NYU Health Sciences Libraries Faculty Bibliography

Fritz Francois

School of Medicine. Medicine. Gastroenterology. Associate Professor of Medicine, 1998-
  1. Abramson, SB; Jacob, D; Rosenfeld, M; Buckvar-Keltz, L; Harnik, V; Francois, F; Rivera, R; Hopkins, MA; Triola, M; Grossman, RI. "A 3-year M.D. - Accelerating careers, diminishing debt". New England journal of medicine. 2013;369(12):1085-1087 (SCOPUS:2-s2.0-84884191240 #785752)       
  2. Abramson, Steven B; Jacob, Dianna; Rosenfeld, Melvin; Buckvar-Keltz, Lynn; Harnik, Victoria; Francois, Fritz; Rivera, Rafael; Hopkins, Mary Ann; Triola, Marc; Grossman, Robert I. "A 3-year M.D.--accelerating careers, diminishing debt". New England journal of medicine. 2013 Sep;369(12):1085-1087 (MEDL:24047055 #541902)       
  3. Awosogba, Temitope; Betancourt, Joseph R; Conyers, F Garrett; Estape, Estela S; Francois, Fritz; Gard, Sabrina J; Kaufman, Arthur; Lunn, Mitchell R; Nivet, Marc A; Oppenheim, Joel D; Pomeroy, Claire; Yeung, Howa. "Prioritizing health disparities in medical education to improve care". Annals of the New York Academy of Sciences. 2013 May;1287(1):17-30 (MEDL:23659676 #371282)       

    Despite yearly advances in life-saving and preventive medicine, as well as strategic approaches by governmental and social agencies and groups, significant disparities remain in health, health quality, and access to health care within the United States. The determinants of these disparities include baseline health status, race and ethnicity, culture, gender identity and expression, socioeconomic status, region or geography, sexual orientation, and age. In order to renew the commitment of the medical community to address health disparities, particularly at the medical school level, we must remind ourselves of the roles of doctors and medical schools as the gatekeepers and the value setters for medicine. Within those roles are responsibilities toward the social mission of working to eliminate health disparities. This effort will require partnerships with communities as well as with academic centers to actively develop and to implement diversity and inclusion strategies. Besides improving the diversity of trainees in the pipeline, access to health care can be improved, and awareness can be raised regarding population-based health inequalities.
  4. Carney, Kerrilynn; Dhalla, Sameer; Aytaman, Ayse; Tenner, Craig T; Francois, Fritz. "Association of tattooing and hepatitis C virus infection: A multicenter case-control study". Hepatology. 2013 Jan;:278-282 (MEDL:23315899 #371272)       

    Although injection drug use (IDU) and blood transfusions prior to 1992 are well-accepted risk factors for hepatitis C virus (HCV) infection, many prior studies that have evaluated tattooing as a risk factor for HCV infection did not control for a history of IDU or transfusion prior to 1992. In this large, multicenter case-control study we analyzed demographic and HCV risk factor exposure history data from 3,871 patients, including 1,930 with chronic HCV infection (HCV RNA positive) and 1,941 HCV negative (HCV antibody negative) controls. Crude and fully adjusted odds ratios of tattoo exposure by multivariate logistic regression in HCV infected versus controls were determined. As expected, injection drug use (65.9% vs. 17.8%, p < 0.001), blood transfusions prior to 1992 (22.3% vs. 11.1%, p < 0.001), and history of having one or more tattoos (OR = 3.81; 95% CI 3.23 - 4.49, p<0.001) were more common in HCV-infected patients than in control subjects. After excluding all patients with a history of ever injecting drugs and those who had a blood transfusion prior to 1992, a total of 1,886 subjects remained for analysis (465 HCV positive and 1,421 controls). Among these individuals without traditional risk factors, HCV positive patients remained significantly more likely to have a history of one or more tattoos after adjustment for age, sex, and race/ethnicity (OR = 5.17; 95% CI 3.75 - 7.11, p<0.001). Conclusion: Tattooing is associated with HCV infection, even among those without traditional HCV risk factors such as injection drug use and blood transfusion prior to 1992. (HEPATOLOGY 2013.).
  5. Khan, Abraham; Sam Serouya, Sam; Poles, Michael A; Traube, Morris; Halahalli-Srinivasa, Vani Murthy; Chen, Chien Ting; Yang, Liying; Pei, Zhiheng; Francois, Fritz. "A Burning Issue: Defining GERD in Non-Erosive Disease [Meeting Abstract]". Gastroenterology. 2013;144(5 Suppl 1):S851-S851 (ORIGINAL:0008452 #523002)    
  6. Salazar, Christian R; Sun, Jinghua; Li, Yihong; Francois, Fritz; Corby, Patricia; Perez-Perez, Guillermo; Dasanayake, Ananda; Pei, Zhiheng; Chen, Yu. "Association between Selected Oral Pathogens and Gastric Precancerous Lesions". PLoS ONE. 2013;8(1):e51604-e51604 (e51604) (MEDL:23308100 #211562)       

    We examined whether colonization of selected oral pathogens is associated with gastric precancerous lesions in a cross-sectional study. A total of 119 participants were included, of which 37 were cases of chronic atrophic gastritis, intestinal metaplasia, or dysplasia. An oral examination was performed to measure periodontal indices. Plaque and saliva samples were tested with real-time quantitative PCR for DNA levels of pathogens related to periodontal disease (Porphyromonas gingivalis, Tannerella forsythensis, Treponema denticola, Actinobacillus actinomycetemcomitans) and dental caries (Streptococcus mutans and S. sobrinus). There were no consistent associations between DNA levels of selected bacterial species and gastric precancerous lesions, although an elevated but non-significant odds ratio (OR) for gastric precancerous lesions was observed in relation to increasing colonization of A. actinomycetemcomitans (OR = 1.36 for one standard deviation increase, 95% Confidence Interval = 0.87-2.12), P. gingivalis (OR = 1.12, 0.67-1.88) and T. denticola (OR = 1.34, 0.83-2.12) measured in plaque. To assess the influence of specific long-term infection, stratified analyses by levels of periodontal indices were conducted. A. actinomycetemcomitans was significantly associated with gastric precancerous lesions (OR = 2.51, 1.13-5.56) among those with >/= median of percent tooth sites with PD>/=3 mm, compared with no association among those below the median (OR = 0.86, 0.43-1.72). A significantly stronger relationship was observed between the cumulative bacterial burden score of periodontal disease-related pathogens and gastric precancerous lesions among those with higher versus lower levels of periodontal disease indices (p-values for interactions: 0.03-0.06). Among individuals with periodontal disease, high levels of colonization of periodontal pathogens are associated with an increased risk of gastric precancerous lesions.
  7. Francois, Fritz; Khan, Abraham; Yang, Liying; Serouya, Sam M; Pei, Zhiheng. "Gastroesophageal Reflux Disease: Molecular Predictors in Neoplastic Progression of Barrett's Esophagus" IN: Gastroesophageal reflux disease. [S. l.] : InTech, cop. 2012. . p.21-60.  (OCLC:840098715-01 #519652)      
  8. Garza-Gonzalez, Elvira; Rios, Merab; Bosques-Padilla, Francisco J; Francois, Fritz; Cho, Ilseung; Gonzalez, Gloria M; Perez-Perez, Guillermo I. "Immune response against Streptococcus gallolyticus in patients with adenomatous polyps in colon". International journal of cancer. 2012 Nov;131(10):2294-2299 (MEDL:22377818 #180133)       

    Our aim was to examine the humoral immune response against Streptococcus gallolyticus subspecies gallolyticus antigens in individuals subjected to a routine colonoscopy in which colon adenomatous polyps were present or not. Serum samples from 133 individuals with adenomatous polyps and serum samples from 53 individuals with a normal colonoscopy were included. Western blot was performed in all subjects using a whole cell antigen from S. gallolyticus ATCC 9809, and rabbit antisera against the whole cell bacteria was prepared as a control. By analyzing the immune profile of the rabbit-immunized sera by Western-blot, at least 22 proteins were identified as immunogenic in S. gallolyticus. When we evaluated sera from human subjects, two proteins of approximately 30 and 22 kDa were most prominent. Based on this 2-protein band pattern, Western-blot profiles from human subjects were compared. The detection of a protein band of 22 kDa was associated with the presence of adenomatous polyps in colon [odds ratios (OR) 7.98, 95% confidence intervals (CI): 3.54-17.93], p < 0.001. When the presence of the 30 kDa protein alone or both the 22 and 30 kDa proteins were analyzed, the OR increased to 22.37 (95% CI: 3.77-131.64), p < 0.001. The specificity was 84.9 for the presence of the 22 kDa protein, and 98.1 for the presence of the 30 kDa protein alone or both 22 and 30 kDa bands. Serum from individuals with adenomatous polyps recognized two proteins from S. gallolyticus. This result confirmed the possible association of S. gallolyticus with adenomatous polyps in the colon.
  9. Liu, J; Youn, H; Sutton-Ramsey, D; Perez-Perez, G; Leon, D; Ren-Fielding, C; Fielding, G; Kurian, M; Weinshel, E; Francois, F. "Gastric band release rapidly impacts eating behavior, satiety hormones and weight [Meeting Abstract]". American journal of gastroenterology. 2012 October 2012;107:S586-S586 (EMBASE:70895091 #180111)    

