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May A, Gerhards H, Wollanke B. Effect of hospitalization on equine local intestinal immunoglobulin A (IgA) concentration measured in feces. J Equine Vet Sci 2024:105078. [PMID: 38697372 DOI: 10.1016/j.jevs.2024.105078] [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: 11/27/2023] [Revised: 03/15/2024] [Accepted: 04/29/2024] [Indexed: 05/05/2024]
Abstract
During hospitalization horses may develop gastrointestinal conditions triggered by a stress-associated weak local immune system. The prospective, clinical trial was conducted to find out whether fecal immunoglobulin A (IgA) concentrations could be determined in hospitalized horses and how they changed during hospitalization and in response to various stressors. Samples were obtained from 110 horses and a control group (n = 14). At arrival in the hospital, horses were categorized into pain grades (1-5), and elective versus strenuous surgery (> 2 hours, traumatic and emergency procedures). Feces were collected on day 1, day 2, day 3, and day 7 in all horses. Blood samples were obtained at the same intervals, but additionally after general anaesthesia in horses undergoing surgery (day 2). IgA concentration in feces was determined by ELISA and measured in optical density at 450nm. The control group showed constant IgA concentrations on all days (mean value 0.30 OD450 ±SD 0.11, 1.26 mg/g; n = 11). After general anaesthesia fecal IgA concentrations decreased considerably independent of duration and type of surgery (P < 0.001 for elective and P = 0.043 for traumatic surgeries). High plasma cortisol concentrations were weakly correlated with low fecal IgA on the day after surgery (P = 0.012, day 3, correlation coefficient r = 0.113). Equine fecal IgA concentrations showed a decline associated with transport, surgery, and hospitalization in general, indicating that stress has an impact on the local intestinal immune function and may predispose horses for developing gastrointestinal diseases such as enterocolitis.
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Affiliation(s)
- A May
- Equine Hospital, Ludwig-Maximilians-University Munich, Sonnenstrasse 14, 85764 Oberschleissheim, Germany.
| | - H Gerhards
- retired, former head of Equine Hospital, Ludwig-Maximilians-University Munich, Germany
| | - B Wollanke
- Equine Hospital, Ludwig-Maximilians-University Munich, Sonnenstrasse 14, 85764 Oberschleissheim, Germany
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2
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Schäfer J, May A, Wittenberg J, Hahn K, Graubner C, Gerber V, Drögemüller C, Unger L. [DDB2-associated incidence of squamous cell carcinoma in Haflingers: risk minimization by genotyping]. SCHWEIZ ARCH TIERH 2023; 165:707-715. [PMID: 37905572 DOI: doi.org/10.17236/sat00409] [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] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
INTRODUCTION SCC (squamous cell carinomas) are among the most common eye neoplasms in horses. In recent studies Haflinger horses with a homozygous genotype for a missense variant in the DDB2 gene (damage specific DNA binding protein 2) had a significant increased risk of developing ocular SCC. The aims of this study were to determine the frequency of the SCC-associated risk allele in the DDB2 gene in Swiss and Austrian Haflinger populations and to validate the previously described phenotypic correlation. For this purpose, Haflingers presented at various horse clinics in Switzerland (n = 21, including 11 SCC cases), privately kept Haflingers (n = 52, including 1 SCC case), and Haflingers from a stud farm in the Austrian Tyrol (n = 53) were recruited. The individual DDB2 genotype of the animals was determined using a polymerase chain ceaction (PCR) test using hair follicle or whole blood samples. Of the 12 horses suffering from SCC, nine had ocular SCC and three had non-ocular SCC. Six of the nine Haflingers with ocular SCC and one of the three Haflingers with non-ocular SCC were homozygous for the DDB2 variant. Of the 113 clinically normal animals, 7/113 were homozygous (6 %) and 42/113 were heterozygous (37 %), which corresponds to an allele frequency of 24,8 % in the control cohort. The risk of ocular SCC occurring in Haflingers is significantly increased with the homozygous DDB2 genotype. However, not all animals with SCC carry this gene variant and not all DDB2 homozygous animals develop SCC, which can be explained by the multifactorial genesis of the disease. Due to the high frequency of the undesirable allele, we recommend taking the individual DDB2 genotype of breeding animals into account in order to avoid homozygous offspring with a greatly increased SCC risk by excluding high-risk matings.
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Affiliation(s)
- J Schäfer
- Swiss Institute of Equine Medicine (ISME), Departement für klinische Veterinärmedizin, Vetsuisse-Fakultät, Universität Bern
| | - A May
- Pferdeklinik der Ludwig-Maximilians-Universität München, Universität München
| | - J Wittenberg
- Pferdeklinik der Ludwig-Maximilians-Universität München, Universität München
| | - K Hahn
- Pferdeklinik der Ludwig-Maximilians-Universität München, Universität München
| | - C Graubner
- Swiss Institute of Equine Medicine (ISME), Departement für klinische Veterinärmedizin, Vetsuisse-Fakultät, Universität Bern
| | - V Gerber
- Swiss Institute of Equine Medicine (ISME), Departement für klinische Veterinärmedizin, Vetsuisse-Fakultät, Universität Bern
| | - C Drögemüller
- Institut für Genetik, Vetsuisse-Fakultät, Universität Bern
| | - L Unger
- Swiss Institute of Equine Medicine (ISME), Departement für klinische Veterinärmedizin, Vetsuisse-Fakultät, Universität Bern
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Mahamat‐Saleh Y, Rinaldi S, Kaaks R, Biessy C, Gonzalez‐Gil EM, Murphy N, Le Cornet C, Huerta JM, Sieri S, Tjønneland A, Mellemkjær L, Guevara M, Overvad K, Perez‐Cornago A, Tin Tin S, Padroni L, Simeon V, Masala G, May A, Monninkhof E, Christakoudi S, Heath AK, Tsilidis K, Agudo A, Schulze MB, Rothwell J, Cadeau C, Severi S, Weiderpass E, Gunter MJ, Dossus L. Metabolically defined body size and body shape phenotypes and risk of postmenopausal breast cancer in the European Prospective Investigation into Cancer and Nutrition. Cancer Med 2023; 12:12668-12682. [PMID: 37096432 PMCID: PMC10278526 DOI: 10.1002/cam4.5896] [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: 10/24/2022] [Revised: 03/06/2023] [Accepted: 03/23/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Excess body fatness and hyperinsulinemia are both associated with an increased risk of postmenopausal breast cancer. However, whether women with high body fatness but normal insulin levels or those with normal body fatness and high levels of insulin are at elevated risk of breast cancer is not known. We investigated the associations of metabolically defined body size and shape phenotypes with the risk of postmenopausal breast cancer in a nested case-control study within the European Prospective Investigation into Cancer and Nutrition. METHODS Concentrations of C-peptide-a marker for insulin secretion-were measured at inclusion prior to cancer diagnosis in serum from 610 incident postmenopausal breast cancer cases and 1130 matched controls. C-peptide concentrations among the control participants were used to define metabolically healthy (MH; in first tertile) and metabolically unhealthy (MU; >1st tertile) status. We created four metabolic health/body size phenotype categories by combining the metabolic health definitions with normal weight (NW; BMI < 25 kg/m2 , or WC < 80 cm, or WHR < 0.8) and overweight or obese (OW/OB; BMI ≥ 25 kg/m2 , or WC ≥ 80 cm, or WHR ≥ 0.8) status for each of the three anthropometric measures separately: (1) MHNW, (2) MHOW/OB, (3) MUNW, and (4) MUOW/OB. Conditional logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Women classified as MUOW/OB were at higher risk of postmenopausal breast cancer compared to MHNW women considering BMI (OR = 1.58, 95% CI = 1.14-2.19) and WC (OR = 1.51, 95% CI = 1.09-2.08) cut points and there was also a suggestive increased risk for the WHR (OR = 1.29, 95% CI = 0.94-1.77) definition. Conversely, women with the MHOW/OB and MUNW were not at statistically significant elevated risk of postmenopausal breast cancer risk compared to MHNW women. CONCLUSION These findings suggest that being overweight or obese and metabolically unhealthy raises risk of postmenopausal breast cancer while overweight or obese women with normal insulin levels are not at higher risk. Additional research should consider the combined utility of anthropometric measures with metabolic parameters in predicting breast cancer risk.
