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Loonis AST, Chesebro AL, Bay CP, Portnow LH, Weiss A, Chikarmane SA, Giess CS. Positive predictive value of axillary lymph node cortical thickness and nodal, clinical, and tumor characteristics in newly diagnosed breast cancer patients. Breast Cancer Res Treat 2024; 203:511-521. [PMID: 37950089 DOI: 10.1007/s10549-023-07155-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/30/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE Axillary lymph nodes (LNs) with cortical thickness > 3 mm have a higher likelihood of malignancy. To examine the positive predictive value (PPV) of axillary LN cortical thickness in newly diagnosed breast cancer patients, and nodal, clinical, and tumor characteristics associated with axillary LN metastasis. METHODS Retrospective review of axillary LN fine needle aspirations (FNAs) performed 1/1/2018-12/31/2019 included 135 axillary FNAs in 134 patients who underwent axillary surgery. Patient demographics, clinical characteristics, histopathology, and imaging features were obtained from medical records. Hypothesis testing was performed to identify predictors of axillary LN metastasis. RESULTS Cytology was positive in 72/135 (53.3%), negative in 61/135 (45.2%), and non-diagnostic in 2/135 (1.5%). At surgery, histopathology was positive in 84 (62.2%) and negative in 51 (37.8%). LN cortices were thicker in metastatic compared to negative nodes (p < 0.0001). PPV of axillary LNs with cortical thickness ≥ 3 mm, ≥ 3.5 mm, ≥ 4 mm and, ≥ 4.25 mm was 0.62 [95% CI 0.53, 0.70], 0.63 [0.54, 0.72], 0.67 [0.57, 0.76] , and 0.74 [0.64, 0.83], respectively. At multivariable analysis, abnormal hilum (OR = 3.44, p = 0.016) and diffuse cortical thickening (OR = 2.86, p = 0.038) were associated with nodal metastasis. CONCLUSION In newly diagnosed breast cancer patients, increasing axillary LN cortical thickness, abnormal fatty hilum, and diffuse cortical thickening are associated with nodal metastasis. PPV of axillary LN cortical thickness ≥ 3 mm and ≥ 3.5 mm is similar but increases for cortical thickness ≥ 4 mm. FNA of axillary LNs with cortex < 4 mm may be unnecessary for some patients undergoing sentinel LN biopsy.
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Affiliation(s)
- Anne-Sophie T Loonis
- Division of Breast Imaging, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Allyson L Chesebro
- Division of Breast Imaging, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
| | - Camden P Bay
- Division of Breast Imaging, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
- Takeda Pharmaceuticals, Cambridge, MA, USA
| | - Leah H Portnow
- Division of Breast Imaging, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Anna Weiss
- Division of Breast Imaging, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Division of Surgical Oncology, Department of Surgery, University of Rochester, Rochester, NY, USA
| | - Sona A Chikarmane
- Division of Breast Imaging, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Catherine S Giess
- Division of Breast Imaging, Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
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Moisés De Almeida Leite R, de Souza AV, Cauley C, Goldstone R, Francone T, Bay CP, Ricciardi R. Effect of Plastic Bag Extraction in Minimally Invasive Appendectomy. Am Surg 2023; 89:4604-4609. [PMID: 36041882 DOI: 10.1177/00031348221124320] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
BACKGROUND Evidence regarding the effects of plastic bag use for appendix removal during minimally invasive appendectomy remains scarce and conflicting. OBJECTIVE This study aimed to analyze the effects of plastic bag use during minimally invasive appendectomy on preoperative infection risk, morbidity and mortality. DESIGN This retrospective analysis of the prospective National Surgical Quality Improvement Program (NSQIP) cohort program. SETTING This study included data from the NSQIP database between the years of 2016 and 2019. PATIENT Adult patients undergoing minimally invasive (laparoscopic or robotic) without unplanned conversion to open surgery. INTERVENTION Use of plastic bag for specimen removal during appendectomy. MAIN OUTCOME MEASURES Risk ratios for the incidence of superficial surgical site infection, intra-abdominal abscess, overall medical morbidity, and overall mortality. RESULTS There were 43 783 cases of minimally invasive appendectomy in the NSQIP database between the years of 2016 and 2019. Among those who reported information regarding use of plastic bag, 28 589 (91.87%) reported use of plastic bag for specimen removal. Use of plastic bag was associated with a significant decrease in superficial surgical site infection (RR .39 (95% CI: .31-.49), P < .001), and in the risk of postoperative intra-abdominal abscess (RR: 0.66 (.57-.77), P < .001)). We also observed a robust reduction in overall medical-related morbidity and overall mortality, even after adjusting for multiple confounders. LIMITATIONS Observational nature of the study cannot exclude residual bias. Also, there was a significant rate of missing values for plastic bag use, which may bias results. CONCLUSIONS In this global prospective cohort using NSQIP database, use of plastic bag for appendix removal during minimally invasive appendectomy was associated with a significant improvement in surgical related outcomes and reduction in morbidity and overall mortality.
