54 results on '"Jeffrey P. Zwerner"'
Search Results
2. Multi-modal learning with missing data for cancer diagnosis using histopathological and genomic data.
- Author
-
Can Cui 0006, Zuhayr Asad, William F. Dean, Isabelle T. Smith, Christopher Madden, Shunxing Bao, Bennett A. Landman, Joseph T. Roland, Lori A. Coburn, Keith T. Wilson, Jeffrey P. Zwerner, Shilin Zhao, Lee E. Wheless, and Yuankai Huo
- Published
- 2022
- Full Text
- View/download PDF
3. Efficacy and Safety of Topical Hypericin Photodynamic Therapy for Early-Stage Cutaneous T-Cell Lymphoma (Mycosis Fungoides): The FLASH Phase 3 Randomized Clinical Trial
- Author
-
Ellen J. Kim, Aaron R. Mangold, Jennifer A. DeSimone, Henry K. Wong, Lucia Seminario-Vidal, Joan Guitart, James Appel, Larisa Geskin, Edward Lain, Neil J. Korman, Nathalie Zeitouni, Neda Nikbakht, Kenneth Dawes, Oleg Akilov, Joi Carter, Michi Shinohara, Timothy M. Kuzel, Warren Piette, Neal Bhatia, Amy Musiek, David Pariser, Youn H. Kim, Dirk Elston, Erin Boh, Madeleine Duvic, Auris Huen, Theresa Pacheco, Jeffrey P. Zwerner, Seung Tae Lee, Michael Girardi, Christiane Querfeld, Kimberly Bohjanen, Elise Olsen, Gary S. Wood, Adam Rumage, Oreola Donini, Andrea Haulenbeek, Christopher J. Schaber, Richard Straube, Christopher Pullion, Alain H. Rook, and Brian Poligone
- Subjects
Adult ,Anthracenes ,Male ,Photosensitizing Agents ,Skin Neoplasms ,Dermatology ,Middle Aged ,Lymphoma, T-Cell, Cutaneous ,Ointments ,Mycosis Fungoides ,Treatment Outcome ,Photochemotherapy ,Humans ,Female ,Triazenes ,Perylene - Abstract
ImportanceGiven that mycosis fungoides−cutaneous T-cell lymphoma (MF/CTCL) is chronic, there is a need for additional therapies with minimal short- and long-term adverse effects. Topical synthetic hypericin ointment, 0.25%, activated with visible light is a novel, nonmutagenic photodynamic therapy (PDT).ObjectivesTo determine the efficacy and safety of topical synthetic hypericin ointment, 0.25%, activated with visible light as a nonmutagenic PDT in early-stage MF/CTCL.Design, Settings, and ParticipantsThis was a multicenter, placebo-controlled, double-blinded, phase 3 randomized clinical trial (FLASH study) conducted from December 2015 to November 2020 at 39 academic and community-based US medical centers. Participants were adults (≥18 years) with early-stage (IA-IIA) MF/CTCL.InterventionsIn cycle 1, patients were randomized 2:1 to receive hypericin or placebo to 3 index lesions twice weekly for 6 weeks. In cycle 2, all patients received the active drug for 6 weeks to index lesions. In cycle 3 (optional), both index and additional lesions received active drug for 6 weeks.Main Outcomes and MeasuresThe primary end point was index lesion response rate (ILRR), defined as 50% or greater improvement in modified Composite Assessment of Index Lesion Severity (mCAILS) score from baseline after 6 weeks of therapy for cycle 1. For cycles 2 and 3, open label response rates were secondary end points. Adverse events (AEs) were assessed at each treatment visit, after each cycle, and then monthly for 6 months. Data analyses were performed on December 21, 2020.ResultsThe study population comprised 169 patients (mean [SD] age, 58.4 [16.0] years; 96 [57.8%] men; 120 [72.3%] White individuals) with early-stage MF/CTCL. After 6 weeks of treatment, hypericin PDT was more effective than placebo (cycle 1 ILRR, 16% vs 4%; P = .04). The ILRR increased to 40% in patients who received 2 cycles of hypericin PDT (P P Conclusion and RelevanceThe findings of this randomized clinical trial indicate that synthetic hypericin PDT is effective in early-stage patch and plaque MF/CTCL and has a favorable safety profile.Trial RegistrationClinicalTrials.gov Identifier: NCT02448381
- Published
- 2023
4. Data from Contribution of Beta-HPV Infection and UV Damage to Rapid-Onset Cutaneous Squamous Cell Carcinoma during BRAF-Inhibition Therapy
- Author
-
Jeffrey A. Sosman, Jeffrey R. Infante, Yu Shyr, James D. Chappell, Peter L. Rady, Stephen K. Tyring, Jason B. Robbins, Jeffrey P. Zwerner, Alan S. Boyd, Pranil K. Chandra, James L. Prescott, Brent R. Moody, Wilfred A. Lumbang, Douglas B. Johnson, Qin He, Harrison P. Nguyen, Liping Du, Aaron C. Shaver, Steven K. Lawson, and Daniel N. Cohen
- Abstract
Purpose: BRAF-inhibition (BRAFi) therapy for advanced melanoma carries a high rate of secondary cutaneous squamous cell carcinoma (cSCC) and risk of other cancers. UV radiation and α-genus human papillomavirus (HPV) are highly associated with SCC, but a novel role for β-genus HPV is suspected in BRAFi-cSCC. Cutaneous β-HPV may act in concert with host and environmental factors in BRAFi-cSCC.Experimental Design: Primary BRAFi-cSCC tissue DNA isolated from patients receiving vemurafenib or dabrafenib from two cancer centers was analyzed for the presence of cutaneous oncogenic viruses and host genetic mutations. Diagnostic specimens underwent consensus dermatopathology review. Clinical parameters for UV exposure and disease course were statistically analyzed in conjunction with histopathology.Results: Twenty-nine patients contributed 69 BRAFi-cSCC lesions. BRAFi-cSCC had wart-like features (BRAFi-cSCC-WF) in 22% of specimens. During vemurafenib therapy, BRAFi-cSCC-WF arose 11.6 weeks more rapidly than conventional cSCC when controlled for gender and UV exposure (P value = 0.03). Among all BRAFi-cSCC, β-genus HPV-17, HPV-38, HPV-111 were most frequently isolated, and novel β-HPV genotypes were discovered (CTR, CRT-11, CRT-22). Sequencing revealed 63% of evaluated BRAFi-cSCCs harbored RAS mutations with PIK3CA, CKIT, ALK, and EGFR mutations also detected.Conclusions: We examined clinical, histopathologic, viral, and genetic parameters in BRAFi-cSCC demonstrating rapid onset; wart-like histomorphology; β-HPV-17, HPV-38, and HPV-111 infection; UV damage; and novel ALK and CKIT mutations. Discovered β-HPV genotypes expand the spectrum of tumor-associated viruses. These findings enhance our understanding of factors cooperating with BRAF inhibition that accelerate keratinocyte oncogenesis as well as broaden the knowledge base of multifactorial mediators of cancer in general. Clin Cancer Res; 21(11); 2624–34. ©2015 AACR.
- Published
- 2023
5. Supplementary Methods, Figures 1-2, Tables 1-3 from Contribution of Beta-HPV Infection and UV Damage to Rapid-Onset Cutaneous Squamous Cell Carcinoma during BRAF-Inhibition Therapy
- Author
-
Jeffrey A. Sosman, Jeffrey R. Infante, Yu Shyr, James D. Chappell, Peter L. Rady, Stephen K. Tyring, Jason B. Robbins, Jeffrey P. Zwerner, Alan S. Boyd, Pranil K. Chandra, James L. Prescott, Brent R. Moody, Wilfred A. Lumbang, Douglas B. Johnson, Qin He, Harrison P. Nguyen, Liping Du, Aaron C. Shaver, Steven K. Lawson, and Daniel N. Cohen
- Abstract
Supplementary Methods, Figures 1-2, Tables 1-3. Phylogenetic analysis, novel HPV alignment and NGS gene panel. Figure S1 - β-genus HPV38, HPV17 and HPV111 are most frequently found in BRAFi-cSCC; Figure S2: Protein and nucleic acid sequence alignments of putative novel HPV genotypes; Table S1: HPV L1 sequences were obtained from NCBI for alignment and relatedness analysis; Table S2 Human Papillomavirus Taxonomy; Table S3: Ion Torrent Ampliseq panel targets.
- Published
- 2023
6. Cutaneous Lymphangitic Carcinomatosis as the First Sign of Recurrent Malignancy in a Patient With a History of Rectal Adenocarcinoma
- Author
-
Cathy Eng, Brittany O'Brian, Jeffrey P. Zwerner, and Cody M. Lebeck Lee
- Subjects
medicine.medical_specialty ,Rectal Neoplasms ,business.industry ,Colorectal cancer ,Carcinoma ,Gastroenterology ,Cancer ,Disease ,Adenocarcinoma ,Administration, Cutaneous ,medicine.disease ,Malignancy ,Primary tumor ,Dermatology ,Oncology ,Lymphangitic Carcinomatosis ,medicine ,Rectal Adenocarcinoma ,Humans ,business ,Peritoneal Neoplasms - Abstract
Clinical Practice Points • Cutaneous lymphangitic carcinomatosis is a rare form of cutaneous metastatic disease which can appear to be a variety of different dermatologic conditions. Clinicians should maintain a high index of suspicion in order to avoid delays in diagnosis and treatment given the poor prognosis of cutaneous metastatic disease. • While the skin is an uncommon site of metastatic disease, it is important to remember that cutaneous metastases can be the sole presenting sign of malignancy or extra nodal disease. • Skin metastases more commonly present within the first 3 years after discovery of a primary tumor. However, they can occur at any time and have been reported up to 22 years after an initial cancer diagnosis. Clinicians should consider this with any new skin lesion in a patient with a history of malignancy.