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Affiliation(s)
| | - S. Rinaldi
- International Agency for Research on CancerLyonFrance
| | - R. Kaaks
- Division of Cancer EpidemiologyGerman Cancer Research Center (DFKZ)HeidelbergGermany
| | - C. Biessy
- International Agency for Research on CancerLyonFrance
| | | | - N. Murphy
- International Agency for Research on CancerLyonFrance
| | - C. Le Cornet
- Division of Cancer EpidemiologyGerman Cancer Research Center (DFKZ)HeidelbergGermany
| | - J. M. Huerta
- Department of EpidemiologyMurcia Regional Health CouncilMurciaSpain
- CIBER Epidemiología y Salud Pública (CIBERESP)MadridSpain
| | - S. Sieri
- Epidemiology and Prevention UnitFondazione IRCCS Istituto Nazionale dei Tumori20133MilanItaly
| | - A. Tjønneland
- Danish Cancer Society Research CenterCopenhagenDenmark
- Department of Public HealthUniversity of CopenhagenCopenhagenDenmark
| | - L. Mellemkjær
- Danish Cancer Society Research CenterCopenhagenDenmark
| | - M. Guevara
- Navarra Public Health Institute31003PamplonaSpain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)28029MadridSpain
- Navarra Institute for Health Research (IdiSNA)31008PamplonaSpain
| | - K. Overvad
- Department of Public Health, Section for EpidemiologyAarhus UniversityAarhusDenmark
| | - A. Perez‐Cornago
- Cancer Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - S. Tin Tin
- Cancer Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - L. Padroni
- Department of Clinical and Biological SciencesUniversity of TurinTurinItaly
| | - V. Simeon
- Dipartimento di Salute Mentale e Fisica e Medicina PreventivaUniversità degli Studi della Campania 'Luigi Vanvitelli'80121NaplesItaly
| | - G. Masala
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO)FlorenceItaly
| | - A. May
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - E. Monninkhof
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - S. Christakoudi
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Department of Inflammation BiologySchool of Immunology and Microbial SciencesKing's College LondonLondonUK
| | - A. K. Heath
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - K. Tsilidis
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - A. Agudo
- Unit of Nutrition and CancerCatalan Institute of Oncology – ICOL'Hospitalet de LlobregatSpain
- Nutrition and Cancer Group; Epidemiology, Public Health, Cancer Prevention and Palliative Care ProgramBellvitge Biomedical Research Institute – IDIBELLL'Hospitalet de LlobregatSpain
| | - M. B. Schulze
- Department of Molecular EpidemiologyGerman Institute of Human Nutrition Potsdam‐RehbrueckeNuthetalGermany
- Institute of Nutritional ScienceUniversity of PotsdamNuthetalGermany
| | - J. Rothwell
- Paris‐Saclay UniversityUVSQ, Inserm, Gustave Roussy, “Exposome and Heredity” team, CESPVillejuifFrance
| | - C. Cadeau
- Paris‐Saclay UniversityUVSQ, Inserm, Gustave Roussy, “Exposome and Heredity” team, CESPVillejuifFrance
| | - S. Severi
- Paris‐Saclay UniversityUVSQ, Inserm, Gustave Roussy, “Exposome and Heredity” team, CESPVillejuifFrance
| | - E. Weiderpass
- International Agency for Research on CancerLyonFrance
| | - M. J. Gunter
- International Agency for Research on CancerLyonFrance
| | - L. Dossus
- International Agency for Research on CancerLyonFrance
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Jourieh R, Schönthaler M, May A, Mehnert J. P-4 Frequency tagging helps understanding multisensory processing of three sensory modalities. Clin Neurophysiol 2023. [DOI: 10.1016/j.clinph.2023.02.021] [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: 03/08/2023]
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5
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Katbamna B, Kashou AH, Shaikh P, Lococo S, Cooper D, Cuculich P, Asirvatham S, Noseworthy P, Desimone C, May A. Transformation of computerized electrocardiogram data into novel means to differentiate wide complex tachycardias. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.394] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Accurate automated wide QRS complex tachycardia (WCT) discrimination between ventricular tachycardia (VT) and supraventricular wide complex tachycardia (SWCT) can be accomplished using novel calculations derived from computerized electrocardiogram (ECG) data from paired WCT and baseline ECGs.
Purpose
Our aim was to develop and trial novel WCT discrimination approaches for WCT patients with and without a corresponding baseline ECG. Central to this analysis was the creation and use of a novel parameter (i.e., percent monophasic time-voltage area [PMonoTVA] [%]) that may be derived from computerized ECG measurements present on the WCT ECG alone.
Methods
In a two-part study, we derived and tested WCT differentiation models comprised of novel and previously established parameters formulated from computerized data of paired WCT and baseline ECGs. In Part 1, novel and established parameters generated from WCT and baseline ECG data were used to derive, validate, and compare five different binary classification models: (i) logistic regression [LR], (ii) artificial neural network [ANN], (iii) Random Forests [RF], (iv) support vector machine [SVM], and (v) ensemble learning (EL). In Part 2, two unique LR models were derived, validated, and compared using parameters generated from computerized data of the (i) WCT ECG alone (i.e., Solo Model) and (ii) paired WCT and baseline ECGs (i.e., Paired Model).
Results
In Part 1, among 103 patients with VT or SWCT diagnoses established from corroborating electrophysiology studies or intra-cardiac device recordings, favorable diagnostic performance was achieved by all modeling technique subtypes: LR (area under the receiver operating characteristic curve [AUC] 0.95), ANN (AUC 0.91), RF (AUC 0.97), SVM (AUC 0.98), and EL (AUC 0.97). In Part 2, among 235 patients with a VT or SWCT diagnosis established with (Gold Standard cohort) or without (Non-Gold Standard cohort) a corroborating electrophysiology procedure or intra-cardiac device recording, favorable diagnostic performance was achieved by the Solo Model (AUC 0.86) and Paired Model (AUC 0.95) (Table).
Conclusion
Accurate WCT discrimination may be accomplished using novel parameters derived from computerized data of the WCT ECG alone and paired WCT and baseline ECGs.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute of Health
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Affiliation(s)
- B Katbamna
- Washington University School of Medicine, Department of Medicine, Division of Cardiovascular Diseases , St Louis , United States of America
| | - A H Kashou
- Mayo Clinic, Department of Cardiovascular Medicine , Rochester , United States of America
| | - P Shaikh
- Washington University School of Medicine, Department of Medicine, Division of Cardiovascular Diseases , St Louis , United States of America
| | - S Lococo
- Washington University School of Medicine, Department of Medicine, Division of Cardiovascular Diseases , St Louis , United States of America
| | - D Cooper
- Washington University School of Medicine, Department of Medicine, Division of Cardiovascular Diseases , St Louis , United States of America
| | - P Cuculich
- Washington University School of Medicine, Department of Medicine, Division of Cardiovascular Diseases , St Louis , United States of America
| | - S Asirvatham
- Mayo Clinic, Department of Cardiovascular Medicine , Rochester , United States of America
| | - P Noseworthy
- Mayo Clinic, Department of Cardiovascular Medicine , Rochester , United States of America
| | - C Desimone
- Mayo Clinic, Department of Cardiovascular Medicine , Rochester , United States of America
| | - A May
- Washington University School of Medicine, Department of Medicine, Division of Cardiovascular Diseases , St Louis , United States of America
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6
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Conze TM, Falkenau A, Goehring LS, May A. Complete AV block in a neonatal foal suffering from nutritional myodegeneration. EQUINE VET EDUC 2022. [DOI: 10.1111/eve.13522] [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)
- T. M. Conze
- Equine Hospital Ludwig‐Maximilians University Munich Munich Germany
| | - A. Falkenau
- Institute of Veterinary Pathology Ludwig‐Maximilians University, Munich Munich Germany
| | - L. S. Goehring
- Equine Hospital Ludwig‐Maximilians University Munich Munich Germany
| | - A. May
- Equine Hospital Ludwig‐Maximilians University Munich Munich Germany
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7
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Brooks C, Gadre P, May A, McGee M. Pacing in Regional Australia: An Audit of Two Recently-Developed Device Implantation Programs Across Two Regional Centres in New South Wales. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.182] [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: 11/26/2022]
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Chuah E, Saunders S, Easey K, Mikhail P, Meere W, Kull T, Spina R, May A, Sarathy K, Ford T. Bystander CPR and Survival Following Out-of-Hospital Cardiac Arrest. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.318] [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: 11/26/2022]
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May A, Pasley K, Johnson M, Nemastil C, Sliemers S, Dell M. 278: Significant worsening in mental health markers in few patients starting elexacaftor/tezacaftor/ivacaftor. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01703-3] [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: 10/20/2022]
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10
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Verweij M, Burbach M, Gal R, May A, van der Graaf R, Intven M, Verkooijen L. PO-1488 Patient’s opinion on serving as control in the trials within cohort design – results of a survey. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07939-1] [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: 10/20/2022]
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12
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May A, Saccone M, van den Berg A, Askey J, Hunt M, Ladak S. Magnetic charge propagation upon a 3D artificial spin-ice. Nat Commun 2021; 12:3217. [PMID: 34050163 PMCID: PMC8163774 DOI: 10.1038/s41467-021-23480-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 04/30/2021] [Indexed: 11/09/2022] Open
Abstract
Magnetic charge propagation in spin-ice materials has yielded a paradigm-shift in science, allowing the symmetry between electricity and magnetism to be studied. Recent work is now suggesting the spin-ice surface may be important in mediating the ordering and associated phase space in such materials. Here, we detail a 3D artificial spin-ice, which captures the exact geometry of bulk systems, allowing magnetic charge dynamics to be directly visualized upon the surface. Using magnetic force microscopy, we observe vastly different magnetic charge dynamics along two principal directions. For a field applied along the surface termination, local energetics force magnetic charges to nucleate over a larger characteristic distance, reducing their magnetic Coulomb interaction and producing uncorrelated monopoles. In contrast, applying a field transverse to the surface termination yields highly correlated monopole-antimonopole pairs. Detailed simulations suggest it is the difference in effective chemical potential as well as the energy landscape experienced during dynamics that yields the striking differences in monopole transport.
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Affiliation(s)
- A May
- School of Physics and Astronomy, Cardiff University, Cardiff, UK
| | - M Saccone
- Center for Nonlinear Studies, Los Alamos National Laboratory, Los Alamos, NM, USA.,Theoretical Division (T4), Los Alamos National Laboratory, Los Alamos, NM, USA
| | - A van den Berg
- School of Physics and Astronomy, Cardiff University, Cardiff, UK
| | - J Askey
- School of Physics and Astronomy, Cardiff University, Cardiff, UK
| | - M Hunt
- School of Physics and Astronomy, Cardiff University, Cardiff, UK
| | - S Ladak
- School of Physics and Astronomy, Cardiff University, Cardiff, UK.
