• Tumor Infiltrating Lymphocytes as a Predictive Biomarker for Response to CTLA-4 and PDL-1 Therapies

      Mousa, Abeer; The University of Arizona College of Medicine – Phoenix; Chang, John (The University of Arizona., 2019)
      Recently approved immunotherapies capitalize on antitumor mechanisms of the patient’s immune system by inhibiting CTLA-4 and PD-1 pathways. Studies have shown better overall survival with increased tumor infiltrating lymphocyte (TIL) across multiple cancer. Recent trials with anti-PDL-1 has shown better response with high PDL-1 expression. However, studies have not evaluated whether TIL level would correlate with anti-PDL-1 or anti-CTLA-4 responses. The aim of this study is to determine if the level of TIL in metastatic melanoma and lung cancer correlates with patient response to modern immunotherapies. We identified 10 patients with melanoma or lung cancer treated with an immune checkpoint inhibitor. The biopsy samples were stratified according to level of TIL. The TIL categories ranged from 0 to 3, with 0 indicating no TIL detected and 3 indicating 67-100% TIL infiltration. Survival analysis was achieved with Kaplan-Meier curve, and tumor size change was evaluated with linear mixed model analysis. Overall survival was significantly longer in patients who had TIL (TIL0-0.3 yr; TIL1-2-2.4 yr; TIL3-1.6 yr, p=0.024). Tumor size also dramatically decreased at first follow up based on TIL level (TIL 1-2: 371% greater decrease than TIL 0, p < 0.01; TIL 3: 406%; p<0.01). Decrease in tumor size for TIL0 was 0.12cm2 at first follow-up. Baseline tumor size for TIL0 was 41.9cm2; TIL1-2 0.4 cm2; TIL3 1.4cm2. Our study shows that TIL level may serve as a biomarker to predict tumor response to immunotherapy, without specific histochemical staining. This study is limited by the low number; a larger review is currently taking place.
    • Use of Uterine Electromyography (EMG) for Estimation of Uterine Contractility and Cervical Dilation During the 1st Stage Labor in Pregnant Women

      Ford, Brandon; The University of Arizona College of Medicine – Phoenix; Garfield, Robert (The University of Arizona., 2019)
      Labor and delivery in pregnant women occurs in three stages: The 1st stage begins with the onset of uterine contractility and progressive cervical dilation. The onset and development of labor are commonly monitored with crude and inaccurate instruments and methods: a force transducer (tocodynamometer or TOCO) strapped to the abdominal surface to measure uterine contractility and digital exams to estimate effacement and cervical dilation. Electrical activity is the underlying basis for uterine contractility as it is in all muscles including the heart, skeletal and smooth muscles and electrical activity can be accurately estimated with electromyography (EMG, electrophysiological methods). In the uterus, electrical activity consists of bursts of spikes and the characteristics of the bursts are responsible for the frequency, duration and force of contractions. The goals of this study were to assess: 1) The potential for measuring uterine electrical activity during the 1st stage of labor as the basis for contractility of the uterus; 2) The causal relationship of contractility to and changes in cervical effacement and dilation in pregnant patients , and 3) Define how predicted values of cervical dilation can be obtained from electrical signals and how predicted values of electrical signal characteristics can be obtained from cervical dilation.
    • What are the physical characteristics of the distal tibiofibular syndesmotic joint in uninjured patients?

      Rahman, Qasim; The University of Arizona College of Medicine – Phoenix; Gridley, Daniel G. (The University of Arizona., 2019)
      The syndesmosis is a crucial component for the ankle joint as any injury to it can immobilize a person. The ultimate goal of treatment is to restore the syndesmosis and ankle joint to their respective pre-injury, anatomic alignments. Few studies have attempted to characterize normal syndesmotic joints. Many of these studies have had certain limitations: small population size, minimal diversity in subject demographics, and very few raters taking part in data collection. The purpose of this study is to review a normal distal tibiofibular syndesmosis and characterize the parameters of an uninjured joint using both computed tomography (CT) and magnetic resonance imaging (MRI).
    • Willingness to Receive HPV Vaccine from Community Pharmacists: Exploring the Perspectives of Rural Caregivers of HPV Vaccine Age Eligible Children

      Dominick, Lauren; The University of Arizona College of Medicine – Phoenix; Koskan, Alexis (The University of Arizona., 2019)
      This study explores the perspectives of caregivers of HPV vaccine age-eligible children living in rural Arizona – in terms of having their child vaccinated by a community retail pharmacist.