    Purpose: Bariatric surgery can achieve sustained weight loss compared to medical management. Among bariatric surgeries, laparoscopic adjustable gastric banding (LAGB) is less-invasive and potentially reversible. LAGB may decrease BMI through restriction of food intake, behavior changes, satiety and digestive hormone levels. The dramatic reduction of appetite observed with LAGB can be ameliorated if the band is underfilled. This effect has not been well evaluated in terms of patient behavior and hormonal changes. Our aim was to assess outcomes related to eating behavior, insulinotropic hormones, and weight change before and after temporary gastric band release. Methods: Adults >= 18 yeaars of age who previously underwent LAGB and achieved successful weight loss were enrolled. All patients underwent standardized evaluation including anthropometric measurements and completion of the Three-Factor Eating Questionnaire (TEFQ-R18) before and after a period of 14 days during which the band was completely loosened. At baseline and follow-up, blood was collected after an overnight fast and 1h after a standard high protein meal, and levels of insulinotropic hormones determined. Results: The mean age of the study cohort (9 women and 6 men) was 42 +/-14 years with mean pre-band adjustment BMI of 32.9 +/- 5.6 and mean waist circumference of 40 +/- 7 inches. All patients had >30% percent reduction in weight within 12-months of the LAGB and demonstrated a lower degree but continued weight loss in the 6-months before study enrollment. Compared to baseline values for the TEFQ-R18, within 2-weeks of loosening the band, cognitive restraint was reduced (11.2 +/- 3 vs. 10.4 +/- 4), while there was a significant increase in both disinhibition (6.4 +/- 3 vs. 9.4 +/- 3, p=0.004) and hunger scores (4.1 +/- 3 vs. 8.0 +/- 3, p=0.004). Compared to baseline, at follow-up insulin output in response to a meal showed a downward trend [Median (IQR) 1,110 (728-1,332) vs. 621 (375-1,325) pg/ml; p=0.21] while leptin was significantly elevated [10,400 (6,030-11,350) vs. 13,700 (10,500-43,900) pg/ml; p=0.001]. Consistent with these findings BMI significantly increased (32.9 +/- 5.6 vs. 34.5 +/- 5.6, p=0.001) along with waist size (40 +/- 7 vs 42 +/- 6, p=0.003). The amount of weight regained within two weeks, returned the cohort to the weight loss level noted at the 12-month post LAGB time point. Conclusion: LAGB adjustment continues to impact eating behavior, satiety hormones, and body weight beyond the initial 12-months following placement. Complete loosening of the LAGB can result in rapid changes in eating behavior, insulinotropic hormones, and significant changes in BMI. Careful adjustment of the band is necessary for continued maintenance of weight loss
  10. Salazar, Christian R; Francois, Fritz; Li, Yihong; Corby, Patricia; Hays, Rosemary; Leung, Celine; Bedi, Sukhleen; Segers, Stephanie; Queiroz, Erica; Sun, Jinghua; Wang, Beverly; Ho, Hao; Craig, Ronald; Cruz, Gustavo D; Blaser, Martin J; Perez-Perez, Guillermo; Hayes, Richard B; Dasanayake, Ananda; Pei, Zhiheng; Chen, Yu. "Association between oral health and gastric precancerous lesions". Carcinogenesis. 2012 Feb;33(2):399-403 (MEDL:22139442 #156487)       

    Although recent studies have suggested that tooth loss is positively related to the risk of gastric non-cardia cancer, the underlying oral health conditions potentially responsible for the association remain unknown. We investigated whether clinical and behavioral measures of oral health are associated with the risk of gastric precancerous lesions. We conducted a cross-sectional study of 131 patients undergoing upper gastrointestinal endoscopy. Cases were defined as those with gastric precancerous lesions including intestinal metaplasia or chronic atrophic gastritis on the basis of standard biopsy review. A validated structured questionnaire was administered to obtain information on oral health behaviors. A comprehensive clinical oral health examination was performed on a subset of 91 patients to evaluate for periodontal disease and dental caries experience. A total of 41 (31%) cases of gastric precancerous lesions were identified. Compared with non-cases, cases were significantly more likely to not floss their teeth [odds ratio (OR) = 2.89, 95% confidence interval (CI): 1.09-7.64], adjusting for age, sex, race, body mass index, smoking status, educational attainment and Helicobacter pylori status in serum. Among participants who completed the oral examination, cases (n = 28) were more likely to have a higher percentage of sites with gingival bleeding than non-cases [OR = 2.63, 95% CI: 1.37-5.05 for a standard deviation increase in bleeding sites (equivalent to 19.7%)], independent of potential confounders. Our findings demonstrate that specific oral health conditions and behaviors such as gingival bleeding and tooth flossing are associated with gastric precancerous lesions.
  11. Sanchez, Nelson F; Stierman, Bryan; Saab, Said; Mahajan, Divya; Yeung, Howa; Francois, Fritz. "Physical activity reduces risk for colon polyps in a multiethnic colorectal cancer screening population". BMC research notes. 2012;5:312-312 (MEDL:22715975 #371292)       

    BACKGROUND: Identifying modifiable factors that influence the epidemiology of colorectal cancer incidence among multiethnic groups might be informative for the development of public health strategies targeting the disease. Minimal data exists describing the impact of physical activity on colorectal polyp risk in United States minority populations. The aim of this study is to evaluate the relationship of exercise on the prevalence of polyps in a multiethnic colorectal cancer screening population. RESULTS: We enrolled 982 patients: 558 Hispanic, 202 Asian,149 Black, and 69 White. Patients who reported exercising one or more hours weekly had a lower prevalence of any polyps (25.3% vs 33.2%, P = 0.008) as well as adenomas (13.8 vs. 18.9%, P = 0.03) compared to those who did not exercise. Black and Hispanic patients and those who were overweight or obese also had lower prevalence of polyps if they led an active lifestyle. Multivariate analysis revealed that age >55, male sex, and Black race/ethnicity were positively associated with the presence of adenomas, while a history of exercising one hour or more weekly was an independent negative predictor for the presence of adenomas anywhere in the colon (OR 0.67; 95% CI 0.4 - 0.9, P = 0.03). CONCLUSIONS: Exercising one hour per week was associated with a lower prevalence of polyps and adenomas when compared to those who exercised less or not at all. An active lifestyle provides benefits to groups who are at risk for colorectal cancer, such as Blacks. It also provides significant protection to overweight and obese individuals. Public health initiatives should promote physical activity as a cancer prevention tool in multiethnic populations. TRIAL REGISTRATION: none.
  12. White PM; Sahu M; Poles MA; Francois F. "Colorectal cancer screening of high-risk populations: A national survey of physicians". BMC research notes. 2012 Jan 24;5(1):64-64 (MEDL:22272666 #150848)       

    ABSTRACT: BACKGROUND: The incidence of colorectal cancer can be decreased by appropriate use of screening modalities. Patients with a family history of colon cancer and of African-American ethnicity are known to be at higher risk of developing colorectal cancer. We aimed to determine if there is a lack of physician knowledge for colorectal cancer screening guidelines based on family history and ethnicity. Between February and April 2009 an anonymous web-based survey was administered to a random sample selected from a national list of 25,000 internists, family physicians and gastroenterologists. A stratified sampling strategy was used to include practitioners from states with high as well as low CRC incidence. All data analyses were performed following data collection in 2009. RESULTS: The average knowledge score was 37 +/- 18% among the 512 respondents. Gastroenterologists averaged higher scores compared to internists, and family physicians, p = 0.001. Only 28% of physicians correctly identified the screening initiation point for African-Americans while only 12% of physicians correctly identified the screening initiation point and interval for a patient with a family history of CRC. The most commonly cited barriers to referring high-risk patients for CRC screening were 'patient refusal' and 'lack of insurance reimbursement.' CONCLUSIONS: There is a lack of knowledge amongst physicians of the screening guidelines for high-risk populations, based on family history and ethnicity. Educational programs to improve physician knowledge and to reduce perceived barriers to CRC screening are warranted to address health disparities in colorectal cancer
  13. Yang, Liying; Francois, Fritz; Pei, Zhiheng. "Molecular pathways: pathogenesis and clinical implications of microbiome alteration in esophagitis and barrett esophagus". Clinical cancer research. 2012 Apr;18(8):2138-2144 (MEDL:22344232 #164339)       