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Boudiaf MDD, Hemmouche L, Louar MA, May A, Mesrati N. Multilevel Analysis of Strain Rate Effect on Visco-Damage Evolution in Short Random Fiber Reinforced Polymer Composites. INT POLYM PROC 2021. [DOI: 10.1515/ipp-2020-4045] [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: 11/15/2022]
Abstract
Abstract
In this study, the strain rate sensitivity of a discontinuous short fiber reinforced composite and the strain rate effect on the damage evolution are investigated. The studied material is a polymeric composite with a polyamide 6.6 matrix reinforced with oriented randomly short glass fibers at a 50% weigh ratio (PA6.6GF50). Tensile tests at low and high strain rate are conducted. In addition, interrupted tensile tests are carried out to quantify the damage at specific stress levels and strain rates. To perform the interrupted tensile tests, an intermediate fixture is realized via double notched mechanical fuses with different widths designed to break at suitable stress levels. The damage is estimated by the fraction of debonded fibers and matrix fractures. Based on the experimental observations, it is concluded that the ultimate stress and strain, and the damage threshold are mainly governed by the strain rate. Furthermore, it is established that the considered composite has a non-linear dynamic behavior with a viscous damage nature.
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Affiliation(s)
- M. D. D. Boudiaf
- Laboratoire Génie des Matériaux, Ecole Militaire Polytechnique Bordj El Bahri , Alger , Algérie
| | - L. Hemmouche
- Laboratoire Génie des Matériaux, Ecole Militaire Polytechnique Bordj El Bahri , Alger , Algérie
| | - M. A. Louar
- Laboratoire Dynamique des Systèmes Mécaniques, Ecole Militaire Polytechnique Bordj El Bahri , Alger , Algérie
| | - A. May
- Laboratoire Génie des Matériaux, Ecole Militaire Polytechnique Bordj El Bahri , Alger , Algérie
| | - N. Mesrati
- Département Métallurgie, Ecole Nationale Polytechnique , El Harrach , Alger , Algérie
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14
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Antonelli M, Capdevila J, Chaudhari A, Granerod J, Canas LS, Graham MS, Klaser K, Modat M, Molteni E, Murray B, Sudre CH, Davies R, May A, Nguyen LH, Drew DA, Joshi A, Chan AT, Cramer JP, Spector T, Wolf J, Ourselin S, Steves CJ, Loeliger AE. Optimal symptom combinations to aid COVID-19 case identification: Analysis from a community-based, prospective, observational cohort. J Infect 2021; 82:384-390. [PMID: 33592254 PMCID: PMC7881291 DOI: 10.1016/j.jinf.2021.02.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 12/17/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 01/10/2023]
Abstract
Objectives Diagnostic work-up following any COVID-19 associated symptom will lead to extensive testing, potentially overwhelming laboratory capacity whilst primarily yielding negative results. We aimed to identify optimal symptom combinations to capture most cases using fewer tests with implications for COVID-19 vaccine developers across different resource settings and public health. Methods UK and US users of the COVID-19 Symptom Study app who reported new-onset symptoms and an RT-PCR test within seven days of symptom onset were included. Sensitivity, specificity, and number of RT-PCR tests needed to identify one case (test per case [TPC]) were calculated for different symptom combinations. A multi-objective evolutionary algorithm was applied to generate combinations with optimal trade-offs between sensitivity and specificity. Findings UK and US cohorts included 122,305 (1,202 positives) and 3,162 (79 positive) individuals. Within three days of symptom onset, the COVID-19 specific symptom combination (cough, dyspnoea, fever, anosmia/ageusia) identified 69% of cases requiring 47 TPC. The combination with highest sensitivity (fatigue, anosmia/ageusia, cough, diarrhoea, headache, sore throat) identified 96% cases requiring 96 TPC. Interpretation We confirmed the significance of COVID-19 specific symptoms for triggering RT-PCR and identified additional symptom combinations with optimal trade-offs between sensitivity and specificity that maximize case capture given different resource settings.
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Affiliation(s)
- M Antonelli
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | | | - A Chaudhari
- Coalition for Epidemic Preparedness Innovations, London, United Kingdom
| | - J Granerod
- Coalition for Epidemic Preparedness Innovations, London, United Kingdom
| | - L S Canas
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - M S Graham
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - K Klaser
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - M Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - E Molteni
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - B Murray
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - C H Sudre
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom; MRC Unit for Lifelong Health and Ageing at UCL/Centre for Medical Image Computing, Department of Computer Science, UCL, London, United Kingdom
| | - R Davies
- Zoe Global, London, United Kingdom
| | - A May
- Zoe Global, London, United Kingdom
| | - L H Nguyen
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - D A Drew
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - A Joshi
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - A T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - J P Cramer
- Coalition for Epidemic Preparedness Innovations, London, United Kingdom
| | - T Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - J Wolf
- Zoe Global, London, United Kingdom
| | - S Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - C J Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom.
| | - A E Loeliger
- Coalition for Epidemic Preparedness Innovations, London, United Kingdom
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Antonelli M, Capdevila J, Chaudhari A, Granerod J, Canas LS, Graham MS, Klaser K, Modat M, Molteni E, Murray B, Sudre CH, Davies R, May A, Nguyen LH, Drew DA, Joshi A, Chan AT, Cramer JP, Spector T, Wolf J, Ourselin S, Steves CJ, Loeliger AE. Optimal symptom combinations to aid COVID-19 case identification: analysis from a community-based, prospective, observational cohort. medRxiv 2021:2020.11.23.20237313. [PMID: 33269364 PMCID: PMC7709185 DOI: 10.1101/2020.11.23.20237313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Diagnostic work-up following any COVID-19 associated symptom will lead to extensive testing, potentially overwhelming laboratory capacity whilst primarily yielding negative results. We aimed to identify optimal symptom combinations to capture most cases using fewer tests with implications for COVID-19 vaccine developers across different resource settings and public health. METHODS UK and US users of the COVID-19 Symptom Study app who reported new-onset symptoms and an RT-PCR test within seven days of symptom onset were included. Sensitivity, specificity, and number of RT-PCR tests needed to identify one case (test per case [TPC]) were calculated for different symptom combinations. A multi-objective evolutionary algorithm was applied to generate combinations with optimal trade-offs between sensitivity and specificity. FINDINGS UK and US cohorts included 122,305 (1,202 positives) and 3,162 (79 positive) individuals. Within three days of symptom onset, the COVID-19 specific symptom combination (cough, dyspnoea, fever, anosmia/ageusia) identified 69% of cases requiring 47 TPC. The combination with highest sensitivity (fatigue, anosmia/ageusia, cough, diarrhoea, headache, sore throat) identified 96% cases requiring 96 TPC. INTERPRETATION We confirmed the significance of COVID-19 specific symptoms for triggering RT-PCR and identified additional symptom combinations with optimal trade-offs between sensitivity and specificity that maximize case capture given different resource settings.
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Affiliation(s)
- M Antonelli
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | | | - A Chaudhari
- Coalition for Epidemic Preparedness Innovations, London, UK
| | - J Granerod
- Coalition for Epidemic Preparedness Innovations, London, UK
| | - L S Canas
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - M S Graham
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - K Klaser
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - M Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - E Molteni
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - B Murray
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - C H Sudre
- MRC Unit for Lifelong Health and Ageing at UCL/Centre for Medical Image Computing, Department of Computer Science, UCL, London, UK
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | | | | | - L H Nguyen
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - D A Drew
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - A Joshi
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - A T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - J P Cramer
- Coalition for Epidemic Preparedness Innovations, London, UK
| | - T Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | | | - S Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - C J Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - A E Loeliger
- Coalition for Epidemic Preparedness Innovations, London, UK
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Kok A, Passchier E, Veenhof C, de Bree R, May A, Stuiver M, Speksnijder C. Feasibility of a combined resistance and endurance training program in head and neck cancer patients during chemoradiotherapy. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.418] [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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17
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McFerrin C, Davaro F, May A, Raza S, Siddiqui S, Hamilton Z. Trends in utilization of neoadjuvant and adjuvant chemotherapy for muscle invasive bladder cancer. Investig Clin Urol 2020; 61:565-572. [PMID: 32985142 PMCID: PMC7606117 DOI: 10.4111/icu.20200132] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/07/2020] [Accepted: 06/07/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose Previous studies have noted increased utilization of perioperative chemotherapy over time. The goal of this study was to determine trends in perioperative chemotherapy use within a contemporary population. Materials and Methods The National Cancer Database was queried for patients diagnosed with cT2-4N0M0 urothelial muscle invasive bladder cancer from 2011 to 2015 and underwent subsequent radical cystectomy. We retrospectively analyzed factors associated with perioperative chemotherapy and evaluated overall treatment trends in the use of neoadjuvant and adjuvant chemotherapy. Linear regression, logistic regression, Cox regression, and Kaplan–Meier analysis were performed. Results In total, 7,101 patients met inclusion criteria for analysis. The use of perioperative chemotherapy increased from 46.4% in 2011 to 57.2% in 2015 (p=0.003). Neoadjuvant chemotherapy use increased from 22.9% to 32.3% (p=0.007) over the time period analyzed, while adjuvant chemotherapy use experienced no significant change (23.5% to 24.9%, p=0.182). Logistic regression demonstrated that increased age and Charlson Comorbidity Index were predictors of not receiving chemotherapy (p<0.05), while those with increasing T stage, income above $48,000, and insurance other than Medicaid or Medicare were more likely to receive perioperative chemotherapy (p<0.05). Kaplan–Meier analysis revealed patients receiving neoadjuvant chemotherapy had the best 5-year overall survival at 48.3% compared to adjuvant chemotherapy (42.6%) or no chemotherapy (37.8%) (p<0.001). Conclusions The increasing use of perioperative chemotherapy noted in prior studies has continued through 2015. Neoadjuvant chemotherapy appears to drive this increase while adjuvant chemotherapy utilization remains unchanged. Clinical and socioeconomic factors affect utilization of perioperative chemotherapy.