- Published
- 2021
7. Cutaneous adverse events caused by immune checkpoint inhibitors
- Author
-
Anna K. Dewan, Henry T. Quach, Jeffrey P. Zwerner, Nicole R. LeBoeuf, and Douglas B. Johnson
- Subjects
medicine.medical_specialty ,integumentary system ,business.industry ,Vitiligo ,Dermatology ,Dermatomyositis ,medicine.disease ,Morbilliform ,Rash ,Scleroderma ,Toxic epidermal necrolysis ,CTLA-4 ,Stevens-Johnson Syndrome ,medicine ,Humans ,Immunotherapy ,medicine.symptom ,skin and connective tissue diseases ,Adverse effect ,business ,Immune Checkpoint Inhibitors ,Skin - Abstract
Importance Immune checkpoint inhibitors (ICIs) have emerged as active therapies for a variety of cancers. Cutaneous toxicities are common immune-related adverse events and patients will often be referred to dermatologists for evaluation. Observations Cutaneous adverse events to ICIs can have a variety of clinical presentations. Among the more common are eczematous, morbilliform, and lichenoid dermatoses, as well as vitiligo and pruritus. Less common adverse events include psoriasiform dermatoses, bullous disorders, and severe cutaneous adverse reactions, including Stevens–Johnson syndrome, toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms. Because of the immunologic mechanism of ICIs, there are also a variety of rheumatologic adverse reactions with cutaneous manifestations, such as scleroderma, dermatomyositis, cutaneous lupus erythematosus, and various vasculitides. These cutaneous reactions often respond to topical or systemic steroids, although specific toxicities may have alternative treatments available. Conclusions and relevance As they become more widely prescribed, dermatologists will see an increasing number of patients with cutaneous adverse events caused by ICI therapies. Accurately diagnosing and treating these toxicities is paramount to achieving the most favorable outcomes for patients.
- Published
- 2021
8. Erythematous Pedunculated Plaque on the Dorsal Aspect of the Foot
- Author
-
Briana R, Halle, Ashli, Fitzpatrick, Jeffrey P, Zwerner, and Sharon E, Albers
- Subjects
Lower Extremity ,Erythema ,Foot ,Humans - Published
- 2022
9. Clinical and Histopathologic Characteristics of Metastatic and Locally Advanced Cutaneous Basal Cell Carcinomas
- Author
-
Lee Wheless, Alan S. Boyd, Laura X. Baker, Erica Grilletta, and Jeffrey P. Zwerner
- Subjects
Adult ,Male ,Pathology ,medicine.medical_specialty ,Skin Neoplasms ,Perineural invasion ,Locally advanced ,Dermatology ,Article ,Pathology and Forensic Medicine ,Metastasis ,Chart review ,medicine ,Humans ,Basal cell ,Aged ,Retrospective Studies ,business.industry ,Level iv ,General Medicine ,Middle Aged ,medicine.disease ,Primary tumor ,Carcinoma, Basal Cell ,Depth of invasion ,Female ,business - Abstract
Locally advanced or metastatic basal cell carcinomas (laBCCs or mBCCs) are rare, with few case series providing information on their epidemiology. We aimed to describe the clinical and histologic features of locally advanced and metastatic basal cell carcinomas. Forty cases of laBCC or mBCC were identified by searching Vanderbilt's database from 1984 to January 2019. A retrospective chart review was performed. Pathology slides were available for 23 cases (13 mBCCs and 10 laBCCs). Twenty-one of 23 cases were Clark level IV or V, with a mean depth of invasion of >7 mm for both types. The mean mitotic rate was 4.4 mitoses/mm2 for laBCCs and 3.3 mitoses/mm2 for mBCCs. Ulceration was identified in 7 laBCC and 8 mBCC cases. Perineural invasion was present in 2 laBCC and 6 mBCC cases, with 3 mBCCs invading nerves >0.1 mm. Of 13 mBCC cases, histologic subtypes included infiltrative (n = 9), nodular (n = 7), morpheaform (n = 4), and superficial (n = 2), with multiple patterns present in some specimens. 10 of 13 patients with mBCC had local recurrence before metastasis. In summary, we identified several potential markers of high-risk BCC, including perineural invasion, deep invasion, elevated mitotic rate, and local recurrence of the primary tumor.
- Published
- 2021
10. Fever and flagellate dermatosis in an otherwise healthy woman
- Author
-
S Kam, Anna K. Dewan, Jeffrey P. Zwerner, and L Ishii
- Subjects
Adult ,medicine.medical_specialty ,Fever ,biology ,business.industry ,Still Disease ,Dermatology ,Exanthema ,biology.organism_classification ,Interleukin 1 Receptor Antagonist Protein ,Antirheumatic Agents ,Humans ,Prednisone ,Medicine ,Female ,Flagellate ,Presentation (obstetrics) ,business ,Glucocorticoids ,Still's Disease, Adult-Onset ,Skin Findings - Abstract
We report a rare presentation of adult-onset Still disease (AoSD) with flagellate dermatosis and unknown trigger. Atypical skin findings have been increasingly reported for AoSD and may be associated with worse prognosis and systemic complications. Increased awareness of nonclassic skin findings in AoSD may lead to earlier diagnosis and treatment.
- Published
- 2021
11. Multi-modal learning with missing data for cancer diagnosis using histopathological and genomic data
- Author
-
Can Cui, Zuhayr Asad, William F. Dean, Isabelle T. Smith, Christopher Madden, Shunxin Bao, Bennett A. Landman, Joseph T. Roland, Lori A. Coburn, Keith T. Wilson, Jeffrey P. Zwerner, Shilin Zhao, Lee E. Wheless, and Yuankai Huo
- Subjects
Article - Abstract
Multi-modal learning (e.g., integrating pathological images with genomic features) tends to improve the accuracy of cancer diagnosis and prognosis as compared to learning with a single modality. However, missing data is a common problem in clinical practice, i.e., not every patient has all modalities available. Most of the previous works directly discarded samples with missing modalities, which might lose information in these data and increase the likelihood of overfitting. In this work, we generalize the multi-modal learning in cancer diagnosis with the capacity of dealing with missing data using histological images and genomic data. Our integrated model can utilize all available data from patients with both complete and partial modalities. The experiments on the public TCGA-GBM and TCGA-LGG datasets show that the data with missing modalities can contribute to multi-modal learning, which improves the model performance in grade classification of glioma cancer.
- Published
- 2022
12. Development of warfarin-induced, non-uremic calciphylaxis following recovery from COVID-19 infection with acute renal injury – A report of a case
- Author
-
Briana Halle, Lisa Ishii, Jeffrey P. Zwerner, and Eva Rawlings Parker
- Published
- 2022
13. Bannayan‐Riley‐Ruvalcaba syndrome with gingival hyperpigmentation and facial papules
- Author
-
Alexander Hicks, Sharon E. Albers, Eden M. Lyons, Jeffrey P. Zwerner, and Eva B. Niklinska
- Subjects
Male ,Gingival hyperpigmentation ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Adolescent ,Genotype ,business.industry ,PTEN Phosphohydrolase ,Context (language use) ,Dermatology ,Cowden syndrome ,medicine.disease ,Angiofibromas ,Phenotype ,Bannayan–Riley–Ruvalcaba syndrome ,Hyperpigmentation ,PTEN HAMARTOMA TUMOR SYNDROME ,Pediatrics, Perinatology and Child Health ,medicine ,Humans ,Hamartoma Syndrome, Multiple ,Facial papules ,business - Abstract
One of the distinctive cutaneous manifestations of Bannayan-Riley-Ruvalcaba syndrome (BRRS), a PTEN hamartoma tumor syndrome, is penile pigmented macules. We present a 13-year-old boy with gingival hyperpigmentation along with facial and ear angiofibromas in the context of a BRRS-concordant phenotype and PTEN hamartoma tumor syndrome genotype. To our knowledge, these two findings have not been previously reported with BRRS and may expand the known phenotype of this disorder.
- Published
- 2021
14. Single-cell immunopathology of systemic contact allergy associated with corticosteroids
- Author
-
Rebecca J. Hertzman, Pooja Deshpande, Katie D. White, Rama Gangula, Abha Chopra, Ramesh Ram, John A. Zic, Jeffrey P. Zwerner, Andrew Gibson, and Elizabeth J. Phillips
- Subjects
Adrenal Cortex Hormones ,Dermatitis, Allergic Contact ,Humans ,Dermatology ,Patch Tests ,Molecular Biology ,Biochemistry ,Article - Published
- 2021
15. An Extensive Presentation of Cutaneous Angiosarcoma
- Author
-
Eva Rawlings Parker, Carolyn G Ahlers, and Jeffrey P Zwerner
- Subjects
Male ,Poor prognosis ,medicine.medical_specialty ,Scalp ,Skin Neoplasms ,medicine.diagnostic_test ,business.industry ,Biopsy ,Hemangiosarcoma ,General Medicine ,Middle Aged ,Dermatology ,digestive system diseases ,medicine.anatomical_structure ,medicine ,Humans ,In patient ,Angiosarcoma ,Presentation (obstetrics) ,business ,neoplasms - Abstract
In this report, the case of a 58-year-old male with extensive, rapidly growing cutaneous angiosarcoma is described. Though involvement of the scalp is common in cutaneous angiosarcoma, the extent of cutaneous disease at presentation in this case was striking. This case provides an important illustration of extensive cutaneous angiosarcoma of the scalp and its potential to rapidly advance. Early diagnosis and treatment of cutaneous angiosarcoma is paramount, as cutaneous angiosarcoma is highly aggressive and is associated with an overall poor prognosis. This case is presented to highlight the need for clinicians to maintain a high index of suspicion and low threshold for biopsy in patients presenting with violaceous or ecchymotic lesions on the head or scalp. J Drugs Dermatol. 2021;20(8):895-897. doi:10.36849/JDD.6051.