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Affiliation(s)
| | | | | | | | | | - Camden P Bay
- Brigham and Women's Hospital Department of Radiology, Boston, MA, USA
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Camacho A, Salah F, Bay CP, Waring J, Umeton R, Hirsch MS, Cole AP, Kibel AS, Loda M, Tempany CM, Fennessy FM. PI-RADS 3 score: A retrospective experience of clinically significant prostate cancer detection. BJUI Compass 2023; 4:473-481. [PMID: 37334024 PMCID: PMC10268585 DOI: 10.1002/bco2.231] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/30/2023] [Accepted: 02/20/2023] [Indexed: 06/20/2023] Open
Abstract
Rationale and objectives The study aims to propose an optimal workflow in patients with a PI-RADS 3 (PR-3) assessment category (AC) through determining the timing and type of pathology interrogation used for the detection of clinically significant prostate cancer (csPCa) in these men based upon a 5-year retrospective review in a large academic medical center. Materials and methods This United States Health Insurance Probability and Accountability Act (HIPAA)-compliant, institutional review board-approved retrospective study included men without prior csPCa diagnosis who received PR-3 AC on magnetic resonance (MR) imaging (MRI). Subsequent incidence and time to csPCa diagnosis and number/type of prostate interventions was recorded. Categorical data were compared using Fisher's exact test and continuous data using ANOVA omnibus F-test. Results Our cohort of 3238 men identified 332 who received PR-3 as their highest AC on MRI, 240 (72.3%) of whom had pathology follow-up within 5 years. csPCa was detected in 76/240 (32%) and non-csPCa in 109/240 (45%) within 9.0 ± 10.6 months. Using a non-targeted trans-rectal ultrasound biopsy as the initial approach (n = 55), another diagnostic procedure was required to diagnose csPCa in 42/55 (76.4%) of men, compared with 3/21(14.3%) men with an initial MR targeted-biopsy approach (n = 21); (p < 0.0001). Those with csPCa had higher median serum prostate-specific antigen (PSA) and PSA density, and lower median prostate volume (p < 0.003) compared with non-csPCa/no PCa. Conclusion Most patients with PR-3 AC underwent prostate pathology exams within 5 years, 32% of whom were found to have csPCa within 1 year of MRI, most often with a higher PSA density and a prior non-csPCa diagnosis. Addition of a targeted biopsy approach initially reduced the need for a second biopsy to reach a for csPCa diagnosis. Thus, a combination of systematic and targeted biopsy is advised in men with PR-3 and a co-existing abnormal PSA and PSA density.
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Affiliation(s)
- Andrés Camacho
- Department of RadiologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Fatima Salah
- Department of RadiologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Camden P. Bay
- Department of RadiologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Jonathan Waring
- Department of Informatics and Analytics, Dana‐Farber Cancer InstituteHarvard Medical SchoolBostonMassachusettsUSA
| | - Renato Umeton
- Department of Informatics and Analytics, Dana‐Farber Cancer InstituteHarvard Medical SchoolBostonMassachusettsUSA
| | - Michelle S. Hirsch
- Department of Pathology, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Alexander P. Cole
- Department of Urology, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Adam S. Kibel
- Department of Urology, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Massimo Loda
- Department of Pathology, Weill Cornell MedicineNew York‐Presbyterian HospitalNew YorkNew YorkUSA
| | - Clare M. Tempany
- Department of RadiologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Fiona M. Fennessy
- Department of RadiologyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
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Chesebro AL, Amornsiripanitch N, Lan Z, Bay CP, Chikarmane SA. Experience of a single healthcare system with screening mammography before and after COVID-19 shutdown. Clin Imaging 2023; 101:97-104. [PMID: 37327551 PMCID: PMC10249341 DOI: 10.1016/j.clinimag.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 05/24/2023] [Accepted: 06/06/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE To evaluate COVID-19's longitudinal impact on screening mammography volume trends. METHODS HIPAA-compliant, IRB-approved, single institution, retrospective study of screening mammogram volumes before (10/21/2016-3/16/2020) and greater than two years after (6/17/2020-11/30/2022) a state-mandated COVID-19 shutdown (3/17/2020-6/16/2020) were reviewed. A segmented quasi-poisson linear regression model adjusting for seasonality and network and regional population growth compared volume trends before and after the shutdown of each variable: age, race, language, financial source, risk factor for severe COVID-19, and examination location. RESULTS Adjusted model demonstrated an overall increase of 65 screening mammograms per month before versus a persistent decrease of 5 mammograms per month for >2 years after the shutdown (p < 0.0001). In subgroup analysis, downward volume trends were noted in all age groups <70 years (age < 50: +9/month before vs. -7/month after shutdown; age 50-60: +17 vs. -7; and age 60-70: +21 vs. -2; all p < 0.001), those identifying as White (+55 vs. -8, p < 0.0001) and Black (+4 vs. +1, p = 0.009), all financial sources (Medicare: +22 vs. -3, p < 0.0001; Medicaid: +5 vs. +2, p = 0.006; private insurance/self-pay: +38 vs. -4, p < 0.0001), women with at least one risk factor for severe COVID-19 (+30 vs. -48, p < 0.0001), and screening mammograms performed at a hospital-based location (+48 vs. -14, p = 0.0001). CONCLUSION The screening mammogram volume trend more than two years after the COVID-19 shutdown has continued to decline for most patient populations. Findings highlight the need to identify additional areas for education and outreach.
