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Hutchinson B, Walter A, Campbell N, Whelton PK, Varghese C, Husain MJ, Nugent R, Kostova D, Honeycutt A. Scaling hypertension treatment in 24 low-income and middle-income countries: economic evaluation of treatment decisions at three blood pressure cut-points. BMJ Open 2024; 14:e071036. [PMID: 38626959 PMCID: PMC11029208 DOI: 10.1136/bmjopen-2022-071036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE Estimate the incremental costs and benefits of scaling up hypertension care in adults in 24 select countries, using three different systolic blood pressure (SBP) treatment cut-off points-≥140, ≥150 and ≥160 mm Hg. INTERVENTION Strengthening the hypertension care cascade compared with status quo levels, with pharmacological treatment administered at different cut-points depending on the scenario. TARGET POPULATION Adults aged 30+ in 24 low-income and middle-income countries spanning all world regions. PERSPECTIVE Societal. TIME HORIZON 30 years. DISCOUNT RATE 4%. COSTING YEAR 2020 USD. STUDY DESIGN DATA SOURCES: Institute for Health Metrics and Evaluation's Epi Visualisations database-country-specific cardiovascular disease (CVD) incidence, prevalence and death rates. Mean SBP and prevalence-National surveys and NCD-RisC. Treatment protocols-WHO HEARTS. Treatment impact-academic literature. Costs-national and international databases. OUTCOME MEASURES Health outcomes-averted stroke and myocardial infarction events, deaths and disability-adjusted life-years; economic outcomes-averted health expenditures, value of averted mortality and workplace productivity losses. RESULTS OF ANALYSIS Across 24 countries, over 30 years, incremental scale-up of hypertension care for adults with SBP≥140 mm Hg led to 2.6 million averted CVD events and 1.2 million averted deaths (7% of expected CVD deaths). 68% of benefits resulted from treating those with very high SBP (≥160 mm Hg). 10 of the 12 highest-income countries projected positive net benefits at one or more treatment cut-points, compared with 3 of the 12 lowest-income countries. Treating hypertension at SBP≥160 mm Hg maximised the net economic benefit in the lowest-income countries. LIMITATIONS The model only included a few hypertension-attributable diseases and did not account for comorbid risk factors. Modelled scenarios assumed ambitious progress on strengthening the care cascade. CONCLUSIONS In areas where economic considerations might play an outsized role, such as very low-income countries, prioritising treatment to populations with severe hypertension can maximise benefits net of economic costs.
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Affiliation(s)
- Brian Hutchinson
- Center for Global Noncommunicable Diseases, RTI International, Seattle, Washington, USA
| | - Adam Walter
- Health Economics Program, Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, North Carolina, USA
| | - Norm Campbell
- Community Health Sciences and Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Cherian Varghese
- Healthier Populations and Noncommunicable Diseases, World Health Organization South East Asia Regional Office, New Delhi, India
| | - Muhammad Jami Husain
- Division of Global Health Protection, Global Health Center, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Seattle, Washington, USA
| | - Deliana Kostova
- Division of Global Health Protection, Global Health Center, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amanda Honeycutt
- Health Economics Program, Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, North Carolina, USA
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Gottschalk I, Walter A, Menzel T, Weber EC, Wendt S, Sreeram N, Gembruch U, Berg C, Abel JS. D-Transposition of the great arteries with restrictive foramen ovale in the fetus: the dilemma of predicting the need for postnatal urgent balloon atrial septostomy. Arch Gynecol Obstet 2024; 309:1353-1367. [PMID: 36971845 PMCID: PMC10894161 DOI: 10.1007/s00404-023-06997-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/01/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Restrictive foramen ovale (FO) in dextro-transposition of the great arteries (d-TGA) with intact ventricular septum may lead to severe life-threatening hypoxia within the first hours of life, making urgent balloon atrial septostomy (BAS) inevitable. Reliable prenatal prediction of restrictive FO is crucial in these cases. However, current prenatal echocardiographic markers show low predictive value, and prenatal prediction often fails with fatal consequences for a subset of newborns. In this study, we described our experience and aimed to identify reliable predictive markers for BAS. METHODS We included 45 fetuses with isolated d-TGA that were diagnosed and delivered between 2010 and 2022 in two large German tertiary referral centers. Inclusion criteria were the availability of former prenatal ultrasound reports, of stored echocardiographic videos and still images, which had to be obtained within the last 14 days prior to delivery and that were of sufficient quality for retrospective re-analysis. Cardiac parameters were retrospectively assessed and their predictive value was evaluated. RESULTS Among the 45 included fetuses with d-TGA, 22 neonates had restrictive FO postnatally and required urgent BAS within the first 24 h of life. In contrast, 23 neonates had normal FO anatomy, but 4 of them unexpectedly showed inadequate interatrial mixing despite their normal FO anatomy, rapidly developed hypoxia and also required urgent BAS ('bad mixer'). Overall, 26 (58%) neonates required urgent BAS, whereas 19 (42%) achieved good O2 saturation and did not undergo urgent BAS. In the former prenatal ultrasound reports, restrictive FO with subsequent urgent BAS was correctly predicted in 11 of 22 cases (50% sensitivity), whereas a normal FO anatomy was correctly predicted in 19 of 23 cases (83% specificity). After current re-analysis of the stored videos and images, we identified three highly significant markers for restrictive FO: a FO diameter < 7 mm (p < 0.01), a fixed (p = 0.035) and a hypermobile (p = 0.014) FO flap. The maximum systolic flow velocities in the pulmonary veins were also significantly increased in restrictive FO (p = 0.021), but no cut-off value to reliably predict restrictive FO could be identified. If the above markers are applied, all 22 cases with restrictive FO and all 23 cases with normal FO anatomy could correctly be predicted (100% positive predictive value). Correct prediction of urgent BAS also succeeded in all 22 cases with restrictive FO (100% PPV), but naturally failed in 4 of the 23 cases with correctly predicted normal FO ('bad mixer') (82.6% negative predictive value). CONCLUSION Precise assessment of FO size and FO flap motility allows a reliable prenatal prediction of both restrictive and normal FO anatomy postnatally. Prediction of likelihood of urgent BAS also succeeds reliably in all fetuses with restrictive FO, but identification of the small subset of fetuses that also requires urgent BAS despite their normal FO anatomy fails, because the ability of sufficient postnatal interatrial mixing cannot be predicted prenatally. Therefore, all fetuses with prenatally diagnosed d-TGA should always be delivered in a tertiary center with cardiac catheter stand-by, allowing BAS within the first 24 h after birth, regardless of their predicted FO anatomy.
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Affiliation(s)
- I Gottschalk
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany.
| | - A Walter
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - T Menzel
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - E C Weber
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - S Wendt
- Heartcenter, Department of Cardiac Surgery, Cardiothoracic Intensive Care and Thoracic Surgery, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - N Sreeram
- Department of Pediatric Cardiology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - U Gembruch
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - C Berg
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - J S Abel
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University Hospital Cologne and Faculty of Medicine, University of Cologne, Cologne, Germany
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Moody N, Walter A, Daudu D, Wahlgren CM, Jongkind V. International Perspective on Extremity Vascular Trauma in Children: A Scoping Review. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00200-4. [PMID: 38428670 DOI: 10.1016/j.ejvs.2024.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 02/17/2024] [Accepted: 02/26/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Extremity vascular trauma in children can result in significant morbidity and mortality. Most published studies have focused on supracondylar humeral fracture related injuries, with little focus on other injuries. This scoping review describes the current state of knowledge on paediatric vascular injuries in the upper and lower limbs, excluding injuries related to supracondylar humeral fractures. METHODS MEDLINE, PubMed, Web of Science, and Cochrane databases were searched for relevant studies evaluating the epidemiology, diagnosis, management, and outcomes of upper and lower limb vascular trauma in those aged under 18 years. Studies related to supracondylar humeral fractures were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews was used. RESULTS A total of 39 studies was included, all of which were retrospective, and 74% of which were based in North America or Europe. Extremity vascular trauma was reported to cause 0.6 - 4.4% of all paediatric trauma admissions, with penetrating mechanisms and upper limb injuries being the most common. Operative intervention was reported in 80 - 100% of children in the included studies. Primary repair was the most commonly reported operative intervention, followed by interposition graft and bypass graft. Synthetic graft use was less commonly reported (incidence range 0.5 - 33%). Lower limb fasciotomies and amputations were not commonly reported (incidence range 0 - 23% and 0 - 13%, respectively). The mortality rate appeared low, with 23 studies reporting no deaths (incidence range 0 - 4%). Complications were reported inconsistently, with no uniform outcome or follow up measures used. CONCLUSION The incidence of extremity vascular trauma appears low in children, with penetrating mechanisms and upper extremity injuries appearing to dominate. Most studies are from high income countries, with probable selection bias towards those treated by operative intervention. Prospective studies are required focusing on patterns of injury, rates of operative and endovascular intervention, and long term outcomes.