- Published
- 2021
16. Infant with hair collar sign and hairy back papules
- Author
-
Eva B. Niklinska, Eden M. Lyons, Jeffrey P. Zwerner, Sharon E. Albers, and Jiancong Liang
- Subjects
Scalp ,business.industry ,Pediatrics, Perinatology and Child Health ,Medicine ,Humans ,Infant ,Dermatology ,Anatomy ,business ,Collar ,Sign (mathematics) ,Hair - Published
- 2021
17. HLA-A*32:01 is strongly associated with vancomycin-induced drug reaction with eosinophilia and systemic symptoms
- Author
-
Jeffrey P. Zwerner, Katherine C. Konvinse, Mark A. Pilkinton, Patricia Martinez, Mark Watson, Francois X. Rwandamuriye, Ian James, Elizabeth J. Phillips, Alec J. Redwood, Misha Rosenbach, Rebecca Pavlos, Katie D. White, Christian M. Shaffer, David A. Ostrov, Cosmin Adrian Bejan, Jason A Trubiano, Jack Bourke, Ryan J. Schutte, Kristina B. Williams, Abha Chopra, and Simon Mallal
- Subjects
Adult ,Male ,0301 basic medicine ,medicine.medical_specialty ,Adolescent ,medicine.drug_class ,Immunology ,Population ,Antibiotics ,Human leukocyte antigen ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Vancomycin ,Internal medicine ,medicine ,Humans ,Immunology and Allergy ,Young adult ,education ,Aged ,education.field_of_study ,HLA-A Antigens ,business.industry ,Middle Aged ,medicine.disease ,Anti-Bacterial Agents ,Molecular Docking Simulation ,030104 developmental biology ,030228 respiratory system ,Drug Hypersensitivity Syndrome ,Delayed hypersensitivity ,Female ,business ,Adverse drug reaction ,medicine.drug - Abstract
Background Vancomycin is a prevalent cause of the severe hypersensitivity syndrome drug reaction with eosinophilia and systemic symptoms (DRESS), which leads to significant morbidity and mortality and commonly occurs in the setting of combination antibiotic therapy, affecting future treatment choices. Variations in HLA class I in particular have been associated with serious T cell–mediated adverse drug reactions, which has led to preventive screening strategies for some drugs. Objective We sought to determine whether variation in the HLA region is associated with vancomycin-induced DRESS. Methods Probable vancomycin-induced DRESS cases were matched 1:2 with tolerant control subjects based on sex, race, and age by using BioVU, Vanderbilt's deidentified electronic health record database. Associations between DRESS and carriage of HLA class I and II alleles were assessed by means of conditional logistic regression. An extended sample set from BioVU was used to conduct a time-to-event analysis of those exposed to vancomycin with and without the identified HLA risk allele. Results Twenty-three subjects met the inclusion criteria for vancomycin-associated DRESS. Nineteen (82.6%) of 23 cases carried HLA-A*32:01 compared with 0 (0%) of 46 of the matched vancomycin-tolerant control subjects (P = 1 × 10−8) and 6.3% of the BioVU population (n = 54,249, P = 2 × 10−16). Time-to-event analysis of DRESS development during vancomycin treatment among the HLA-A*32:01–positive group indicated that 19.2% had DRESS and did so within 4 weeks. Conclusions HLA-A*32:01 is strongly associated with vancomycin-induced DRESS in a population of predominantly European ancestry. HLA-A*32:01 testing could improve antibiotic safety, help implicate vancomycin as the causal drug, and preserve future treatment options with coadministered antibiotics.
- Published
- 2019
18. Contributors
- Author
-
David R. Adams, Stewart Adams, Mina Amin, Nidhi Avashia-Khemka, Kristen M. Beck, Bhavnit K. Bhatia, Sravya Mallam Bhatia, Tina Bhutani, Jonathan A. Braue, Robert T. Brodell, David G. Brodland, Candace Broussard-Steinberg, Jeffrey P. Callen, Charles Camisa, Ahmad Chehade, Margot Chima, Richard A. Clark, Abigail Cline, Kelly M. Cordoro, Julio C. Cruz Ramón, Loretta S. Davis, Salma de la Feld, Cynthia M.C. DeKlotz, Gabrielle-Eugenie Duprat, William H. Eaglstein, Carly A. Elston, Dirk M. Elston, Ashley N. Emerson, Stephanie K. Fabbro, Steven R. Feldman, Laura K. Ferris, Kelly A. Foley, Seth B. Forman, Craig Garofola, Jeffrey R. Gehlhausen, Joel M. Gelfand, Michael Girardi, Tobias Goerge, Kenneth B. Gordon, Teri M. Greiling, Erin E. Grinich, Daniel Grove, Aditya K. Gupta, Anita Haggstrom, Christopher T. Haley, Russell P. Hall, Iltefat Hamzavi, Michael P. Heffernan, Yolanda R. Helfrich, Adam B. Hessel, Shauna Higgins, Whitney A. High, Katherine Hrynewycz, Sylvia Hsu, Michael J. Huether, Michael J. Isaacs, Michael S. Kaminer, Prasanthi Kandula, Swetha Kandula, Sewon Kang, Marshall B. Kapp, Hee Jin Kim, Sa Rang Kim, Melanie Kingsley, Sandra R. Knowles, John Y.M. Koo, Carol L. Kulp-Shorten, Megan N. Landis, Mark G. Lebwohl, Erica B. Lee, Katherine B. Lee, Amy B. Lewis, Geoffrey F.S. Lim, Henry W. Lim, Benjamin N. Lockshin, Thomas A. Luger, Jacquelyn Majerowski, Lawrence A. Mark, Dana Marshall, David Martell, Rachel R. Mays, Linda F. McElhiney, Ginat W. Mirowski, Shoko Mori, Kiran Motaparthi, Uyen Ngoc Mui, Christian Murray, Colton Nielson, Megan H. Noe, Ginette A. Okoye, Cindy England Owen, Timothy Patton, Warren W. Piette, Sahand Rahnama-Moghadam, Sarika Manoj Ramachandran, Elizabeth A. Rancour, Jaggi Rao, Misha Rosenbach, Katherine Roy, Dana L. Sachs, Naveed Sami, Marty E. Sawaya, Courtney R. Schadt, William Schaffenburg, Bethanee J. Schlosser, Sahil Sekhon, Vidhi V. Shah, Lori E. Shapiro, Neil H. Shear, Michael Sheehan, Eric L. Simpson, Alexandra Snodgrass, Nowell Solish, Ally-Khan Somani, Najwa Somani, Bruce Strober, Mathias Sulk, Kathleen C. Suozzi, Michael D. Tharp, Mary M. Tomayko, Stephen K. Tyring, Kaitlin Vogt-Schiavo, Raj Vuppalanchi, Steve Q. Wang, Gillian Weston, Stephen E. Wolverton, Jashin J. Wu, Ashley Wysong, John Zic, and Jeffrey P. Zwerner
- Published
- 2021
19. Mycophenolates
- Author
-
Jonathan A. Braue, Courtney R. Schadt, and Jeffrey P. Zwerner
- Published
- 2021
20. Prospective Observational Trial of Low-Dose Skin Electron Beam Therapy in Mycosis Fungoides Using a Rotational Technique
- Author
-
Evan C. Osmundson, N.B. Newman, Jeffrey P. Zwerner, Austin N. Kirschner, John A. Zic, Chirayu G. Patel, and George X. Ding
- Subjects
Male ,medicine.medical_specialty ,Skin Neoplasms ,Observational Trial ,Dermatology ,Severity of Illness Index ,Article ,Time-to-Treatment ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Total skin electron beam therapy ,0302 clinical medicine ,Mycosis Fungoides ,Quality of life ,Interquartile range ,Surveys and Questionnaires ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Aged ,Mycosis fungoides ,Radiotherapy ,business.industry ,Low dose ,Radiotherapy Dosage ,Middle Aged ,medicine.disease ,Treatment Outcome ,030220 oncology & carcinogenesis ,Electron Beam Therapy ,Quality of Life ,Female ,Radiology ,business - Abstract
Low-dose total skin electron beam therapy provides a durable treatment response for skin lesions caused by cutaneous T-cell lymphoma. We prospectively assessed the durability of response and quality of life for patients receiving low-dose total skin electron beam therapy using a novel rotational technique and dosing regimen.Patients completed baseline Skindex-29 quality-of-life surveys and had baseline Modified Severity-Weighted Assessment Tool score recorded. Patients received 12 Gy in 12 fractions with a dual-field rotational technique. The primary outcome was overall response rate, with the secondary outcomes being time to treatment response, duration of clinical benefit, and quality-of-life change.We enrolled 20 patients and recorded an overall response rate of 90%. The median time to treatment response was 6.5 weeks. The baseline Modified Severity-Weighted Assessment Tool score was 55.6 and it declined to a median of 2.2 at last follow-up (P .001). The median duration of clinical benefit was 21 months. There was a decline in the Skindex-29 total score and every subdomain when each follow-up visit was compared (P = .004).This prospective study demonstrated a very high overall response rate and improvement in skin-related quality of life. Low-dose rotational total skin electron beam therapy can be implemented routinely in clinical practice.