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Affiliation(s)
- Allyson L Chesebro
- Brigham and Women's Hospital, Department of Radiology, 75 Francis St., Boston, MA 02115, United States of America; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States of America.
| | - Nita Amornsiripanitch
- Brigham and Women's Hospital, Department of Radiology, 75 Francis St., Boston, MA 02115, United States of America; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States of America.
| | - Zhou Lan
- Brigham and Women's Hospital, Department of Radiology, 75 Francis St., Boston, MA 02115, United States of America; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States of America.
| | - Camden P Bay
- Brigham and Women's Hospital, Department of Radiology, 75 Francis St., Boston, MA 02115, United States of America; Takeda Pharmaceuticals, USA, Inc., 650 Kendall St., Cambridge, MA 02142, United States of America
| | - Sona A Chikarmane
- Brigham and Women's Hospital, Department of Radiology, 75 Francis St., Boston, MA 02115, United States of America; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States of America.
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Tran NA, Palotai M, Hanna GJ, Schoenfeld JD, Bay CP, Rettig EM, Bunch PM, Juliano AF, Kelly HR, Suh CH, Zander DA, Morales Pinzon A, Kann BH, Huang RY, Haddad RI, Guttmann CRG, Guenette JP. Diagnostic performance of computed tomography features in detecting oropharyngeal squamous cell carcinoma extranodal extension. Eur Radiol 2023; 33:3693-3703. [PMID: 36719493 DOI: 10.1007/s00330-023-09407-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 12/06/2022] [Accepted: 12/27/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Accurate pre-treatment imaging determination of extranodal extension (ENE) could facilitate the selection of appropriate initial therapy for HPV-positive oropharyngeal squamous cell carcinoma (HPV + OPSCC). Small studies have associated 7 CT features with ENE with varied results and agreement. This article seeks to determine the replicable diagnostic performance of these CT features for ENE. METHODS Five expert academic head/neck neuroradiologists from 5 institutions evaluate a single academic cancer center cohort of 75 consecutive HPV + OPSCC patients. In a web-based virtual laboratory for imaging research and education, the experts performed training on 7 published CT features associated with ENE and then independently identified the "single most (if any) suspicious" lymph node and presence/absence of each of the features. Inter-rater agreement was assessed using percentage agreement, Gwet's AC1, and Fleiss' kappa. Sensitivity, specificity, and positive and negative predictive values were calculated for each CT feature based on histologic ENE. RESULTS All 5 raters identified the same node in 52 cases (69%). In 15 cases (20%), at least one rater selected a node and at least one rater did not. In 8 cases (11%), all raters selected a node, but at least one rater selected a different node. Percentage agreement and Gwet's AC1 coefficients were > 0.80 for lesion identification, matted/conglomerated nodes, and central necrosis. Fleiss' kappa was always < 0.6. CT sensitivity for histologically confirmed ENE ranged 0.18-0.94, specificity 0.41-0.88, PPV 0.26-0.36, and NPV 0.78-0.96. CONCLUSIONS Previously described CT features appear to have poor reproducibility among expert head/neck neuroradiologists and poor predictive value for histologic ENE. KEY POINTS • Previously described CT imaging features appear to have poor reproducibility among expert head and neck subspecialized neuroradiologists as well as poor predictive value for histologic ENE. • Although it may still be appropriate to comment on the presence or absence of these CT features in imaging reports, the evidence indicates that caution is warranted when incorporating these features into clinical decision-making regarding the likelihood of ENE.
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Affiliation(s)
- Ngoc-Anh Tran
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Miklos Palotai
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Glenn J Hanna
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Jonathan D Schoenfeld
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Camden P Bay
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eleni M Rettig
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Paul M Bunch
- Division of Neuroradiology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Amy F Juliano
- Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Hillary R Kelly
- Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Division of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - David A Zander
- Division of Neuroradiology, University of Colorado, Aurora, CO, USA
| | - Alfredo Morales Pinzon
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Benjamin H Kann
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Division of Neuroradiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street Boston, Boston, MA, 02115, USA
| | - Robert I Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Charles R G Guttmann
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey P Guenette
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Division of Neuroradiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street Boston, Boston, MA, 02115, USA.