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Affiliation(s)
- Coleman McFerrin
- Division of Urology, Department of Surgery, Saint Louis University, St. Louis, MO, USA
| | - Facundo Davaro
- Division of Urology, Department of Surgery, Saint Louis University, St. Louis, MO, USA
| | - Allison May
- Division of Urology, Department of Surgery, Saint Louis University, St. Louis, MO, USA
| | - Syed Raza
- Division of Urology, Department of Surgery, Saint Louis University, St. Louis, MO, USA
| | - Sameer Siddiqui
- Division of Urology, Department of Surgery, Saint Louis University, St. Louis, MO, USA
| | - Zachary Hamilton
- Division of Urology, Department of Surgery, Saint Louis University, St. Louis, MO, USA.
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Martin JL, Sankari A, Salloum A, Zeineddine S, Arvai K, Henzel MK, Shamim-Uzzaman Q, May A, Fung CH, Mitchell MN, Strohl KP, Badr MS. 0644 An Educational and Behavioral Intervention Failed to Improve PAP Use Among Veterans With Spinal Cord Injuries and Diseases: Results of a Randomized Controlled Trial. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.640] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Sleep disordered breathing (SDB) is common among individuals with spinal cord injuries or diseases (SCI/D), many of whom are military Veterans, and physical limitations make use of positive airway pressure (PAP) therapy challenging. This study sought to test the effects of an educational and behavioral intervention to improve PAP adherence among Veterans with SCI/D over the first 3 months of use.
Methods
63 Veterans (mean age=60.7(10.2) years; 92% male) with SCI/D (33 SCI, 30 SCD; 25 cervical involvement; 38 thoracic and below) and SDB (23 with AHI 5-15; 40 with AHI≥15) who received PAP treatment (CPAP or BPAP) were randomly assigned to receive a comprehensive 3-month intervention (INT) or an equal attention control (EAC). INT and EAC both included 1 face-to-face session (week 1) and 5 additional telephone sessions (weeks 2, 3, 4, 8 and 12). Main outcome measures were PAP use over the first 3 months: nights of use, nights of use ≥4 hours, and mean hours of use per night. Repeated measures ANCOVA models were used to test the differences between INT and EAC over the first 3 months of treatment.
Results
Number of nights with ≥4 hours of use in months 1-3 was 9, 7, and 6 nights in the INT and 8, 5 and 4 nights in the EAC (p’s≥.37), respectively. There were no significant differences between INT and EAC for number of nights with any use (p’s≥.24), or mean hours of use per night (p’s≥.30). All 3 PAP use variables declined over time in both groups.
Conclusion
Sustained use of PAP therapy was difficult to achieve among those with SCI/D, and a 6-session behavioral intervention did not lead to significant improvements in use. Even when relatively high levels of initial use are achieved, this is difficult to sustain over time. Future studies should explore whether SCI/D patients experience significant symptom relief with PAP, and if so, whether home-based interventions or more intensive face-to-face PAP adherence programs will be effective.
Support
VA Rehabilitation Research and Development Service, Merit Review (1RX002116; PI: Badr); NIH/NHLBI K24 HL143055 (Martin).
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Affiliation(s)
- J L Martin
- VA Greater Los Angeles, North Hills, CA
- University of California, Los Angeles, Los Angeles, CA
| | - A Sankari
- Wayne State University, Detroit, MI
- John D. Dingell VA Medical Center, Detroit, MI
| | - A Salloum
- Wayne State University, Detroit, MI
- John D. Dingell VA Medical Center, Detroit, MI
| | - S Zeineddine
- Wayne State University, Detroit, MI
- John D. Dingell VA Medical Center, Detroit, MI
| | - K Arvai
- Wayne State University, Detroit, MI
| | - M K Henzel
- VA Northeast Ohio Healthcare System, Cleveland, OH
- Case Western Reserve University, Cleveland, OH
| | | | - A May
- VA Northeast Ohio Healthcare System, Cleveland, OH
| | - C H Fung
- VA Greater Los Angeles, North Hills, CA
- University of California, Los Angeles, Los Angeles, CA
| | | | - K P Strohl
- VA Northeast Ohio Healthcare System, Cleveland, OH
| | - M S Badr
- Wayne State University, Detroit, MI
- John D. Dingell VA Medical Center, Detroit, MI
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May A, Joshi P, Davaro F, Raza SJ, Siddiqui S, Hamilton Z. Trends in treatment of cT1 penile cancer: Analysis of the National Cancer Database. Urol Oncol 2020; 38:688.e1-688.e9. [PMID: 32409201 DOI: 10.1016/j.urolonc.2020.04.013] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/03/2020] [Accepted: 04/06/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To characterize the treatment trends and outcomes in clinical stage T1 penile cancer using the National Cancer Database (NCDB). METHODS The National Cancer Database was queried for all men with cT1 penile cancer from 2004 to 2015. Patients were categorized as cT1a or cT1b. Treatment was categorized as no treatment, local therapy (including penile sparing therapies), partial penectomy, or radical penectomy. Trends in treatment were analyzed over time and in correlation with stage and demographic variables. Stage and treatment type were evaluated in respect to pathological outcomes and survival. RESULTS A total of 2,484 men were identified with cT1 penile cancer, 90.1% of which had cT1a disease. The most common treatments were local therapy for cT1a and partial penectomy for cT1b. Over the time period studied, use of local therapy decreased while use of partial or radical penectomy increased. Patients treated at low volume facilities were more likely to undergo no treatment (8.0% vs. 6.5% in high volume) or local therapy (49.9% vs. 41.5% in high volume, P < 0.001). Local therapy was associated with increased risk of positive margin (odds ratio 4.7, P < 0.001) and positive margin was associated with a trend toward decreased overall survival (P = 0.07). CONCLUSIONS In the past decade, there has been decreased use of local therapy and increased use of partial or radical penectomy in cT1 penile cancer. Men treated at low volume facilities are more likely to be treated with local therapy which is associated with increased rates of positive margins and may also be associated with a trend toward decreased overall survival. Centralization of care in T1 penile cancer may lead to improved outcomes.
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Affiliation(s)
- Allison May
- Division of Urology, Department of Surgery, Saint Louis University, St Louis, MO
| | - Parth Joshi
- Saint Louis University School of Medicine, St Louis, MO
| | - Facundo Davaro
- Division of Urology, Department of Surgery, Saint Louis University, St Louis, MO
| | - Syed Johar Raza
- Division of Urology, Department of Surgery, Saint Louis University, St Louis, MO
| | - Sameer Siddiqui
- Division of Urology, Department of Surgery, Saint Louis University, St Louis, MO
| | - Zachary Hamilton
- Division of Urology, Department of Surgery, Saint Louis University, St Louis, MO.
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van der Wiel SE, May A, Poley JW, Grubben MJAL, Wetzka J, Bruno MJ, Koch AD. Preliminary report on the safety and utility of a novel automated mechanical endoscopic tissue resection tool for endoscopic necrosectomy: a case series. Endosc Int Open 2020; 8:E274-E280. [PMID: 32118101 PMCID: PMC7035027 DOI: 10.1055/a-1079-5015] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 10/06/2019] [Accepted: 11/11/2019] [Indexed: 12/22/2022] Open
Abstract
Background and study aims Endoscopic drainage of walled-off necrosis and subsequent endoscopic necrosectomy has been shown to be an effective step-up management strategy in patients with acute necrotizing pancreatitis. One of the limitations of this endoscopic approach however, is the lack of dedicated and effective instruments to remove necrotic tissue. We aimed to evaluate the technical feasibility, safety, and clinical outcome of the EndoRotor, a novel automated mechanical endoscopic tissue resection tool, in patients with necrotizing pancreatitis. Methods Patients with infected necrotizing pancreatitis in need of endoscopic necrosectomy after initial cystogastroscopy, were treated using the EndoRotor. Procedures were performed under conscious or propofol sedation by six experienced endoscopists. Technical feasibility, safety, and clinical outcomes were evaluated and scored. Operator experience was assessed by a short questionnaire. Results Twelve patients with a median age of 60.6 years, underwent a total of 27 procedures for removal of infected pancreatic necrosis using the EndoRotor. Of these, nine patients were treated de novo. Three patients had already undergone unsuccessful endoscopic necrosectomy procedures using conventional tools. The mean size of the walled-off cavities was 117.5 ± 51.9 mm. An average of two procedures (range 1 - 7) per patient was required to achieve complete removal of necrotic tissue with the EndoRotor. No procedure-related adverse events occurred. Endoscopists deemed the device to be easy to use and effective for safe and controlled removal of the necrosis. Conclusions Initial experience with the EndoRotor suggests that this device can safely, rapidly, and effectively remove necrotic tissue in patients with (infected) walled-off pancreatic necrosis.
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Affiliation(s)
- S. E. van der Wiel
- Department of Gastroenterology and Hepatology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - A. May
- Department of Gastroenterology, Sana Klinikum Offenbach GmbH, Offenbach am Main, Germany
| | - J. W. Poley
- Department of Gastroenterology and Hepatology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M. J. A. L. Grubben
- Department of Gastroenterology and Hepatology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J. Wetzka
- Department of Gastroenterology, Sana Klinikum Offenbach GmbH, Offenbach am Main, Germany
| | - M. J. Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - A. D. Koch
- Department of Gastroenterology and Hepatology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
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May A, Roustio L, Hamilton ZA. The Role of Immunotherapy in Urologic Cancers. Mo Med 2020; 117:127-132. [PMID: 32308237 PMCID: PMC7144716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In recent decades, there has been significant growth in the understanding of the immune system and its role in cancer. The recent introduction of checkpoint inhibitors has drastically changed the treatment landscape of cancer as a whole. In this review, we discuss the major clinical developments of immunotherapy in urologic specific cancers, as well as address future directions in this field.
