Faculty Bibliography

Purpose The purpose of this study is to explore the impact and feasibility of a pilot Community Health Worker (CHW) intervention to improve diabetes management among Bangladeshi-American individuals with type 2 diabetes living in New York City. Methods Participants were recruited at clinic- and community-based venues. The intervention consisted of 6 monthly, CHW-facilitated group sessions on topics related to management of diabetes. Surveys were collected at baseline and follow-up time points. Study outcomes included clinical, behavioral, and satisfaction measures for participants, as well as qualitative measures from CHWs. Results Improvements were seen in diabetes knowledge, exercise and diet to control diabetes, frequency of checking feet, medication compliance, and self-efficacy of health and physical activity from baseline to 12 months. Additionally, there were decreases in A1C, weight, and body mass index. Program evaluation revealed a high acceptability of the intervention, and qualitative findings indicated that CHWs helped overcome barriers and facilitated program outcomes through communal concordance, trust, and leadership. Conclusions The intervention demonstrated high acceptability and suggested efficacy in improving diabetes management outcomes among Bangladeshi immigrants in an urban setting. The US Bangladeshi population will continue to increase, and given the high rates of diabetes, as well as linguistic and economic barriers faced by this community, effective and culturally tailored health interventions are needed to overcome barriers and provide support for diabetes management.

Purpose To classify patterns of retinal ganglion cell (RGC) defects in glaucoma patients as seen on frequency-domain optical coherence tomography (fdOCT) volume macular scans and to compare these patterns to associated visual fields (VF). Methods One eye of 35 glaucoma patients or suspects (inclusion criteria: 24-2 MD of -6 or better) was prospectively tested with fdOCT and 10-2 VFs. The combined RGC and inner plexiform layers (RGC+) of the OCT scans were segmented using a computer-assisted manual segmentation technique.[1,2] RGC+ probability plots [3] (divided into an 8 by 8 grid) were generated. First, a scan was considered abnormal if at least 3 contiguous abnormal squares (at 5%, 2%, 2%) respecting the horizontal midline were present. This criterion yielded 24 abnormal OCT hemifields, similar to the number (26) of abnormal 10-2 VFs yielded by the typical 5%, 5%, 1% criterion. The 24 abnormal OCT hemifields were classified as arcuate-like, widespread, or "other." "Other" included temporal and non-continuous defects. RGC+ thinning plots were obtained by averaging the RGC+ thickness by classification and subtracting the average control thickness.[4] For each OCT group, the means of the associated 10-2 total deviation values were acquired. Results 24 (34%) of the 70 OCT hemifields were abnormal. Of these, 10 (14%) were arcuate-like, 8 (11%) widespread, and 6 (9%) "other." Fig. 1 (field view) shows the average OCT thinning plots for the inferior retinal hemifield and Fig. 2 the averaged associated VFs. For OCTs classified as normal (Fig. 1A), the mean 10-2 VF appeared normal (Fig. 2A). OCTs classified as arcuate exhibited greater thickness loss in the nasal retina (Fig. 1B) and the mean 10-2 VF appeared arcuate (Fig. 2B). For OCTs classified as widespread (Fig. 1C), the mean 10-2 VF also appeared widespread (Fig. 2C). Finally, there was no clear correspondence between OCT (Fig. 1D) and VF (Fig. 2D) for the "other" class, although the sample size was small. Conclusions The pattern of RGC defects on OCT could be classified into 4 groups. Except for the "other" category, the average 10-2 VF closely resembled the pattern of OCT RGC+ thinning.(Table Presented)