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Haber MA, Matalon SA, Bay CP, Gaviola GC. A Team-Based Approach to Radiology Resident Case Conference to Improve Camaraderie Among Trainees. Curr Probl Diagn Radiol 2023; 52:192-196. [PMID: 36273947 DOI: 10.1067/j.cpradiol.2022.09.004] [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] [Received: 09/09/2022] [Accepted: 09/21/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION In light of increasing concerns regarding resident burnout, we developed a team-based approach (TBA) to radiology resident case conference to foster wellness by cultivating camaraderie and a positive learning environment. METHODS Teaching faculty provided both a traditional hot-seat and a TBA format case conference. Resident perceptions of each conference format were assessed using a 16-item questionnaire, with 14 of the items utilizing a 7-point Likert scale to assess the learning environment, including measures related to wellness. A two-sided Wilcoxon rank-sum test was used to compare responses between the 2 formats of teaching conferences. RESULTS Four paired teaching sessions were performed by 4 individual faculty. Sixty-six individual resident responses were received for the hot-seat and TBA conferences in aggregate. Residents responded "strongly agree" to positive statements more often for the TBA format compared with hot-seat for 13 out of the 14 items used to assess perceptions of the learning environment, including measures of wellness and camaraderie. The level of agreement on a 7-point Likert scale pertaining to the statement "The format of this case conference improves camaraderie among my co-residents" had a median value of 4.5 for the hot-seat format and 7 for the TBA format (P = 0.002). DISCUSSION A TBA format for resident case conference may foster a sense of camaraderie among trainees. Residency programs may consider supplementing hot-seat conferences with the TBA method to address increasing burnout among trainees and promote resident wellbeing.
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Affiliation(s)
- Matthew A Haber
- Brigham and Women's Hospital, Department of Radiology, Boston, MA; Harvard Medical School, Boston, MA.
| | - Shanna A Matalon
- Brigham and Women's Hospital, Department of Radiology, Boston, MA; Harvard Medical School, Boston, MA.
| | - Camden P Bay
- Brigham and Women's Hospital, Department of Radiology, Boston, MA; Harvard Medical School, Boston, MA.
| | - Glenn C Gaviola
- Brigham and Women's Hospital, Department of Radiology, Boston, MA; Harvard Medical School, Boston, MA.
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Ritland BM, Neumeier WH, Jiang SH, Smith CD, Heaton KJ, Hildebrandt AM, Jabbar MA, Liao HJ, Coello E, Zhao W, Bay CP, Lin AP. Short-term neurochemical effects of transcutaneous trigeminal nerve stimulation using 7T magnetic resonance spectroscopy. J Neuroimaging 2023; 33:279-288. [PMID: 36495053 DOI: 10.1111/jon.13074] [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: 08/29/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND PURPOSE The purpose was to explore the effects of transcutaneous trigeminal nerve stimulation (TNS) on neurochemical concentrations (brainstem, anterior cingulate cortex [ACC], dorsolateral prefrontal cortex [DLPFC], ventromedial prefrontal cortex [VMPFC], and the posterior cingulate cortex [PCC]) using ultrahigh-field magnetic resonance spectroscopy. METHODS This double-blinded study tested 32 healthy males (age: 25.4 ± 7.3 years) on two separate occasions where participants received either a 20-minute TNS or sham session. Participants were scanned at baseline and twice post-TNS/sham administration. RESULTS There were no group differences in concentration changes of glutamate, gamma-aminobutyric acid, glutamine, myoinositol (mI), total N-acetylaspartate, total creatine (tCr), and total choline between the baseline scan and the first post-TNS/sham scan and between the first and second post-TNS/sham scan in the brainstem, ACC, DLPFC, VMPFC, and PCC. Between the baseline scan and the second post-TNS/sham scan, changes in tCr (mean difference = 0.280 mM [0.075 to 0.485], p = .026) and mI (mean difference = 0.662 mM [0.203 to 1.122], p = .026) in the DLPFC differed between groups. Post hoc analyses indicated that there was a decrease in tCr (mean change = -0.201 mM [-0.335 to -0.067], p = .003) and no change in mI (mean change = -0.327 mM [-0.737 to 0.083], p = .118) in the TNS group; conversely, there was no change in tCr (mean change = -0.100 mM [-0.074 to 0.274], p = .259) and an increase in mI (mean change = 0.347 mM [0.106 to 0.588], p = .005) in the sham group. CONCLUSION These data demonstrate that a single session of unilateral TNS slightly decreased tCr concentrations in the DLPFC region.