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Affiliation(s)
- Allison May
- Allison May, MD, Loren Roustio, BS, and Zachary A Hamilton, MD, are in the Division of Urology, Department of Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Loren Roustio
- Allison May, MD, Loren Roustio, BS, and Zachary A Hamilton, MD, are in the Division of Urology, Department of Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Zachary A Hamilton
- Allison May, MD, Loren Roustio, BS, and Zachary A Hamilton, MD, are in the Division of Urology, Department of Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
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Diener HC, Förderreuther S, Gaul C, Giese F, Hamann T, Holle-Lee D, Jürgens TP, Kamm K, Kraya T, Lampl C, May A, Reuter U, Scheffler A, Tfelt-Hansen P. Prophylaxe der Migräne mit monoklonalen Antikörpern gegen CGRP oder den CGRP-Rezeptor, Ergänzung der S1-Leitlinie Therapie der Migräneattacke und Prophylaxe der Migräne. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s42451-020-00163-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Davaro F, May A, McFerrin C, Raza SJ, Siddiqui S, Hamilton Z. Chemotherapy increases survival and downstaging of upper tract urothelial cancer. Can J Urol 2019; 26:9938-9944. [PMID: 31629443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION To evaluate the overall survival and pathologic downstaging effect of neoadjuvant chemotherapy for upper tract urothelial cell carcinoma. MATERIALS AND METHODS The National Cancer Database (NCDB) was queried for patients with stage II-IV upper tract urothelial cell carcinoma undergoing definitive surgical resection (nephroureterectomy) from 2004-2015. Patients with metastatic disease were excluded. Cohorts were stratified by receipt of neoadjuvant chemotherapy (NAC). Kaplan-Meier analysis and Cox regression were used to evaluate overall survival. Logistic regression was used to predict the odds of pathologic downstaging to non-invasive disease (< pT2). Propensity score matched analysis was performed between groups. RESULTS A total of 3634 patients were identified with non-metastatic stage II-IV disease undergoing surgical resection; 3364 received no chemotherapy and 270 received NAC. Patients undergoing NAC had a 10.9% rate of downstaging to non-invasive disease (OR 6.35, p < 0.001). Moreover, on Kaplan-Meier analysis, median survival was 27.3 months and 44.8 months for no chemotherapy versus NAC, respectively (log-rank, p = 0.001). Cox regression for death also revealed benefits for receiving NAC (HR 0.67, p < 0.001). Findings were confirmed on propensity score matching (532 matched patients). After matching, Cox regression for death noted improvement with neoadjuvant as compared to no chemotherapy (HR 0.61, p < 0.001). CONCLUSION Neoadjuvant chemotherapy increases likelihood of downstaging to non-invasive disease in patients with upper tract urothelial cell carcinoma. Chemotherapy also provides an overall survival benefit in patients undergoing nephroureterectomy.
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Affiliation(s)
- Facundo Davaro
- Division of Urology, Department of Surgery, Saint Louis University, St Louis, Missouri, USA
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Davaro F, Roberts J, May A, McFerrin C, Siddiqui S, Hamilton Z. Robotic surgery does not affect upstaging of T1 renal masses. J Robot Surg 2019; 14:447-454. [PMID: 31456083 DOI: 10.1007/s11701-019-01015-z] [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: 06/20/2019] [Accepted: 08/22/2019] [Indexed: 11/29/2022]
Abstract
Partial nephrectomy is the mainstay of treatment for localized kidney cancer. A proportion of patients are upstaged post-operatively to locally advanced disease (pT3a). We aimed to identify the incidence of upstaging to pT3a during partial nephrectomy and its relationship to a robotic approach. The National Cancer Database was queried for patients diagnosed with cT1M0 disease between 2010 and 2015 who underwent an open or robotic partial nephrectomy with final stage pT1-3a. Our primary outcome was rate of upstaging to pT3a in patients undergoing partial nephrectomy and secondary outcomes were stage migration, rate of positive margins, and overall survival (OS). The relationship between open and robotic surgery was examined. Logistical regression and Kaplan-Meier analyses were performed. Of 68,976 patients identified, 5.9% of patients were upstaged from cT1 to pT3a post-operatively. The incidence of upstaging to pT3a disease has increased from 5.7% in 2010 to 6.9% in 2015. Similarly, the proportion of patients undergoing a robotic approach is also increasing (31.6-64.4%); however, a robotic approach is not associated with pT3a upstaging on multivariable analysis. The probability of being upstaged was significantly proportional to increasing tumor size (OR 2.634-11.641, p < 0.05). pT3a disease was associated with a significant increase in positive margins (10.7% vs 5.0%, p < 0.001). Interestingly, pT3a patients with positive margin had worsened survival (5-year OS 75.5% vs 65.9%, p < 0.001). A robotic surgical approach to partial nephrectomy does not increase risk of upstaging to pT3a disease. Those who are upstaged have increased risk of positive margins and associated risk of decreased survival.
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Affiliation(s)
- Facundo Davaro
- Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA
| | - Jacob Roberts
- Saint Louis University School of Medicine, St Louis, MO, USA
| | - Allison May
- Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA
| | | | - Sameer Siddiqui
- Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA
| | - Zachary Hamilton
- Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA.
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Raza SJ, Miller C, May A, Davaro F, Siddiqui SA, Hamilton Z. Lymph node density for stratification of survival outcomes with node positive upper tract urothelial carcinoma. Can J Urol 2019; 26:9852-9858. [PMID: 31469641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The use of lymph node density (LND) as a predictor of survival outcomes has been studied with urothelial carcinoma of the bladder. Similar results can be postulated to upper tract urothelial carcinoma (UTUC). This study aims to determine the overall survival of patients with lymph node positive UTUC based on LND, utilizing the National Cancer Database (NCDB). MATERIALS AND METHODS Data was derived from NCDB Participant User Kidney Dataset using the histology code 'transitional cell carcinoma', utilizing pN+ patients from 2004-2015. LND was calculated as number of positive nodes divided by total number of nodes removed. Patients were stratified by traditional AJCC pN stage and compared to LND groups (< 30%, ≥ 30%). Primary outcome was overall survival. Kaplan-Meier and Cox regression analyses were performed. RESULTS A total of 2049 patients were identified (pN1 = 1022, pN2 = 1027; LND < 30% = 370, ≥ 30% = 1679). Mean LND was 71%. Cox regression for mortality using pN stage was not significant (p = 0.11); however, Cox regression for mortality using LND group noted significantly worsened survival with LND ≥ 30% (HR 1.54, p = 0.001). Kaplan Meier analysis for overall survival at 2 years showed no difference between pN1 and pN2 stages (35.3% versus 34.1%; log rank p = 0.37). Kaplan Meier analysis for overall survival at 2 years revealed significant difference between LND groups (LND < 30%, 47.3% versus LND ≥ 30%, 32.0%; log rank p < 0.001). CONCLUSIONS LND provides improved prognostic information regarding overall survival, compared to traditional AJCC pN staging. Future studies need to evaluate LND to improve prognostic understanding of lymph node positive UTUC.
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Affiliation(s)
- Syed Johar Raza
- Division of Urology, Department of Surgery, Saint Louis University, St Louis, Missouri, USA
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May A, Henke J, Au D, Raza SJ, Davaro F, Hamilton Z, Siddiqui SA. National Trends in the Utilization of Androgen Deprivation Therapy for Very Low Risk Prostate Cancer. Urology 2019; 130:79-85. [DOI: 10.1016/j.urology.2019.02.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/29/2019] [Accepted: 02/06/2019] [Indexed: 10/26/2022]
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McFerrin C, Raza SJ, May A, Davaro F, Siddiqui S, Hamilton Z. Charlson comorbidity score is associated with readmission to the index operative hospital after radical cystectomy and correlates with 90-day mortality risk. Int Urol Nephrol 2019; 51:1755-1762. [PMID: 31346955 DOI: 10.1007/s11255-019-02247-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 05/21/2019] [Accepted: 07/22/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE Our objective was to determine perioperative variables associated with 30-day readmission to the index operative hospital after radical cystectomy for bladder cancer and subsequent survival outcomes. METHODS Retrospective cohort study utilizing the United States National Cancer Database from 2004-2015. All clinical stages undergoing radical cystectomy were analyzed. Exclusion criteria included clinical suspicion of nodal disease, metastasis, or preoperative radiation therapy. Multivariable logistic regression was used for 30-day readmission risk to the index hospital. Kaplan-Meier analysis and multivariable Cox regressions were used for survival outcomes. RESULTS 31,147 patients were identified and stratified by 30-day readmission (n = 2628) or no readmission (n = 28,519). Thirty-day readmission to the index surgery hospital was 8.4%. Groups were comparable in terms of age, gender, race, income, facility type, insurance, length of hospital stay, and pathologic stage. There were significantly more patients with higher Charlson comorbidity score in the readmission cohort. On logistic regression analysis, increasing Charlson score was the only predictor of 30-day readmission (OR 1.39-1.73, p < 0.001). The 90-day mortality rate was 7.2% overall (7.0% no readmission vs 9.9% 30-day readmission, p < 0.001). Cox regression analysis for mortality revealed increasing age (HR 1.04), higher Charlson score (HR 1.42-1.85), readmission within 30 days (HR 1.38) and pathologic stage pT ≥ 2 (HR 1.88-7.09, all p < 0.001) as independent predictors of 90-day mortality. CONCLUSIONS Increasing comorbidity is a strong predictor of readmission to the index surgery hospital after radical cystectomy. Readmission is associated with worsened mortality at 90 days.
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Affiliation(s)
- Coleman McFerrin
- Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA
| | - Syed Johar Raza
- Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA
| | - Allison May
- Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA
| | - Facundo Davaro
- Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA
| | - Sameer Siddiqui
- Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA
| | - Zachary Hamilton
- Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA.