- Published
- 2020
21. A unique variant of juvenile papular-purpuric gloves and socks syndrome
- Author
-
Jeffrey P. Zwerner, Matthew M. Wallace, and Zijun Zhao
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,computer.internet_protocol ,viruses ,Papular purpuric gloves and socks syndrome ,Erythema Infectiosum ,Dermatology ,Hand Dermatoses ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Petechial eruption ,Parvovirus B19, Human ,Medicine ,Juvenile ,Humans ,Child ,Exanthem ,Purpura ,Foot Dermatoses ,biology ,business.industry ,Parvovirus ,Syndrome ,medicine.disease ,biology.organism_classification ,body regions ,SOCKS ,030220 oncology & carcinogenesis ,Pediatrics, Perinatology and Child Health ,business ,computer ,Pediatric population - Abstract
Parvovirus B19 is the most common causative agent of papular-purpuric gloves and socks syndrome (PPGSS), an often-underreported condition in the pediatric population. Classically, PPGSS presents with a papular-purpuric and at times petechial eruption of the hands and feet. (Dermatology. 1994;188:85; Int J Dermatol. 1996;35:626) We report a unique variant of juvenile PPGSS with prominent involvement of the flexural and extensor elbows, wrists, and knees.
- Published
- 2020
22. Clinical pathologic conference: diffuse papillomatous lesions of the gingiva with posterolateral neck skin tags
- Author
-
Paul M. Hinchey, Jeffrey P. Zwerner, Joseph R. Mort, Susie I. Lin, and James S. Lewis
- Subjects
Pathology ,medicine.medical_specialty ,Biopsy ,Pathology and Forensic Medicine ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Dentistry (miscellaneous) ,Skin tags ,Gingival Neoplasms ,medicine.diagnostic_test ,business.industry ,030206 dentistry ,Middle Aged ,medicine.disease ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,Female ,Surgery ,Oral Surgery ,Hamartoma Syndrome, Multiple ,business - Published
- 2018
23. Intraocular involvement of mycosis fungoides associated with immunophenotypic switch from CD4+ to CD8+
- Author
-
Jonathan A. Braue, John A. Zic, Stephen J. Kim, Anthony B. Daniels, and Jeffrey P. Zwerner
- Subjects
Mycosis fungoides ,medicine.medical_specialty ,business.industry ,Extramural ,Immunology ,Cell Biology ,Hematology ,medicine.disease ,Biochemistry ,Dermatology ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Immunophenotyping ,030221 ophthalmology & optometry ,Medicine ,Stage (cooking) ,Letter to Blood ,business ,CD8 - Abstract
TO THE EDITOR: Alibert first described mycosis fungoides (MF) in 1806, and Bazin later defined the natural evolution into the stages known today as patch, plaque, and tumor.[1][1] In the earliest stage, known as IA, MF is indolent. As progression ensues, extracutaneous invasion is not uncommon
- Published
- 2018
24. Loss of Rab25 promotes the development of skin squamous cell carcinoma through the dysregulation of integrin trafficking
- Author
-
Buhyun Lee, Ki Taek Nam, Joseph T. Roland, Byron C. Knowles, Haengdueng Jeong, Kwang H. Kim, Kyung Min Lim, Yejin Cho, Jeffrey P. Zwerner, and James R. Goldenring
- Subjects
0301 basic medicine ,Keratinocytes ,Integrins ,Mice, 129 Strain ,Skin Neoplasms ,Integrin ,Down-Regulation ,medicine.disease_cause ,Article ,Pathology and Forensic Medicine ,Malignant transformation ,03 medical and health sciences ,0302 clinical medicine ,Cell Line, Tumor ,Skin Squamous Cell Carcinoma ,medicine ,Animals ,Humans ,Neoplastic transformation ,Cell Proliferation ,Mice, Knockout ,biology ,Cell growth ,Tumor Suppressor Proteins ,Proteins ,Tumor Burden ,Gene Expression Regulation, Neoplastic ,HaCaT ,Protein Transport ,030104 developmental biology ,Cell culture ,rab GTP-Binding Proteins ,030220 oncology & carcinogenesis ,biology.protein ,Cancer research ,Carcinoma, Squamous Cell ,Carcinogenesis ,Signal Transduction - Abstract
Rab25 can function as both a tumor suppressor and a tumor promoter across different tissues. This study sought to clarify the role of Rab25 as a tumor suppressor in skin squamous cell carcinoma (SCC). Rab25 loss was closely associated with neoplastic transition in both humans and mice. Rab25 loss was well correlated with increased cell proliferation and poor differentiation in human SCC. While Rab25 knockout (KO) in mice did not induce spontaneous tumor formation, it did significantly accelerate tumor generation and promote malignant transformation in a mouse two-stage skin carcinogenesis model. Xenografting of a Rab25-deficient human keratinocyte cell line, HaCaT, also elicited neoplastic transformation. Notably, Rab25 deficiency led to dysregulation of integrins β1, β4, and α6, which matched well with increased epidermal proliferation and impaired desmosome-tight junction formation. Rab25 deficiency induced impairment of integrin recycling, leading to the improper expression of integrins. In line with this, significant attenuation of integrin β1, β4, and α6 expression was identified in human SCCs where Rab25 was deficient. Collectively, these results suggest that loss of Rab25 promotes the development and neoplastic transition of SCC through dysregulation of integrin trafficking. © 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
- Published
- 2019
25. Single-cell immunopathology of systemic contact allergy associated with corticosteroids
- Author
-
Abha Chopra, Elizabeth J. Phillips, John A. Zic, Andrew Gibson, Ramesh Ram, Rebecca J Hertzman, Shay Leary, Jeffrey P. Zwerner, Katie D. White, Rama Gangula, and Pooja Deshpande
- Subjects
education.field_of_study ,business.industry ,Immunology ,Population ,Methylprednisolone acetate ,medicine.disease ,Rash ,Methylprednisolone ,Delayed hypersensitivity ,Immunopathology ,Immunology and Allergy ,Medicine ,medicine.symptom ,business ,education ,Allergic contact dermatitis ,Dexamethasone ,medicine.drug - Abstract
Rationale Allergic contact dermatitis (ACD) is a classic delayed hypersensitivity reaction commonly associated with corticosteroids that can rarely manifest as a delayed rash following systemic administration. Methods A 50-year old woman developed local edema and delayed spreading rash following interarticular injection with dexamethasone and methylprednisolone acetate (MA). 6-months following this intradermal skin testing (IDST) was positive to MA and methylprednisolone sodium succinate, and IDST and patch test negative to other corticosteroids. She tolerated dexamethasone challenge. Cells were isolated from 4-mm punch biopsies from 48-hour positive IDST and unaffected skin with liberase digestion and sorted on CD3. scTCR and scRNA-seq were performed using plate-based assays (Smart-seq-2). Data was filtered using Seurat and analysed with Visual Genomics Analysis Studio (VGAS) software. Results Histopathology showed a superficial perivascular dermatitis with epidermal spongiosis in keeping with ACD. T-cells were 18x more prevalent in affected skin and those from both affected and unaffected sites were predominantly CD8+ T-cells that expressed CD45RO and polyclonal TCR alpha beta. Differentially expressed genes (DEG) in T-cells from affected skin reflected homing (CCR7,S1PR1), T-cell activation and proliferation (TNFRS9, GRAP2, ZYG11A, ZHX1), T-cell effector differentiation (IL-21R), and stress survival (EEF1A1, IFI6) without representation of markers of T-cell residency (ITGAE) or regulation. Conclusions We demonstrate insights into the immunopathogenesis of drug-induced ACD by showing that IDST+ methylprednisolone associated ACD is corticosteroid-specific and associated with a polyclonal population of primarily CD45RO+ memory CD8+ T-cells showing upregulation of markers of homing, T-cell activation, proliferation and differentiation but lacking markers of T-cell residency and regulation.
- Published
- 2021
26. TOX expression and role in CTCL
- Author
-
C.A. Degesys, Vanessa E. Johnson, John A. Zic, Laura Y. McGirt, Christine M. Eischen, and Jeffrey P. Zwerner
- Subjects
0301 basic medicine ,CD30 ,T cell ,Lymphoproliferative disorders ,GATA3 Transcription Factor ,Dermatology ,Article ,03 medical and health sciences ,Mycosis Fungoides ,fluids and secretions ,0302 clinical medicine ,hemic and lymphatic diseases ,medicine ,Humans ,RNA, Messenger ,Gene knockdown ,Mycosis fungoides ,business.industry ,High Mobility Group Proteins ,GATA3 ,medicine.disease ,Lymphoma, T-Cell, Cutaneous ,Lymphoma ,030104 developmental biology ,Infectious Diseases ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Immunology ,Cancer research ,bacteria ,business ,Large plaque parapsoriasis - Abstract
Background Cutaneous T-cell lymphomas (CTCL) are skin malignancies including mycosis fungoides (MF) and CD30+ lymphoproliferative disorders (LPD). In early disease, CTCL can be difficult to diagnose, especially in MF for which there is no reliable diagnostic marker. MF/CTCL have increased expression of thymocyte selection-associated HMG box protein (TOX). Although TOX has been proposed to be a diagnostic marker for MF, further validation studies are needed. Moreover, it is unclear what drives TOX expression or its role in MF/CTCL. Objective We hypothesize evaluation of TOX levels across a spectrum of CTCL, including MF precursor (large plaque parapsoriasis, LPP), will help elucidate the implications of altered TOX expression. Materials and Methods TOX staining was performed in MF, CD30+ LPD, LPP as well as benign inflammatory dermatoses (BID) and normal skin (NS). CTCL cell lines were utilized to evaluate the regulation of TOX. Results Positive TOX expression was identified in 73.6% of MF cases and in 31.6% of BID/NS. TOX had a positive predictive value (PPV) for MF of 86.7% and a negative predictive value (NPV) of 48.1%. TOX expression in MF was detected more commonly in Black patients (P = 0.015) and less commonly in transformed MF (P = 0.045). LPP had positive TOX staining in 70.0%. In CTCL cells, GATA3 knockdown decreased TOX mRNA and protein expression. TOX expression also decreased in the presence of CTCL therapeutics. Conclusion Our data indicate that TOX is useful as a diagnostic marker in MF. Moreover, TOX expression was evident in LPP, indicating it may have a previously unappreciated role in the development of MF. Finally, our data suggest that GATA3 regulates TOX, revealing insight into TOX regulation.