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Affiliation(s)
- Bradley M Ritland
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - William H Neumeier
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Sam H Jiang
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carl D Smith
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Kristin J Heaton
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Audrey M Hildebrandt
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Muhammad A Jabbar
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Hui Jun Liao
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Eduardo Coello
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Wufan Zhao
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Camden P Bay
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander P Lin
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Chai JL, Alencar RO, Hirsch MS, Bhagavatula S, Bay CP, Siegmund S, Chang SL, Silverman SG. Reliability and Management Outcomes Following a Percutaneous Biopsy Diagnosis of Oncocytoma: A 15-year Retrospective Analysis. Radiology 2023; 307:e221156. [PMID: 36692400 DOI: 10.1148/radiol.221156] [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: 01/25/2023]
Abstract
Background There is uncertainty in the management of renal masses diagnosed as oncocytomas with image-guided percutaneous biopsy. Purpose To assess the reliability of a diagnosis of oncocytoma based on image-guided percutaneous renal mass biopsy and evaluate patient outcomes following different management strategies. Materials and Methods In this retrospective study, image-guided percutaneous biopsy pathology reports from April 2004 to April 2019 were searched for keywords "oncocytoma" and "oncocytic neoplasm" and compared with surgical pathology or repeat biopsy results. Patients with at least 12 months of clinical follow-up and known cause of death were grouped according to management strategies, and disease-specific survival and metastatic renal cell carcinoma (RCC)-free survival were compared. Mass growth rates were calculated with use of a normal linear mixed model. Results The database yielded 160 biopsy reports of 149 renal masses in 139 patients; 149 masses were categorized as oncocytoma (n = 107), likely oncocytoma (n = 12), oncocytic neoplasm (n = 28), and indeterminate with oncocytoma in differential (n = 2). Biopsied masses categorized as oncocytoma or likely oncocytoma were oncocytomas in 16 of 17 masses (94%) based on surgical pathology or repeat biopsy; four of eight masses (50%) categorized as oncocytic neoplasms were low-grade RCCs. Outcome analysis included 121 patients (mean age ± SD, 68 years ± 9.1; 82 men); 80 patients initially underwent active surveillance (11 were later treated), 33 underwent ablation, and eight underwent surgery. Disease-specific survival and metastatic-free survival were 100% after each management strategy (median follow-up, 86.6 months; range, 14.2-207.9 months). Mass growth rate (mean, 1.7 mm per year) showed no evidence of a significant difference among biopsy result categories (P = .37) or initial (P = .84) or final management strategies (P = .11). Conclusion Image-guided percutaneous biopsy diagnosis of renal oncocytoma was reliable. Although some masses diagnosed as oncocytic neoplasms were low-grade renal cell carcinomas (RCCs) at final diagnosis, no patients died of RCC, including those managed with active surveillance. © RSNA, 2023 See also the editorial by Lockhart in this issue.
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Affiliation(s)
- Jessie L Chai
- From the Division of Abdominal Imaging and Intervention, Department of Radiology (J.L.C., R.O.A., S.B., C.P.B., S.G.S.), Department of Pathology (M.S.H., S.S.), Department of Radiology (C.P.B.), and Division of Urology, Department of Surgery (S.L.C.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Raquel O Alencar
- From the Division of Abdominal Imaging and Intervention, Department of Radiology (J.L.C., R.O.A., S.B., C.P.B., S.G.S.), Department of Pathology (M.S.H., S.S.), Department of Radiology (C.P.B.), and Division of Urology, Department of Surgery (S.L.C.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Michelle S Hirsch
- From the Division of Abdominal Imaging and Intervention, Department of Radiology (J.L.C., R.O.A., S.B., C.P.B., S.G.S.), Department of Pathology (M.S.H., S.S.), Department of Radiology (C.P.B.), and Division of Urology, Department of Surgery (S.L.C.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Sharath Bhagavatula
- From the Division of Abdominal Imaging and Intervention, Department of Radiology (J.L.C., R.O.A., S.B., C.P.B., S.G.S.), Department of Pathology (M.S.H., S.S.), Department of Radiology (C.P.B.), and Division of Urology, Department of Surgery (S.L.C.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Camden P Bay
- From the Division of Abdominal Imaging and Intervention, Department of Radiology (J.L.C., R.O.A., S.B., C.P.B., S.G.S.), Department of Pathology (M.S.H., S.S.), Department of Radiology (C.P.B.), and Division of Urology, Department of Surgery (S.L.C.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Stephanie Siegmund
- From the Division of Abdominal Imaging and Intervention, Department of Radiology (J.L.C., R.O.A., S.B., C.P.B., S.G.S.), Department of Pathology (M.S.H., S.S.), Department of Radiology (C.P.B.), and Division of Urology, Department of Surgery (S.L.C.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Steven L Chang
- From the Division of Abdominal Imaging and Intervention, Department of Radiology (J.L.C., R.O.A., S.B., C.P.B., S.G.S.), Department of Pathology (M.S.H., S.S.), Department of Radiology (C.P.B.), and Division of Urology, Department of Surgery (S.L.C.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