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Bendtsen L, Zakrzewska JM, Abbott J, Braschinsky M, Di Stefano G, Donnet A, Eide PK, Leal PRL, Maarbjerg S, May A, Nurmikko T, Obermann M, Jensen TS, Cruccu G. European Academy of Neurology guideline on trigeminal neuralgia. Eur J Neurol 2019; 26:831-849. [DOI: 10.1111/ene.13950] [Citation(s) in RCA: 191] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/08/2019] [Indexed: 12/19/2022]
Affiliation(s)
- L. Bendtsen
- Department of Neurology Faculty of Health and Medical Sciences Danish Headache Center Rigshospitalet‐Glostrup University of Copenhagen Glostrup Denmark
| | - J. M. Zakrzewska
- Pain Management Centre National Hospital for Neurology and Neurosurgery London UK
- Eastman Dental Hospital UCLH NHS Foundation Trust London UK
| | - J. Abbott
- Trigeminal Neuralgia Association UK Oxted Surrey UK
| | | | - G. Di Stefano
- Department of Human Neuroscience Sapienza University Rome Italy
| | - A. Donnet
- Headache and Pain Department CHU La Timone APHM Marseille France
| | - P. K. Eide
- Department of Neurosurgery Oslo University Hospital‐Rikshospitalet Oslo Norway
- Institute of Clinical Medicine Faculty of Medicine University of Oslo Oslo Norway
| | - P. R. L. Leal
- Department of Neurosurgery Faculty of Medicine of Sobral Federal University of Ceará Sobral Brazil
- University of Lyon 1 Lyon France
| | - S. Maarbjerg
- Department of Neurology Faculty of Health and Medical Sciences Danish Headache Center Rigshospitalet‐Glostrup University of Copenhagen Glostrup Denmark
| | - A. May
- Department of Systems Neuroscience Universitäts‐Krankenhaus Eppendorf Hamburg Germany
| | - T. Nurmikko
- Neuroscience Research Centre Walton Centre NHS Foundation Trust Liverpool UK
| | - M. Obermann
- Center for Neurology Asklepios Hospitals Schildautal Seesen Germany
| | - T. S. Jensen
- Department of Neurology and Danish Pain Research Center Aarhus University Hospital University of Aarhus Aarhus C Denmark
| | - G. Cruccu
- Department of Human Neuroscience Sapienza University Rome Italy
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Dotson A, May A, Davaro F, Raza SJ, Siddiqui S, Hamilton Z. Squamous cell carcinoma of the bladder: poor response to neoadjuvant chemotherapy. Int J Clin Oncol 2019; 24:706-711. [PMID: 30707342 DOI: 10.1007/s10147-019-01409-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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] [Received: 11/04/2018] [Accepted: 01/28/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Squamous cell carcinoma (SCC) of the bladder is a rare, aggressive malignancy. Unlike urothelial cell carcinoma, SCC is resistant to chemotherapy and guidelines recommend radical cystectomy (RC) without neoadjuvant chemotherapy (NAC). We aimed to evaluate the current management and survival of patients with invasive SCC treated with or without NAC. METHODS 671 patients with invasive SCC bladder cancer from 2004 to 2015 in the National Cancer Data Base were identified. Patients were stratified by treatment with RC alone or NAC prior to RC (NAC + RC). Survival analysis was performed with Kaplan-Meier and Cox regression. Secondary outcomes included length of stay and readmission. RESULTS Of 671 patients, 92.8% were treated with RC alone and 7.2% with NAC + RC. Cox regression for mortality was performed including age, Charlson score, clinical stage, and NAC. Increased risk of mortality was noted with increasing age (OR 1.01, p = 0.023) and Charlson score of 1-3 (HR 1.58-1.68, p < 0.05). NAC did not confer survival advantage (HR 1.17, p = 0.46). On Kaplan-Meier analysis, the overall survival was equivalent (log-rank p = 0.804). Hospital stay and readmission were similar between RC and NAC + RC groups. CONCLUSIONS Analysis of a national tumor registry suggests a lack of overall survival benefit for NAC with localized, muscle invasive SCC of the bladder. Further research directed at chemotherapy regimens for SCC is needed to optimize treatment and improve survival outcomes.
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Affiliation(s)
- Aaron Dotson
- Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA
| | - Allison May
- Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA
| | - Facundo Davaro
- Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA
| | - Syed Johar Raza
- Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA
| | - Sameer Siddiqui
- Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA
| | - Zachary Hamilton
- Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA.
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Davaro F, Schaefer J, May A, Raza SJ, Siddiqui S, Hamilton Z. The current treatment patterns of metastatic renal cell carcinoma: A national cancer database review, 2004–2015. Journal of Clinical Urology 2019. [DOI: 10.1177/2051415818821226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Our objective was to analyze patterns of treatment for metastatic renal cell carcinoma (mRCC) (no treatment (NT), cytoreductive nephrectomy only (CN), systemic therapy only (ST), and both systemic and cytoreductive (ST+CN)), and correlate them with racial or socioeconomic factors. Materials and Methods: Cases of mRCC from 2004–2015 were selected from the National Cancer Database. Our primary outcome was the temporal trend of treatment types. Secondary outcomes included the association of treatment with racial and socioeconomic factors. Logistical regression was performed. Results: In total, 40,372 patients with mRCC were identified. Treatment modalities included 37.0% NT, 13.9% CN only, 31.6% ST only and 17.5% ST+CN. From 2004–2015, NT decreased (53.4 vs. 32.1%, p < 0.001), CN alone decreased (18.1 vs. 12.1%, p < 0.001), ST alone increased (18.1 vs. 36.7%, p < 0.001) and ST+CN increased (10.3 vs. 19.1%, p < 0.001). On logistical regression, we found non-white races (odds ratio 1.29–1.73, p < 0.001), low-volume centers (hazard ratio (HR) 1.18, p < 0.001), no insurance (HR 2.29, p < 0.001) and low income (HR 1.24, p < 0.001) increased the likelihood of receiving NT. Conclusion: More patients are receiving ST and ST+CN; however, racial and socioeconomic factors may affect the treatment patterns for mRCC, and the underlying cause of these health disparities is unknown. Level of Evidence: 2c6
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Affiliation(s)
| | | | - Allison May
- Department of Surgery, Saint Louis University, USA
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Chen D, Untaru R, Stavropoulou G, Nesbitt A, Kelly C, Croft A, May A, Boyle A, Collin N, Leitch J, Sugito S, Baker D, Ngo D, Sverdlov A. Role of soluble sST2 Levels in Predicting Major Adverse Cardiovascular Events (MACE) Hospital Readmissions Within 30 Days. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.428] [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: 10/26/2022]
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Untaru R, Nesbitt A, Kelly C, Croft A, Chen D, Assadi-Khansari B, Collins N, Boyle A, Leitch J, Baker D, Sugito S, May A, Sverdlov A, Ngo D. Suboptimal Use of Cardioprotective Drugs in Patients with a History of Cancer. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.434] [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: 10/26/2022]
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Fitzgerald J, May A, McGee M, Leitch J, Haldar S, Sanchez AP, Gizurarson S, Nanthakumar K, Jackson N. Decrement Evoked Potential Mapping (DEEP) for Atrial Fibrillation Ablation. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.176] [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: 10/26/2022]
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Miller C, Raza SJ, Davaro F, May A, Siddiqui S, Hamilton ZA. Trends in the treatment of clinical T1 renal cell carcinoma for octogenarians: Analysis of the National Cancer Database. J Geriatr Oncol 2018; 10:285-291. [PMID: 30528544 DOI: 10.1016/j.jgo.2018.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 09/10/2018] [Revised: 11/13/2018] [Accepted: 11/28/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Treatment of renal cell carcinoma has evolved with emphasis on nephron preservation for small renal masses. Our objective was to evaluate the proportions of treatment types for octogenarians with clinical stage 1 renal cell carcinoma. MATERIALS AND METHODS The National Cancer Database was analyzed from 2004 to 2015. Patients with clinical stage 1, tumor size ≤ 7 cm, and age 80-89 years old were compared to a younger control arm of patients ≤ 70 years old. Treatment modality was categorized as radical nephrectomy (RN), partial nephrectomy (PN), percutaneous ablative therapy (PAT), and no treatment (NT). Primary outcome was treatment utilization over time using estimated annual percentage change (EAPC). Secondary outcomes included logistic regression for 30 day readmission after treatment and any definitive tumor treatment choice. RESULTS 18,903 octogenarians were identified and compared to a control of 142,179 patients ≤ 70 years old. Overall, NT (36%) was the most common modality for octogenarians while PN (44.8%) was most common for the control arm. Using EAPC for octogenarians, we found increases for PAT (7.1%), PN (2.8%), and NT (1.6%) but a decrease for RN (-4.6%). EAPC for the younger cohort noted increases for PAT (6.8%), PN (5.4%), and NT (4.4%) but a decrease for RN (-5.5%). CONCLUSION For octogenarians with stage 1 renal cell carcinoma, minimally invasive treatments are increasingly utilized, while RN is decreasing. Compared to a younger cohort, a greater proportion of octogenarians are receiving NT. These findings remain encouraging for appropriate treatment of localized disease in patients with advanced age.
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Affiliation(s)
- Caleb Miller
- Division of Urology, Department of Surgery, Saint Louis University, St Louis, MO, United States
| | - Syed J Raza
- Division of Urology, Department of Surgery, Saint Louis University, St Louis, MO, United States
| | - Facundo Davaro
- Division of Urology, Department of Surgery, Saint Louis University, St Louis, MO, United States
| | - Allison May
- Division of Urology, Department of Surgery, Saint Louis University, St Louis, MO, United States
| | - Sameer Siddiqui
- Division of Urology, Department of Surgery, Saint Louis University, St Louis, MO, United States
| | - Zachary A Hamilton
- Division of Urology, Department of Surgery, Saint Louis University, St Louis, MO, United States.