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Affiliation(s)
- N Moody
- Queen Elizabeth University Hospital, Glasgow, UK.
| | - A Walter
- Queen Elizabeth University Hospital, Glasgow, UK
| | - Davina Daudu
- Department of Surgery, University of Western Australia, Perth, Australia
| | - Carl-Magnus Wahlgren
- Department of Vascular Surgery, Karolinska University Hospital/Karolinska Institute, Stockholm, Sweden
| | - Vincent Jongkind
- Department of Surgery, Amsterdam UMC location Vrije Universiteit, Amsterdam, the Netherlands; Microcirculation - Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
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Nemunaitis J, Stanbery L, Walter A, Rocconi R, Stephens P. Rationale for the Use of Homologous Recombination Proficient Molecular Profile as a Biomarker for Therapeutic Targeting in Ovarian Cancer. Oncol Rev 2023; 17:11471. [PMID: 37799595 PMCID: PMC10547877 DOI: 10.3389/or.2023.11471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/31/2023] [Indexed: 10/07/2023] Open
Affiliation(s)
| | | | - Adam Walter
- Gradalis, Inc, Dallas, TX, United States
- ProMedica, Toledo, OH, United States
| | - Rodney Rocconi
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Mobile, AL, United States
| | - Philip Stephens
- Gradalis, Inc, Dallas, TX, United States
- Naveris, Waltham, MA, United States
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Watkins DE, Craig DJ, Vellani SD, Hegazi A, Fredrickson KJ, Walter A, Stanbery L, Nemunaitis J. Advances in Targeted Therapy for the Treatment of Cervical Cancer. J Clin Med 2023; 12:5992. [PMID: 37762931 PMCID: PMC10531664 DOI: 10.3390/jcm12185992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Cervical cancer is an international public health crisis, affecting several hundred thousand women annually. While not universally protective due to other risk factors, many such cases are preventable with vaccination against high-risk serotypes of the human papilloma virus (HPV 6, 11, 16, 18, 31, 33, 45, 53, 58). Advanced-stage and recurrent cervical cancers are typically lethal and have been the focus in recent years of the integration of immune checkpoint inhibitors (CPIs) to improve survival. We have consolidated information regarding the role of the immune system in both disease progression and disease clearance with the aid of targeted therapies and immunotherapeutic agents. Additionally, we have characterized the treatment modalities currently indicated as the standard of care-such as bevacizumab and the immune CPIs-and those recently approved or in development, including Tivdak, Vigil, and chimeric antigen receptor (CAR) T-cells.
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Affiliation(s)
- Dean E. Watkins
- University of Toledo Medical Center, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43614, USA
| | - Daniel J. Craig
- University of Toledo Medical Center, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43614, USA
| | - Shahnaz D. Vellani
- University of Toledo Medical Center, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43614, USA
| | - Ahmad Hegazi
- University of Toledo Medical Center, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43614, USA
| | - Kaylee J. Fredrickson
- University of Toledo Medical Center, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43614, USA
| | - Adam Walter
- ProMedica Toledo Hospital, Toledo, OH 43606, USA
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Bradley NA, Walter A, Roxburgh CSD, McMillan DC, Guthrie GJK. The relationship between clinical frailty score, CT-derived body composition, systemic inflammation, and survival in patients with chronic limb threatening ischaemia. Ann Vasc Surg 2023:S0890-5096(23)00339-4. [PMID: 37356659 DOI: 10.1016/j.avsg.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/23/2023] [Accepted: 06/06/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTIO Frailty is a chronic condition with complex aetiology and impaired functional performance, which has been associated altered body composition and chronic inflammation. Chronic Limb Threatening Ischaemia (CLTI) carries significant morbidity and mortality and is associated with poor quality of life. The present study aims to examine these relationships and their prognostic value in patients with CLTI. METHODS Consecutive patients presenting as unscheduled admissions to a single tertiary centre with CLTI were included over a 12-month period. Frailty was diagnosed using the clinical frailty scale (CFS). Body composition was assessed using CT at the L3 vertebral level (CT-BC) to generate visceral and subcutaneous fat indices (VFI, SFI), skeletal muscle index (SMI), and skeletal muscle density (SMD). SMI and SMD were combined to form the CT-sarcopenia score (CT-SS). Systemic inflammation was assessed by the modified Glasgow Prognostic Score (mGPS). The primary outcome was overall mortality. RESULTS There were 190 patients included with a median (IQR) follow-up of 22 (6) months (range 15-32 months), and 79 deaths during the follow-up period. 100 patients (53%) had a CFS > 4. CFS > 4 (HR 2.14, 95% CI 1.25 - 3.66, p <0.01), CT-SS (HR 1.47, 95% CI 1.03 - 2.09, p <0.05), and mGPS (HR 1.54, 95% CI 1.11 - 2.13, p <0.01) were independently associated with increased mortality. CT-SS (OR 1.88, 95% CI 1.09 - 3.24, p < 0.01) was independently associated with CFS > 4. Patients with CT-SS 0 & CFS ≤4 had 90% (SE 5%) 1-year survival, compared with 35% (SE 9%) in patients with CT-SS 2 & CFS >4 (p <0.001). Patients with mGPS 0 & CFS ≤ 4 had 94% (SE 4%) 1-year survival compared with 44% (SE 6%) in the mGPS 2 & CFS > 4 subgroup (p <0.001). CONCLUSIONS Frailty assessed by CFS was associated with CT-BC. CFS, CT-SS and mGPS were associated with poorer survival in patients presenting as unscheduled admissions with CLTI. CT-SS and mGPS may contribute to part of frailty and prognostic assessment in this patient cohort.
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Affiliation(s)
- N A Bradley
- Clinical Research Fellow, University of Glasgow
| | | | | | - D C McMillan
- Professor of Surgical Science, University of Glasgow
| | - G J K Guthrie
- Consultant Vascular Surgeon, NHS Tayside, Honorary Clinical Senior Lecturer, University of Glasgow
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Pernea P, Annabi E, Walter A, Blum L, Bennacer Y, Begon E. Cutaneous exanthema revealing Multisystem-Inflammatory Syndrome in adults (MIS-A) in the course of SARS-CoV-2 infection. Ann Dermatol Venereol 2023; 150:164-166. [PMID: 36870930 PMCID: PMC9889252 DOI: 10.1016/j.annder.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 12/07/2022] [Accepted: 01/19/2023] [Indexed: 02/04/2023]
Affiliation(s)
- P Pernea
- Department of Dermatology, Hôpital René Dubos, 6 Avenue de l'Ile de France, 95300 Pontoise, France
| | - E Annabi
- Department of Dermatology, Hôpital René Dubos, 6 Avenue de l'Ile de France, 95300 Pontoise, France
| | - A Walter
- Department of Dermatology, Hôpital René Dubos, 6 Avenue de l'Ile de France, 95300 Pontoise, France
| | - L Blum
- Department of Dermatology, Hôpital René Dubos, 6 Avenue de l'Ile de France, 95300 Pontoise, France
| | - Y Bennacer
- Department of Cardiology, Hôpital René Dubos, 6 Avenue de l'Ile de France, 95300 Pontoise, France
| | - E Begon
- Department of Dermatology, Hôpital René Dubos, 6 Avenue de l'Ile de France, 95300 Pontoise, France.
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Rocconi RP, Monk BJ, Walter A, Herzog TJ, Galanis E, Manning L, Bognar E, Wallraven G, Stanbery L, Aaron P, Senzer N, Coleman RL, Nemunaitis J. Corrigendum to "Gemogenovatucel-T (Vigil) immunotherapy demonstrates clinical benefit in homologous recombination proficient (HRP) ovarian cancer" [Gynecologic Oncology Volume 161, Issue 3, June 2021, Pages 676-680]. Gynecol Oncol 2023; 169:173. [PMID: 36456375 DOI: 10.1016/j.ygyno.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Rodney P Rocconi
- University of South Alabama - Mitchell Cancer Institute, Mobile, AL, United States of America
| | | | - Adam Walter
- ProMedica, Toledo, OH, United States of America
| | - Thomas J Herzog
- University of Cincinnati Cancer Center, Cincinnati, OH, United States of America
| | | | - Luisa Manning
- Gradalis, Inc., Carrollton, TX, United States of America
| | - Ernest Bognar
- Gradalis, Inc., Carrollton, TX, United States of America
| | | | - Laura Stanbery
- Gradalis, Inc., Carrollton, TX, United States of America
| | - Phylicia Aaron
- Gradalis, Inc., Carrollton, TX, United States of America
| | - Neil Senzer
- Gradalis, Inc., Carrollton, TX, United States of America
| | - Robert L Coleman
- US Oncology Research, The Woodlands, TX, United States of America
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Morin L, Couineau F, Begon E, Walter A, Faucon B, Al Tabaa K. Randomized trial of the effect of video training on residents' surgical skills in facial skin reconstructive surgery: A SQUIRE study. Eur Ann Otorhinolaryngol Head Neck Dis 2022; 139:321-325. [PMID: 35717531 DOI: 10.1016/j.anorl.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the impact of facial skin reconstruction training videos for head and neck and maxillofacial surgery residents. MATERIAL AND METHODS This randomized trial, conducted in France, involved residents in head and neck and maxillofacial surgery. A website was created containing facial skin reconstruction training videos. Selected residents performed facial skin flap dissections in the Paris School of Surgery. They were randomized into two groups, one receiving a standard course before the dissection, and the other a standard course plus a video of the flap ("no-video" and "video" groups). Each resident performed 4 facial flaps and was graded (blindly) during dissection. The main study endpoint was intergroup difference in grading score (out of 15). The article was written up following the SQUIRE-EDU (Standards for QUality Improvement Reporting Excellence in EDUcation) criteria. RESULTS Eighteen residents were included. For the main endpoint, scores were significantly higher in the "video" than the "no-video" group (6 [IQR, 4: 9] vs. 10 [9: 12]; P<0.001). In addition, as secondary endpoint, "no-video" group residents requested more assistance (3 [2: 4] vs. 1 [1: 2] P<0.001). Power was lacking for any subgroup analysis according to year of residency or to the 4 flaps. CONCLUSION Videos improved surgical residents' performance during dissections. However, these results would be difficult to transpose to real clinical conditions. They need validating in a larger study evaluating performance in real-life procedures.