    Esophageal adenocarcinoma is preceded by the development of reflux-related intestinal metaplasia or Barrett esophagus, which is a response to inflammation of the esophageal squamous mucosa, reflux esophagitis. Gastroesophageal reflux impairs the mucosal barrier in the distal esophagus, allowing chronic exposure of the squamous epithelium to the diverse microbial ecosystem or microbiome and inducing chronic inflammation. The esophageal microbiome is altered in both esophagitis and Barrett esophagus, characterized by a significant decrease in gram-positive bacteria and an increase in gram-negative bacteria in esophagitis and Barrett esophagus. Lipopolysaccharides (LPS), a major structure of the outer membrane in gram-negative bacteria, can upregulate gene expression of proinflammatory cytokines via activation of the Toll-like receptor 4 and NF-kappaB pathway. The potential impact of LPS on reflux esophagitis may be through relaxation of the lower esophageal sphincter via inducible nitric oxide synthase and by delaying gastric emptying via cyclooxygenase-2. Chronic inflammation may play a critical role in the progression from benign to malignant esophageal disease. Therefore, analysis of the pathways leading to chronic inflammation in the esophagus may help to identify biomarkers in patients with Barrett esophagus for neoplastic progression and provide insight into molecular events suitable for therapeutic intervention in prevention of esophageal adenocarcinoma development in patients with reflux esophagitis and Barrett esophagus. Clin Cancer Res; 18(8); 2138-44. (c)2012 AACR.
  14. Francois, Fritz; Roper, Jatin; Joseph, Neal; Pei, Zhiheng; Chhada, Aditi; Shak, Joshua R; de Perez, Asalia Z Olivares; Perez-Perez, Guillermo I; Blaser, Martin J. "The effect of H. pylori eradication on meal-associated changes in plasma ghrelin and leptin". BMC gastroenterology. 2011;11:37-37 (MEDL:21489301 #132313)       

    ABSTRACT: BACKGROUND: Appetite and energy expenditure are regulated in part by ghrelin and leptin produced in the gastric mucosa, which may be modified by H. pylori colonization. We prospectively evaluated the effect of H. pylori eradication on meal-associated changes in serum ghrelin and leptin levels, and body weight. METHODS: Veterans referred for upper GI endoscopy were evaluated at baseline and >/=8 weeks after endoscopy, and H. pylori status and body weight were ascertained. During the first visit in all subjects, and during subsequent visits in the initially H. pylori-positive subjects and controls, blood was collected after an overnight fast and 1 h after a standard high protein meal, and levels of eight hormones determined. RESULTS: Of 92 enrolled subjects, 38 were H. pylori-negative, 44 H. pylori-positive, and 10 were indeterminate. Among 23 H. pylori-positive subjects who completed evaluation after treatment, 21 were eradicated, and 2 failed eradication. After a median of seven months following eradication, six hormones related to energy homeostasis showed no significant differences, but post-prandial acylated ghrelin levels were nearly six-fold higher than pre-eradication (p = 0.005), and median integrated leptin levels also increased (20%) significantly (p < 0.001). BMI significantly increased (5 +/- 2%; p = 0.008) over 18 months in the initially H. pylori-positive individuals, but was not significantly changed in those who were H. pylori-negative or indeterminant at baseline. CONCLUSIONS: Circulating meal-associated leptin and ghrelin levels and BMI changed significantly after H. pylori eradication, providing direct evidence that H. pylori colonization is involved in ghrelin and leptin regulation, with consequent effects on body morphometry
  15. Jain, Shilpa; Singhal, Shashideep; Francis, Franto; Hajdu, Cristina; Wang, Jin-Hua; Suriawinata, Arief; Wang, Yin-Quan; Zhang, Miao; Weinshel, Elizabeth H; Francois, Fritz; Pei, Zhi-Heng; Lee, Peng; Xu, Ru-Liang. "Association of overexpression of TIF1gamma with colorectal carcinogenesis and advanced colorectal adenocarcinoma". World journal of gastroenterology : WJG. 2011 Sep 21;17(35):3994-4000 (MEDL:22046087 #140416)       

    AIM: To determine the expression and clinical significance of transcriptional intermediary factor 1 gamma (TIF1gamma), Smad4 and transforming growth factor-beta (TGFbetaR) across a spectrum representing colorectal cancer (CRC) development. METHODS: Tissue microarrays were prepared from archival paraffin embedded tissue, including 51 colorectal carcinomas, 25 tubular adenomas (TA) and 26 HPs, each with matched normal colonic epithelium. Immunohistochemistry was performed using antibodies against TIF1gamma, Smad4 and TGFbetaRII. The levels of expression were scored semi-quantitatively (score 0-3 or loss and retention for Smad4). RESULTS: Overexpression of TIF1gamma was detected in 5/26 (19%) HP; however, it was seen in a significantly higher proportion of neoplasms, 15/25 (60%) TAs and 24/51 (47%) CRCs (P < 0.05). Normal colonic mucosa, HP, and TAs showed strong Smad4 expression, while its expression was absent in 22/51 (43%) CRCs. Overexpression of TGFbetaRII was more commonly seen in neoplasms, 13/25 (52%) TAs and 29/51 (57%) CRCs compared to 9/26 (35%) HP (P < 0.05). Furthermore, there was a correlation between TIF1gamma overexpression and Smad4 loss in CRC (Kendall tau rank correlation value = 0.35, P < 0.05). The levels of TIF1gamma overexpression were significantly higher in stage III than in stage I and II CRC (P < 0.05). CONCLUSION: The findings suggest that over-expression of TIF1gamma occurs in early stages of colorectal carcinogenesis, is inversely related with Smad4 loss, and may be a prognostic indicator for poor outcome
  16. Kharlamb, Viktoria; Schelker, Jennifer; Francois, Fritz; Jiang, Juquan; Holmes, Ross P; Goldfarb, David S. "Oral Antibiotic Treatment of Helicobacter pylori Leads to Persistently Reduced Intestinal Colonization Rates with Oxalobacter formigenes". Journal of endourology. 2011 Nov;25(11):1781-1785 (MEDL:22017284 #141076)       

    Abstract Background and Purpose: Oxalobacter formigenes (OF) may play a protective role in preventing calcium oxalate stones. This is the first prospective study to evaluate the effect of antibiotics on OF colonization. Intestinal colonization by OF is associated with reduced urinary oxalate excretion. Exposure to antibiotics may be an important factor determining rates of colonization. Materials and Methods: The effect of antibiotics on OF colonization was compared in two groups: A group receiving antibiotics for gastric infection with Helicobacter pylori (HP) and a group without HP whose members were not receiving antibiotics. OF colonization in stool was detected by oxalate degradation at baseline and after 1 and 6 months. Results: The prevalence at baseline of intestinal colonization with OF was 43.1% among all patients screened. Among the 12 patients who were positive for OF who did not receive antibiotics, 11 (92%) had OF on stool tests at 1 month and 6 months. Of the 19 participants who were positive for OF and who received antibiotics for HP, only 7 (36.8%) continued to be colonized by OF on follow-up stool testing at 1 and 6 months (P=0.003 by Fisher exact test). Amoxicillin and clarithromycin caused 62.5% of subjects to become negative for OF at 1 month; 56.2% remained negative for OF at 6 months. Conclusions: Antibiotics for HP infection effectively reduced colonization with OF, an effect present at 1 and 6 months after treatment. The lasting elimination of OF could be associated with hyperoxaluria and be a factor in recurrent kidney stone disease
  17. Nair, Navya; Marciscano, Ariel E; Vivar, Karina L; Schaeffer, Sarah; LaMont, Elizabeth; Francois, Fritz. "Introduction to the medical professions through an innovative medical student-run pipeline program". Journal of the National Medical Association. 2011 Sep-Oct;103(9-10):832-838 (MEDL:22364050 #158276)    