- Published
- 2016
27. 870 Clinical and histopathologic characteristics of metastatic and locally aggressive basal cell carcinomas
- Author
-
Alan S. Boyd, E. Grilletta, Lee Wheless, Jeffrey P. Zwerner, and L.X. Baker
- Subjects
Pathology ,medicine.medical_specialty ,business.industry ,Medicine ,Basal cell ,Cell Biology ,Dermatology ,business ,Molecular Biology ,Biochemistry - Published
- 2020
28. Drug-induced linear IgA bullous dermatosis in a patient with a vancomycin-impregnated cement spacer
- Author
-
Kelsie, Riemenschneider, Daren A, Diiorio, John A, Zic, Matthew R, Livingood, Jo-David, Fine, Jennifer G, Powers, Jeffrey P, Zwerner, and Eric, Tkaczyk
- Subjects
Linear IgA Bullous Dermatosis ,Male ,Vancomycin ,Bone Cements ,Humans ,Knee Prosthesis ,Article ,Aged ,Anti-Bacterial Agents - Abstract
Linear IgA bullous dermatosis (LABD) is an autoimmune blistering rash caused by IgA autoantibodies against the epidermal basement membrane zone. It commonly is drug induced, often in association with systemic vancomycin. We report a case of a previously healthy 77-year-old man who developed a diffuse macular rash and hemorrhagic bullae on the left leg 10 days after placement of a vancomycin-impregnated cement spacer (VICS) during a revision knee arthroplasty and initiation of postoperative treatment with intravenous (IV) vancomycin. The lesions initially were limited to the leg in which the hardware was placed, but the patient later developed painful palmoplantar and oropharyngeal blisters as well as edematous, erythematous plaques on the back and buttocks. A punch biopsy from a lesion on the left thigh revealed neutrophil-rich subepidermal bullae, and immunofluorescence revealed linear IgA and C3 deposition along the dermoepidermal junction, confirming a diagnosis of LABD. This report illustrates the importance of considering antibiotic-impregnated cement spacers, which frequently are used to manage prosthetic joint infections, as potential culprits in patients with cutaneous eruptions.
- Published
- 2018
29. Cutaneous Lymphomas
- Author
-
Trisha Bhat, Jeffrey P. Zwerner, and Amy Musiek
- Published
- 2018
30. Whole-genome sequencing reveals oncogenic mutations in mycosis fungoides
- Author
-
Christine M. Eischen, Peilin Jia, John A. Zic, Jeffrey P. Zwerner, Kimberly B. Dahlman, Donald Hucks, Robert Duszynski, Utpal P. Davé, Devin A. Baerenwald, Zhongming Zhao, and Laura Y. McGirt
- Subjects
Adult ,Male ,Skin Neoplasms ,Ultraviolet Rays ,Immunology ,Biochemistry ,Mycosis Fungoides ,Aldesleukin ,hemic and lymphatic diseases ,medicine ,Ultraviolet light ,Humans ,Exome ,Epigenetics ,Exome sequencing ,Aged ,Retrospective Studies ,Whole genome sequencing ,Mycosis fungoides ,Lymphoid Neoplasia ,Genome, Human ,business.industry ,Janus kinase 3 ,High-Throughput Nucleotide Sequencing ,Oncogenes ,Sequence Analysis, DNA ,Cell Biology ,Hematology ,Middle Aged ,medicine.disease ,Lymphoma ,Mutation ,Cancer research ,Female ,business ,Follow-Up Studies - Abstract
The pathogenesis of mycosis fungoides (MF), the most common cutaneous T-cell lymphoma (CTCL), is unknown. Although genetic alterations have been identified, none are considered consistently causative in MF. To identify potential drivers of MF, we performed whole-genome sequencing of MF tumors and matched normal skin. Targeted ultra-deep sequencing of MF samples and exome sequencing of CTCL cell lines were also performed. Multiple mutations were identified that affected the same pathways, including epigenetic, cell-fate regulation, and cytokine signaling, in MF tumors and CTCL cell lines. Specifically, interleukin-2 signaling pathway mutations, including activating Janus kinase 3 (JAK3) mutations, were detected. Treatment with a JAK3 inhibitor significantly reduced CTCL cell survival. Additionally, the mutation data identified 2 other potential contributing factors to MF, ultraviolet light, and a polymorphism in the tumor suppressor p53 (TP53). Therefore, genetic alterations in specific pathways in MF were identified that may be viable, effective new targets for treatment.
- Published
- 2015
31. A Rapidly Growing Facial Mass: Answer
- Author
-
Anna K. Dewan, Alan S. Boyd, Jeffrey P. Zwerner, Eric R. Tkaczyk, Deanna Dickerman, and Jami L. Miller
- Subjects
Skin Neoplasms ,Dermatologic Surgical Procedures ,MEDLINE ,Dermatology ,Bioinformatics ,Risk Assessment ,Skin Diseases ,Pathology and Forensic Medicine ,Diagnosis, Differential ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Text mining ,Rare Diseases ,Carcinoma ,medicine ,Humans ,Neoplasm Invasiveness ,Neoplasm Staging ,business.industry ,Disease progression ,General Medicine ,Middle Aged ,medicine.disease ,Pilomatrixoma ,Prognosis ,FACIAL MASS ,Carcinoma, Basal Cell ,030220 oncology & carcinogenesis ,Ill-Housed Persons ,Disease Progression ,Neoplasm staging ,Female ,Facial Neoplasms ,Risk assessment ,business - Published
- 2017
32. A Rapidly Growing Facial Mass: Challenge
- Author
-
Anna K. Dewan, Eric R. Tkaczyk, Alan S. Boyd, Deanna Dickerman, Jami L. Miller, and Jeffrey P. Zwerner
- Subjects
medicine.medical_specialty ,Skin Neoplasms ,Dermatologic Surgical Procedures ,Dermatology ,Pathology and Forensic Medicine ,Rare Diseases ,medicine ,Humans ,Facial neoplasm ,business.industry ,Disease progression ,Biopsy, Needle ,General Medicine ,Middle Aged ,medicine.disease ,Pilomatrixoma ,Prognosis ,FACIAL MASS ,Immunohistochemistry ,Hair disease ,Ill-Housed Persons ,Disease Progression ,Female ,Facial Neoplasms ,business ,Hair Diseases - Published
- 2017
33. Unusual Cutaneous Malignancies
- Author
-
Charles T. Darragh, Lee E. Wheless, William G. Stebbins, Jeffrey P. Zwerner, Anthony J. Crimaldi, Thomas Olencki, and Laura Y. McGirt
- Published
- 2017
34. Painful, violaceous plaques in a patient with pruritus
- Author
-
C. T. Darragh, Jeffrey P. Zwerner, and E. A. Merkel
- Subjects
030203 arthritis & rheumatology ,Male ,business.industry ,Pancytopenia ,Pruritus ,Pain ,Dermatology ,Middle Aged ,Skin Diseases ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Necrosis ,0302 clinical medicine ,Methotrexate ,Thigh ,Medicine ,Humans ,Kidney Failure, Chronic ,business ,Skin - Published
- 2017
35. miR-223 Regulates Cell Growth and Targets Proto-Oncogenes in Mycosis Fungoides/Cutaneous T-Cell Lymphoma
- Author
-
John A. Zic, Jeffrey P. Zwerner, Laura Y. McGirt, Devin A. Baerenwald, Christine M. Eischen, and Clare M. Adams
- Subjects
Cell Survival ,Biopsy ,Cell ,Dermatology ,Biology ,Peripheral blood mononuclear cell ,Biochemistry ,Article ,Mice ,Mycosis Fungoides ,mir-223 ,Cell Line, Tumor ,hemic and lymphatic diseases ,Proto-Oncogenes ,microRNA ,medicine ,Animals ,Humans ,3' Untranslated Regions ,Molecular Biology ,Cell Proliferation ,Skin ,Mycosis fungoides ,Cell growth ,Gene Expression Profiling ,Cutaneous T-cell lymphoma ,Cell Biology ,medicine.disease ,Lymphoma, T-Cell, Cutaneous ,Lymphoma ,Gene Expression Regulation, Neoplastic ,MicroRNAs ,medicine.anatomical_structure ,Disease Progression ,Leukocytes, Mononuclear ,NIH 3T3 Cells ,Cancer research - Abstract
The pathogenesis of the cutaneous T-cell lymphoma (CTCL), mycosis fungoides (MF), is unclear. MicroRNA (miRNA) are small noncoding RNAs that target mRNA leading to reduced mRNA translation. Recently, specific miRNA were shown to be altered in CTCL. We detected significantly reduced expression of miR-223 in early-stage MF skin, and further decreased levels of miR-223 in advanced-stage disease. CTCL peripheral blood mononuclear cells and cell lines also had reduced miR-223 as compared with controls. Elevated expression of miR-223 in these cell lines reduced cell growth and clonogenic potential, whereas inhibition of miR-223 increased cell numbers. Investigations into putative miR-223 targets with oncogenic function, including E2F1 and MEF2C , and the predicted miR-223 target, TOX , revealed that all three were targeted by miR-223 in CTCL. E2F1, MEF2C, and TOX proteins were decreased with miR-223 overexpression, whereas miR-223 inhibition led to increased protein levels in CTCL. In addition, we showed that the 3′-UTR of TOX mRNA was a genuine target of miR-223. Therefore, reduced levels of miR-223 in MF/CTCL lead to increased expression of E2F1, MEF2C, and TOX, which likely contributes to the development and/or progression of CTCL. Thus, miR-223 and its targets may be useful for the development of new therapeutics for MF/CTCL.