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Affiliation(s)
- L Morin
- Service d'ORL, Hôpital René Dubos, Pontoise, France.
| | - F Couineau
- Service d'ORL, Hôpital Foch, Suresnes, France
| | - E Begon
- Service de Dermatologie, Hôpital René Dubos, Pontoise, France
| | - A Walter
- Service de Dermatologie, Hôpital René Dubos, Pontoise, France
| | - B Faucon
- Service d'ORL, Hôpital René Dubos, Pontoise, France
| | - K Al Tabaa
- Service d'ORL, Hôpital René Dubos, Pontoise, France
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Craig DJ, Ambrose S, Stanbery L, Walter A, Nemunaitis J. Systemic benefit of radiation therapy via abscopal effect. Front Oncol 2022; 12:987142. [PMID: 36387120 PMCID: PMC9641206 DOI: 10.3389/fonc.2022.987142] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/05/2022] [Indexed: 08/30/2023] Open
Abstract
Evidence of a systemic response related to localized radiation therapy (RT) in cancer management is rare. However, enhancing the immune response via immunotherapy followed by localized RT has shown evidence of tumor shrinkage to non-irradiated metastatic disease thereby inducing an "abscopal effect." Combined induction of the cGAS-STING pathway and activation of IFN-gamma signaling cascade related to RT within an activated immune environment promotes neoantigen presentation and expansion of cytotoxic effector cells enabling enhancement of systemic immune response. A proposed mechanism, case examples, and clinical trial evidence of "abscopal effect" benefit are reviewed. Results support strategic therapeutic testing to enhance "abscopal effect."
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Affiliation(s)
- Daniel J. Craig
- University of Toledo, Department of Internal Medicine, Toledo, OH, United States
| | | | - Laura Stanbery
- Medical Affairs, Gradalis, Inc., Carrollton, TX, United States
| | - Adam Walter
- Medical Affairs, Gradalis, Inc., Carrollton, TX, United States
- Gynecologic Oncology, Promedica, Toledo, OH, United States
| | - John Nemunaitis
- Medical Affairs, Gradalis, Inc., Carrollton, TX, United States
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Walter A, Rocconi RP, Monk BJ, Herzog TJ, Manning L, Bognar E, Wallraven G, Aaron P, Horvath S, Tang M, Stanbery L, Coleman RL, Nemunaitis J. Gemogenovatucel-T (Vigil) maintenance immunotherapy: 3-year survival benefit in homologous recombination proficient (HRP) ovarian cancer. Gynecol Oncol 2021; 163:459-464. [PMID: 34702567 DOI: 10.1016/j.ygyno.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Previously, Vigil demonstrated clinical benefit to prolong relapse free and overall survival in the BRCA wild-type (BRCA-wt), homologous recombination proficient (HRP) patient population. Here we provide long term follow up of 3 years in the HRP patient population enrolled in the Phase 2b VITAL study. METHODS HRP patients treated with Vigil (n = 25) or placebo (n = 20) who were enrolled in the Phase 2b, double-blind, placebo-controlled (VITAL study, NCT02346747) were followed for safety, OS and RFS. OS and RFS from time of randomization (immediately prior to maintenance therapy) and from debulking tissue procurement time points were analyzed by Kaplan-Meier (KM) and restricted mean survival time (RMST) analysis. RESULTS OS for Vigil treated patients at 3 years has not yet reached median OS time point (95% CI 41.6 months to not achieved) compared to 26.9 (95% CI 17.4 months to not achieved) in placebo treated patients (HR 0.417 p = 0.020). Three year RFS also showed benefit to Vigil (stratified HR 0.405, p = 0.011) and no long term toxicity to Vigil was observed. Three year OS for Vigil of 70% vs. 40% for placebo from time of randomization was observed (p = 0.019). RMST analysis was also significant for OS (45.7 vs. 32.8 months, p = 0.008) and RFS (p = 0.025). CONCLUSION In conclusion, results suggest durable activity of Vigil on RFS and OS and support further evaluation of Vigil in HRP ovarian cancer.
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Affiliation(s)
- Adam Walter
- ProMedica, Toledo, OH, United States of America
| | - Rodney P Rocconi
- University of South Alabama - Mitchell Cancer Institute, Mobile, AL, United States of America
| | | | - Thomas J Herzog
- University of Cincinnati Cancer Institute, Cincinnati, OH, United States of America
| | - Luisa Manning
- Gradalis, Inc., Carrollton, TX, United States of America
| | - Ernest Bognar
- Gradalis, Inc., Carrollton, TX, United States of America
| | | | - Phylicia Aaron
- Gradalis, Inc., Carrollton, TX, United States of America
| | - Staci Horvath
- Gradalis, Inc., Carrollton, TX, United States of America
| | - Min Tang
- StatBeyond Consulting, LLC., Irvine, CA, United States of America
| | - Laura Stanbery
- Gradalis, Inc., Carrollton, TX, United States of America
| | - Robert L Coleman
- US Oncology Research, The Woodlands, TX, United States of America
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Rocconi RP, Stanbery L, Madeira da Silva L, Barrington RA, Aaron P, Manning L, Horvath S, Wallraven G, Bognar E, Walter A, Nemunaitis J. Long-Term Follow-Up of Gemogenovatucel-T (Vigil) Survival and Molecular Signals of Immune Response in Recurrent Ovarian Cancer. Vaccines (Basel) 2021; 9:vaccines9080894. [PMID: 34452019 PMCID: PMC8402348 DOI: 10.3390/vaccines9080894] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/03/2021] [Accepted: 08/06/2021] [Indexed: 12/20/2022] Open
Abstract
Aim: To determine the relationship between gene expression profile (GEP) and overall survival (OS) by NanoString following treatment with Vigil. Patients and Methods: Recurrent ovarian cancer patients (n = 21) enrolled in prior clinical trials. Results: GEP stratified by TISHIGH vs. TISLOW demonstrated OS benefit (NR vs. 5.8 months HR 0.23; p = 0.0379), and in particular, MHC-II elevated baseline expression was correlated with OS advantage (p = 0.038). Moreover, 1-year OS was 75% in TISHIGH patients vs. 25% in TISLOW (p = 0.03795). OS was also correlated with positive γ-IFN ELISPOT response, 36.8 vs. 23.0 months (HR 0.19, p = 0.0098). Conclusion: Vigil demonstrates OS benefit in correlation with TISHIGH score, elevated MHC-II expression and positive γ-IFN ELISPOT in recurrent ovarian cancer patients.
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Affiliation(s)
- Rodney P. Rocconi
- Mitchell Cancer Institute, Division of Gynecologic Oncology, University of South Alabama, Mobile, AL 36604, USA;
| | - Laura Stanbery
- Gradalis, Inc., 2545 Golden Bear Drive, Suite 110, Carrollton, TX 75006, USA; (L.S.); (P.A.); (L.M.); (S.H.); (G.W.); (E.B.)
| | - Luciana Madeira da Silva
- Department of Microbiology and Immunology, University of South Alabama, Mobile, AL 36688, USA; (L.M.d.S.); (R.A.B.)
| | - Robert A. Barrington
- Department of Microbiology and Immunology, University of South Alabama, Mobile, AL 36688, USA; (L.M.d.S.); (R.A.B.)
| | - Phylicia Aaron
- Gradalis, Inc., 2545 Golden Bear Drive, Suite 110, Carrollton, TX 75006, USA; (L.S.); (P.A.); (L.M.); (S.H.); (G.W.); (E.B.)
| | - Luisa Manning
- Gradalis, Inc., 2545 Golden Bear Drive, Suite 110, Carrollton, TX 75006, USA; (L.S.); (P.A.); (L.M.); (S.H.); (G.W.); (E.B.)
| | - Staci Horvath
- Gradalis, Inc., 2545 Golden Bear Drive, Suite 110, Carrollton, TX 75006, USA; (L.S.); (P.A.); (L.M.); (S.H.); (G.W.); (E.B.)
| | - Gladice Wallraven
- Gradalis, Inc., 2545 Golden Bear Drive, Suite 110, Carrollton, TX 75006, USA; (L.S.); (P.A.); (L.M.); (S.H.); (G.W.); (E.B.)
| | - Ernest Bognar
- Gradalis, Inc., 2545 Golden Bear Drive, Suite 110, Carrollton, TX 75006, USA; (L.S.); (P.A.); (L.M.); (S.H.); (G.W.); (E.B.)
| | | | - John Nemunaitis
- Gradalis, Inc., 2545 Golden Bear Drive, Suite 110, Carrollton, TX 75006, USA; (L.S.); (P.A.); (L.M.); (S.H.); (G.W.); (E.B.)
- Correspondence:
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14
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Oh J, Barve M, Senzer N, Aaron P, Manning L, Wallraven G, Bognar E, Stanbery L, Horvath S, Manley M, Nemunaitis J, Walter A, Rocconi RP. Corrigendum to "Long-term follow-up of Phase 2A trial results involving advanced ovarian cancer patients treated with Vigil® in frontline maintenance" [Gynecol. Oncol. Rep. 34 (2020) 100648]. Gynecol Oncol Rep 2021; 36:100740. [PMID: 34095420 DOI: 10.1016/j.gore.2021.100740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
[This corrects the article DOI: 10.1016/j.gore.2020.100648.].