| | - Stuart G Silverman
- From the Division of Abdominal Imaging and Intervention, Department of Radiology (J.L.C., R.O.A., S.B., C.P.B., S.G.S.), Department of Pathology (M.S.H., S.S.), Department of Radiology (C.P.B.), and Division of Urology, Department of Surgery (S.L.C.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
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Chang YF, Lee TL, Oyerinde O, Desai SR, Aljabban A, Bay CP, Bain PA, Chung HJ. Efficacy and safety of topical agents in the treatment of melasma: What's evidence? A systematic review and meta-analysis. J Cosmet Dermatol 2022; 22:1168-1176. [PMID: 36566490 DOI: 10.1111/jocd.15566] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 10/31/2022] [Accepted: 12/01/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Various topical agents have been used to treat melasma; however, a large-scale evaluation among the currently available treatment is lacking. OBJECTIVES The aim of this study was to evaluate the efficacy and safety of topical agents for melasma. METHODS The MEDLINE, Embase, Web of Science, Cochrane, and Alt-Healthwatch databases were searched in November 2021. Original studies that reported pre- and post-treatment Melasma Area Severity Index (MASI)/modified Melasma Area Severity Index (mMASI) scores and/or adverse effects (AEs) were eligible for inclusion. The main outcome was the efficacy analyzed by the changes in the pre- and post-treatment with standardized mean difference (SMD) of MASI/mMASI scores; the AEs were calculated with incidence proportion by the reported percentage of skin irritations. RESULTS A total of 45 studies (2359 patients) and 55 studies (4539 patients) met the inclusion criteria for efficacy and AEs, respectively. Hydroquinone (HQ) monotherapy (SMD -1.3, 95% CI [-1.6 to -1.0]), HQ-containing combination therapy (-1.4, [-1.7 to -1.1]), cysteamine (-1.6, [-2.0 to -1.2]), tranexamic acid (-1.5, [-2.0 to -1.1]), azelaic acid (-1.3, [-1.7 to -1.0]), and kojic acid (-0.9, [-1.3 to -0.5]) demonstrated comparable efficacy, while zinc sulfate did not exhibit statistically significant improvement (-1.2, [-2.7 to 0.4]). HQ-containing combination therapy (50.9%) and cysteamine (42.2%) demonstrated the highest incidence of irritation, while azelaic acid (18.7%), kojic acid (5.3%), and tranexamic acid (0.8%) revealed a lower risk. CONCLUSIONS In this meta-analysis, non-HQ agents except zinc sulfate may be considered as an alternative to HQ-containing agents. However, treatment should be guided by patient's tolerance, availability, and physicians' experience.
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Affiliation(s)
- Yu-Feng Chang
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Tai Lin Lee
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Oyetewa Oyerinde
- Harvard Combined Dermatology Residency Training Program, Boston, Massachusetts, USA
| | - Seemal R Desai
- Department of Dermatology, The University of Texas Southwestern Medical Center and Innovative Dermatology, Dallas, Texas, USA
| | - Ali Aljabban
- Harvard Medical School, Boston, Massachusetts, USA.,Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Camden P Bay
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Paul A Bain
- Countway Library, Harvard Medical School, Boston, Massachusetts, USA
| | - Hye Jin Chung
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Portnow LH, Pollock JL, Bay CP, Gombos EC. Mammographic positioning in women with pectus excavatum: An anatomic challenge. Clin Imaging 2022; 92:117-123. [DOI: 10.1016/j.clinimag.2022.10.006] [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] [Received: 05/23/2022] [Revised: 10/04/2022] [Accepted: 10/12/2022] [Indexed: 11/03/2022]
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Auchus RJ, Bay CP, Honzel B, Luther JM, Peng D, Vaidya A, Yozamp N, Brown JM. OR20-3 Characterization of the Pathophysiologic Spectrum of Subclinical Primary Aldosteronism in Normotension. J Endocr Soc 2022. [PMCID: PMC9629410 DOI: 10.1210/jendso/bvac150.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Abstract
Context
Accumulating evidence suggests that primary aldosteronism can manifest across a broad phenotypic spectrum and that its origins can at times be detected among normotensive individuals. Herein, we conducted deep-phenotyping studies to interrogate the pathophysiologic continuum of the primary aldosteronism phenotype among normotensive participants.
Methods
Normotensive participants with obesity, metabolic syndrome, and/or high-normal untreated blood pressure underwent dietary sodium loading and restriction protocols (to maximally suppress and stimulate angiotensin II-mediated aldosterone production), dexamethasone suppression and cosyntropin stimulation protocols (to maximally suppress and stimulate ACTH-mediated aldosterone production), and 24h ambulatory blood pressure monitoring. Measurement of aldosterone and 18-hybrid steroids via LC-MS/MS was conducted to quantify the degree of dysregulated CYP11B2 expression. Urinary extracellular vesicles (uEV) were isolated to measure renal tubular protein content associated with mineralocorticoid receptor activation. In order to characterize parameters across the severity spectrum of non-suppressible and renin-independent aldosterone production, participants with suppressed renin activity were categorized by tertile of 24h urinary aldosterone production following oral sodium suppression testing. Repeated measures linear mixed models were used to analyze trends for each parameter across tertiles of autonomous aldosterone production; for ease of presentation, the mean [SD] of the first vs. third tertile are presented for selected parameters.
