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UC San Francisco Previously Published Works

Cover page of Development and Initial Validation of Mindfulness-Based Pain Reduction (MBPR) in Patients With Chronic Low Back Pain

Development and Initial Validation of Mindfulness-Based Pain Reduction (MBPR) in Patients With Chronic Low Back Pain

(2025)

Purpose

Mindfulness-Based Stress Reduction (MBSR) has shown efficacy for alleviating chronic low back pain (cLBP) and is included in current treatment guidelines. However, benefits are moderate. We aimed to optimize MBSR for chronic pain by using recent research to develop Mindfulness-Based Pain Reduction (MBPR) and test it in patients with cLBP.

Patients and methods

Phase 1: We modified the MBSR curriculum with theory-driven components and convened focus groups with local and international mindfulness and clinical pain management experts to refine an 8-week MBPR program. Phase 2: We recruited participants with cLBP from Northern California using outreach in newsletters, social media, and other methods to test and iteratively modify the curriculum. MBPR was delivered in a group format by videoconference. The first three groups received MBPR; a fourth group was randomized to MBSR or MBPR to assess randomization feasibility. We assessed feasibility and acceptability by attendance, practice logs, and exit interviews. We assessed changes in patient-reported outcome measures for low back pain trials using a single arm (treatment group only) approach at 2 and 6 months with linear mixed models (primary: pain intensity and interference (PEG) scores).

Results

Phase 1: The MBPR curriculum included: 1) mindful interoceptive exposure to pain, 2) pain neuroscience education, and 3) yoga postures specifically for cLBP. Phase 2: we enrolled 58 patients in 4 cohorts; 49 completed post-intervention and 41 completed 6-month follow-up assessments; 29 of the 41 received MBPR. Participants attended a mean of 80% of sessions and 23 of 24 participants accepted randomization in the 4th cohort. Mean PEG scores improved for 20 of 29 MBPR participants in a clinically meaningful way (PEG scores >30%).

Conclusion

MBPR was feasible and acceptable. Two-thirds of MBPR participants experienced clinically meaningful improvements in pain intensity and interference scores. MBPR warrants further investigation through a randomized, controlled trial.

Cover page of Facilitators and barriers of alcohol goals for Latinx men hospitalized with alcohol use disorder seen by an Addiction Consult Team.

Facilitators and barriers of alcohol goals for Latinx men hospitalized with alcohol use disorder seen by an Addiction Consult Team.

(2025)

INTRODUCTION: Latinx individuals are disproportionately affected by alcohol use disorder (AUD). Understanding Latinx individuals barriers and facilitators to reach AUD-related goals can help implement culturally and linguistically concordant interventions to improve alcohol-related outcomes. METHODS: We conducted semi-structured qualitative interviews with Latinx, Spanish-speaking men with AUD within 20 weeks of hospital discharge who were seen by an addiction consult team during hospitalization in an urban, safety-net hospital in San Francisco. Interviews focused on the facilitators and barriers to participants AUD-related goals pre-, during, and post-hospitalization. We recorded and transcribed interviews and used a mixed deductive and inductive analytic approach until we reached thematic saturation (n = 10). RESULTS: We identified three major themes: 1. Hospitalization was an actionable moment for change; 2. Social factors were closely intertwined with AUD goals; and 3. Accessible addiction, physical health, and mental health services can help achieve AUD goals. CONCLUSIONS: Hospitalization may serve as a facilitator for Latinx individuals with AUD to achieve AUD goals. Addressing social determinants of health including housing, immigration status, and social support networks before, during, and after hospitalization, may help facilitate AUD goals. Providing language-concordant and accessible services may decrease barriers to achieving AUD goals.

Cover page of Patient-derived tumor explant models of tumor immune microenvironment reveal distinct and reproducible immunotherapy responses.

Patient-derived tumor explant models of tumor immune microenvironment reveal distinct and reproducible immunotherapy responses.