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Affiliation(s)
- Jonathan Oh
- Texas Oncology, P.A., Dallas, TX, United States
| | - Minal Barve
- Texas Oncology, P.A., Dallas, TX, United States.,Mary Crowley Cancer Research Centers, Dallas, TX, United States
| | - Neil Senzer
- Gradalis, Inc., Carrolton, TX, United States
| | | | | | | | | | | | | | | | | | | | - Rodney P Rocconi
- University of South Alabama - Mitchell Cancer Institute, Mobile, AL, United States
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15
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Walter A, DeWerd L. PP-0118 Dosimeter evaluation for measurement of radial dose distributions for electronic brachytherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06428-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Tsolakian IG, Crim A, Lynn A, Zoorob D, Klein P, Walter A. Endometriosis-associated colorectal carcinosarcoma: A case report and review of the literature. Gynecol Oncol Rep 2021; 35:100696. [PMID: 33537388 PMCID: PMC7840852 DOI: 10.1016/j.gore.2021.100696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/22/2020] [Accepted: 12/31/2020] [Indexed: 12/02/2022] Open
Abstract
•Endometriosis associated intestinal tumors are rare, with 5 cases documented.•Endometriosis associated intestinal tumors might present like colorectal carcinoma.•Endometriosis associated intestinal Carcinoma is associated with poor prognosis.
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Affiliation(s)
- Ibrahim G. Tsolakian
- University of Toledo College of Medicine and Life Sciences – Department of ObGyn, United States
| | - Aleia Crim
- ProMedica Toledo Hospital, United States
| | - Amy Lynn
- ProMedica Toledo Hospital, United States
| | - Dani Zoorob
- University of Toledo College of Medicine and Life Sciences – Department of ObGyn, United States
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Gogineni V, Morand S, Staats H, Royfman R, Devanaboyina M, Einloth K, Dever D, Stanbery L, Aaron P, Manning L, Walter A, Edelman G, Dworkin L, Nemunaitis J. Current Ovarian Cancer Maintenance Strategies and Promising New Developments. J Cancer 2021; 12:38-53. [PMID: 33391401 PMCID: PMC7738841 DOI: 10.7150/jca.49406] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/17/2020] [Indexed: 12/11/2022] Open
Abstract
While ovarian cancer typically responds well to front line treatment, many patients will relapse within 5 years. Treatment options are less effective at each recurrence highlighting the need for novel maintenance therapies. PolyADP-ribose polymerase (PARP) inhibitors have recently gained approval in ovarian cancer maintenance. Niraparib was approved regardless of BRCA mutation status, however impact on overall survival is limited. Oliparib was approved for BRCA mutant and BRCA wildtype/homologous recombination deficient patients. This review will focus on current frontline ovarian cancer treatment as well molecularly based approaches to ovarian cancer management.
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18
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Oh J, Barve M, Senzer N, Aaron P, Manning L, Wallraven G, Bognar E, Stanbery L, Horvath S, Manley M, Nemunaitis J, Walter A, Rocconi RP. Long-term follow-up of Phase 2A trial results involving advanced ovarian cancer patients treated with Vigil® in frontline maintenance. Gynecol Oncol Rep 2020; 34:100648. [PMID: 33364285 PMCID: PMC7752749 DOI: 10.1016/j.gore.2020.100648] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/03/2020] [Accepted: 09/06/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
| | - Minal Barve
- Texas Oncology, P.A., Dallas, TX, United States
- Mary Crowley Cancer Research Centers, Dallas, TX, United States
| | - Neil Senzer
- Gradalis, Inc., Carrolton, TX, United States
| | | | | | | | | | | | | | | | | | | | - Rodney P Rocconi
- University of South Alabama - Mitchell Cancer Institute, Mobile, AL, United States
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19
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Castellano T, Maxwell J, Walter A, Thompson J, Landrum L. Phase II trial of vaginal cuff brachytherapy followed by dose-dense chemotherapy in early-stage endometrial cancer patients with enriched, high-intermediate risk factors for recurrence. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Walter A, Calite E, Gembruch U, Müller A, Geipel A. Intrauterine Wachstumsretardierung und Polyhydramnion – Spektrum möglicher Ursachen und Einfluss auf das postnatale Outcome. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- A Walter
- Universität Bonn, Abteilung für Geburtshilfe und Pränatale Medizin
| | - E Calite
- Universität Bonn, Abteilung für Geburtshilfe und Pränatale Medizin
| | - U Gembruch
- Universität Bonn, Abteilung für Geburtshilfe und Pränatale Medizin
| | - A Müller
- Universität Bonn, Abteilung für Neonatologie
| | - A Geipel
- Universität Bonn, Abteilung für Geburtshilfe und Pränatale Medizin
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21
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Morand S, Stanbery L, Walter A, Rocconi RP, Nemunaitis J. BRCA1/2 Mutation Status Impact on Autophagy and Immune Response: Unheralded Target. JNCI Cancer Spectr 2020; 4:pkaa077. [PMID: 33409454 PMCID: PMC7771003 DOI: 10.1093/jncics/pkaa077] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 12/27/2022] Open
Abstract
BRCA1 and possibly BRCA2 proteins may relate to the regulation of autophagy. Autophagy plays a key role in immune response from both a tumor and immune effector cell standpoint. In cells with BRCA mutations, increased autophagy leads to elevated expression of major histocompatibility complex class II but may cause subclonal neoantigen presentation, which may impair the immune response related to clonal neoantigen visibility. We review evidence of BRCA1/2 regulation of autophagy, immune response, and antigen presentation.
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Affiliation(s)
- Susan Morand
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | | | | | - Rodney P Rocconi
- University of South Alabama - Mitchell Cancer Institute, Mobile, AL, USA
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22
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Malczewska A, Procner A, Walter A, Kusnierz K, Zajecki W, Aslanian H, Kos-Kudla B. The NETest liquid biopsy is diagnostic for gastric neuroendocrine tumors: observations on the blood-based identification of microscopic and macroscopic residual diseaseOK. BMC Gastroenterol 2020; 20:235. [PMID: 32703157 PMCID: PMC7376918 DOI: 10.1186/s12876-020-01348-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 06/16/2020] [Indexed: 12/19/2022] Open
Abstract
Background NETest, a novel multi-gene liquid biopsy has utility in neuroendocrine tumor (NET) diagnosis and identification of residual disease. We independently assessed utility of the NETest to diagnose gastric neuroendocrine neoplasms (GNENs) and identify micro- and macroscopic residual disease. Methods Cohorts comprised histologically confirmed GNENs at biopsy, n = 46; GNETs Type 1: 42 (32 NET G1, 10 NET G2), a GNET Type 3: 1 well-differentiated NET G3, neuroendocrine carcinomas (NECs) (n = 3), and controls (n = 63). Disease status at sampling was assessed by gastroscopy, histology (resection margin [R] positivity of polypectomy or biopsy), EUS, CT or MRI, and/or 68Ga-DOTA-TATE PET/CT. Groups included image- (gastroscopy, EUS, and anatomical and/or functional imaging) positive or image negative disease. NETest assay by PCR (spotted plates, normal cut-off: 20). Data: mean ± SD. Results Disease extent: Image-negative (n = 30) (21 R0, 9 R1); Image-positive, n = 16. Diagnosis: NETest was increased in GNETs (23 ± 11) vs. controls (7 ± 4, p < 0.0001). In histology-positive, the NETest accuracy was 100% (25/25). Microscopic disease: In image-negative but R1, NETest was elevated in 100% (9/9; 28 ± 9). Levels were elevated vs. controls (7 ± 4, p < 0.0001), or R0 (16 ± 11, p = 0.02). Eight of 21 R0, exhibited positive NETest. Macroscopic disease: Gastric lesions were multiple: 38%, single: 62%, submucosal: 13%, or ulcerated: 13%. Lesions size was ≤5 mm (50%), > 5–9.9 mm (17%), 10–19.9 mm (17%), ≥20 mm (17%) [≥10 mm: 34%). The NETest accuracy was 100% (16/16). Levels (28 ± 7) were higher than controls (7 ± 4, p < 0.0001) or R0 (16 ± 11, p = 0.002) but not to R1 (28 ± 9, p = 0.5). Conclusions NETest is diagnostic for gastric NETs. Elevated levels identify both microscopic and macroscopic residual disease. In histology/image-negative disease, elevated NETest may reflect early evidence of increased neuroendocrine gene expression of hypergastrinemia-induced neoplastic transformation of enterochromaffin-like (ECL) cells to tumor status. A sensitive liquid biopsy has utility in the management and surveillance of gastric NET disease.