Results
Following oral sodium loading, greater non-suppressible renin-independent aldosterone production was associated with greater kaliuresis, higher daytime ambulatory systolic blood pressure within the normal range, and a progressive impairment in the ability to suppress production of serum aldosterone (P-trend=0.009), 18-hydroxycorticosterone (9.3 [5.0] vs. 19.6 [6.5] ng/dL, P-trend=0.004), 18-hydroxycortisol (45.0 [25.4] vs. 70.9 [29.9] ng/dL, P-trend=0.03), and 18-oxocortisol (1.2 [0.03] vs. 3.4 [7.2], P-trend=0.01). Similarly, following dexamethasone suppression testing, there was a progressive inability to suppress 18-hydroxycorticosterone (8.3 [5.0] vs. 15.4 [8.2] ng/dL, P-trend=0.004), 18-hydroxycortisol (6.6 [3.8] vs. 10.2 [3.6] ng/dL, P-trend=0.03), and 18-oxocortisol (1.2 [0.01] vs. 1.4 [0.6] ng/dL, P-trend=0.01) in parallel with greater renin-independent aldosterone production. In contrast, following stimulation with cosyntropin, greater non-suppressible and renin-independent aldosterone production was associated with progressively enhanced production of 18-hydroxycorticosterone (77.6 [25.4] vs. 121.1 [31.1] ng/dL, P-trend=0.004), 18-hydroxycortisol (68.5 [28.4] vs. 86.2 [26.3] ng/dL, P-trend=0.03), and 18-oxocortisol (3.2 [2.8] vs. 7.3 [3.5] ng/dL, P-trend=0.01). Excretion of uEV's of pendrin (P=0.002) and aquaporin 2 (P=0.002) all increased with greater non-suppressible aldosterone production.
Conclusions
Dynamic phenotyping studies in normotensive individuals demonstrate a continuum of non-suppressible and renin-independent aldosterone production that parallels higher blood pressure, greater kaliuresis, increased 18-hybrid steroid production indicative of dysregulated CYP11B2 expression, and increased uEV excretion indicative of renal mineralocorticoid receptor activation. This pathophysiologic continuum of normotensive primary aldosteronism provides phenotypic support for histopathology studies showing ectopic CYP11B2 expression within adrenal glands of normotensive humans, and for epidemiologic studies demonstrating renin-independent aldosterone production in normotensive populations increases risk for developing hypertension.
Presentation: Monday, June 13, 2022 11:30 a.m. - 11:45 a.m.
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Cuddy SA, Datar Y, Ovsak G, Saith S, Murphy SP, Bay CP, Haddad M, Lilleness B, Muralidhar V, Pipilas A, Vuong J, Guardino E, Maurer MS, Ruberg FL, Falk RH, Dorbala S. Optimal Echocardiographic Parameters to Improve the Diagnostic Yield of Tc-99m-Bone Avid Tracer Cardiac Scintigraphy for Transthyretin Cardiac Amyloidosis. Circ Cardiovasc Imaging 2022; 15:e014645. [PMID: 36378779 PMCID: PMC9667717 DOI: 10.1161/circimaging.122.014645] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Echocardiographic deformation-based ratios and novel multi-parametric scores have been suggested to discriminate transthyretin cardiac amyloidosis (ATTR-CM) from other causes of increased left ventricular wall thickness among patients referred for ATTR-CM evaluation. Their relative predictive accuracy has not been well studied. We sought to (1) identify echocardiographic parameters predictive of ATTR-CM and (2) compare the diagnostic accuracy of these parameters in patients with suspected ATTR-CM referred for technetium-99m-pyrophosphate scintigraphy. METHODS Echocardiograms from 598 patients referred to 3 major amyloidosis centers for technetium-99m-pyrophosphate to detect ATTR-CM were analyzed, including longitudinal strain (LS) analysis. Deformation ratios (septal apex to base ratio, relative apical sparing, ejection fraction to global LS), a multi-center European increased wall thickness score, and Mayo Clinic derived ATTR score (transthyretin cardiac amyloidosis score) were calculated. A logistic regression model was used to identify the parameters that best associated with a diagnosis of ATTR-CM. Comparison of the diagnostic capacity of the parameters was performed by receiver operating characteristic curves and the area under the curve (AUC). RESULTS Over half of the subjects (54.2%) were diagnosed with ATTR-CM (78% were men, median age of 76 years). Age, inferolateral wall thickness, and basal LS were the strongest predictors of ATTR-CM, AUC of 0.87 (95% CI: 0.83, 0.90), superior to the increased wall thickness score AUC of 0.78 (95% CI: 0.73, 0.83; P=0.004). An inferolateral wall thickness of ≥14 mm (AUC: 0.73) was as accurate as the published cut-offs for transthyretin cardiac amyloidosis score and septal apex to base (AUC: 0.72 and 0.69, P=0.8 and P=0.1, respectively), and was superior to ejection fraction to global LS and relative apical sparing (AUC: 0.64 and 0.53, P<0.001, respectively). A cut-off of ≥-8% for average basal LS (AUC: 0.76, CI: 0.72-0.79) had a similar area under the curve to transthyretin cardiac amyloidosis score (TCAS) (P=0.2); outperforming the other indices (P<0.01). CONCLUSION Inferolateral wall thickness and average basal LS performed as well as or better than more complex echo ratios and multiparametric scores to predict ATTR-CM.