    Underrepresented minorities (URMs) make up a disproportionately small percentage of medical school applicants, matriculants, and physicians relative to the general US population. Preprofessional pipeline programs may help introduce URMs to careers in the medical field. MiniMeds was developed as a paracurricular enrichment program that targeted URM students. The curriculum was designed and administered by medical students, and 2 trials of this program were conducted. Data were collected pre and post program through a survey that assessed knowledge of medical concepts and knowledge of and interest in careers in medicine. Attendance at program sessions correlated with baseline knowledge about medical professions. Knowledge about medical concepts increased significantly from baseline to follow-up for boys, a group significantly represented by URMs in our cohort. Median scores for knowledge of medical careers increased significantly from baseline to followup for URMs as well as for boys and girls. Preprofessional pipeline programs such as MiniMeds are able to engage and develop medical knowledge in URM students at a critical developmental age. Further evaluation and implementation of programs that incorporate medical students to actively develop and lead pipeline programs are warranted.
  18. Sanchez N.F.; Stierman B.D.; Saab S.; Mahajan D.; Francois F.. "Physical activity reduces risk for colon polyps in a multiethnic colorectal cancer screening population [Meeting Abstract]". Gastrointestinal endoscopy. 2011;73(4 SUPPL 1):AB300-AB300 (EMBASE:70414969 #132600)    

    Background: Physical activity may play an important role in the risk of colon cancer development. Studies that have observed a possible effect were either limited by the use of sigmoidoscopy alone, or did not include a diverse screening population. It remains unclear if the benefits of physical activity are protective against polyps located throughout the colon, and if these benefits are consistent across all ethnic groups. The aim of this study was to evaluate the relationship of exercise on the prevalence of polyps in a multiethnic CRC screening population. Methods: Consecutive average-risk adults referred for screening colonoscopy in a municipal hospital were prospectively enrolled. A detailed questionnaire was administered to collect data on medical, dietary, and exercise history. The number, size, and location of all polyps were documented during colonoscopy. Based on pathologic review, advanced neoplasms were defined as adenomas >= 10mm in diameter or any adenoma, regardless of size, with villous histology, high-grade dysplasia, or adenocarcinoma. Results: Among the 982 patients enrolled, 558 (56.8%) were Hispanic, 202 (20.6%) were Asian, 149 (15.2%) were African American, and 69 (7.0%) were Caucasian. BMI was abnormal (>=25) in 603 (61.4%) patients. 513 patients (52.2%) reported exercising at least one hour weekly. The median number of years of exercise was 5.0 years (IQR 1.5-10.0). The overall prevalence of colon polyps was 29.5%. Among patients who did not exercise at least one hour weekly the prevalence of polyps was 33.2%, while it was 25.3% in those who exercised one or more hours weekly (p=0.008). Among patients with a BMI>=25, at least one hour of weekly exercise was protective against any adenomas (OR 0.60, 95% CI 0.39-0.93) as well as any advanced adenomas (OR 0.37, 95% CI 0.16-0.88). Looking at racial/ethnic differences in the study group, the odds ratio for adenomas was lowest for Hispanics (OR 0.47, 95% CI 0.29-0.76) compared to their counterparts who exercised less. The odds ratio for advanced adenomas (>=1 cm) and carcinomas was lowest for African-Americans who exercised (0.16, 95% CI 0.03-0.77). In a logistic regression controlling for age, sex, race, and body mass index, one hour or more of weekly exercise remained protective against colonic polyps regardless of location, compared to those who exercised less (OR 0.69; 95% CI 0.52 - 0.91, p=0.009). Conclusion: In this multiethnic population, exercising at least one hour/week was associated with a lower prevalence of colonic polyps compared to those who exercised less or not at all. Polyps were less prevalent among overweight and obese individuals who exercised compared to those who did not exercise. Physical activity should be further evaluated as a preventative measure in colorectal cancer development
  19. Cohen, D; Zhou, F; Rodriguez, A; Francois, F. "Helicobacter pylori Testing in Patients with Funcional Dyspepsia: What Factors Dictate the Practice? [Meeting Abstract]". American journal of gastroenterology. 2009 OCT;104(2):S41-S42 (ISI:000270853600104 #106464)    
  20. Francois, Fritz; Elysee, Greta; Shah, Susan; Gany, Francesca. "Colon Cancer Knowledge and Attitudes in an Immigrant Haitian Community". Journal of immigrant & minority health. 2009 Aug;11(4):319-325 (MEDL:18322798 #78625)       

    Objective To qualitatively evaluate the views of Haitian immigrants on cancer and the influence of cultural and socio-ecological factors on cancer screening behavior. Methods Six focus groups, consisting of 4-10 individuals each, were conducted among Haitian adults at average risk for colorectal cancer. The interviews were conducted in Haitian Creole and featured questions that addressed beliefs and attitudes about general health, access to health care, colon cancer, and screening practices. Results The focus groups provided insight into the health service utilization patterns in the Haitian community, as well as the factors driving them including language and the pattern of accessing healthcare only for emergencies. Conclusions Many misconceptions regarding cancer and its development were evident in the discussions. However participants were willing to follow the recommendations of a physician. This highlighted the importance in this community of disseminating information at every opportunity about preventative care, including colorectal cancer screening
  21. Imanpour, J; Pevsner, P; Kachalov, V; Mathur, S; Moore, H; Melamed, J; Remsen, T; Kanaparthi, C; Mujtaba, G; Kothiya, P; Momin, Z; Vasani, N; Sobel, N; Oprihory, J; Francois, F; Momeni, M; Stern, A; Anand, S. "MALDI Imaging and LCMS Identification of Colon Cancer Biomarkers in Benign Polyps and Normal Tandem Mucosa [Meeting Abstract]". American journal of gastroenterology. 2009 OCT;104(2):S575-S575 (ISI:000270853601517 #106467)    
  22. Nair, N; Marciscano, A; Vivar, K; Lamont, E; Schaeffer, S; Francois, F. "IMPROVING DIVERSITY IN THE MEDICAL PROFESSIONS THROUGH AN INNOVATIVE MEDICAL STUDENT-RUN PIPELINE EDUCATION PROGRAM [Meeting Abstract]". Journal of general internal medicine. 2009 APR;24(10):231-231 (ISI:000265382000611 #99173)    
  23. Pevsner, Paul H; Melamed, Jonathan; Remsen, Tiffany; Kogos, Alexander; Francois, Fritz; Kessler, Paul; Stern, Arnold; Anand, Sury. "Mass spectrometry MALDI imaging of colon cancer biomarkers: a new diagnostic paradigm". Biomarkers in medicine. 2009 Feb;3(1):55-69 (MEDL:20477496 #110097)       

    Colorectal cancer (CRC), is the second-leading cause of cancer-related deaths in the USA, affecting both men and women. Current projections show little or no change since the publication of a morbidity and mortality study in 2005. The projected number of new cases for 2008 is 154,000, and the projected number of CRC cancer deaths for 2008 is 53,000. The standard diagnostic paradigm is based on histopathology of either biopsy or surgical specimens. This article suggests a new paradigm for colon cancer diagnosis and staging using matrix-assisted laser desorption/ionization imaging mass spectrometry (MALDI IMS or IMS). IMS may identify potential tumors in normal tissue of cancer patients and predict those cancer patients who are at risk for recurrent cancer
  24. Pevsner, PH; Melamed, J; Kogos, A; Remsen, T; Francois, F; Imanpour, J; Mathur, S; Kachalov, V; Kanaparthi, C; Kessler, P; Moore, HG; Stern, A; Momeni, M; Anand, S. "Mass Spectrometry MALDI Imaging and LCMS Identification of Colon Cancer Proteins in Benign Polyps [Meeting Abstract]". Gastroenterology. 2009;136(5):A303-A303 (ISI:000275277201497 #110784)    
  25. Yang, Liying; Lu, Xiaohua; Nossa, Carlos W; Francois, Fritz; Peek, Richard M; Pei, Zhiheng. "Inflammation and intestinal metaplasia of the distal esophagus are associated with alterations in the microbiome". Gastroenterology. 2009 Aug;137(2):588-597 (MEDL:19394334 #101280)       