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Affiliation(s)
- A Malczewska
- Department of Endocrinology and Neuroendocrine Tumors, Medical University of Silesia, ul. Ceglana 35, 40-514, Katowice, Poland.
| | - A Procner
- Department of Endocrinology and Neuroendocrine Tumors, Medical University of Silesia, ul. Ceglana 35, 40-514, Katowice, Poland
| | - A Walter
- Department of Endocrinology and Neuroendocrine Tumors, Medical University of Silesia, ul. Ceglana 35, 40-514, Katowice, Poland
| | - K Kusnierz
- Department of Gastrointestinal Surgery, Medical University of Silesia, ul. Medykow 14, 40-752, Katowice, Poland
| | - W Zajecki
- Department of Pathology, Medical University of Silesia, ul. 3 Maja 13-15, 41-800, Zabrze, Poland
| | - H Aslanian
- Department of Digestive Diseases, Center for Advanced Endoscopy, Yale University School of Medicine, 310 Cedar Street, New Haven, CT, 06510, USA.
| | - B Kos-Kudla
- Department of Endocrinology and Neuroendocrine Tumors, Medical University of Silesia, ul. Ceglana 35, 40-514, Katowice, Poland
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23
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Amos LE, Yoo B, Miller N, Farrow EG, Walter A, Gibson M, Durham S, Herd S, Soden S, Carpenter SL. Using dried blood spots for variant analysis for patients with haemophilia. Haemophilia 2019; 25:e339-e341. [PMID: 31361374 DOI: 10.1111/hae.13824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 06/19/2019] [Accepted: 06/26/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Lauren E Amos
- Division of Hematology/Oncology, Children's Mercy Hospital, Kansas City, Missouri, USA.,Center for Pediatric Genomic Medicine, Children's Mercy Hospital, Kansas City, Missouri, USA.,Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Byunggil Yoo
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Neil Miller
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Emily G Farrow
- Center for Pediatric Genomic Medicine, Children's Mercy Hospital, Kansas City, Missouri, USA.,Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri, USA.,School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Adam Walter
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Margaret Gibson
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Sara Durham
- Division of Hematology/Oncology, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Suzanne Herd
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Sarah Soden
- Center for Pediatric Genomic Medicine, Children's Mercy Hospital, Kansas City, Missouri, USA.,Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri, USA.,School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Shannon L Carpenter
- Division of Hematology/Oncology, Children's Mercy Hospital, Kansas City, Missouri, USA.,Center for Pediatric Genomic Medicine, Children's Mercy Hospital, Kansas City, Missouri, USA.,Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri, USA
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24
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Vollmer B, Steblau N, Ladwig N, Mayer C, Macek B, Mitousis L, Sigle S, Walter A, Wohlleben W, Muth G. Role of the Streptomyces spore wall synthesizing complex SSSC in differentiation of Streptomyces coelicolor A3(2). Int J Med Microbiol 2019; 309:151327. [PMID: 31324525 DOI: 10.1016/j.ijmm.2019.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 07/02/2019] [Accepted: 07/07/2019] [Indexed: 10/26/2022] Open
Abstract
A crucial stage of the Streptomyces life cycle is the sporulation septation, a process were dozens of cross walls are synchronously formed in the aerial hyphae in a highly coordinated manner. This process includes the remodeling of the spore envelopes to make Streptomyces spores resistant to detrimental environmental conditions. Sporulation septation and the synthesis of the thickened spore envelope in S. coelicolor A3(2) involves the Streptomyces spore wall synthesizing complex SSSC. The SSSC is a multi-protein complex including proteins directing peptidoglycan synthesis (MreBCD, PBP2, Sfr, RodZ) and cell wall glycopolymer synthesis (PdtA). It also includes two eukaryotic like serin/threonine protein kinases (eSTPK), PkaI and PkaH, which were shown to phosphorylate MreC. Since unbalancing phosphorylation activity by either deleting eSTPK genes or by expressing a second copy of an eSTPK gene affected proper sporulation, a model was developed, in which the activity of the SSSC is controlled by protein phosphorylation.
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Affiliation(s)
- B Vollmer
- Interfakultaeres Institut für Mikrobiologie und Infektionsmedizin Tuebingen IMIT, Mikrobiologie/Biotechnologie, Eberhard Karls Universitaet Tuebingen, Auf der Morgenstelle 28, 72076, Tuebingen, Germany
| | - N Steblau
- Interfakultaeres Institut für Mikrobiologie und Infektionsmedizin Tuebingen IMIT, Mikrobiologie/Biotechnologie, Eberhard Karls Universitaet Tuebingen, Auf der Morgenstelle 28, 72076, Tuebingen, Germany
| | - N Ladwig
- Interfakultaeres Institut für Mikrobiologie und Infektionsmedizin Tuebingen IMIT, Mikrobiologie/Biotechnologie, Eberhard Karls Universitaet Tuebingen, Auf der Morgenstelle 28, 72076, Tuebingen, Germany
| | - C Mayer
- Interfakultaeres Institut für Mikrobiologie und Infektionsmedizin Tuebingen IMIT, Mikrobiologie/Biotechnologie, Eberhard Karls Universitaet Tuebingen, Auf der Morgenstelle 28, 72076, Tuebingen, Germany
| | - B Macek
- Proteome Center Tuebingen, Interfakultaeres Institut für Zellbiologie, Eberhard Karls Universitaet Tuebingen, Auf der Morgenstelle 15, 72076 Tübingen, Germany
| | - L Mitousis
- Interfakultaeres Institut für Mikrobiologie und Infektionsmedizin Tuebingen IMIT, Mikrobiologie/Biotechnologie, Eberhard Karls Universitaet Tuebingen, Auf der Morgenstelle 28, 72076, Tuebingen, Germany
| | - S Sigle
- Interfakultaeres Institut für Mikrobiologie und Infektionsmedizin Tuebingen IMIT, Mikrobiologie/Biotechnologie, Eberhard Karls Universitaet Tuebingen, Auf der Morgenstelle 28, 72076, Tuebingen, Germany
| | - A Walter
- Interfakultaeres Institut für Mikrobiologie und Infektionsmedizin Tuebingen IMIT, Mikrobiologie/Biotechnologie, Eberhard Karls Universitaet Tuebingen, Auf der Morgenstelle 28, 72076, Tuebingen, Germany
| | - W Wohlleben
- Interfakultaeres Institut für Mikrobiologie und Infektionsmedizin Tuebingen IMIT, Mikrobiologie/Biotechnologie, Eberhard Karls Universitaet Tuebingen, Auf der Morgenstelle 28, 72076, Tuebingen, Germany
| | - G Muth
- Interfakultaeres Institut für Mikrobiologie und Infektionsmedizin Tuebingen IMIT, Mikrobiologie/Biotechnologie, Eberhard Karls Universitaet Tuebingen, Auf der Morgenstelle 28, 72076, Tuebingen, Germany.
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Nagelmüller S, Yates S, Walter A. Diel leaf growth of rapeseed at critically low temperature under winter field conditions. Funct Plant Biol 2018; 45:1110-1118. [PMID: 32290972 DOI: 10.1071/fp17337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 04/23/2018] [Indexed: 06/11/2023]
Abstract
Growth and development of winter crops is strongly limited by low temperature during winter. Monitoring the temporal dynamics and thermal limits of leaf growth in that period can give important insights into the growth physiology at low temperature, crop management and future breeding traits for winter crops. In this study, we focussed on winter rapeseed as a model, dicotyledonous winter crop to study leaf growth under natural winter field conditions. Leaf growth was measured using a high-resolution marker based image sequence analysis method and the results were evaluated in the context of environmental conditions. Leaves stopped growing at a base temperature of 0°C. Above ~4°C, leaves grew with a diel (24h) growth rhythm, which is typically known for dicots at thermally non-limiting growth conditions. Relative leaf growth rates at temperatures above this 4°C threshold were higher at night and showed a pronounced depression during the day, which we could describe by a model based on the environmental factors vapour pressure deficit (VPD), temperature and light with VPD exerting the strongest negative effect on leaf growth. We conclude that leaf growth of the selected model species at low temperatures shows a transition between pronounced environmental regulation and a superposition of environmental and internal, possibly circadian-clock-dependent regulation.
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Affiliation(s)
- S Nagelmüller
- Institute of Agricultural Sciences, Swiss Federal Institute of Technology, Universitätstrasse 2, 8092 Zurich, Switzerland
| | - S Yates
- Institute of Agricultural Sciences, Swiss Federal Institute of Technology, Universitätstrasse 2, 8092 Zurich, Switzerland
| | - A Walter
- Institute of Agricultural Sciences, Swiss Federal Institute of Technology, Universitätstrasse 2, 8092 Zurich, Switzerland
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Abstract
Plant disease detection represents a tremendous challenge for research and practical applications. Visual assessment by human raters is time-consuming, expensive, and error prone. Disease rating and plant protection need new and innovative techniques to address forthcoming challenges and trends in agricultural production that require more precision than ever before. Within this context, hyperspectral sensors and imaging techniques-intrinsically tied to efficient data analysis approaches-have shown an enormous potential to provide new insights into plant-pathogen interactions and for the detection of plant diseases. This article provides an overview of hyperspectral sensors and imaging technologies for assessing compatible and incompatible plant-pathogen interactions. Within the progress of digital technologies, the vision, which is increasingly discussed in the society and industry, includes smart and intuitive solutions for assessing plant features in plant phenotyping or for making decisions on plant protection measures in the context of precision agriculture.
