Faculty Bibliography

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.

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)

The trick to surviving was to shuttle patients to another area of the hospital as quickly as possible. This patient was a perfect candidate for the intermediate care unit, a holding station for patients with no active medical issues who were awaiting discharge. First we just had to rule out any treatable medical conditions -- get the labs, head CT scan and chest X-ray. But the docs at the intermediate ward left at 5 p.m. and it was 4:45. I quickly scanned through the labs, called the ward's doctor and ran through the case -- demented patient, still demented, return to nursing home tomorrow. I remember the doctor's voice so clearly: "You're sure the labs and everything are normal?" Yes, yes, I said, everything is fine. She hesitated, then said O.K. The intern and I high-fived each other, and bolted back to our other admissions. Much attention has been paid to reducing medical errors. Electronic prescriptions avoid penmanship mistakes. Bar codes on wristbands ensure that medications go to the right patient. Checklists and timeouts before surgeries help prevent common oversights. But we can stop only the errors we know about. There remains a black hole of near misses, of uncharted errors -- a black hole of shame that prevents caregivers from coming forward

First we just had to rule out any treatable medical conditions -- get the labs, head CT scan and chest X-ray. (According to a 2006 report, medication errors alone injure an estimated 1.5 million patients a year.)