    BACKGROUND & AIMS: Gastroesophageal reflux causes inflammation and intestinal metaplasia and its downstream sequelum adenocarcinoma in the distal esophagus. The incidence of esophageal adenocarcinoma has increased approximately 6-fold in the United States since the 1970s, accompanied with a significant increase in the prevalence of gastroesophageal reflux disease (GERD). Despite extensive epidemiologic study, the cause for GERD and the unexpected increases remain unexplainable. Microbes are among the environmental factors that may contribute to the etiology of GERD, but very little research has been done on the esophageal microbiome, particularly in its relation to GERD. This is the first comprehensive reported correlation between a change in the esophageal microbiome and esophageal diseases. METHODS: Biopsy samples of the distal esophagus were collected from 34 patients. Host phenotypes were histologically defined as normal, esophagitis, or Barrett's esophagus (intestinal metaplasia). Microbiomes from the biopsy samples were analyzed by bacterial 16S ribosomal RNA gene survey and classified into types using unsupervised cluster analysis and phenotype-guided analyses. Independence between host phenotypes and microbiome types were analyzed by Fisher exact test. RESULTS: Esophageal microbiomes can be classified into 2 types. The type I microbiome was dominated by the genus Streptococcus and concentrated in the phenotypically normal esophagus. Conversely, the type II microbiome contained a greater proportion of gram-negative anaerobes/microaerophiles and primarily correlated with esophagitis (odds ratio, 15.4) and Barrett's esophagus (odds ratio, 16.5). CONCLUSIONS: In the human distal esophagus, inflammation and intestinal metaplasia are associated with global alteration of the microbiome. These findings raise the issue of a possible role for dysbiosis in the pathogenesis of reflux-related disorders
  26. Francois, F; Cho, I. "Colonic taeniasis". Endoscopy. 2008 Sep;40 Suppl 2:E28-E28 (MEDL:18278726 #92162)       
  27. Francois, F; Frederick, J; Joseph, N; John, S; Elysee, G; Rey, M. "Hepatitis B knowledge, attitudes, and susceptibility in an immigrant Caribbean community [Meeting Abstract]". American journal of gastroenterology. 2008 SEP;103(9):S134-S134 (ISI:000259145200347 #86596)    
  28. Francois, F; Roper, J; Goodman, A J; Pei, Z; Ghumman, M; Mourad, M; de Perez, A Z Olivares; Perez-Perez, G I; Tseng, C-H; Blaser, M J. "The association of gastric leptin with oesophageal inflammation and metaplasia". Gut: journal of the British Society of Gastroenterology. 2008 Jan;57(1):16-24 (MEDL:17761783 #75709)       

    BACKGROUND: Gastro-oesophageal reflux disease complications may reflect imbalances between protective and injurious factors. Through its effects on cell growth, leptin may influence oesophageal mucosal homeostasis. AIMS: To determine whether leptin receptors are present in the oesophagus, and whether serum or gastric leptin levels are associated with oesophageal inflammation and metaplasia. METHODS: From patients referred for upper endoscopy, biopsies were obtained from the stomach and distal oesophagus, and serum samples were collected. Patients were classified as having normal, inflamed or Barrett's oesophagus. Quantitative immunohistochemistry was performed on representative sections, and leptin levels in plasma and gastric biopsy samples were determined by specific immunoassay. RESULTS: Of 269 individuals enrolled, 105 were Helicobacter pylori-negative. Of the 88 patients with complete oesophageal biopsies, 44 were normal, 24 were inflamed and 20 were Barrett's oesophagus. Receptors for leptin were highly expressed on oesophageal epithelial cells, with similar density and staining pattern in all three conditions, and plasma and antral leptin levels did not differ significantly. Patients with Barrett's had significantly (p = 0.01) higher fundic leptin levels (median 202 (interquartile range 123-333) pg/mg) compared with normal (126 (78-221) pg/mg) or inflamed (114 (76-195) pg/mg) oesophagus. In multivariate analysis, for every twofold increase in fundic leptin, the odds of having Barrett's was 3.4 times (95% CI 1.5 to 7.6) higher compared with having a normal oesophagus. CONCLUSIONS: Leptin receptor expression on oesophageal epithelial cells provides a pathway for leptin-mediated signal transduction. Variation in gastric leptin production could contribute to differential oesophageal healing and metaplasia progression
  29. Gamagaris, Zoi; Patterson, Carlie; Schaye, Verity; Francois, Fritz; Traube, Morris; Fielding, Christine J; Fielding, George A; Youn, Allison Heekoung; Weinshel, Elizabeth H. "Lap-band impact on the function of the esophagus". Obesity surgery. 2008 Oct;18(10):1268-1272 (MEDL:18663546 #91869)       

    BACKGROUND: The laparoscopic adjustable gastric band (LAGB) has been widely used to treat morbid obesity. There is conflicting data on its long-term effect on esophageal function. Our aim was to assess the long-term impact of the LAGB on esophageal motility and pH-metry in patients who had LAGB who had normal and abnormal esophageal function at baseline. METHODS: Consecutive patients referred for bariatric surgery were prospectively enrolled. A detailed medical history was obtained, and esophageal manometric and 24-h pH evaluations were performed in standard fashion preoperatively and 6 and 12 months postoperatively; patients served as their own controls. RESULTS: Twenty-two patients completed manometric evaluation. Ten patients had normal manometric parameters at baseline; at 6 months, mean lower esophageal sphincter (LES) residual pressure increased significantly from baseline (3.9 +/- 2 vs. 8.9 +/- 4 mmHg, p = 0.014). At 12 months, the mean peristaltic wave duration increased from 3.6 +/- 1 at baseline to 6.8 +/- 2 s, p = 0.025 and wave amplitude decreased during the same period (98.7 +/- 22 vs. 52.3 +/- 24, p = 0.013). LES pressure and percent peristalsis did not differ significantly pre- and post-LAGB. Twelve patients had one or more abnormal manometric findings at baseline; at 12 months, LES pressure in these 12 patients decreased significantly (31.1 +/- 10 vs 23.6 +/- 7, p = 0.011) and wave amplitude was significantly reduced (125.9 +/- 117 vs 103 +/- 107, p = 0.039). LES residual pressure did not change significantly pre- and post-LAGB. Twenty-two individuals were evaluated for impact of Lap-Band on esophageal acid exposure. Sixteen of these patients had normal esophageal pH-metry values at baseline and had no significant changes in 12 months in any pH-metry measurement. Six patients had abnormal pH-metry values at baseline. Among these patients, time with pH < 4.0 and Johnson/DeMeester score did not change significantly during follow-up. There was a significant decrease in the number of reflux episodes from baseline to 6 months (159 +/- 48 vs. 81 +/- 61, p = 0.016). CONCLUSIONS: Abnormal manometric findings are frequently encountered post-LAGB. Increases in LES residual pressure and peristaltic wave duration were the most significant changes. LAGB is not associated with an increase in total esophageal acidification time. Further evaluation of the clinical significance of manometric abnormalities is warranted
  30. Pevsner, P; Eskaros, S; Melamed, J; Remsen, T; Diamond, I; Francois, F; Momeni, M; Kessler, P; Stern, A; Anand, S. "Inflammatory bowel disease (IBD) - Protein profile of active disease [Meeting Abstract]". American journal of gastroenterology. 2008 SEP;103(9):S449-S449 (ISI:000259145201138 #86598)    
  31. Pevsner, P; Melamed, J; Remsen, T; Duddempudi, S; Francois, F; Momeni, M; Sandar, N; Kessler, P; Stern, A; Anand, S. "Colon tumor biomarkers-Maldi imaging of tissue microarray [Meeting Abstract]". American journal of gastroenterology. 2008 SEP;103(9):S196-S197 (ISI:000259145200504 #86597)    
  32. Roper, Jatin; Francois, Fritz; Shue, Peter L; Mourad, Michelle S; Pei, Zhiheng; Olivares de Perez, Asalia Z; Perez-Perez, Guillermo I; Tseng, Chi-Hong; Blaser, Martin J. "Leptin and ghrelin in relation to Helicobacter pylori status in adult males". Journal of clinical endocrinology & metabolism. 2008 Jun;93(6):2350-2357 (MEDL:18397989 #159212)       

    CONTEXT: Leptin and ghrelin, hormones involved in human energy homeostasis, are both produced in the stomach. OBJECTIVE: We sought to determine whether the presence of Helicobacter pylori affects gastric and systemic levels of leptin and ghrelin. DESIGN, SETTING, AND PATIENTS: We consecutively enrolled 256 patients referred for upper endoscopy at a Veterans Affairs outpatient endoscopy center. OUTCOMES: We obtained fasting serum, fundic and antral biopsies, and gastric juice. Based on histological, biochemical, and serological assays, patients were categorized as H. pylori+ or H. pylori-. Leptin and total ghrelin levels in serum, gastric biopsies, and gastric juice were determined by specific ELISAs. RESULTS: Of the 256 subjects, 120 were H. pylori+ and 96 were H. pylori-; 40 patients of indeterminate status were excluded. Serum and fundic leptin levels correlated with body mass index in the H. pylori+ (r = 0.35; P < 0.0001 and r = 0.35; P < 0.0001, respectively) and H. pylori- (r = 0.65; P < 0.0001 and r = 0.41; P < 0.0001, respectively) groups, but H. pylori+ subjects had significantly lower serum leptin levels [median 2.2 ng/ml (interquartile range 0.9-4.6) vs. 4.0 ng/ml (1.7-7.2); P = 0.0003]. Serum ghrelin levels were similar in the H. pylori+ and H. pylori- groups [median 1651 pg/ml (interquartile range 845-2247) vs. 1629 pg/ml (992-2886); P = 0.23]. H. pylori status did not significantly affect gastric biopsy leptin and ghrelin levels. Ghrelin levels in gastric juice varied over 4 log(10) (<80-776,000 pg/ml) and correlated with gastric juice pH in the H. pylori+ group (r = 0.68; P < 0.0001). CONCLUSIONS: These findings provide evidence that H. pylori status affects leptin and ghrelin homeostasis, presumably via intragastric interactions.
  33. Shak, Joshua R; Roper, Jatin; Perez-Perez, Guillermo I; Tseng, Chi-hong; Francois, Fritz; Gamagaris, Zoi; Patterson, Carlie; Weinshel, Elizabeth; Fielding, George A; Ren, Christine; Blaser, Martin J. "The Effect of Laparoscopic Gastric Banding Surgery on Plasma Levels of Appetite-Control, Insulinotropic, and Digestive Hormones". Obesity surgery. 2008 Sep;18(9):1089-1096 (MEDL:18408980 #78623)       