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Affiliation(s)
- A-K Mahlein
- Institute of Sugar Beet Research (IfZ), 37079 Göttingen, Germany;
| | - M T Kuska
- Institute of Crop Science and Resource Conservation (INRES)-Plant Diseases and Plant Protection, University of Bonn, 53115 Bonn, Germany
| | - J Behmann
- Institute of Crop Science and Resource Conservation (INRES)-Plant Diseases and Plant Protection, University of Bonn, 53115 Bonn, Germany
| | - G Polder
- Greenhouse Horticulture, Wageningen University and Research, 6708PB Wageningen, Netherlands
| | - A Walter
- Institute of Agricultural Sciences, ETH Zürich, 8092 Zürich, Switzerland
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27
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Walter A, Gembruch U, Flöck A, Merz WM. Schwangerschaft bei hereditärer peripherer sensomotorischer Neuropathie: Ein Fallbericht. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1660666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- A Walter
- Abteilung für Geburtshilfe und Pränatale Medizin, Universitätsklinikum Bonn
| | - U Gembruch
- Abteilung für Geburtshilfe und Pränatale Medizin, Universitätsklinikum Bonn
| | - A Flöck
- Abteilung für Geburtshilfe und Pränatale Medizin, Universitätsklinikum Bonn
| | - WM Merz
- Abteilung für Geburtshilfe und Pränatale Medizin, Universitätsklinikum Bonn
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Le Fèvre C, Vigneron C, Schuster H, Walter A, Marcellin L, Massard G, Lutz P, Noël G. Metastatic mediastinal mature teratoma with malignant transformation in a young man with an adenocarcinoma in a Klinefelter's syndrome: Case report and review of the literature. Cancer Radiother 2018; 22:255-263. [DOI: 10.1016/j.canrad.2017.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 09/18/2017] [Accepted: 10/19/2017] [Indexed: 11/25/2022]
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Bordeianu C, Parat A, Piant S, Walter A, Zbaraszczuk-Affolter C, Meyer F, Begin-Colin S, Boutry S, Muller RN, Jouberton E, Chezal JM, Labeille B, Cinotti E, Perrot JL, Miot-Noirault E, Laurent S, Felder-Flesch D. Evaluation of the Active Targeting of Melanin Granules after Intravenous Injection of Dendronized Nanoparticles. Mol Pharm 2018; 15:536-547. [PMID: 29298480 DOI: 10.1021/acs.molpharmaceut.7b00904] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The biodistribution of dendronized iron oxides, NPs10@D1_DOTAGA and melanin-targeting NPs10@D1_ICF_DOTAGA, was studied in vivo using magnetic resonance imaging (MRI) and planar scintigraphy through [177Lu]Lu-radiolabeling. MRI experiments showed high contrast power of both dendronized nanoparticles (DPs) and hepatobiliary and urinary excretions. Little tumor uptake could be highlighted after intravenous injection probably as a consequence of the negatively charged DOTAGA-derivatized shell, which reduces the diffusion across the cells' membrane. Planar scintigraphy images demonstrated a moderate specific tumor uptake of melanoma-targeted [177Lu]Lu-NPs10@D1_ICF_DOTAGA at 2 h post-intravenous injection (pi), and the highest tumor uptake of the control probe [177Lu]Lu-NPs10@D1_DOTAGA at 30 min pi, probably due to the enhanced permeability and retention effect. In addition, ex vivo confocal microscopy studies showed a high specific targeting of human melanoma samples impregnated with NPs10@D1_ICF_Alexa647_ DOTAGA.
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Affiliation(s)
- C Bordeianu
- Université de Strasbourg , CNRS, Institut de Physique et Chimie des Matériaux de Strasbourg, UMR 7504, F-67000 Strasbourg, France.,Fondation IcFRC/Université de Strasbourg , 8 allée Gaspard Monge BP 70028, F-67083 Strasbourg Cedex, France
| | - A Parat
- Université de Strasbourg , CNRS, Institut de Physique et Chimie des Matériaux de Strasbourg, UMR 7504, F-67000 Strasbourg, France.,Fondation IcFRC/Université de Strasbourg , 8 allée Gaspard Monge BP 70028, F-67083 Strasbourg Cedex, France
| | - S Piant
- Université de Strasbourg , CNRS, Institut de Physique et Chimie des Matériaux de Strasbourg, UMR 7504, F-67000 Strasbourg, France.,Fondation IcFRC/Université de Strasbourg , 8 allée Gaspard Monge BP 70028, F-67083 Strasbourg Cedex, France
| | - A Walter
- Université de Strasbourg , CNRS, Institut de Physique et Chimie des Matériaux de Strasbourg, UMR 7504, F-67000 Strasbourg, France.,Fondation IcFRC/Université de Strasbourg , 8 allée Gaspard Monge BP 70028, F-67083 Strasbourg Cedex, France
| | - C Zbaraszczuk-Affolter
- Université de Strasbourg , INSERM, UMR 1121 Biomatériaux et Bioingénierie, 11 rue Humann F-67000 Strasbourg, France
| | - F Meyer
- Université de Strasbourg , INSERM, UMR 1121 Biomatériaux et Bioingénierie, 11 rue Humann F-67000 Strasbourg, France
| | - S Begin-Colin
- Université de Strasbourg , CNRS, Institut de Physique et Chimie des Matériaux de Strasbourg, UMR 7504, F-67000 Strasbourg, France.,Fondation IcFRC/Université de Strasbourg , 8 allée Gaspard Monge BP 70028, F-67083 Strasbourg Cedex, France
| | - S Boutry
- University of Mons , General, Organic and Biomedical Chemistry NMR and Molecular Imaging Laboratory, Avenue Maistriau 19, 7000 Mons, Belgium.,CMMI - Center for Microscopy and Molecular Imaging, MRI & Optical Imaging , Rue Adrienne Bolland 8, 6041 Gosselies, Belgium
| | - R N Muller
- University of Mons , General, Organic and Biomedical Chemistry NMR and Molecular Imaging Laboratory, Avenue Maistriau 19, 7000 Mons, Belgium.,CMMI - Center for Microscopy and Molecular Imaging, MRI & Optical Imaging , Rue Adrienne Bolland 8, 6041 Gosselies, Belgium
| | - E Jouberton
- Clermont Université, Université d'Auvergne , Laboratoire d'Imagerie Moléculaire et Thérapie Vectorisée, BP 10448, F-63000 Clermont-Ferrand, France.,INSERM, U1240 , F-63005 Clermont-Ferrand, France
| | - J-M Chezal
- Clermont Université, Université d'Auvergne , Laboratoire d'Imagerie Moléculaire et Thérapie Vectorisée, BP 10448, F-63000 Clermont-Ferrand, France.,INSERM, U1240 , F-63005 Clermont-Ferrand, France
| | - B Labeille
- CHU , Département de Dermatologie, F-42000 St. Etienne, France
| | - E Cinotti
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena , S. Maria alle Scotte Hospital, F-53100 Siena, Italy
| | - J-L Perrot
- CHU , Département de Dermatologie, F-42000 St. Etienne, France
| | - E Miot-Noirault
- Clermont Université, Université d'Auvergne , Laboratoire d'Imagerie Moléculaire et Thérapie Vectorisée, BP 10448, F-63000 Clermont-Ferrand, France.,INSERM, U1240 , F-63005 Clermont-Ferrand, France
| | - S Laurent
- University of Mons , General, Organic and Biomedical Chemistry NMR and Molecular Imaging Laboratory, Avenue Maistriau 19, 7000 Mons, Belgium.,CMMI - Center for Microscopy and Molecular Imaging, MRI & Optical Imaging , Rue Adrienne Bolland 8, 6041 Gosselies, Belgium
| | - D Felder-Flesch
- Université de Strasbourg , CNRS, Institut de Physique et Chimie des Matériaux de Strasbourg, UMR 7504, F-67000 Strasbourg, France.,Fondation IcFRC/Université de Strasbourg , 8 allée Gaspard Monge BP 70028, F-67083 Strasbourg Cedex, France
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Walter A, Finelli K, Bai X, Arnett P, Bream T, Seidenberg P, Lynch S, Johnson B, Slobounov S. Effect of Enzogenol® Supplementation on Cognitive, Executive, and Vestibular/Balance Functioning in Chronic Phase of Concussion. Dev Neuropsychol 2017; 42:93-103. [PMID: 28452602 DOI: 10.1080/87565641.2016.1256404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study examined the feasibility of Enzogenol® as a potential treatment modality for concussed individuals with residual symptoms in the chronic phase. Forty-two student-athletes with history of sport-related concussion were enrolled, comparing Enzogenol® versus placebo. Testing was conducted using virtual reality (VR) and electroencephalography (EEG), with neuropsychological (NP) tasks primarily used to induce cognitive challenges. After six weeks, the Enzogenol® group showed enhanced frontal-midline theta, and decreased parietal theta power, indicating reduced mental fatigue. Subjects enrolled in the Enzogenol® group also self-reported reduced mental fatigue and sleep problems. This suggests that Enzogenol® has the potential to improve brain functioning in the chronic phase of concussion.