(2025)

Tumor-resident immune cells play a crucial role in eliciting anti-tumor immunity and immunomodulatory drug responses, yet these functions have been difficult to study without tractable models of the tumor immune microenvironment (TIME). Patient-derived ex vivo models contain authentic resident immune cells and therefore, could provide new mechanistic insights into how the TIME responds to tumor or immune cell-directed therapies. Here, we assessed the reproducibility and robustness of immunomodulatory drug responses across two different ex vivo models of breast cancer TIME and one of renal cell carcinoma. These independently developed TIME models were treated with a panel of clinically relevant immunomodulators, revealing remarkably similar changes in gene expression and cytokine profiles among the three models in response to T cell activation and STING-agonism, while still preserving individual patient-specific response patterns. Moreover, we found two common core signatures of adaptive or innate immune responses present across all three models and both types of cancer, potentially serving as benchmarks for drug-induced immune activation in ex vivo models of the TIME. The robust reproducibility of immunomodulatory drug responses observed across diverse ex vivo models of the TIME underscores the significance of human patient-derived models in elucidating the complexities of anti-tumor immunity and therapeutic interventions.

Cover page of Placental malaria induces a unique methylation profile associated with fetal growth restriction.

Placental malaria induces a unique methylation profile associated with fetal growth restriction.

(2025)

Fetal growth restriction (FGR) is associated with perinatal death and adverse birth outcomes, as well as long-term complications, including increased childhood morbidity, abnormal neurodevelopment, and cardio-metabolic diseases in adulthood. Placental epigenetic reprogramming associated with FGR may mediate these long-term outcomes. Placental malaria (PM), characterized by sequestration of Plasmodium falciparum-infected erythrocytes in placental intervillous space, is the leading global cause of FGR, but its impact on placental epigenetics is unknown. We hypothesized that placental methylomic profiling would reveal common and distinct mechanistic pathways of non-malarial and PM-associated FGR. We analyzed placentas from a US cohort with no malaria exposure (n = 12) and a cohort from eastern Uganda, a region with a high prevalence of malaria (n = 12). From each site, 8 cases of FGR and 4 healthy controls were analyzed. PM was diagnosed by placental histopathology. We compared the methylation levels of over 850K CpGs of the placentas using Infinium MethylationEPIC v1 microarray. Non-malarial FGR was associated with 65 differentially methylated CpGs (DMCs), whereas PM-FGR was associated with 133 DMCs, compared to their corresponding controls without FGR. One DMC (cg16389901, located in the promoter region of BMP4) was commonly hypomethylated in both groups. We identified 522 DMCs between non-malarial FGR vs. PM-FGR placentas, independent of differing geographic location or cellular composition. Placentas with PM-associated FGR have distinct methylation profiles compared to placentas with non-malarial FGR, suggesting novel epigenetic reprogramming in response to malaria. Larger cohort studies are needed to determine the distinct long-term health outcomes in PM-associated FGR pregnancies.

Cover page of Novel Risk Factors for Uveal Melanoma in Adolescent and Young Adult Patients: A Comprehensive Case–Control Analysis

Novel Risk Factors for Uveal Melanoma in Adolescent and Young Adult Patients: A Comprehensive Case–Control Analysis

(2025)

Purpose

To identify risk factors associated with uveal melanoma (UM) in adolescents and young adults (AYAs).

Design

A retrospective case-control study.

Participants

Two hundred forty-seven UM patients aged 13 to 45 treated with proton beam radiation therapy and 401 age- and sex-matched controls at a tertiary academic center.

Methods

We obtained demographic and genetic data, environmental exposures, and social, medical, and ocular history via retrospective chart review and phone follow-up.

Main outcome measures

The main outcome measures included the prevalence and odds ratios (ORs) of the investigated risk factors in UM patients compared with controls.