    BACKGROUND: We hypothesized that laparoscopic adjustable gastric banding (LAGB) reduces weight and modulates ghrelin production, but largely spares gastrointestinal endocrine function. To examine this hypothesis, we determined plasma concentrations of appetite-control, insulinotropic, and digestive hormones in relation to LAGB. METHODS: Twenty-four patients undergoing LAGB were prospectively enrolled. Body mass index (BMI) was measured and blood samples obtained at baseline and 6 and 12 months post-surgery. Plasma concentrations of leptin, acylated and total ghrelin, pancreatic polypeptide (PP), insulin, glucose-dependent insulinotropic peptide (GIP), active glucagon-like peptide-1 (GLP-1), gastrin, and pepsinogens I and II were measured using enzyme-linked immunoassays. RESULTS: Median percent excess weight loss (%EWL) over 12 months was 45.7% with median BMI decreasing from 43.2 at baseline to 33.8 at 12 months post-surgery (p < 0.001). Median leptin levels decreased from 19.7 ng/ml at baseline to 6.9 ng/ml at 12 months post-surgery (p < 0.001). In contrast, plasma levels of acylated and total ghrelin, PP, insulin, GIP, GLP-1, gastrin, and pepsinogen I did not change in relation to surgery (p > 0.05). Pepsinogen II levels were significantly lower 6 months after LAGB but returned to baseline levels by 12 months. CONCLUSIONS: LAGB yielded substantial %EWL and a proportional decrease in plasma leptin. Our results support the hypothesis that LAGB works in part by suppressing the rise in ghrelin that normally accompanies weight loss. Unchanged concentrations of insulinotropic and digestive hormones suggest that gastrointestinal endocrine function is largely maintained in the long term
  34. Francois, Fritz; Tadros, Caroline; Diehl, David. "Pan-colonic varices and idiopathic portal hypertension". Journal of gastrointestinal & liver diseases : JGLD. 2007 Sep;16(3):325-328 (MEDL:17925930 #74573)    

    Varices of the lower GI tract, although rare, are a known cause of hematochezia. They are usually found in a segmental distribution and are often associated with cirrhosis, portal hypertension, or portal vein obstruction. We present the case of a 43-year-old male with no personal or family history of liver disease, who experienced recurrent rectal bleeding over a 27-year period. Colonoscopy revealed varices from the rectum to the cecum confirmed with endoscopic ultrasound, while esogastroduodenoscopy, small bowel series, and CT were all normal. Portal hypertension was present without an identifiable cause
  35. Ghose, Chandrabali; Perez-Perez, Guillermo I; Torres, Victor J; Crosatti, Marialuisa; Nomura, Abraham; Peek, Richard M Jr; Cover, Timothy L; Francois, Fritz; Blaser, Martin J. "Serological Assays for Identification of Human Gastric Colonization by Helicobacter pylori Strains Expressing VacA m1 or m2". Clinical & vaccine immunology. 2007 Apr;14(4):442-450 (MEDL:17267587 #71774)       

    The Helicobacter pylori vacA gene encodes a secreted protein (VacA) that alters the function of gastric epithelial cells and T lymphocytes. H. pylori strains containing particular vacA alleles are associated with differential risk of disease. Because the VacA midregion may exist as one of two major types, m1 or m2, serologic responses may potentially be used to differentiate between patients colonized with vacA m1- or vacA m2-positive H. pylori strains. In this study, we examined the utility of specific antigens from the m regions of VacA as allele-specific diagnostic antigens. We report that serological responses to P44M1, an H. pylori m1-specific antigen, are observed predominantly in patients colonized with m1-positive strains, whereas responses to VacA m2 antigens, P48M2 and P55M2, are observed in patients colonized with either m1- or m2-positive strains. In an Asian-American population, serologic responses to VacA m region-specific antigens were not able to predict the risk of development of gastric cancer
  36. Khaykis, I; Ren, CJ; Fielding, GA; Huberman, W; Wolfe, B; Youn, H; Hong, S; Francois, FF; Weinshel, E. "Gender differences and bariatric surgery outcome [Meeting Abstract]". American journal of gastroenterology. 2007 SEP;102(9):891-559 (ISI:000249397800889 #98043)    
  37. Young, B; Roper, H; Mourad, M; Olivares de Perez, AZ; Perez-Perez, GI; Pei, ZH; Blaser, MJ; Francois, F. "Fasting gastric leptin levels are elevated in diabetics independent of BMI [Meeting Abstract]". American journal of gastroenterology. 2007 SEP;102(6):S163-S163 (ISI:000249397800125 #74153)    
  38. Bik, Elisabeth M; Eckburg, Paul B; Gill, Steven R; Nelson, Karen E; Purdom, Elizabeth A; Francois, Fritz; Perez-Perez, Guillermo; Blaser, Martin J; Relman, David A. "Molecular analysis of the bacterial microbiota in the human stomach". Proceedings of the National Academy of Sciences of the United States of America. 2006 Jan 17;103(3):732-737 (MEDL:16407106 #62128)       

    The microbiota of the human stomach and the influence of Helicobacter pylori colonization on its composition remain largely unknown. We characterized bacterial diversity within the human gastric mucosa by using a small subunit 16S rDNA clone library approach and analyzed 1,833 sequences generated by broad-range bacterial PCR from 23 gastric endoscopic biopsy samples. A diverse community of 128 phylotypes was identified, featuring diversity at this site greater than previously described. The majority of sequences were assigned to the Proteobacteria, Firmicutes, Actinobacteria, Bacteroidetes, and Fusobacteria phyla. Ten percent of the phylotypes were previously uncharacterized, including a Deinococcus-related organism, relatives of which have been found in extreme environments but not reported before in humans. The gastric clone libraries from 19 subjects contained H. pylori rDNA; however, only 12 of these subjects tested positive for H. pylori by conventional laboratory methods. Statistical analysis revealed a large degree of intersubject variability of the gastric ecosystem. The presence of H. pylori did not affect the composition of the gastric community. This gastric bacterial rDNA data set was significantly different from sequence collections of the human mouth and esophagus described in other studies, indicating that the human stomach may be home to a distinct microbial eco-system. The gastric microbiota may play important, as-yet-undiscovered roles in human health and disease
  39. Bini, Edmund J; Park, James; Francois, Fritz. "Use of flexible sigmoidoscopy to screen for colorectal cancer in HIV-infected patients 50 years of age and older". Archives of internal medicine. 2006 Aug 14-28;166(15):1626-1631 (MEDL:16908796 #68540)       