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Affiliation(s)
- A Walter
- a Penn State Center for Sport Concussion , Pennsylvania State University , University Park , Pennsylvania.,b Department of Kinesiology , Pennsylvania State University , University Park , Pennsylvania
| | - K Finelli
- a Penn State Center for Sport Concussion , Pennsylvania State University , University Park , Pennsylvania.,b Department of Kinesiology , Pennsylvania State University , University Park , Pennsylvania
| | - X Bai
- c Social, Life, and Engineering Sciences Imaging Center , Pennsylvania State University , University Park , Pennsylvania
| | - P Arnett
- c Social, Life, and Engineering Sciences Imaging Center , Pennsylvania State University , University Park , Pennsylvania
| | - T Bream
- d Department of Psychology , Pennsylvania State University , University Park , Pennsylvania
| | - P Seidenberg
- a Penn State Center for Sport Concussion , Pennsylvania State University , University Park , Pennsylvania.,e Intercollegiate Athletics , Pennsylvania State University , University Park , Pennsylvania
| | - S Lynch
- a Penn State Center for Sport Concussion , Pennsylvania State University , University Park , Pennsylvania.,e Intercollegiate Athletics , Pennsylvania State University , University Park , Pennsylvania
| | - B Johnson
- a Penn State Center for Sport Concussion , Pennsylvania State University , University Park , Pennsylvania.,b Department of Kinesiology , Pennsylvania State University , University Park , Pennsylvania
| | - S Slobounov
- a Penn State Center for Sport Concussion , Pennsylvania State University , University Park , Pennsylvania.,b Department of Kinesiology , Pennsylvania State University , University Park , Pennsylvania
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Bredin S, Fabre-Aubrespy M, Blondel B, Falguières J, Schuller S, Walter A, Fuentes S, Tropiano P, Steib JP, Charles YP. Percutaneous surgery for thoraco-lumbar fractures in ankylosing spondylitis: Study of 31 patients. Orthop Traumatol Surg Res 2017; 103:1235-1239. [PMID: 28964918 DOI: 10.1016/j.otsr.2017.07.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/11/2017] [Accepted: 07/18/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The risk of vertebral fracture is increased 4-fold in patients with ankylosing spondylitis (AS). Diagnostic challenges and the vulnerability associated with AS combine to generate high morbidity and mortality rates. The objective of this study was to assess the outcome of percutaneous thoraco-lumbar fracture surgery in patients with AS, in terms of quality of life, fracture healing, and complications. HYPOTHESIS Percutaneous surgery used to treat thoraco-lumbar fractures in patients with AS reliably provides fracture healing, preserves self-sufficiency, and minimises post-operative complications. METHODS Two centres included 31 patients with AS who were managed by percutaneous surgery for thoraco-lumbar fractures in 2013-2015. The data were reviewed retrospectively, although admission data were collected prospectively. Clinical outcomes were assessed by comparing the values at baseline and last follow-up of three variables: the Parker score, the visual analogue scale (VAS) pain score, and the EuroQol five dimensions (EQ-5D) quality-of-life score. Computed tomography was performed 1 year after surgery to evaluate bone healing, screw position, and implant loosening. Intra- and post-operative complications were recorded. RESULTS The 31 patients had a mean age at surgery of 75.1 years, a mean follow-up of 35.6 months, and a minimum follow-up of 12 months. Three patients died during follow-up. Mean hospital stay duration was 6 days. Cemented screw fixation was used in 18 patients. At last follow-up, all patients had recovered their self-sufficiency; the mean Parker score was 7.14, compared to 6.73 at baseline, the mean VAS pain score was 1.8, and the mean EQ-5D score decrease versus baseline was 0.07 (P=0.02). Bone healing was consistently achieved. Loosening of an uncemented pedicle screw was noted in 1 patient. Of the 228 screws implanted, 6 (2.6%) were improperly positioned, including 1 within the spinal canal in a patient free of neurological manifestations. Asymptomatic cement leakage was noted in 2 patients. DISCUSSION Percutaneous fixation of thoraco-lumbar fractures in patients with AS is a reliable method that produces a high healing rate and allows prompt patient mobilisation with preservation of self-sufficiency. The post-operative complication rate is low. LEVEL OF EVIDENCE IV, retrospective observational study.
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Affiliation(s)
- S Bredin
- Department of Orthopaedic Surgery, CHU Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
| | - M Fabre-Aubrespy
- Service de chirurgie du rachis, université Aix-Marseille, CHU Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - B Blondel
- Service de chirurgie du rachis, université Aix-Marseille, CHU Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - J Falguières
- Service de chirurgie du rachis, université Aix-Marseille, CHU Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - S Schuller
- Service de chirurgie du rachis, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg, France
| | - A Walter
- Service de chirurgie du rachis, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg, France
| | - S Fuentes
- Service de neurochirurgie, université Aix-Marseille, CHU Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - P Tropiano
- Service de chirurgie du rachis, université Aix-Marseille, CHU Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - J-P Steib
- Service de chirurgie du rachis, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg, France
| | - Y-P Charles
- Service de chirurgie du rachis, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg, France
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Affiliation(s)
- Kathleen Moore
- Stephenson Cancer Center, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Rebecca Stone
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Adam Walter
- Stephenson Cancer Center, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Adjei A, Walter A, Cupit L, Siegel J, Holynskyj A, Childs B, Elbi C. Phase 1b multi-indication study of the antibody drug conjugate anetumab ravtansine in patients with mesothelin-expressing advanced or recurrent malignancies. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx367.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Knüppel S, Walter A, Boeing H. Updated Multiple Source Method (MSM). Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1606024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- S Knüppel
- Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke, Epidemiologie, Nuthetal
| | - A Walter
- Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke, Epidemiologie, Nuthetal
| | - H Boeing
- Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke, Epidemiologie, Nuthetal
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Kousa YA, Roushangar R, Patel N, Walter A, Marangoni P, Krumlauf R, Klein OD, Schutte BC. IRF6 and SPRY4 Signaling Interact in Periderm Development. J Dent Res 2017; 96:1306-1313. [PMID: 28732181 DOI: 10.1177/0022034517719870] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Rare mutations in IRF6 and GRHL3 cause Van der Woude syndrome, an autosomal dominant orofacial clefting disorder. Common variants in IRF6 and GRHL3 also contribute risk for isolated orofacial clefting. Similarly, variants within genes that encode receptor tyrosine kinase (RTK) signaling components, including members of the FGF pathway, EPHA3 and SPRY2, also contribute risk for isolated orofacial clefting. In the mouse, loss of Irf6 or perturbation of Fgf signaling leads to abnormal oral epithelial adhesions and cleft palate. Oral adhesions can result from a disruption of periderm formation. Here, we find that IRF6 and SPRY4 signaling interact in periderm function. We crossed Irf6 heterozygous ( Irf6+/-) mice with transgenic mice that express Spry4 in the basal epithelial layer ( TgKRT14::Spry4). While embryos with either of these mutations can have abnormal oral adhesions, using a new quantitative assay, we observed a nonadditive effect of abnormal oral epithelial adhesions in the most severely affected double mutant embryos ( Irf6+/-;TgKRT14::Spry4). At the molecular level, the sites of abnormal oral adhesions maintained periderm-like cells that express keratin 6, but we observed abnormal expression of GRHL3. Together, these data suggest that Irf6 and RTK signaling interact in regulating periderm differentiation and function, as well as provide a rationale to screen for epistatic interactions between variants in IRF6 and RTK signaling pathway genes in human orofacial clefting populations.
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Affiliation(s)
- Y A Kousa
- 1 Department of Biochemistry and Molecular Biology, Michigan State University, East Lansing, MI, USA
| | - R Roushangar
- 1 Department of Biochemistry and Molecular Biology, Michigan State University, East Lansing, MI, USA
| | - N Patel
- 2 Pediatrics and Human Development, Michigan State University, East Lansing, MI, USA
| | - A Walter
- 2 Pediatrics and Human Development, Michigan State University, East Lansing, MI, USA
| | - P Marangoni
- 3 Departments of Orofacial Sciences and Pediatrics and Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA
| | - R Krumlauf
- 4 Stowers Institute for Medical Research, Kansas City, MO, USA.,5 Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, KS, USA
| | - O D Klein
- 3 Departments of Orofacial Sciences and Pediatrics and Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA
| | - B C Schutte
- 2 Pediatrics and Human Development, Michigan State University, East Lansing, MI, USA.,6 Departments of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI, USA
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Crim A, Rowland M, Ruskin R, Dvorak J, Greenwade M, Walter A, Gillen J, Ding K, Moore K, Gunderson C. Evaluation of the efficacy and toxicity profile associated with intraperitoneal chemotherapy use in older women. Gynecol Oncol 2017; 146:268-272. [PMID: 28583323 DOI: 10.1016/j.ygyno.2017.05.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 05/11/2017] [Accepted: 05/24/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Intraperitoneal (IP) chemotherapy (CT) for treatment of epithelial ovarian cancer (EOC) has been shown to provide a substantial OS advantage. This study aims to compare the toxicity and benefits of IP CT in patients ≥70 with those <70. METHODS We performed a single institution retrospective review of patients diagnosed with Stage IIA-IIIC EOC from 2000 to 2013 who received IP CT. Clinicopathologic characteristics were extracted, and survival was calculated. RESULTS 133 patients were included with 100 pts. <70years old and 33 pts. ≥70years old. Clinical trial enrollment was similar despite age. In trial enrolled patients, older patients received statistically fewer cycles of therapy (6.4 vs 5.8, p=0.002) but had similar dose delays (0.9 vs 0.7, p=0.72), and modifications (0.9 vs 0.36, p=0.11). Median PFS (27 vs 31months) and OS (71 and 62months) were not statistically different. Grade 3/4 neutropenia was significantly worse in the older patients (82% vs 100%, p=0.04). Neuropathy grade ≥2 and other non-hematologic toxicities were not different between age groups. CONCLUSIONS Despite completing fewer cycles of IP CT, older EOC patients had comparable survival to younger patients. The population of older patients receiving IP CT in this study were on clinical trial and likely to be heartier than the general older population. IP CT appears well tolerated and effective among select older patients and is likely under-utilized outside of clinical trials.
