Patient Engagement by the Tobacco Quitline After Electronic Referrals.

Introduction: Referrals through the electronic health record (EHR) system provide an efficient evidence-based method to connect patients to the Tobacco Quitline. However, patients frequently do not respond to Quitline phone calls or accept services. The goal of this study was to characterize factors associated with successful engagement with Quitline following e-referrals by physicians in Maryland.

Text Messaging as a Communication Modality to Promote Screening Mammography in Low-income African American Women.

Introduction: Though text messages are increasingly used in health promotion, the current understanding of text message-based interventions to increase screening mammography in low-income African American women is limited. This study aimed to assess the feasibility and acceptability of a text message-based intervention to increase screening mammography in low-income African American women.

Materials And Methods: A 15-item, self-administered, paper-based survey on cell phone ownership, text messaging practices and preferences for future breast health information was administered to 120 female patients at an urban family medicine office.

Association of COVID-19 With Race and Socioeconomic Factors in Family Medicine.

Introduction: Recent data demonstrated that socioeconomic, environmental, demographic, and health factors can contribute to vulnerability for coronavirus 2019 (COVID-19). The goal of this study was to assess association between severe acute respiratory syndrome coronavirus (SARS CoV-2) infection and demographic and socioeconomic factors in patients from a large academic family medicine practice to support practice operations.

Methods: Patients referred for SARS CoV-2 testing by practice providers were identified using shared patient lists in the electronic health records (Epic).

Utilizing the Learning Health System Adaptation to guide Family Medicine Practice to COVID-19 response.

COVID-19 supportive quarantine care in the community is managed by primary care practices. There is no current guidance on how a primary care practice with high volumes of patients screened for COVID-19 can re-configure itself to become responsive to the pandemic. We examined Learning Health System guidance from the National Academies of Science, Engineering and Medicine and adapted it to our primary care practice to create an efficient, effective, adaptive response to the COVID-19 pandemic.

The effect of a primary care-based Medical Weight Loss Program on weight loss and anthropomorphic metrics.

Background: Diet and lifestyle intervention programs have been shown to be effective in decreasing obesity/overweight and many associated comorbidities in specialty research settings. There is very little information however as to the efficacy of such programs conducted in usual/typical primary care practices. We analysed effectiveness of the Medical Weight Loss Program (MWLP) designed to specifically address overweight/obesity in the setting of an urban academic primary care practice.

Outcomes of a Community-based Breast Cancer Screening Program in Baltimore City.

Introduction: African American women have disproportionately high breast cancer (BC) mortality in comparison with White women. Early BC detection rates are lower in African American women than White women, reflecting sub-optimal use of screening mammography particularly among women who are uninsured.

Methods: A descriptive analysis of a community-based, cancer control program targeted at uninsured African Americans is presented.

A Statewide Analysis of the Incidence and Outcomes of Acute Mesenteric Ischemia in Maryland from 2009 to 2013.

Introduction: Acute mesenteric ischemia is a surgical emergency that entails complex, multi-modal management, but its epidemiology and outcomes remain poorly defined. The aim of this study was to perform a population analysis of the contemporary incidence and outcomes of mesenteric ischemia.

Methods: This was a retrospective analysis of acute mesenteric ischemia in the state of Maryland during 2009-2013 using a comprehensive statewide hospital admission database.

Acute Care Surgery: Defining the Economic Burden of Emergency General Surgery.

Background: Trauma centers (TCs) have been shown to provide lifesaving, but more expensive, care when compared with non-TCs (NTC). Limited data exist about the economic impact of emergency general surgery (EGS) patients on health care systems. We hypothesized that the economic burden would be higher for EGS patients managed at TCs vs NTCs.

Emergency General Surgery: Defining Burden of Disease in the State of Maryland.

Acute care surgery services continue expanding to provide emergency general surgery (EGS) care. The aim of this study is to define the characteristics of the EGS population in Maryland. Retrospective review of the Health Services Cost Review Commission database from 2009 to 2013 was performed.

Immunostimulatory early phenotype of tumor-associated macrophages does not predict tumor growth outcome in an HLA-DR mouse model of prostate cancer.