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Farrell C, Foy S, May A, Lee R, Gaskell C, Yorke J. Developing a patient reported experience measure (PREM) in secondary breast cancer (SBC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy341.039] [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: 11/14/2022] Open
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Ziegeler C, Wasiljeff K, May A. Nondental orofacial pain in dental practices – diagnosis, therapy and self‐assessment of German dentists and dental students. Eur J Pain 2018; 23:66-71. [DOI: 10.1002/ejp.1283] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2018] [Indexed: 11/06/2022]
Affiliation(s)
- C. Ziegeler
- Department of Systems Neuroscience University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - K. Wasiljeff
- Department of Systems Neuroscience University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - A. May
- Department of Systems Neuroscience University Medical Center Hamburg‐Eppendorf Hamburg Germany
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Bagot KS, Matthews SA, Mason M, Squeglia LM, Fowler J, Gray K, Herting M, May A, Colrain I, Godino J, Tapert S, Brown S, Patrick K. Current, future and potential use of mobile and wearable technologies and social media data in the ABCD study to increase understanding of contributors to child health. Dev Cogn Neurosci 2018; 32:121-129. [PMID: 29636283 PMCID: PMC6447367 DOI: 10.1016/j.dcn.2018.03.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 02/15/2018] [Accepted: 03/18/2018] [Indexed: 01/06/2023] Open
Abstract
Mobile and wearable technologies and novel methods of data collection are innovating health-related research. These technologies and methods allow for multi-system level capture of data across environmental, physiological, behavioral, and psychological domains. In the Adolescent Brain Cognitive Development (ABCD) Study, there is great potential for harnessing the acceptability, accessibility, and functionality of mobile and social technologies for in-vivo data capture to precisely measure factors, and interactions between factors, that contribute to childhood and adolescent neurodevelopment and psychosocial and health outcomes. Here we discuss advances in mobile and wearable technologies and methods of analysis of geospatial, ecologic, social network and behavioral data. Incorporating these technologies into the ABCD study will allow for interdisciplinary research on the effects of place, social interactions, environment, and substance use on health and developmental outcomes in children and adolescents.
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Affiliation(s)
- K S Bagot
- University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
| | - S A Matthews
- Penn State University, 507 Oswald Tower, University Park, PA, 16802, USA.
| | - M Mason
- University of Tennessee, Henson Hall, 213 Knoxville, Knoxville, TN, 37996-3332, USA.
| | - Lindsay M Squeglia
- Medical University of South Carolina, 125 Doughty Street, Suite 190, MSC861, Charleston, SC, 29425, USA.
| | - J Fowler
- University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
| | - K Gray
- Medical University of South Carolina, 125 Doughty Street, Suite 190, MSC861, Charleston, SC, 29425, USA.
| | - M Herting
- University of Southern California, 2011 N Soto St., Los Angeles, CA, 90032, USA.
| | - A May
- University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA
| | - I Colrain
- SRI International, 333 Ravenswood Avenue, Menlo Park, CA, 94025, USA.
| | - J Godino
- University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
| | - S Tapert
- University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
| | - S Brown
- University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
| | - K Patrick
- University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
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Davaro F, Schaefer J, May A, Raza J, Siddiqui S, Hamilton Z. Invasive non-urachal adenocarcinoma of the bladder: analysis of the National Cancer Database. World J Urol 2018; 37:497-505. [PMID: 30030660 DOI: 10.1007/s00345-018-2411-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 06/12/2018] [Accepted: 07/17/2018] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To review the United States National Cancer Database (NCDB) from 2004 to 2015 and analyze survival outcomes of invasive non-urachal adenocarcinoma based on treatment modality. METHODS The NCDB 2004-2015 bladder dataset was queried for adenocarcinoma histology, excluding urachal variant, and limited to patients with clinical stage T2-T4 disease. Treatment modality was categorized as no treatment, cystectomy (partial or radical), external beam radiation therapy (EBRT), or EBRT plus cystectomy. Our primary outcome was overall survival. Cox regression (CR) and Kaplan-Meier (KM) analysis were performed. RESULTS 851 patients were identified with invasive (cT2-T4) adenocarcinoma of the bladder. Treatment modalities included 398 (47.8%) no treatment, 298 (35.8%) cystectomy, 124 (14.9%) EBRT, and 31 (3.7%) EBRT plus cystectomy. On KM analysis excluding those with metastatic disease, the 5-year survival was significantly better (p < 0.001) for patients who underwent cystectomy (39.6%), versus no treatment (21.0%), EBRT (18.6%), or EBRT plus cystectomy (26.9%) (log rank, p < 0.001). On CR for mortality, age (HR 1.030, p < 0.001), Charlson score 1 (HR 1.287, p = 0.034), cT4 (HR 1.768, p < 0.001), and receiving treatment at a low-volume center (HR 1.289, p = 0.026) were associated with worsened survival; however, cystectomy (HR 0.593, p < 0.001) was the only factor associated with improved survival. For those undergoing cystectomy, the mean length of stay was 8.5 days and the 30-day readmission rate was 7.0%. CONCLUSIONS Invasive non-urachal adenocarcinoma of the bladder is a rare diagnosis. Survival benefits in patients without metastatic disease are seen only in those patients undergoing definitive surgery.
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Affiliation(s)
- Facundo Davaro
- Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA
| | - Jared Schaefer
- Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA
| | - Allison May
- Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA
| | - Johar Raza
- Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA
| | - Sameer Siddiqui
- Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA
| | - Zachary Hamilton
- Division of Urology, Department of Surgery, Saint Louis University, 3635 Vista Ave, 3rd Floor Desloge Towers, St. Louis, MO, 63110, USA.
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Raza SJ, Xu P, Barnes J, Fisher R, May A, Darwish O, Dang B, Adsul P, Freeman CA, Siddiqui SA. Outcomes of renal salvage for penetrating renal trauma: a single institution experience. Can J Urol 2018; 25:9323-9327. [PMID: 29900820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Conservative management of penetrating renal trauma is emerging, with data originating from centers with variable level of trauma care. This study reviews the outcomes of renal salvage after penetrating trauma at a level I trauma center. MATERIALS AND METHODS An institutional review board approved trauma registry at Saint Louis University Hospital was retrospectively analyzed, for patients with penetrating renal trauma from 2009 to 2014. Patients were divided into nephrectomy group (NG) or non-nephrectomy group (non-NG), and compared. A multi-variable analysis was performed to determine predictors of nephrectomy, with cross validation to evaluate the performance of the multi-variable model. Data was analyzed using R version 3.3.2. A p value of < 0.05 was considered as significant. RESULTS A total of 121 patients were identified with penetrating renal trauma. Gunshot injury was the leading cause of injury (87%). Eighteen (15%) patients required nephrectomy. The overall mean injury severity score (ISS). was 20. High grade (grade 4-5) renal injuries were noted in 41 patients (34%). Among these, 14 patients (34%) underwent a nephrectomy, while 27 patients (66%) were managed conservatively to salvage renal units. CT grade of renal injury was the only predictor of nephrectomy, on multi-variable analysis (OR 17.09 CI 2.75-105.99, p = 0.002). CT grade of injury and injury severity score were predictors of endoscopic intervention on a sub group analysis of non-NG. CONCLUSIONS CT grade of injury predicts nephrectomy after penetrating renal trauma. Conservative management is a feasible option in penetrating renal trauma even with a higher grade of injury.
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Affiliation(s)
- S Johar Raza
- Division of Urology, Department of Surgery, Saint Louis University Hospital, St. Louis, Missouri, USA
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Schwanz LE, Hodgson MJ, May A. Costs of thermoregulation in variable thermal environments in the jacky dragon (
Amphibolurus muricatus
). J Zool (1987) 2018. [DOI: 10.1111/jzo.12559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- L. E. Schwanz
- Evolution & Ecology Research Centre School of Biological, Earth, and Environmental Sciences UNSW Sydney Sydney NSW Australia
| | - M. J. Hodgson
- Evolution & Ecology Research Centre School of Biological, Earth, and Environmental Sciences UNSW Sydney Sydney NSW Australia
| | - A. May
- Evolution & Ecology Research Centre School of Biological, Earth, and Environmental Sciences UNSW Sydney Sydney NSW Australia
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May A, Abuirqeba S, Hamilton Z, Flaveny C, Siddiqui S. MP70-14 REGULATION OF PROSTATE CANCER METABOLISM AND INVASIVENESS BY THE LIVER X RECEPTOR. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2258] [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: 10/17/2022]
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Abstract
ZusammenfassungDie Kopfschmerzklassifikation der International Headache Society unterscheidet in ihrem Kapitel 4 verschiedene idiopathische Kopfschmerzerkrankungen, die als selten gelten, aber als eigenständige Entitäten aufgefasst werden müssen. Zu diesen gehören der primäre stechende Kopfschmerz, der primäre Hustenkopfschmerz, der primäre Kopfschmerz bei körperlicher Anstrengung, der primäre Kopfschmerz bei sexueller Aktivität, der primäre schlafgebundene Kopfschmerz, der primäre Donnerschlagkopfschmerz, die Hemicrania continua und der neu aufgetretene tägliche Kopfschmerz. Es handelt sich um harmlose Erkrankungen mit einer guten Prognose, die aber die Lebensqualität der Betroffenen erheblich einschränken können. Aufgrund einer Analyse der publizierten Fallberichte und einem Expertenkonsens werden für diese Kopfschmerzerkrankungen Therapieempfehlungen gegeben, auch wenn große randomisierte, kontrollierte Studien nicht vorliegen. Die meisten dieser Erkrankungen sprechen neben einer spezifischen Therapie unter anderem auf Indometacin an.