    BACKGROUND: Although many patients with human immunodeficiency virus (HIV) infection are now living well beyond 50 years of age, there are no data available on colorectal cancer screening in this population. The aim of this study was to determine the utility of screening flexible sigmoidoscopy in patients with HIV. METHODS: Consecutive patients at average risk for colorectal cancer who were referred for screening flexible sigmoidoscopy were prospectively identified. A detailed medical history was obtained from all patients before flexible sigmoidoscopy, and colonoscopy was recommended for all subjects with positive sigmoidoscopic findings. RESULTS: A total of 2382 patients were enrolled in the study; 165 were HIV positive. The prevalence of neoplastic lesions (adenomas or adenocarcinomas) in the distal colon was significantly higher in HIV-infected patients than in control subjects (25.5% vs 13.1%, P<.001), and the odds of HIV-infected patients having a neoplastic lesion was significantly higher even after adjustment for potential confounding variables (odds ratio, 2.34; 95% confidence interval, 1.60-3.44). The prevalence of adenomas of any size (25.5% vs 12.9%, P<.001) and advanced neoplasia (7.3% vs 3.8%, P = .03) in the distal colon was significantly higher in HIV-infected patients. Among individuals with positive results on flexible sigmoidoscopy, proximal colonic neoplastic lesions on follow-up colonoscopy were more common in HIV-infected patients after adjustment for age, sex, and race/ethnicity (odds ratio, 1.88; 95% confidence interval, 1.02-3.46). CONCLUSIONS: Patients infected with HIV are more likely to have colonic neoplasms on screening flexible sigmoidoscopy than those without HIV, and these individuals should be offered colorectal cancer screening
  40. Francois, Fritz; Blaser, Martin J. "Improving Helicobacter pylori eradication regimens [Editorial]". Annals of internal medicine. 2006 Jan 17;144(2):140-141 (MEDL:16418415 #62127)    
  41. Francois, Fritz; Park, James; Bini, Edmund J. "Colon Pathology Detected After a Positive Screening Flexible Sigmoidoscopy: A Prospective Study in an Ethnically Diverse Cohort". American journal of gastroenterology. 2006 Apr;101(4):823-830 (MEDL:16494591 #62736)       

    OBJECTIVES: Although the association between distal neoplasia on sigmoidoscopy and proximal colonic pathology on follow-up colonoscopy has been well-described, it is not known if these findings are consistent across ethnic groups. The aim of this study was to evaluate ethnic variations in the prevalence of proximal neoplasia on follow-up colonoscopy after a neoplastic lesion is found on sigmoidoscopy. METHODS: Consecutive asymptomatic patients at average-risk for colorectal cancer who were referred for screening flexible sigmoidoscopy were prospectively enrolled. Colonoscopy was recommended for all patients with a polyp on flexible sigmoidoscopy, regardless of size. Advanced neoplasms were defined as adenomas >/=10 mm in diameter or any adenoma, regardless of size, with villous histology, high-grade dysplasia, or cancer. RESULTS: Among the 2,207 patients who had sigmoidoscopy, 970 were Caucasian, 765 were African American, 395 were Hispanic, and 77 were Asian. The prevalence of neoplasia in the distal colon was 12.6% in Caucasians, 11.2% in African Americans, 15.9% in Hispanics, and 24.7% in Asians (p= 0.002). Of the 290 patients with neoplastic lesions on sigmoidoscopy, follow-up colonoscopy identified neoplasms in the proximal colon in 63.9% of Caucasians, 59.3% of African Americans, 66.7% of Hispanics, and 26.3% of Asians (p= 0.01). Advanced neoplasms in the proximal colon were highest in African Americans (34.9%) and lowest in Asians (10.5%). CONCLUSIONS: In our study population, Asians demonstrated a higher prevalence of distal colonic neoplasia and a lower prevalence of proximal colonic neoplasia compared to non-Asians. Future studies should explore ethnic variation in colonic neoplasia prevalence and location since ethnic variation could lead to tailored colorectal cancer screening strategies
  42. Gamagaris, Z; Patterson, C; Francois, F; Ren, C; Youn, H; Weinshel, E. "The impact of adjustable laparoscopic gastric banding on esophageal motility [Meeting Abstract]". American journal of gastroenterology. 2006 SEP;101(9):S69-S69 (ISI:000240656100082 #69308)    
  43. Cho, Ilseung; Blaser, Martin J; Francois, Fritz; Mathew, Jomol P; Ye, Xiang Y; Goldberg, Judith D; Bini, Edmund J. "Helicobacter pylori and overweight status in the United States: data from the Third National Health and Nutrition Examination Survey". American journal of epidemiology. 2005 Sep 15;162(6):579-584 (MEDL:16093294 #58658)       

    Obesity is an important public health problem in the United States. Because of its potential effects on gastric leptin homeostasis, Helicobacter pylori may play a role in regulating body weight. The authors' aim in this study was to examine the association between H. pylori colonization and overweight status. Nonpregnant participants in the Third National Health and Nutrition Examination Survey (1988-1994) aged > or = 20 years who had had H. pylori testing performed and body mass index (weight (kg)/height (m2)) measured were studied. Overweight was defined as a body mass index greater than or equal to 25. On the basis of serologic results, the participants were categorized into three H. pylori status groups: H. pylori-positive and cytotoxin-associated gene A (cagA)-positive (H. pylori+ cagA+), H. pylori-positive and cagA-negative (H. pylori+ cagA-), and H. pylori-negative (H. pylori-). Of the 7,003 subjects with complete body mass index and H. pylori data, 2,634 (weighted percentage, 22.9%) were H. pylori+ cagA+, 1,385 (15.1%) were H. pylori+ cagA-, and 2,984 (62.0%) were H. pylori-. The adjusted odds of being overweight were 1.17 (95% confidence interval: 0.98, 1.39; p = 0.075) for the H. pylori+ cagA+ group and 0.99 (95% confidence interval: 0.80, 1.22; p = 0.92) for the H. pylori+ cagA- group in comparison with H. pylori- subjects. Serum leptin levels did not differ significantly between the three H. pylori groups. In this US population-based study, there was no significant association between H. pylori colonization, cagA+ strains of H. pylori, and being overweight
  44. Chowdhury, R; Olstein, J; Francois, F. "The yield and impact of upper endoscopy in a diverse population with refractory GERD [Meeting Abstract]". American journal of gastroenterology. 2005 SEP;100(9):S30-S30 (ISI:000231853500023 #58692)    
  45. Lin, RM; Francois, F; Olivares, A; Williams, R; Huang, GJ; Poles, MA; Perez-Perez, G. "II-lbeta-511 polymorphism is associated with increased risk of colonic adenomas in an ethnically diverse population". Gastroenterology. 2005 APR;128(4):A9-A9 (ISI:000228619300043 #519622)    
  46. Olstein, J; Chowdhury, R; Francois, F. "The prevalence and characteristics of gastric pathology in refractory GERD patients undergoing upper endoscopy [Meeting Abstract]". American journal of gastroenterology. 2005 SEP;100(9):S33-S33 (ISI:000231853500032 #58693)    
  47. Park, J; Francois, F; Bini, EJ. ""Obesity is associated with an increased prevalence of hyperplastic polyps, adenomas, and cancers that are detected by screening flexible sigmoidoscopy" [Meeting Abstract]". Gastrointestinal endoscopy. 2005;61(5):AB261-AB261 (ISI:000228874801259 #108219)    
  48. Williams, R; Lin, RM; Huang, GJ; Tran, HA; Poles, MA; Francois, F. "The effect of fiber, folate, and exercise on the risk for colon polyps in a multiethnic colon cancer screening population". Gastroenterology. 2005 APR;128(4):A299-A299 (ISI:000228619302278 #519632)    
  49. Bini, EJ; Park, J; Francois, F. "Prospective study of flexible sigmoidoscopy to screen for colorectal cancer in HIV-infected patients 50 years of age and older [Meeting Abstract]". Gastroenterology. 2004;126(4):A343-A343 (ISI:000220890201718 #108222)    
  50. Cho, I; Bini, EJ; Francois, F; Blaser, MJ. "Helicobacter pylori seropositivity is not associated with being overweight among persons in the United States: Data from the Third National Health and Nutrition Examination Survey (NHANES III) [Meeting Abstract]". American journal of gastroenterology. 2004 OCT;99(10):S43-S43 (ISI:000224479700128 #49060)    
  51. Cho, I; Bini, EJ; Francois, F; Blaser, MJ. "Lack of association between Helicobacter pylori seropositivity and the metabolic syndrome among persons in the United States: Data from the Third National Health and Nutrition Examination Survey (NHANES III) [Meeting Abstract]". American journal of gastroenterology. 2004 OCT;99(10):S42-S42 (ISI:000224479700124 #49059)    
  52. Francois, F; Bini, EJ; Perez-Perez, GI; Yee, HT; Blaser, MJ. "A three-component clinical model to predict reflux-related histopathology [Meeting Abstract]". Gastroenterology. 2004;126(4):A324-A324 (ISI:000220890201628 #108227)    
  53. Francois, F; Park, J; Bini, EJ. "Racial variation in colon pathology detected after a positive screening flexible sigmoidoscopy [Meeting Abstract]". Gastrointestinal endoscopy. 2004;59(5):AB277-AB277 (ISI:000221183600733 #108226)    
  54. Park, J; Francois, F; Bini, EJ. "Importance of hyperplastic polyps and adenomas 5mm or less in diameter that are detected by screening flexible sigmoidoscopy [Meeting Abstract]". Gastrointestinal endoscopy. 2004;59(5):AB283-AB283 (ISI:000221183600759 #108228)    
  55. Pei, Zhiheng; Bini, Edmund J; Yang, Liying; Zhou, Meisheng; Francois, Fritz; Blaser, Martin J. "Bacterial biota in the human distal esophagus". Proceedings of the National Academy of Sciences of the United States of America. 2004 Mar 23;101(12):4250-4255 (MEDL:15016918 #42671)       