Tumor-associated macrophages (TAM) were shown to support the progression of many solid tumors. However, anti-tumor properties of TAM were also reported in several types of cancer. Here, we investigated the phenotype and functions of TAM in two transgenic mouse models of prostate cancer that display striking differences in tumor growth outcome.

Acute care surgery: defining mortality in emergency general surgery in the state of Maryland.

Background: Emergency general surgery (EGS) is a major component of acute care surgery, however, limited data exist on mortality with respect to trauma center (TC) designation. We hypothesized that mortality would be lower for EGS patients treated at a TC vs non-TC (NTC).

Study Design: A retrospective review of the Maryland Health Services Cost Review Commission database from 2009 to 2013 was performed.

Association of obesity and sleep problems among breast cancer survivors: results from a registry-based survey study.

Purpose: Sleep-related complaints are common among breast cancer survivors. However, the risk factors underlying sleep disturbances in this population are not completely understood. Some studies have shown that maintaining normal weight can result in a reduced risk of cancer-related symptoms, including sleep problems; however, data from published studies are not consistent.

Breaking immune tolerance by targeting CD25+ regulatory T cells is essential for the anti-tumor effect of the CTLA-4 blockade in an HLA-DR transgenic mouse model of prostate cancer.

Introduction: Recent studies suggest that the cancer immunotherapy based on the blockade of the CTLA-4-mediated inhibitory pathway is efficacious only in select populations, predominantly for immunogenic tumors or when delivered in combination with modalities that can break immunologic tolerance to tumor antigens.

Methods: We studied the effect of CD25+ cell depletion and CTLA-4 blockade on the growth of Transgenic Mouse Adenocarcinoma of Prostate (TRAMP)-PSA tumor cells in DR2bxPSA F1 mice. In these mice, immunological tolerance to PSA was established in a context of the HLA-DRB1*1501(DR2b) allele.

Serum Antibody Repertoire Profiling Using In Silico Antigen Screen.

Serum antibodies are valuable source of information on the health state of an organism. The profiles of serum antibody reactivity can be generated by using a high throughput sequencing of peptide-coding DNA from combinatorial random peptide phage display libraries selected for binding to serum antibodies. Here we demonstrate that the targets of immune response, which are recognized by serum antibodies directed against sequential epitopes, can be identified using the serum antibody repertoire profiles generated by high throughput sequencing.

A cytomegalovirus-based vaccine expressing a single tumor-specific CD8+ T-cell epitope delays tumor growth in a murine model of prostate cancer.

Cytomegalovirus (CMV) is a highly immunogenic virus that results in a persistent, life-long infection in the host typically with no ill effects. Certain unique features of CMV, including its capacity to actively replicate in the presence of strong host CMV-specific immunity, may give CMV an advantage compared with other virus-based vaccine delivery platforms. In the present study, we tested the utility of mouse CMV (mCMV)-based vaccines expressing human prostate-specific antigen (PSA) for prostate cancer immunotherapy in double-transgenic mice expressing PSA and HLA-DRB1*1501 (DR2bxPSA F1 mice).

CD4 T-Cell-mediated immune response to prostatic proteins in HLA-DRB1*1503 transgenic mice and identification of a novel HLA-DRB1*1503-restricted T-cell epitope from human prostatic acid phosphatase.

Background: Transgenic mice engineered to express human leukocyte antigen (HLA) alleles are widely used for identification of immunogenic and naturally processed epitopes. Using HLA-DRB1*1501 (DR2b) transgenic mice, we have previously identified epitopes from two prostatic antigens, prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP). These antigens are implicated in the development of autoimmunity in the prostate and also are considered promising targets for prostate cancer immunotherapy.

T-cell recognition of prostatic peptides in men with chronic prostatitis/chronic pelvic pain syndrome.

Purpose: A potential etiology of chronic prostatitis/chronic pelvic pain syndrome is autoimmunity. We determined whether T cells from men with chronic prostatitis/chronic pelvic pain syndrome would recognize peptides derived from the normal self-prostatic proteins prostate specific antigen and prostatic acid phosphatase.