- Published
- 2014
- Full Text
- View/download PDF
36. Chondrodermatitis Nodularis Chronica Helicis of the Right Nasal Vestibule
- Author
-
Jeffrey P Zwerner, Amit Om, and Charles T Darragh
- Subjects
medicine.medical_specialty ,Chondrodermatitis nodularis chronica helicis ,business.industry ,medicine.medical_treatment ,Dermatology ,General Medicine ,medicine.disease ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Right nasal vestibule ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Mohs surgery ,medicine ,Surgery ,business - Published
- 2018
37. Key Histopathology Features of Cutaneous Acute Graft-Versus-Host Disease Can be Detected Noninvasively
- Author
-
Madan Jagasia, Salvador González, Melissa Gill, Michi M. Shinohara, Inga Saknite, Roberto A. Novoa, Eric R. Tkaczyk, Alessi-Fox Christi, Jeffrey P. Zwerner, Julia S. Lehman, Marco Ardigò, and Michael Byrne
- Subjects
Pathology ,medicine.medical_specialty ,medicine.diagnostic_test ,Erythema ,business.industry ,medicine.medical_treatment ,ADRENAL CORTICOSTEROIDS ,Immunology ,Cell Biology ,Hematology ,Hematopoietic stem cell transplantation ,Virus diseases ,Biochemistry ,Transplantation ,Acute graft versus host disease ,Biopsy ,medicine ,Histopathology ,medicine.symptom ,business - Abstract
BACKGROUND. Cutaneous erythema and histopathology features in patients post allogeneic hematopoietic cell transplantation (HCT) are nonspecific, making it difficult to distinguish acute graft-versus-host disease (aGVHD) from engraftment syndrome, drug reactions, viral infections, and other etiologies. Biopsies from different locations on the same patient frequently differ in aGVHD grade, and serial biopsies of a single lesion are not possible. Proper biopsy site selection, timing, and serial noninvasive microscopic monitoring may improve our understanding and management of aGVHD. In this study, we tested the feasibility of noninvasive reflectance confocal microscopy (RCM) to detect key histopathology features of cutaneous aGVHD. STUDY POPULATION. We enrolled 11 patients with high clinical suspicion of cutaneous aGVHD, as determined by a transplant physician. In total, 16 lesions of cutaneous aGVHD-affected site were imaged by RCM (6x6 mm2en face images at four different depths) and subsequently biopsied (4x4 mm punch biopsy). 9 out of 11 patients had only skin involvement, and 2 patients had skin and gut aGVHD. 5 patients had >50% body surface area (BSA) affected, 1 had 18-50% BSA, and 5 had METHODS. We used a clinical confocal microscope (Vivascope 1500, Caliber I.D.), which enables real-time evaluation of epidermal and superficial dermal tissue at sub-cellular resolution. Four reflectance confocal microscopists blinded to histopathology independently evaluated the presence or absence of 18 RCM features1. Concurrently, four dermatopathologists blinded to clinical and confocal information determined the presence or absence of 19 histopathology features, as well as the Lerner aGVHD grade. A histologic feature was determined as "present" in a lesion when marked by most experts (expert vote) or resolved by a fifth expert in case of a disagreement among four experts. The reflectance confocal microscopist vote was then correlated to the dermatopathologist expert vote for 17 overlapping features. We also evaluated the interrater variability among microscopists and among dermatopathologists. RESULTS. The main aGVHD features by Lerner grade had > 88% correlation between RCM and histopathology: (1) basal vacuolar change, (2) presence of dyskeratotic keratinocytes, and (3) dermal inflammation. By contrast, dyskeratotic cells and inflammation at the adnexal structures had CONCLUSIONS. In this pilot study, we show that noninvasive label-free RCM of skin enables detection of the main Lerner grade features of cutaneous aGVHD. We found a similar interrater variability among reflectance confocal microscopists and among dermatopathologists who each independently evaluated the presence or absence of a list of aGVHD features. Future studies can build on this work to evaluate the feasibility of RCM to determine cutaneous aGVHD grade, as well as distinguish between rash due to aGVHD and drug reactions. ACKNOWLEDGEMENT. This work was supported in part by Career Development Award Number IK2 CX001785 from the United Sates Department of Veterans Affairs Clinical Science R&D (CSRD) Service. Saknite I, Gill M, Alessi-Fox C, Byrne M, Jagasia M, Gonzalez S, Ardigo M, Tkaczyk ER. Features of cutaneous acute graft-versus-host disease by reflectance confocal microscopy. Br J Dermatol (2019). Disclosures Christi: Caliber I.D.: Employment, Equity Ownership. Byrne:Karyopharm: Research Funding. Jagasia:Kadmon: Consultancy; Incyte: Consultancy; Janssen: Research Funding. Tkaczyk:Incyte: Consultancy.
- Published
- 2019
38. Severe Cutaneous and Neurologic Toxicity in Melanoma Patients during Vemurafenib Administration Following Anti-PD-1 Therapy
- Author
-
Mark C. Kelley, Sunaina S. Likhari, Richard W. Joseph, Jeffrey P. Zwerner, Lisa Shinn, Erika Wallender, Jeffrey A. Sosman, Jennifer G. Powers, Douglas B. Johnson, and Daniel N. Cohen
- Subjects
Adult ,Oncology ,Drug ,Cancer Research ,medicine.medical_specialty ,Indoles ,Skin Neoplasms ,medicine.medical_treatment ,media_common.quotation_subject ,Programmed Cell Death 1 Receptor ,Immunology ,Ipilimumab ,Guillain-Barre Syndrome ,Article ,Immune system ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Vemurafenib ,Anaphylaxis ,Melanoma ,media_common ,Sulfonamides ,Imiquimod ,business.industry ,Antibodies, Monoclonal ,Immunotherapy ,Middle Aged ,medicine.disease ,Nivolumab ,Toxicity ,Aminoquinolines ,Female ,Drug Eruptions ,business ,medicine.drug - Abstract
Immune checkpoint inhibitors such as ipilimumab and targeted BRAF inhibitors have dramatically altered the landscape of melanoma therapeutics over the past few years. Agents targeting the programmed cell death-1/ligand (PD-1/PD-L1) axis are now being developed and seem to be highly active clinically with favorable toxicity profiles. We report on two patients with BRAF V600E–mutant melanoma who were treated with anti-PD-1 agents as first-line therapy without significant toxicity, followed by vemurafenib at disease progression. Both patients developed severe hypersensitivity drug eruptions with multiorgan injury early in their BRAF inhibitor treatment course. One patient subsequently developed acute inflammatory demyelinating polyneuropathy, and the other developed anaphylaxis upon low-dose vemurafenib rechallenge. Further investigation of the immune response during combination or sequences of melanoma therapeutics is warranted. Furthermore, clinicians should maintain a high index of suspicion for these toxicities when vemurafenib is administered following an anti-PD-1 agent. Cancer Immunol Res; 1(6); 373–7. ©2013 AACR.
- Published
- 2013
39. Chronic, dusky, indurated plaques on the legs of a 31-year-old woman
- Author
-
Jeffrey P. Zwerner, Anna K. Dewan, Alan S. Boyd, John A. Zic, and Jerrold L. Abraham
- Subjects
Adult ,Nephrogenic Fibrosing Dermopathy ,Pathology ,medicine.medical_specialty ,Leg Dermatosis ,030232 urology & nephrology ,Dermatology ,Leg Dermatoses ,Bone and Bones ,Diagnosis, Differential ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Hyperpigmentation ,Metaplasia ,Humans ,Medicine ,business.industry ,Chronic disease ,Chronic Disease ,Female ,Differential diagnosis ,medicine.symptom ,business - Published
- 2015
40. An Erythematous papular eruption in a woman with Crohn disease treated with infliximab
- Author
-
Hannah E, Howard, Jeffrey P, Zwerner, Jeffrey, Byers, and Eric, Tkaczyk
- Subjects
Adult ,Granuloma ,Crohn Disease ,Gastrointestinal Agents ,Neutrophils ,Humans ,Dermatitis ,Female ,Infliximab - Abstract
We report the case of a 44-year-old woman with a history of Crohn disease treated with infliximab who presented with erythematous papules and plaques on the upper extremities accompanied by fevers. She was subsequently diagnosed with palisaded neutrophilic and granulomatous dermatitis (PNGD). Whereas immune-complex mediated diseases such as rheumatoid arthritis and systemic lupus erythematosus are most commonly associated, inflammatory bowel disease deserves increased consideration as one of the systemic diseases that can present with PNGD. Additionally, PNGD should remain in the differential diagnosis of cutaneous eruptions that develop in the setting of tumor necrosis factor (TNF) antagonist therapy.