    The esophagus, like other luminal organs of the digestive system, provides a potential environment for bacterial colonization, but little is known about the presence of a bacterial biota or its nature. By using broad-range 16S rDNA PCR, biopsies were examined from the normal esophagus of four human adults. The 900 PCR products cloned represented 833 unique sequences belonging to 41 genera, or 95 species-level operational taxonomic units (SLOTU); 59 SLOTU were homologous with culture-defined bacterial species, 34 with 16S rDNA clones, and two were not homologous with any known bacterial 16S rDNA. Members of six phyla, Firmicutes, Bacteroides, Actinobacteria, Proteobacteria, Fusobacteria, and TM7, were represented. A large majority of clones belong to 13 of the 41 genera (783/900, 87%), or 14 SLOTU (574/900, 64%) that were shared by all four persons. Streptococcus (39%), Prevotella (17%), and Veilonella (14%) were most prevalent. The present study identified approximately 56-79% of SLOTU in this bacterial ecosystem. Most SLOTU of esophageal biota are similar or identical to residents of the upstream oral biota, but the major distinction is that a large majority (82%) of the esophageal bacteria are known and cultivable. These findings provide evidence for a complex but conserved bacterial population in the normal distal esophagus
  56. Chalasani, Naga; Kahi, Charles; Francois, Fritz; Pinto, Amar; Marathe, Atul; Bini, Edmund J; Pandya, Prashant; Sitaraman, Shanti; Shen, Jianzhao. "Improved patient survival after acute variceal bleeding: a multicenter, cohort study". American journal of gastroenterology. 2003 Mar;98(3):653-659 (MEDL:12650802 #45223)       

    OBJECTIVE: Existing literature indicates that the mortality rate with each variceal bleeding episode is 30-50%. Over the past 2 decades, there have been significant developments in the management of variceal bleeding. The effect of these developments on the natural history of variceal bleeding is unclear. Therefore, a retrospective, multicenter study was conducted to define the outcomes of variceal bleeding and to describe the patterns of current practice in the management of variceal bleeding. METHODS: All patients with documented variceal bleeding hospitalized at four large county hospitals from January 1, 1997, to June 30, 2000, were included. Study outcomes were in-hospital, 6-wk, and overall mortality, rate of rebleeding, transfusion requirement, and length of stay. After discharge, patients were followed until death or study closure date, on June 30, 2000. RESULTS: A total of 231 subjects were included, and their in-hospital, 6-wk, and overall mortality rates were 14.2%, 17.5%, and 33.5%, respectively. The frequency of rebleeding during follow-up was 29%. Median length of total hospital stay was 8 days (0-34 days). Median number of packed red cell units transfused was 4 U (0-60 U). Upper endoscopy was performed in 95% of patients within 24 h, and endoscopic therapy was done in all but eight patients (ligation 64%, sclerotherapy 33%). Octreotide was administered in 74% of the patients. Portasystemic shunts were performed in 7.5% of the patients for controlling acute variceal bleeding. CONCLUSIONS: The mortality rate after variceal bleeding in this study was substantially lower than previously reported. This suggests that advances made in the management of variceal bleeding have improved outcomes after variceal bleeding
  57. Francois, F; Bini, EJ; Perez-Perez, GI; Blaser, MJ. "Do GERD symptoms predict Helicobacter pylori colonization? [Meeting Abstract]". Gastroenterology. 2003;124(4):A624-A624 (ISI:000182675903158 #108237)    
  58. Francois, F; Bini, EJ; Perez-Perez, GI; Yee, HT; Blaser, MJ. "Relationship of Helicobacter pylori and strain characteristics to esophageal pathology [Meeting Abstract]". Gastroenterology. 2003;124(4):A55-A55 (ISI:000182675900269 #108235)    
  59. Francois, F; Park, J; Tenner, CT; Finkelstein, S. "A rocky situation [Meeting Abstract]". Journal of general internal medicine. 2003 APR;18:50-50 (ISI:000182564300098 #50923)    
  60. Francois, F; Weinshel, EH; Perez-Perez, GI; Yee, HT; Blazer, MJ; Bini, EJ. "Endoscopic training: Looking past the surface [Meeting Abstract]". Gastrointestinal endoscopy. 2003;57(5):AB109-AB109 (ISI:000182696600122 #108236)    
  61. Francois, Fritz; Tadros, Caroline; Diehl, David. "Idiopathic pan-colonic varices". American journal of gastroenterology. 2003 September;98(9 Supplement):S190-S190 (BIOSIS:PREV200400061769 #519642)       
  62. Khaykis, I; Shim, M; Park, J; Francois, F; Bini, EJ. "Susceptibility to hepatitis B in patients with hepatitis C: Missed opportunities for vaccination [Meeting Abstract]". Gastroenterology. 2003;124(4):A386-A386 (ISI:000182675901954 #108239)    
  63. Park, J; Shim, M; Khaykis, I; Francois, F; Bini, EJ. "Vaccination against hepatitis A and B in patients coinfected with HIV and hepatitis C [Meeting Abstract]". Gastroenterology. 2003;124(4):A386-A386 (ISI:000182675901952 #108240)    
  64. Shim, M; Khaykis, I; Park, J; Francois, F; Bini, EJ. "Susceptibility to hepatitis A in patients with hepatitis C: Missed opportunities for vaccination [Meeting Abstract]". Gastroenterology. 2003;124(4):A754-A754 (ISI:000182675903805 #108243)    
  65. Chalasani, Naga; Kahi, Charles; Francois, Fritz; Pinto, Amar; Marathe, Atul; Bini, Edmund J; Pandya, Prashant; Sitaraman, Shanti; Shen, Jianzhao. "Model for end-stage liver disease (MELD) for predicting mortality in patients with acute variceal bleeding [Letter]". Hepatology. 2002 May;35(5):1282-1284 (MEDL:11981782 #45224)       
  66. Francois, F; Faroozi, B; Adams, J; Gamagaris, Z. "Pemphigoid associated esophagitis dessicans superficialis complicated by acquired hemophilia A". American journal of gastroenterology. 2002 SEP;97(9):44-285 (ISI:000178230400045 #32553)    
  67. Francois, F; Jager, D; Weinshel, E. "Aspirin induced hepatitis in a lupus patient". American journal of gastroenterology. 2002 SEP;97(9):286-285 (ISI:000178230400287 #32556)    
  68. Herold, B C; Scordi-Bello, I; Cheshenko, N; Marcellino, D; Dzuzelewski, M; Francois, F; Morin, R; Casullo, V Mas; Anderson, R A; Chany, C 2nd; Waller, D P; Zaneveld, L J D; Klotman, M E. "Mandelic acid condensation polymer: novel candidate microbicide for prevention of human immunodeficiency virus and herpes simplex virus entry". Journal of virology. 2002 Nov;76(22):11236-11244 (MEDL:12388683 #826552)       

    Presently marketed vaginal barrier methods are cytotoxic and damaging to the vaginal epithelium and natural vaginal flora when used frequently. Novel noncytotoxic agents are needed to protect men and women from sexually transmitted diseases. One novel candidate is a mandelic acid condensation polymer, designated SAMMA. The spectrum and mechanism of antiviral activity were explored using clinical isolates and laboratory-adapted strains of human immunodeficiency virus (HIV) and herpes simplex virus (HSV). SAMMA is highly effective against all CCR5 and CXCR4 isolates of HIV in primary human macrophages and peripheral blood mononuclear cells. SAMMA also inhibits infection of cervical epithelial cells by HSV. Moreover, it exhibits little or no cytotoxicity and has an excellent selectivity index. SAMMA, although not a sulfonated or sulfated polymer, blocks the binding of HIV and HSV to cells by targeting the envelope glycoproteins gp120 and gB-2, respectively, and also inhibits HSV entry postattachment. SAMMA is an excellent, structurally novel candidate microbicide that warrants further preclinical evaluation.
  69. Chalasani, N; Kahl, CJ; Francois, F; Pinto, A; Marathe, A; Pandya, P; Bini, EJ; Sitaraman, S; Shen, J. "Mayo Clinic end-stage liver disease model (MELD) for predicting patient outcomes following acute variceal bleeding". Hepatology. 2001;34(4):691-691 (ISI:000171224700685 #108254)    




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