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Affiliation(s)
- A Crim
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK, USA.
| | - M Rowland
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK, USA.
| | - R Ruskin
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK, USA.
| | - J Dvorak
- Department of Biostatistics and Epidemiology, University of Oklahoma, Oklahoma City, OK, USA.
| | - M Greenwade
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK, USA.
| | - A Walter
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK, USA.
| | - J Gillen
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK, USA.
| | - K Ding
- Department of Biostatistics and Epidemiology, University of Oklahoma, Oklahoma City, OK, USA.
| | - K Moore
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK, USA.
| | - C Gunderson
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK, USA.
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Gripp K, Baker L, Kandula V, Piatt J, Walter A, Chen Z, Messiaen L. Constitutional LZTR1
mutation presenting with a unilateral vestibular schwannoma in a teenager. Clin Genet 2017; 92:540-543. [DOI: 10.1111/cge.13013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 03/08/2017] [Accepted: 03/10/2017] [Indexed: 12/17/2022]
Affiliation(s)
- K.W. Gripp
- A. I. du Pont Hospital for Children/Nemours; Wilmington Delaware
| | - L. Baker
- A. I. du Pont Hospital for Children/Nemours; Wilmington Delaware
| | - V. Kandula
- A. I. du Pont Hospital for Children/Nemours; Wilmington Delaware
| | - J. Piatt
- A. I. du Pont Hospital for Children/Nemours; Wilmington Delaware
| | - A. Walter
- A. I. du Pont Hospital for Children/Nemours; Wilmington Delaware
| | - Z. Chen
- University of Alabama; Birmingham Alabama
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Kärger J, Shdanov SP, Walter A. NMR-Untersuchungen zur intrakristallinen Selbstdiffusion von n-Butan und n-Heptan an NaX-Zeolithen. ACTA ACUST UNITED AC 2017. [DOI: 10.1515/zpch-1975-25641] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kärger J, Pfeifer H, Rauscher M, Walter A. Selbstdiffusionsverhalten der homologen Reihe der n-Alkane von n-Butan bis n-Oktadekan in NaX-Zeolithen. Z PHYS CHEM 2017. [DOI: 10.1515/zpch-1978-25999] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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40
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Postel-Vinay S, Herbschleb K, Massard C, Woodcock V, Ocker M, Wilkinson G, Walter A, Ewerton F, Poelman M, Middleton M, Soria J. First-in-human phase I dose escalation study of the Bromodomain and Extra-Terminal motif (BET) inhibitor BAY 1238097 in subjects with advanced malignancies. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)32620-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Affiliation(s)
- W. N. Chan
- Universidade Estadual de Campinas, Brazil; Petróleo Brasileiro S.A., Brasil
| | - A. Walter
- Universidade Estadual de Campinas, Brazil
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Hampel OA, Hasmann R, Karpinski N, Gießelmann LS, Hasmann SE, Hubig C, Böcking K, Hasmann T, Volkert LR, Böhm D, Melder L, Walter A, Schlaich S, Engler-Plörer S, Holl RW, Petermann F. Stepping Stones Triple P. Monatsschr Kinderheilkd 2016. [DOI: 10.1007/s00112-016-0175-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Affiliation(s)
- A. Zormann
- Department of Psychiatry, University of Basel, Basel, Switzerland
| | - J. Blum
- Department of Psychiatry, University of Basel, Basel, Switzerland
| | - C. Suenderhauf
- Clinical Pharmacology and Toxicology, University Hospital Basel, Basel, Switzerland
| | - M. Vogel
- Department of Psychiatry, University of Basel, Basel, Switzerland
| | - A. Walter
- Department of Psychiatry, University of Basel, Basel, Switzerland
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Greenwade M, Rowland M, Ruskin R, Ding K, Gillen J, Crim A, Walter A, Kleis B, Moore K, Gunderson C. Factors influencing clinical trial enrollment among ovarian cancer patients. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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45
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Rowland M, Ruskin R, Dvorak J, Gunderson C, Walter A, Crim A, Gillen J, Greenwade M, Ding K, Moore K. Exploring further the poor outcomes of elderly patients with platinum-sensitive recurrent ovarian cancer using a contemporary application of the SOCRATES study. Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Crim A, Rowland M, Ruskin R, Dvorak J, Greenwade M, Walter A, Gillen J, Ding K, Moore K, Gunderson C. Is intraperitoneal chemotherapy as effective within the elderly population for the treatment of epithelial ovarian cancer? Gynecol Oncol 2016. [DOI: 10.1016/j.ygyno.2016.04.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Chahoud I, Talsness C, Walter A, Grote K. Postnatal investigation of prenatally induced effects on the vertebral column of rats reduces the uncertainty of classification of anomalies. Reprod Toxicol 2015. [DOI: 10.1016/j.reprotox.2015.07.078] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Olson R, Ozier D, LaPointe V, Walter A, Bowering G, Curtis S, Nichol A. Incidence of Patient Reported Depression at Time of Radiation Therapy Planning for Brain Metastases: Impact on Radiation Therapists and Counseling Services. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ruskin R, Rowland MR, Moore KN, Slaughter K, Walter A, Landrum LM, Walker JL, Matzo M. Predictors of referral to outpatient specialty palliative care (SPC) in gynecologic cancer (GC) patients. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.29_suppl.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
159 Background: Prior studies in GC patients have described predictors of inpatient palliative care (PC) consultation, but predictors of outpatient SPC consultation have not been elucidated. We sought to identify factors predictive of referral and associated care outcomes. Methods: We performed a cross-sectional study of GC patients seen in the gynecologic oncology clinic at a comprehensive cancer center over a three month period. As a part of routine care, patients completed a symptom questionnaire. Patients previously seen at the outpatient PC clinic were compared to those who had not with respect to demographics, disease characteristics, symptom scores, and provider factors using univariate statistics. A multivariate model was created to identify independent predictors of referral. Results: 913 patients completed the symptom survey. 76 patients (8%) had been seen in the outpatient PC clinic. Disease factors associated with referral included site (p < 0.01), stage (p < 0.01), evidence of disease (p < 0.01), active treatment (p < 0.01), and time point in the disease trajectory (p < 0.01). Women with moderate to severe pain (p < 0.01), sadness (p = 0.03), distress (p < 0.01), fatigue (p < 0.01), neuropathy (p = 0.03), and sexual dysfunction (p < 0.01) were more likely to have seen PC. Marital status, number of symptoms, and patient provider were also predictive of referral (all p < 0.01). In a multivariate model, site, stage, number of symptoms, moderate to severe sexual dysfunction, and provider were independently associated with referral. Compared to women who had not been referred, patients seen in the PC clinic were more likely to have a health care proxy documented in the electronic medical record (p < 0.01). Among patients with related symptoms, patients referred to PC more often had an opioid prescribed for pain (p < 0.01) and medications prescribed for depression (p < 0.01), anxiety (p = 0.04), insomnia (p < 0.01), and fatigue (p < 0.01). Conclusions: Women with depression, anxiety, insomnia, and fatigue were more likely to receive pharmacologic treatment for these symptoms from a SPC provider. Future research should identify referral triggers for those patients most likely to benefit from outpatient SPC consultation.
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Affiliation(s)
- Rachel Ruskin
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | | | | | - Adam Walter
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | - Joan L. Walker
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Marianne Matzo
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
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Ruskin R, Rowland MR, Moore KN, Lefkowits C, Walter A, Slaughter K, Landrum LM, Walker JL, Matzo M. How do palliative care needs vary across the disease trajectory in patients with gynecologic cancer? J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.29_suppl.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
106 Background: The WHO’s integrated model emphasizes that palliative care (PC) should be provided concurrently with curative and life-prolonging care, with disease-directed treatments decreasing and PC increasing over time. This study aimed to understand how accurately this theoretical model matches the PC needs of gynecologic cancer (GC) patients. Methods: GC patients at a comprehensive cancer center completed a symptom and needs assessment questionnaire as part of routine care. Needs were divided into physical, emotional, social, practical, and informational domains. Patients reporting at least one symptom score ≥ 4/10 made the physical need domain positive. For the remainder of the categories, patients endorsing at least one need in a given domain made that domain positive. Time points in the illness trajectory were categorized as diagnosis, primary treatment, remission, and progression/recurrence. Univariate analyses were utilized to assess differences in needs at various time points. Results: Questionnaires from 1348 patient visits over 3 months were included. Patients had ovarian (39%), uterine (36%), cervical (16%), and vulvar (5%) cancer. Visits occurred around the time of diagnosis (6%), during primary therapy (28%), during remission (42%), and during disease progression or recurrence (23%). Physical needs were most common at diagnosis and during progression/recurrence (p < 0.01). Emotional needs (p < 0.01), social needs (p < 0.01), and informational needs (p < 0.01) all varied throughout the course of disease and were highest at diagnosis. At each time point, at least 65% of patients had one or more PC needs. Having needs in multiple domains ( ≥ 3) was associated with time point, with patients around the time of diagnosis having the highest rate of need in multiple domains (p < 0.01). Conclusions: GC patients have a broad range of PC needs across the trajectory of their illness. The WHO schema fails to capture the full scope of these needs and under-appreciates their prevalence earlier in the course of the disease. These results underscore the importance of training gynecologic oncologists in primary PC as well as increasing referrals to specialist PC providers.
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Affiliation(s)
- Rachel Ruskin
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | | | | | - Adam Walter
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | | | - Joan L. Walker
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Marianne Matzo
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
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