewer labeled neurons to occur in the rostral and caudal poles of the nucleus, HRP labeling provides no evidence of a somatotopic pattern.

Authors
Fine, ML; Mosca, PJ
MLA Citation
Fine, ML, and Mosca, PJ. "Anatomical study of the innervation pattern of the sonic muscle of the oyster toadfish." Brain Behav Evol 34.5 (1989): 265-272.
PMID
2611636
Source
pubmed
Published In
Brain, behavior and evolution
Volume
34
Issue
5
Publish Date
1989
Start Page
265
End Page
272
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Research Areas:

  • Cancer Vaccines
  • Carcinoma, Merkel Cell
  • Immunity, Cellular
  • Immunotherapy
  • Lymph Node Excision
  • Melanoma
  • Sarcoma
  • Surgery
  • T-Lymphocytes