Results

The median age of UM diagnosis was 38 years (range: 13-45 years); the median follow-up was 102 months (range: 3-329 months). Identified novel risk factors for UM included family history of cutaneous melanoma (OR = 3.06, P = 0.002), Ashkenazi Jewish ancestry (2.98, P = 0.02), prior eye trauma (2.94, P = 0.01), secondhand cigarette smoke exposure (2.39, P < 0.001), and previous head and neck surgery (1.81, P = 0.007). Some known risk factors identified include choroidal nevi (11.39, P < 0.001), light eye color (4.69, P < 0.001), White race (4.63, P < 0.001), outdoor sunlight exposure (4.20, P < 0.001), recent pregnancy (4.0, P = 0.002), occupational (2.39, P = 0.003) and toxic chemical (2.27, P = 0.03) exposures, family history of any cancer (2.16, P < 0.001), lack of ultraviolet-blocking eyewear use (2.13, P = 0.01), indoor tanning (2.10, P = 0.03), and propensity to sunburn (1.89, P < 0.05). The prevalence of oculodermal melanocytosis (P = 0.03) and family history of UM (P < 0.001) were significantly greater in UM patients than in controls. Uveal melanoma T-categories were as follows: 39% T1, 37% T2, 19% T3, and 5% T4. Gene expression profiling was available in 64 patients and showed 59% class 1A, 19% class 1B, and 22% class 2 tumors. Thirteen patients underwent genetic screening; identified germline mutations included CDH1, NF1, and PALB2. The estimated 10-year metastasis-free progression rate and overall survival were 80% and 81%, respectively.

Conclusions

This study identified several novel risk factors for UM in AYAs and confirmed select established risk factors seen in UM patients of all ages. To the best of our knowledge, this is the first explicit and comprehensive investigation of risk factors among a younger cohort and may help further elucidate UM pathogenesis.

Financial disclosures

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Cover page of The contribution of community transmission to the burden of hospital-associated pathogens: A systematic scoping review of epidemiological models.

The contribution of community transmission to the burden of hospital-associated pathogens: A systematic scoping review of epidemiological models.

(2025)

Healthcare-associated infections (HAI), particularly those involving multi-drug resistant organisms (MDRO), pose a significant public health threat. Understanding the transmission of these pathogens in short-term acute care hospitals (STACH) is crucial for effective control. Mathematical and computational models play a key role in studying transmission but often overlook the influence of long-term care facilities (LTCFs) and the broader community on transmission. In a systematic scoping review of 4,733 unique studies from 2016 to 2022, we explored the modeling landscape of the hospital-community interface in HAI-causing pathogen transmission. Among the 29 eligible studies, 28 % (n = 8) exclusively modeled LTCFs, 45 % (n = 13) focused on non-healthcare-related community settings, and 31 % (n = 9) considered both settings. Studies emphasizing screening and contact precautions were more likely to include LTCFs but tended to neglect the wider community. This review emphasizes the crucial need for comprehensive modeling that incorporates the communitys impact on both clinical and public health outcomes.

Cover page of Outer retinal reflectivity and visual function loss after anatomically successful macula-off rhegmatogenous retinal detachment repair

Outer retinal reflectivity and visual function loss after anatomically successful macula-off rhegmatogenous retinal detachment repair

(2025)

Purpose

Rhegmatogenous retinal detachment (RRD) can cause permanent photoreceptor damage with subsequent vision loss, even after prompt repair. Here we compared photoreceptor structure in retinal areas with varying levels of residual visual function loss following anatomically successful macula-off RRD repair.

Observations

Five eyes of four individuals (2 male, 2 female; ages 18-77 years) with successful macula-off RRD repair were included. Two were repaired via scleral buckle, one via vitrectomy, and two with both. Postoperative visual acuity measured 4-11 months after surgical repair ranged from 20/20 to 20/100. In each eye, areas of previously detached macula exhibited reduced or variable cone reflectivity on adaptive optics scanning light ophthalmoscopy (AOSLO) images. This was typically associated with reduced or variable inner segment/outer segment junction (IS/OS) band reflectivity on optical coherence tomography (OCT) images. Areas of the macula with reduced photoreceptor reflectivity also showed lower sensitivity on microperimetric testing.