Cushing's disease (CD) is a rare endocrine disorder that is caused by an adrenocorticotropin (ACTH)-producing pituitary adenoma that chronically stimulates adrenocortical cortisol production. CD is primarily treated by transsphenoidal surgery, resulting in long-term biochemical remission in approximately 60-90% of the patients. Patients who are ineligible for surgery or have undergone unsuccessful surgery are candidates for drug therapy. Medical treatment can aim to inhibit the excess ACTH production at the level of the pituitary adenoma, to decrease adrenocortical steroidogenesis or to antagonize the effects of cortisol at the level of its receptor. In recent years, a number of studies have been published that evaluated the efficacy of medical therapy, either as monotherapy or combination therapy, in patients with CD. In particular, the effects of the somatostatin analog pasireotide and the glucocorticoid receptor antagonist mifepristone have been investigated in two large clinical trials. Moreover, the first clinical experiences with the novel steroidogenesis inhibitor LCI699 and the pituitary-directing retinoic acid have become available. Finally, an in vitro study with gefitinib, an epidermal growth factor receptor-antagonist, showed promising results that warrant further exploration. In this review, the efficacy and limitations of drugs that have been used in the treatment of CD will be discussed as well as recent developments with respect to new pituitary- and adrenal-targeting compounds.

OBJECTIVE:The widespread application of abdominal computerized tomography (CT) imaging has revealed that 0.98-4.0% of individuals harbour adrenal lesions (incidentalomas). There is, however, paucity of information regarding the prevalence of adrenal lesions in patients with gastroenteropancreatic neuroendocrine tumours (GEP-NETS). Purpose of this study was to estimate the prevalence of adrenal lesions in patients with GEP-NETS and identify their radiological features and clinical significance. DESIGN/METHODS:The prevalence of adrenal lesions was estimated retrospectively in 438 patients with GEP-NETS who underwent abdominal imaging. Secretory status and changes in size were documented during subsequent follow-up. MEN-1 patients and ectopic ACTH-secreting tumours were excluded. RESULTS:Adrenal lesions were detected in 32 (8.4%) of 383 patients included. The majority (22 patients - 69%) were located at the left adrenal gland and the mean size was 23.6 mm. In two patients, one with a well and another with a poorly differentiated tumour, clinicopathological features suggested adrenal metastases. During a mean follow-up period of 69.5 months, no subsequent growth of any adrenal lesion was observed. Endocrine evaluation documented subclinical glucocorticoid hypersecretion in 4 cases (14%). The presence of adrenal lesions did not correlate to distant metastases, however, they were observed more frequently in patients with G3 tumours. CONCLUSION/CONCLUSIONS:The prevalence of adrenal lesions in patients with GEP-NETs was found to be higher than the general population and mostly represent benign adrenal adenomas (except patients with G3 tumours). Nevertheless, individualized assessment of imaging characteristics should be still considered.

OBJECTIVES: We examined the relationship between cigarette excise tax increases and tax-avoidant purchasing behaviors among New York City adult smokers. METHODS: We analyzed data from the city's annual Community Health Survey to assess changes in rates of tax avoidance over time (2003-2010) and smokers' responses to the 2008 state cigarette tax increase. Multivariable logistic regression analysis identified correlates of buying more cigarettes on the street in response to the increase. RESULTS: After the 2002 tax increase, the percentage of smokers engaged in tax-avoidant behavior decreased with time from 30% in 2003 to 13% in 2007. Following the 2008 tax increase, 21% of smokers reported buying more cigarettes from another person on the street. Low-income, younger, Black, and Hispanic smokers were more likely than respondents with other sociodemographic characteristics to purchase more cigarettes on the street. CONCLUSIONS: To maximize public health impact, cigarette tax increases should be paired with efforts to limit the flow of untaxed cigarettes entering jurisdictions with high cigarette pack prices.