Materials And Methods: CD4 T cells purified from peripheral blood of 31 patients with chronic prostatitis/chronic pelvic pain syndrome and from the buffy coat preparation of 27 normal male blood donors were stimulated in vitro with a panel of immunogenic peptides from prostate specific antigen and prostatic acid phosphatase, and assayed for reactivity with the peptides by interferon-gamma enzyme-linked immunosorbent spot assay.

Vaccination with agonist peptide PSA: 154-163 (155L) derived from prostate specific antigen induced CD8 T-cell response to the native peptide PSA: 154-163 but failed to induce the reactivity against tumor targets expressing PSA: a phase 2 study in patients with recurrent prostate cancer.

We conducted a clinical trial of peptide prostate specific antigen (PSA): 154-163 (155L) vaccination in human leukocyte antigen (HLA)-A2 patients with detectable and rising serum PSA after radical prostatectomy for prostate cancer (Clinicaltrials.gov identifier NCT00109811). The trial was a single dose-level, phase 2 pilot trial of 1 mg of PSA: 154-163 (155L) emulsified with adjuvant (Montanide ISA-51).

Cutting edge: permissive MHC class II allele changes the pattern of antitumor immune response resulting in failure of tumor rejection.

We studied the growth of transgenic adenocarcinoma of mouse prostate (TRAMP)-C1 tumor cells expressing human prostate-specific Ag (PSA) in HLA-DRB1*1501 (DR2b) transgenic mice. TRAMP-PSA tumors were frequently rejected by HLA-DR2b(-) mice but had increased incidence in HLA-DR2b(+) littermates. The levels of PSA-specific CD8 T cell responses were significantly higher in the HLA-DR2b(-) mice that rejected TRAMP-PSA tumors compared with HLA-DR2b(+) tumor-bearing littermates.

Identification of HLA-DRB1*1501-restricted T-cell epitopes from human prostatic acid phosphatase.

Background: The crucial role of CD4 T-cells in anti-tumor immune response is widely recognized, yet the identification of HLA class II-restricted epitopes derived from tumor antigens has lagged behind compared to class I epitopes. This is particularly true for prostate cancer. Based on the hypothesis that successful cancer immunotherapy will likely resemble autoimmunity, we searched for the CD4 T-cell epitopes derived from prostatic proteins that are restricted by human leukocyte antigen (HLA)-DRB1*1501, an allele associated with granulomatous prostatitis (GP), a disease that may have an autoimmune etiology.

Activation of innate immunity by prostate specific antigen (PSA).

Background: Prostate specific antigen (PSA) is a serine protease secreted by the prostatic epithelium. The only known function of the protein is to cleave seminogelin. We wished to determine if PSA activated peripheral blood mononuclear cells (PBMC).

Identification of HLA-DRB1*1501-restricted T-cell epitopes from prostate-specific antigen.

The development of immunotherapy for prostate cancer based on the induction of autoimmunity to prostate tissue is very attractive because prostate is not a vital organ beyond the reproductive years. CD4 T cells play an important role in the development of antitumor immune responses, yet the identification of naturally processed MHC Class II-restricted epitopes derived from prostate differentiation antigens has not been described. To facilitate the search for prostate-specific antigen (PSA)-derived MHC class II-restricted peptides, we immunized mice transgenic for HLA-DRB1*1501 with human PSA and showed a robust dose-dependent immune response to the antigen.

Granulomatous prostatitis linked to HLA-DRB1*1501.

Purpose: Granulomatous prostatitis is characterized by a pattern of granulomatous inflammation in the prostate. In most cases the etiology is unknown. Based on the hypothesis that granulomatous prostatitis may be an autoimmune disease we performed intermediate and selective high resolution typing of HLA-DR in a group of patients with the disease and compared the frequency of class II HLA phenotypes to that in a control group of volunteer marrow donors in the military.

CD4 and CD8 T-lymphocyte recognition of prostate specific antigen in granulomatous prostatitis.

In order to develop immunotherapies for prostate cancer, many groups are exploring vaccination strategies to induce an immune response against prostate specific antigen (PSA). To determine if T-cell recognition of PSA might be a feature of a naturally occurring human disease, we have studied patients with prostatitis, a poorly understood clinical syndrome of men in which there is evidence that an immune response directed against the prostate may be occurring. We wished to determine if a T-cell response to PSA might be occurring in these patients.