Conclusions

Despite anatomically successful repair, RRD results in photoreceptor changes, including reduced reflectivity of cone profiles and the IS/OS band that were associated with reduced macular sensitivity. As ophthalmologic imaging progresses towards higher resolution modalities, AOSLO may be useful in monitoring outcomes after RRD repair. Low cone reflectivity, cataract, high axial length, and poor visual fixation may be barriers to quantification of cone structure in this patient population.

Cover page of Social epidemiology of cardiometabolic risk factors in early adolescents

Social epidemiology of cardiometabolic risk factors in early adolescents

(2025)

Background

To estimate associations between sociodemographic factors and cardiometabolic risk factors among a demographically diverse sample of U.S. adolescents aged 10-14 years.

Methods

This study analyzed data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 1412), Years 2 and 3 (2018-2021). Cardiometabolic risk factors including hemoglobin A1c and cholesterol (total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and non-HDL-C) were assessed. Multivariable linear regression models were conducted to estimate the associations between sociodemographic factors (age, sex, race and ethnicity, household income, and parental education) and cardiometabolic risk factors (hemoglobin A1c, TC, HDL-C, and non-HDL-C).

Results

The average hemoglobin A1c level was 5.2 % (±0.4 %), the average TC level was 156.6 (±28.9) mg/dL, and the average HDL-C level was 56.0 (±12.9) mg/dL. Out of our sample, 0.5 % had diabetes (hemoglobin A1c ≥ 6.5 %), 7.6 % had high TC (≥200 mg/dL), and 7.4 % had low HDL-C (<40 mg/dL). Older age was associated with lower TC, HDL-C, and non-HDL-C levels. Male sex was associated with higher hemoglobin A1c (beta coefficient [B] 0.04; 95 % confidence interval [CI], 0.00, 0.08; p = 0.037) and lower TC (B -3.14; 95 % CI, -6.17, -0.11; p = 0.042) compared to female sex. Black and Native American race and ethnicity were associated with higher hemoglobin A1c compared to White race. Higher household income was associated with higher TC and HDL-C.

Conclusion

This study of a diverse population of early adolescents identified sociodemographic differences in hemoglobin A1c and cholesterol levels that can inform clinical and public health interventions.

Cover page of A flexible MRF approach to improve kinetic rate estimation with bSSFP-based hyperpolarized [1-13C]pyruvate MRI.

A flexible MRF approach to improve kinetic rate estimation with bSSFP-based hyperpolarized [1-13C]pyruvate MRI.

(2025)

PURPOSE: In this work, we adopt the MR fingerprinting (MRF) framework and leverage its flexibility in quantitative pulse sequence design to propose improved balanced steady-state free precession (bSSFP)-based hyperpolarized Carbon-13 (13C) acquisitions for robust metabolic conversion rate quantification. METHODS: Spectrally selective bSSFP-based acquisitions with variable RF excitation were implemented for [1-13C]pyruvate and used in conjunction with prior implementation of [1-13C]lactate selective bSSFP imaging. MRF framework parameter estimation was performed using dictionary-based template matching. Influences of bSSFP-based acquisitions and sigmoid RF excitation scheme were assessed with simulation experiments and Monte Carlo evaluation. Methods were then compared using experimental data from rat kidney acquired on a clinical 3 T scanner. RESULTS: Simulations indicated that combining bSSFP-based acquisitions and variable RF excitation (MRF-Sigmoid) exhibited bias <0.1% across the majority (86%) of combinations of pyruvate-to-lactate conversion rate (kPL) and noise level investigated when estimating kPL with the MRF framework. bSSFP-based experiments, with and without sigmoid excitation scheme, showed lower variance in fits at all levels of kPL and noise investigated compared to the method used in prior work by this group (hybrid gradient echo). Positive, linear correlations were found for in vivo voxel-wise estimates of kPL in healthy rat kidneys when comparing all experiment methods. MRF-Sigmoid experiment design increased pyruvate cumulative SNR by 3.5-fold over hybrid gradient echo while maintaining similar lactate cumulative SNR. CONCLUSION: The use of the MRF framework for kPL estimation demonstrates the feasibility of dictionary-based template matching and can be used to accurately estimate physiologically relevant kPL and improve cumulative SNR.