Compared to white women, premenopausal Chinese-American women have more plate-like trabecular (Tb) bone. It is unclear whether these findings are relevant to postmenopausal women and if there are racial differences in the deterioration of bone microarchitecture with aging. We applied individual trabecula segmentation and finite element analysis to high-resolution peripheral quantitative computed tomography images in premenopausal and postmenopausal Chinese-American and white women to quantify within-race age-related differences in Tb plate-versus-rod microarchitecture and bone stiffness. Race-menopause status interactions were assessed. Comparisons between races within menopause status were adjusted for age, height and weight. Comparisons between premenopausal and postmenopausal women were adjusted for height and weight. Adjusted analyses at the radius indicated that premenopausal Chinese-Americans had a higher plate bone volume fraction (pBV/TV), Tb plate-to-rod ratio (P-R ratio), and greater plate-plate junction densities (P-P Junc.D) versus white women (all p < 0.01), resulting in 27% higher Tb stiffness (p < 0.05). Greater cortical thickness and density (Ct.Th and Dcort) and more Tb plates led to 19% greater whole bone stiffness (p < 0.05). Postmenopausal Chinese-Americans had similar pBV/TV and P-P Junc.D, yet a higher P-R ratio versus white women. Postmenopausal Chinese-American versus white women had greater Ct.Th, Dcort, and relatively intact Tb plates, resulting in similar Tb stiffness but 12% greater whole bone stiffness (p < 0.05). In both races, Ct.Th and Dcort were lower in postmenopausal versus premenopausal women and there were no differences between races. Tb plate parameters were also lower in postmenopausal versus premenopausal women, but age-related differences in pBV/TV, P-R ratio, and P-P Junc D were greater (p < 0.05) in Chinese-Americans versus white women. There are advantages in cortical and Tb bone in premenopausal Chinese-American women. Within-race cross-sectional differences between premenopausal and postmenopausal women suggest greater loss of plate-like Tb bone with aging in Chinese-Americans, though thicker cortices and more plate-like Tb bone persists.

Adrenocortical carcinoma (ACC) is an aggressive tumor with very poor prognosis. Novel medical treatment opportunities are required. We investigated the effects of interferon-β (IFN-β), alone or in combination with mitotane, on cell growth and cortisol secretion in primary cultures of 13 human ACCs, three adrenal hyperplasias, three adrenal adenomas, and in two ACC cell lines. Moreover, the interrelationship between the effects of IGF2 and IFN-β was evaluated. Mitotane inhibited cell total DNA content/well (representing cell number) in 7/11 (IC50: 38±9.2 μM) and cortisol secretion in 5/5 ACC cultures (IC50: 4.5±0.1 μM). IFN-β reduced cell number in 10/11 (IC50: 83±18 IU/ml) and cortisol secretion in 5/5 ACC cultures (IC50: 7.3±1.5 IU/ml). The effect of IFN-β on cell number included the induction of apoptosis. IFN-β strongly inhibited mRNA expression of STAR, CYP11A1, CYP17A1, and CYP11B1. Mitotane and IFN-β induced an additive inhibitory effect on cell number and cortisol secretion. IGF2 (10 nM) inhibited apoptosis and increased cell number and cortisol secretion. These effects were counteracted by IFN-β treatment. Finally, IFN-β inhibited IGF2 secretion and mRNA expression. In conclusion, IFN-β is a potent inhibitor of ACC cell growth in human primary ACC cultures, partially mediated by an inhibition of the effects of IGF2, as well as its production. The increased sensitivity of ACC cells to mitotane induced by treatment with IFN-β may open the opportunity for combined treatment regimens with lower mitotane doses. The inhibition of the expression of steroidogenic enzymes by IFN-β is a novel mechanism that may explain its inhibitory effect on cortisol production.

Rates of food insecurity are high among medically underserved patients. We analyzed food pantry responsiveness to the needs of medically ill cancer patients in New York City with the intent ofidentifying barriers to available food resources. Our data, collected from 60 pantries, suggest that the emergency food system is currently unable to accommodate patient needs. Accessibility issues include restricted service hours and documentation requirements. Food services were limited in quantity of food provided and the number of nutritious, palatable options. Additional emergency food resources and long-term approaches that provide ongoing food support to patients throughout their treatment period are needed.

There is growing evidence that exposure to cooking oil fumes (COF) is linked to lung cancer. Existing literature on this risk was reviewed, specifically as it may relate to potentially at-risk populations such as Chinese immigrants and restaurant workers in the United States. Studies were identified by searching the NCBI database with key terms. All studies that examined the significance, prevalence, and/or mechanism(s) of the association between COF exposure and cancer (all types) were included. A majority of epidemiologic studies found associations between lung cancer and COF exposure. All studies that examined the mechanisms underlying the risk found evidence for mutagenic and/or carcinogenic compounds in COF extract and/or molecular mechanisms for COF-induced DNA damage or carcinogenesis. The evidence reviewed underscores the need to thoroughly investigate the association among at-risk groups in the United States, as well as to develop and assess concrete interventions to reduce these risks.