- Published
- 2016
41. Autopsy-proven demyelination associated with infliximab treatment
- Author
-
Bret C. Mobley, Jeffrey P. Zwerner, Michael J. Bradshaw, and Subramaniam Sriram
- Subjects
Pathology ,medicine.medical_specialty ,Inflammatory bowel disease ,Proinflammatory cytokine ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Demyelinating disease ,Clinical/Scientific Notes ,030203 arthritis & rheumatology ,Autoimmune encephalitis ,business.industry ,Multiple sclerosis ,medicine.disease ,Infliximab ,Neurology ,Rheumatoid arthritis ,Immunology ,Tumor necrosis factor alpha ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Tumor necrosis factor–α (TNF-α) is a well-studied proinflammatory cytokine that contributes to the pathogenesis of immune and infectious diseases. TNF-α effects are mediated by signaling through TNF-α receptors, which are present ubiquitously.1 Limiting the actions of TNF-α, either by blocking the receptor or inhibiting circulating (free) TNF-α, is a useful treatment strategy in autoimmune disorders with prominent inflammation, such as inflammatory bowel disease and rheumatoid arthritis (RA). However, when treatment with agents that inhibit TNF-α function was applied to multiple sclerosis (MS), an unanticipated worsening was observed. The clinical trial of lenercept (a recombinant TNF-α receptor–immunoglobulin 1g fusion protein that protected against experimental autoimmune encephalitis) for the treatment of relapsing-remitting multiple sclerosis was stopped prematurely when the treatment arm was noted to have earlier and more frequent exacerbations.2 TNF-α antagonists are therefore contraindicated in patients with MS. In patients with no history of demyelinating disease, TNF-α antagonism has led to unmasking of demyelinating events with a clinical pattern typical of that seen in MS.3 All CNS cases of demyelinating disease to date have been based on clinical, laboratory, and radiographic findings. Herein we present a unique case of histologically confirmed demyelination following treatment with TNFα inhibitors.
- Published
- 2016
42. An Erythematous papular eruption in a woman with Crohn disease treated with infliximab
- Author
-
Jeffrey Byers, Jeffrey P. Zwerner, Hannah E Howard, and Eric R. Tkaczyk
- Subjects
medicine.medical_specialty ,Pathology ,business.industry ,Crohn disease ,Erythematous papule ,Dermatology ,General Medicine ,medicine.disease ,Inflammatory bowel disease ,Infliximab ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Rheumatoid arthritis ,medicine ,palisaded neutrophilic and granulomatous dermatitis (PNGD), interstitial granulomatous dermatitis (IGD), immune-complex mediated diseases, inflammatory bowel disease, tumor necrosis factor-α (TNF-α) antagonists ,Tumor necrosis factor alpha ,Differential diagnosis ,Granulomatous Dermatitis ,business ,medicine.drug - Abstract
We report the case of a 44-year-old woman with a history of Crohn disease treated with infliximab who presented with erythematous papules and plaques on the upper extremities accompanied by fevers. She was subsequently diagnosed with palisaded neutrophilic and granulomatous dermatitis (PNGD). Whereas immune-complex mediated diseases such as rheumatoid arthritis and systemic lupus erythematosus are most commonly associated, inflammatory bowel disease deserves increased consideration as one of the systemic diseases that can present with PNGD. Additionally, PNGD should remain in the differential diagnosis of cutaneous eruptions that develop in the setting of tumor necrosis factor (TNF) antagonist therapy.
- Published
- 2016
43. Subcutaneous Colletotrichum truncatum Infection in a Child
- Author
-
Jeffrey P. Zwerner, Leslie Gilbert, Leigh M. Howard, M. Cecilia Di Pentima, and Kristen M. Snyder
- Subjects
0301 basic medicine ,Microbiology (medical) ,Male ,Pathology ,medicine.medical_specialty ,Biopsy ,030106 microbiology ,Treatment outcome ,Article ,03 medical and health sciences ,Neuroblastoma ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Colletotrichum ,Dermatomycoses ,Humans ,Disseminated disease ,Skin pathology ,Skin ,biology ,medicine.diagnostic_test ,Extramural ,business.industry ,fungi ,food and beverages ,030108 mycology & parasitology ,medicine.disease ,biology.organism_classification ,Dermatology ,Infectious Diseases ,Treatment Outcome ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Colletotrichum species ,Colletotrichum truncatum ,business - Abstract
Human infection with Colletotrichum species is typically limited to ophthalmologic manifestations. We present the first reported pediatric case of subcutaneous Colletotrichum truncatum infection. This case highlights the potential importance of C. truncatum as an agent of subcutaneous or disseminated disease in immunocompromised children.
- Published
- 2015
44. Herpes simplex virus-induced plasmacytic atypia
- Author
-
Alan S. Boyd, Jami L. Miller, and Jeffrey P. Zwerner
- Subjects
Adult ,Pathology ,medicine.medical_specialty ,Histology ,Herpesvirus 2, Human ,Prednisolone ,Plasma Cells ,Acyclovir ,Herpesvirus 1, Human ,Dermatology ,Biology ,Perineum ,medicine.disease_cause ,Antiviral Agents ,Skin Diseases ,Pathology and Forensic Medicine ,Lesion ,Prednisone ,Biopsy ,medicine ,Atypia ,Humans ,Ulcer ,Skin ,medicine.diagnostic_test ,Pemphigus vulgaris ,Verrucous Lesion ,Herpes Simplex ,Valine ,medicine.disease ,Methotrexate ,Herpes simplex virus ,Cytopathology ,Valacyclovir ,Immunology ,Female ,Dermatologic Agents ,medicine.symptom ,Pemphigus ,medicine.drug - Abstract
The clinical and histopathological features of cutaneous herpes simplex virus (HSV) infection have been well described. Genital herpetic infections are largely induced by HSV type 2, but 30% of cases can be caused by HSV type 1. Immunocompromised patients are known to exhibit atypical patterns of clinical presentation with variable lesion morphology and anatomic location. A subset of patients may show morphology such as nodules or verrucous lesions. Analogously, some biopsy specimens may show unusual microscopical features, such as a lack of keratinocyte cytopathology, lymphocyte infiltration or vasculopathic changes that are expected irrespective of the patient's immune status. We present the case of a patient carrying a previous diagnosis of pemphigus vulgaris, status posttreatment with methotrexate and prednisone, who developed a perineal ulcer exhibiting significant numbers of plasma cells, many of which were cytologically atypical. This morphology was suggestive of a hematopoietic malignancy. Immunoperoxidase staining for HSV decorated a focal collection of keratinocytes that lacked appreciable viral changes expected of HSV infection.
- Published
- 2011
45. Rituximab monotherapy to treat intravascular large B-cell lymphoma manifesting as pruritic calf patch in an elderly female
- Author
-
Kelsie Riemenschneider, Alan S. Boyd, Jeffrey P. Zwerner, and Jennifer G. Powers
- Subjects
Intravascular large B-cell lymphoma ,Pathology ,medicine.medical_specialty ,Erythema ,business.industry ,Dermatology ,General Medicine ,medicine.disease ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Immunology ,medicine ,Rituximab ,medicine.symptom ,business ,Positron Emission Tomography-Computed Tomography ,medicine.drug - Published
- 2016
46. EWS/FLI function varies in different cellular backgrounds
- Author
-
William A. May, Jennifer S. Guimbellot, and Jeffrey P Zwerner
- Subjects
Oncogene Proteins, Fusion ,Blotting, Western ,Mice, SCID ,Sarcoma, Ewing ,Biology ,Mice ,Downregulation and upregulation ,Differential function ,medicine ,Animals ,Humans ,Transcription factor ,Platelet-Derived Growth Factor ,Lymphokines ,Proto-Oncogene Protein c-fli-1 ,fungi ,In vitro transformation ,Ewing's sarcoma ,Neoplasms, Experimental ,Cell Biology ,Fibroblasts ,Blotting, Northern ,medicine.disease ,Phenotype ,Up-Regulation ,Gene Expression Regulation, Neoplastic ,Cell Transformation, Neoplastic ,Cancer research ,RNA-Binding Protein EWS ,Function (biology) ,Transcription Factors - Abstract
EWS/FLI and other EWS/ets chimeric transcription factors play a central role in the biology of the Ewing family tumors. As with many oncogenes, EWS/FLI biologic activity can be demonstrated in a limited range of cellular contexts. To investigate the causes of this restriction, we demonstrate that two immortalized fibroblast lines resistant to EWS/FLI transformation, Rat1 and Yal7, express stable levels of EWS/FLI protein. Despite their resistance to EWS/FLI, Rat1 and Yal7 can be transformed by the potent EWS/FLI downstream mediator PDGF-C. In contrast to NIH3T3, the EWS/FLI resistant lines show no upregulation of PDGF-C in response to EWS/FLI, demonstrating differential EWS/FLI function in different cellular backgrounds. This phenomenon of differential function can also be demonstrated for several other NIH3T3 targets of EWS/FLI. Despite the correlation between anchorage-independent growth and PDGF-C induction, PDGF-C does not fully reproduce all aspects of the EWS/FLI phenotype in NIH3T3 cells. These results further point to the importance of PDGF-C in mediating EWS/FLI in vitro transformation and suggest caution in assuming that a transcription factor will produce identical effects in different cellular backgrounds.