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Paulus W, Tronnier V, Gaul C, Lampl C, Gantenbein A, May A, Diener HC, Jürgens T. Einsatz neuromodulierender Verfahren bei primären Kopfschmerzen. ACTA ACUST UNITED AC 2018. [DOI: 10.1055/s-0038-1627764] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZusammenfassungNeuromodulierende Verfahren haben die Behandlung von Patienten mit therapierefraktären primären Kopfschmerzen im letzten Jahrzehnt revolutioniert. Unterschieden werden die invasiven (periphere Nervenstimulation, vor allem des N. okzipitalis major, Vagusnervstimulation, zervikale Rückenmarkstimulation und hypothalamische Tiefenhirnstimulation) von den nicht invasiven Verfahren (repetitive transkranielle Magnetstimulation, transkutane elektrische Nervenstimulation und transkranielle Magnetstimulation). In diesen Therapieempfehlungen werden zunächst Kriterien für therapierefraktäre Verläufe primärer Kopfschmerzen und darauf basierende Ein-und Ausschlusskriterien für eine Neuromodulation definiert. Aus dem Bereich der invasiven Verfahren ist die subkutane Stimulation des N. okzipitalis major bei chronischem Clusterkopfschmerz sowie eingeschränkt bei Hemicrania continua, Okzipitalisneuralgie und chronischer Migräne zu empfehlen. Alternativ ist bei chronischem Clusterkopfschmerz und SUNCT-Syndrom auch die hypothalamische Tiefenhirnstimulation wirksam. Für andere Kopfschmerzarten und Stimulationsverfahren fehlen derzeit überzeugende Daten. Der alleinige oder additive Einsatz nicht invasiver Verfahren ist nicht gut belegt.
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May A, Fritsche G, Kropp P, Lampl C, Limmroth V, Malzacher V, Sandor P, Straube A, Diener HC, Evers S. Akuttherapie und Prophylaxe der Migräne. ACTA ACUST UNITED AC 2018. [DOI: 10.1055/s-0038-1627343] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZusammenfassungDie Deutsche Migräne- und Kopfschmerzgesellschaft und die Deutsche Gesellschaft für Neurologie legen eine revidierte Fassung ihrer gemeinsamen evidenzbasierten Leitlinie für die Therapie der Migräne vor. Zur Akuttherapie der leichten Migräneattacke wird die frühzeitige und hochdosierte Einnahme von NSAR oder von Paracetamol empfohlen. Bei schweren Migräneattacken wird die Einnahme eines Triptans empfohlen, eine generelle Präferenz für eine bestimmte Substanz wird hierbei nicht ausgesprochen. Zur medikamentösen Prophylaxe der Migräne werden als Substanzen der ersten Wahl Metoprolol, Propranolol, Flunarizin, Valproinsäure und Topiramat empfohlen. Substanzen der zweiten Wahl sind Amitriptylin, Venlafaxin, Gabapentin, Naproxen, Acetylsalicylsäure, Pestwurz, Magnesium und Vitamin B2. Im Mittelpunkt der nicht medikamentösen Behandlung der Migräne stehen neben Empfehlungen zur Lebensführung, Entspannungsverfahren (progressive Muskelrelaxation), Biofeedbackverfahren und kognitive Verhaltenstherapie. Gerade die Kombination von nicht medikamentösen Verfahren untereinander oder mit einer medikamentösen Prophylaxe ist besonders wirksam.
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Haag G, May A, Lampl C, Sandor P, Diener HC, Ever S, Straube A, Marziniak M. Therapie des Kopfschmerzes bei Medikamentenübergebrauch. ACTA ACUST UNITED AC 2018. [DOI: 10.1055/s-0038-1628495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZusammenfassungNach der zweiten Ausgabe der Internationalen Kopfschmerzklassifikation (ICHD-II, 2004) wird der Kopfschmerz bei Medikamentenübergebrauch (medication overuse headache – MOH) als chronischer Kopfschmerz definiert, induziert durch den Übergebrauch von Ergotamin, Triptanen, Analgetika, Opioiden, Kombinationspräparaten, Kombinationen einzelner Substanzen oder anderer, nicht näher spezifizierter Medikamente. Obwohl bisher keine epidemiologische Studie die tatsächliche MOH-Prävalenz (incl. erfolgreichen Entzug) untersucht hat, wird seine durchschnittliche Prävalenz auf ca. 1% der Gesamtbevölkerung geschätzt. Die genaue Pathophysiologie ist derzeit noch unklar, eine genetische Prädisposition scheint wahrscheinlich. Die Behandlung besteht in den meisten Fällen aus einem akuten Entzug der Medikation und dem Beginn einer vorbeugenden medikamentösen Therapie. Eine Ausnahme davon stellt der Übergebrauch von Opioiden und Barbituraten (in Europa sehr selten) dar, die schrittweise reduziert werden sollen. Es besteht aktuell keine klare Evidenz für die Bevorzugung einer ambulanten oder stationären Entzugstherapie. Steroide werden zur Begleitung des Entzuges eingesetzt, die Studienlage dazu ist jedoch überwiegend negativ. Topiramat und Onabotulinumtoxin können bei Patienten mit Migräne und MOH die Attackenfrequenz so reduzieren, dass die Kriterien des MOH nicht mehr erfüllt sind, ohne dass vorher ein formaler Entzug durchgeführt worden ist.
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May A, Kropp P, Katsarava Z, Haag G, Lampl C, Sándor PS, Diener HC, Evers S, Straube A. Therapie primärer chronischer Kopfschmerzen: Chronische Migräne, chronischer Kopfschmerz vom Spannungstyp und andere chronische tägliche Kopfschmerzen. ACTA ACUST UNITED AC 2018. [DOI: 10.1055/s-0038-1626848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZusammenfassungDie IHS-Kriterien definieren vier primäre Kopfschmerzerkrankungen, die zu täglichen Dauerkopfschmerzen führen können: 1) chronische Migräne, 2) Kopfschmerz vom Spannungstyp, 3) Hemicrania continua, 4) neu aufgetretener Kopfschmerz. In der Praxis ist davon häufig der Kopfschmerz durch Medikamentenübergebrauch (früher: Analgetikakopfschmerz) abzugrenzen. Die jetzt von der Deutschen, Österreichischen und Schweizer Kopfschmerzgesellschaft gemeinsam vorgelegte Therapieleitlinie fasst die Literatur zur Therapie dieser Kopfschmerzformen zusammen und gibt Therapieempfehlungen, die die Literaturevidenz, aber auch die Praktikabilität berücksichtigen.
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Fitzgerald J, Ezad S, Whitehead N, May A, Trevaskis N, Leitch J, Jackson N. Four Different SVT Mechanisms in One Case. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.269] [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: 11/26/2022]
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May A. Combining digital innovation to create a scalable model of musculoskeletal physiotherapy as a first point of contact within general practice. Physiotherapy 2017. [DOI: 10.1016/j.physio.2017.11.121] [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: 11/30/2022]
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Haist T, Knabe M, May A, Lorenz D. [Endoscopic and surgical treatment of early gastric and esophageal carcinoma]. Chirurg 2017; 88:997-1004. [PMID: 29110039 DOI: 10.1007/s00104-017-0543-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The treatment of early gastric (EGC) and esophageal carcinomas (EEC) is an interdisciplinary challenge. The risk of lymph node metastasis (LNM) is the crucial point in choosing the correct treatment option. OBJECTIVE This article gives an overview of the current treatment options and provides help in choosing the correct therapy. METHOD Current concepts and therapy algorithms are presented on the basis of a literature review and data from our own center. RESULTS Endoscopic submucosal dissection (ESD) is recommended for mucosal gastric cancer with good or moderate differentiation (G1,2) without macroscopic ulceration, in elevated type lesions smaller than 2 cm in size or depressed lesions smaller than 1 cm in size. In additional chromoendoscopy should be carried out. The extent of surgical resection is defined by the location of the tumor. A safety margin of at least 3 cm should be applied in distal gastric resections whereas the first line goal in gastrectomy is to achieve an R0 resection. In cN0 tumors a D1 lymphadenectomy (LA) seems to be sufficient. Minimally invasive techniques currently show promising results especially for a subtotal resection. The treatment strategy in EEC differs depending on the tumor entity. Mucosal squamous cell carcinoma with high risk factors (L1,V1) and all cN0 submucosal tumors without the detection of LNM should be referred to primary surgical resection. Early stage cN+ squamous cell carcinomas should be preoperatively treated with chemoradiotherapy. Adenocarcinoma with infiltration of the deeper submucosa (sm2,3) and high-risk sm1 tumors require surgical treatment. The standard operating procedure for EEC is an Ivor Lewis esophagectomy with 2‑field LA preferably performed as a hybrid or by a completely minimally invasive procedure. The procedure of choice in endoscopic resection of EEC is resection with the suck and cut technique.
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Affiliation(s)
- T Haist
- Abteilung Allgemein- und Viszeralchirurgie, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Deutschland
| | - M Knabe
- Medizinische Klinik II/IV, Sana Klinikum Offenbach, Offenbach, Deutschland
| | - A May
- Medizinische Klinik II/IV, Sana Klinikum Offenbach, Offenbach, Deutschland
| | - D Lorenz
- Abteilung Allgemein- und Viszeralchirurgie, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Deutschland.
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Kurk S, Peeters P, Stellato R, Dorresteijn B, Jourdan M, Creemers GJ, Erdkamp F, de Jongh F, Kint P, Poppema B, Radema S, Simkens L, Tanis B, Tjin-A-Ton M, Van der Velden A, Punt C, Koopman M, May A. Impact of sarcopenia on dose limiting toxicities in metastatic colorectal cancer patients (mCRC pts) receiving palliative systemic treatment. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx388.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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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