32 research outputs found

    Lenalidomide, Thalidomide, and Pomalidomide Reactivate the Epstein-Barr Virus Lytic Cycle through Phosphoinositide 3-Kinase Signaling and Ikaros Expression

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    PURPOSE: Lenalidomide, thalidomide, and pomalidomide (LTP) are immunomodulatory agents approved for use in multiple myeloma, but in some settings, especially with alkylating agents, an increase in Hodgkin’s lymphoma (HL) and other secondary primary malignancies (SPM) has been noted. Some of these malignancies have been linked to Epstein-Barr virus (EBV), raising the possibility that immunomodulatory drugs disrupt latent EBV infection. EXPERIMENTAL DESIGN: We studied the ability of LTP to reactivate latently infected EBV-positive cell lines in vitro and in vivo, and evaluated the EBV viral load in archived serum samples from patients who received a lenalidomide, thalidomide and dexamethasone (LTD) combination. RESULTS: Treatment of EBV-infected B-cell lines with LTP at physiologically relevant concentrations induced the immediate early gene BZLF1, the early gene BMRF1, and the late proteins VCA and BCFR1. This occurred in the potency order pomalidomide>lenalidomide>thalidomide, and the nucleoside analogue ganciclovir enhanced the cytotoxic effects of lenalidomide and pomalidomide in Burkitt’s lymphoma cells in vitro and in vivo. EBV reactivation was related to phosphatidylinositol-3 kinase (PI3K) stimulation and Ikaros suppression, and blocked by the PI3K-δ inhibitor idelalisib. Combinations of lenalidomide with dexamethasone or rituximab increased EBV reactivation compared to lenalidomide alone and, importantly, lenalidomide with melphalan produced even greater reactivation CONCLUSIONS: We conclude LTP may reactivate EBV-positive resting memory B-cells thereby enhancing EBV lytic cycle and host immune suppression

    Reliability of a Stool Consistency Classification System

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    The Effects of Music Intervention on Women’s Anxiety Before and After Cesarean Delivery: A Randomized Controlled Trial

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    Objective: To assess effect of perioperative music intervention on maternal anxiety levels, physiologic metrics, and medication use for anxiety, nausea and pain during and after scheduled cesarean section. Methods: Women assigned to music intervention group were compared against controls. Physiologic metrics, medication requirements, and STAI scores were assessed for all participants. Results: 50 women were enrolled, assigned to either music intervention (n=25) or control (n=25) and analyzed. Physiologic metrics were similar between groups. Antiemetic, anxiolytic, and analgesic medication use intraoperatively and postoperatively were not significantly different. State and Trait scores by the STAI did not vary significantly by intervention (p=0.09). STAI scores before and after procedure demonstrated the least change for the intervention group (r=0.6) when compared to controls (r=0.2; p\u3c0.05). Conclusion: Contrary to studies with formal music therapy, our data do not support use of patient-selected music as an intervention to reduce maternal anxiety or need for analgesics, anxiolytics, or antiemetics with scheduled cesarean section
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