- Published
- 2003
47. Dominant negative PDGF-C inhibits growth of Ewing family tumor cell lines
- Author
-
William A. May and Jeffrey P Zwerner
- Subjects
Cancer Research ,medicine.medical_specialty ,medicine.drug_class ,Blotting, Western ,Green Fluorescent Proteins ,Sarcoma, Ewing ,Transfection ,Tyrosine-kinase inhibitor ,Cell Line ,Mice ,Internal medicine ,Tumor Cells, Cultured ,Genetics ,medicine ,Animals ,Humans ,Receptors, Platelet-Derived Growth Factor ,Enzyme Inhibitors ,Autocrine signalling ,Molecular Biology ,Transcription factor ,Genes, Dominant ,Platelet-Derived Growth Factor ,Lymphokines ,biology ,Cell growth ,3T3 Cells ,Precipitin Tests ,Up-Regulation ,Cell biology ,Luminescent Proteins ,Phenotype ,Endocrinology ,Cell culture ,biology.protein ,Dimerization ,Tyrosine kinase ,Cell Division ,Platelet-derived growth factor receptor ,Signal Transduction ,Transforming growth factor - Abstract
Nearly all cases of Ewing Family Tumors (EFT) harbor chimeric EWS/ETS transcription factors which are thought to aberrantly regulate transcriptional targets of phenotypic consequence. We have recently demonstrated that EWS/ETS proteins up-regulate platelet derived growth factor-C (PDGF-C), a novel transforming growth factor. To determine if PDGF-C signaling contributes to the malignant phenotype of EFT cell lines, we attempted to disrupt this presumed autocrine loop. AG1296, a PDGF receptor selective tyrosine kinase inhibitor, markedly inhibits anchorage-independent growth in an EFT cell line. To effect specific disruption, we have developed a dominant negative form of PDGF-C which is appropriately secreted and processed. This mutant has greatly reduced activity as a PDGF receptor agonist. When co-expressed with PDGF-C in a fibroblast transformation model, this dominant negative dramatically inhibits anchorage-independent growth. When this mutant is expressed in EFT cell lines, there is a similar reduction in anchorage-independent growth. This demonstrates that specific inhibition of PDGF-C signaling in EFT cell lines partially reverts their phenotype. These data support a significant role of PDGF-C in the biology of EFT. They also suggest that PDGF-C driven signaling may be a possible therapeutic target of more clinically relevant tyrosine kinase inhibitors.
- Published
- 2002
48. Spindle cell squamous carcinoma during BRAF inhibitor therapy for advanced melanoma: an aggressive secondary neoplasm of undetermined biologic potential
- Author
-
Jeffrey A. Sosman, Alan S. Boyd, Daniel N. Cohen, Wilfred A. Lumbang, and Jeffrey P. Zwerner
- Subjects
Oncology ,Proto-Oncogene Proteins B-raf ,medicine.medical_specialty ,Skin Neoplasms ,Cell ,Dermatology ,Risk Assessment ,Drug Administration Schedule ,Secondary Neoplasm ,Internal medicine ,Biopsy ,medicine ,Carcinoma ,Humans ,Neoplasm Invasiveness ,Melanoma ,Advanced melanoma ,Neoplasm Staging ,medicine.diagnostic_test ,Dose-Response Relationship, Drug ,business.industry ,Biopsy, Needle ,Neoplasms, Second Primary ,Middle Aged ,medicine.disease ,Immunohistochemistry ,Squamous carcinoma ,medicine.anatomical_structure ,Withholding Treatment ,Cancer research ,Carcinoma, Squamous Cell ,Female ,business ,Follow-Up Studies - Published
- 2014
49. PDGF-C is an EWS/FLI induced transforming growth factor in Ewing family tumors
- Author
-
William A. May and Jeffrey P Zwerner
- Subjects
Cancer Research ,Proto-Oncogene Protein c-fli-1 ,Oncogene Proteins, Fusion ,Sarcoma, Ewing ,medicine.disease_cause ,Article ,Mice ,Genetics ,medicine ,Animals ,Humans ,Neuroectodermal Tumors, Primitive ,Molecular Biology ,Transcription factor ,Platelet-Derived Growth Factor ,Regulation of gene expression ,Lymphokines ,biology ,Reverse Transcriptase Polymerase Chain Reaction ,Peripheral Primitive Neuroectodermal Tumor ,ETS transcription factor family ,fungi ,3T3 Cells ,Artificial Gene Fusion ,Up-Regulation ,Gene Expression Regulation, Neoplastic ,Cell Transformation, Neoplastic ,Cancer research ,biology.protein ,RNA-Binding Protein EWS ,Carcinogenesis ,Platelet-derived growth factor receptor ,Transcription Factors ,Transforming growth factor - Abstract
The aberrant transcription factors associated with many human malignancies function by deregulation of tumorigenic pathways. However, identification of these pathways has come slowly. Virtually all cases of Ewing’s Sarcoma and peripheral Primitive Neuroectodermal Tumor (PNET) are associated with aberrant transcription factors which fuse amino-terminal EWS with the DNA binding moiety of an ETS transcription factor (FLI-1 in 90% of cases). Attempts to identify the downstream targets of these chimeras in the Ewing Family Tumors (EFT) on the basis of differential gene regulation have produced little association with tumor biology. As an alternative approach, we have used highly efficient retroviral systems to biologically screen cDNA derived from cells transformed by EWS/FLI-1. We have identified the recently described PDGF-C as target of EWS/ETS transcriptional deregulation. This transcriptional deregulation is specific to EWS/FLI. PDGF-C possesses substantial biologic activity in vitro and in vivo. It is expressed in EFT cell lines and in primary tumors. Within these EFT cell lines, PDGF-C expression is dependent upon EWS/FLI activity. These results suggest that PDGF-C may be a significant mediator of EWS/FLI driven oncogenesis.
- Published
- 2001
50. List of contributors
- Author
-
David R. Adams, Stephanie S. Badalamenti, Mark A. Bechtel, Brian Berman, Tina Bhutani, Robert Bissonnette, Robert T. Brodell, David G. Brodland, Jeffrey P. Callen, Charles Camisa, Caroline V. Caperton, Jaehyuk Choi, Richard A. Clark, Kevin D. Cooper, Julio C. Cruz-Ramon, Marc A. Darst, Loretta S. Davis, Cynthia M.C. DeKlotz, James Q. Del Rosso, Catherine M. DiGiorgio, Zoe D. Draelos, William H. Eaglstein, Kim Edhegard, Dirk Elston, Jason J. Emer, Steven R. Feldman, Ashley N. Feneran, Laura K. Ferris, Seth B. Forman, Mark S. Fradin, Algin B. Garrett, Joel M. Gelfand, Jennifer G. Gill, Michael Girardi, Tobias Goerge, Cristina Gómez-Fernández, Kenneth B. Gordon, Malcolm W. Greaves, Aditya K. Gupta, Anita N. Haggstrom, Kassie A. Haitz, Russell P. Hall, Peter W. Heald, Michael P. Heffernan, Yolanda R. Helfrich, Adam B. Hessel, Whitney A. High, Ginette A. Hinds, Hsu Sylvia, Michael J. Huether, Michael S. Kaminer, Swetha Kandula, Sewon Kang, Marshall B. Kapp, Francisco A. Kerdel, Susun Kim, Grace K. Kim, Youn H. Kim, Melanie Kingsley, Dana M. Klinger, Alfred L. Knable, Sandra R. Knowles, John Y.M. Koo, Shiva S. Krishnan, Carol L. Kulp-Shorten, Mario E. Lacouture, Megan N. Landis, Sinéad M. Langan, Whitney J. Lapolla, Amir Larian, Sancy A. Leachman, Keith G. LeBlanc, Mark G. Lebwohl, Chai S. Lee, Samantha M. Lee, Katherine B. Lee, Craig L. Leonardi, Michelle M. Levender, Stanley B. Levy, Amy B. Lewis, Andrew N. Lin, Benjamin N. Lockshin, Thomas A. Luger, George D. Magel, Lawrence A. Mark, Linda F. McElhiney, Stephanie Mehlis, Natalia Mendoza, Andrei I. Metelitsa, Brent D. Michaels, Ginat W. Mirowski, Anjali V. Morales, Warwick L. Morison, Kiran Motaparthi, Nico Mousdicas, Christian Murray, Cindy E. Owen, Timothy J. Patton, Rhea M. Phillips, Sarika M. Ramachandran, Jaggi Rao, Jennifer Reddan, Kathleen A. Remlinger, Elisabeth G. Richard, Alyx C. Rosen, Theodore Rosen, Katherine Roy, Dana L. Sachs, Naveed Sami, Marty E. Sawaya, Courtney R. Schadt, Bethanee J. Schlosser, Lori E. Shapiro, Neil H. Shear, Michael Sheehan, Pranav B. Sheth, Nowell Solish, Najwa Somani, Ally-Khan Somani, Brandie T. Styron, Eunice Y. Tsai, Stephen K. Tyring, Susan J. Walker, Michael R. Warner, Christine H. Weinberger, Stephen E. Wolverton, Henry K. Wong, Blair K. Young, John A. Zic, Matthew J. Zirwas, and Jeffrey P. Zwerner
- Published
- 2013
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.