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Affiliation(s)
- Sarah Am Cuddy
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA (S.A.M.C., Y.D., S.P.M., M.H., R.H.F., S.D.)
- CV imaging program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, MA (S.A.M.C., Y.D., G.O., S.D.)
| | - Yesh Datar
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA (S.A.M.C., Y.D., S.P.M., M.H., R.H.F., S.D.)
- CV imaging program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, MA (S.A.M.C., Y.D., G.O., S.D.)
| | - Gavin Ovsak
- CV imaging program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, MA (S.A.M.C., Y.D., G.O., S.D.)
| | - Sunil Saith
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY (S.S., M.S.M.)
| | - Sean P Murphy
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA (S.A.M.C., Y.D., S.P.M., M.H., R.H.F., S.D.)
| | - Camden P Bay
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA (C.P.B., S.D.)
| | - Mia Haddad
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA (S.A.M.C., Y.D., S.P.M., M.H., R.H.F., S.D.)
| | - Brian Lilleness
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, Boston, MA (B.L., V.M., A.P., J.V., E.G., F.L.R.)
| | - Varsha Muralidhar
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, Boston, MA (B.L., V.M., A.P., J.V., E.G., F.L.R.)
| | - Alexandra Pipilas
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, Boston, MA (B.L., V.M., A.P., J.V., E.G., F.L.R.)
| | - Jacqueline Vuong
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, Boston, MA (B.L., V.M., A.P., J.V., E.G., F.L.R.)
| | - Eric Guardino
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, Boston, MA (B.L., V.M., A.P., J.V., E.G., F.L.R.)
| | - Mathew S Maurer
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY (S.S., M.S.M.)
| | - Frederick L Ruberg
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, Boston, MA (B.L., V.M., A.P., J.V., E.G., F.L.R.)
| | - Rodney H Falk
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA (S.A.M.C., Y.D., S.P.M., M.H., R.H.F., S.D.)
| | - Sharmila Dorbala
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA (S.A.M.C., Y.D., S.P.M., M.H., R.H.F., S.D.)
- CV imaging program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, MA (S.A.M.C., Y.D., G.O., S.D.)
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA (C.P.B., S.D.)
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DeSimone AK, Jhala K, Osayande DE, Bay CP, Seltzer SE, Matalon SA. Think Like an MBA: Development, Implementation, and Evaluation of an Academic Radiology Business Series (ARBS) for Radiology Trainees. Acad Radiol 2022; 30:975-982. [PMID: 35690538 DOI: 10.1016/j.acra.2022.05.008] [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: 04/09/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 11/27/2022]
Abstract
RATIONALE AND OBJECTIVES To address existing educational gaps in the business of radiology and medicine, we developed, implemented, and evaluated an Academic Radiology Business Series (ARBS) as part of a longitudinal noninterpretive skills curriculum in our radiology residency program. MATERIALS AND METHODS Mixed lecture- and discussion-based sessions were prepared and taught by content experts and radiologist-leaders at our institution in the style of a typical MBA curriculum, drawing on five core pillars: strategy, management, operations, finance, and health policy and economics. The series concluded with an interactive discussion of a Harvard Business School case study. To study the effectiveness of the curriculum, Wilcoxon rank-sum test was used to compare survey results before and after the curriculum. RESULTS Nearly 80% of the pre-curriculum survey respondents were not satisfied with the current training offered in the business of medicine. Although 94% of trainees were interested in pursuing leadership positions in healthcare, they have self-reported knowledge gaps in the fundamentals of the business of medicine. There were significant improvements in satisfaction with their training in the business of medicine and perceived improvements in knowledge of important concepts in the business of medicine after participating in the curriculum (p < 0.001). CONCLUSION Radiology trainees have strong interest in the business of radiology and appreciate its importance yet feel inadequately prepared during training. Intentional training incorporated into residency education in the form of an innovative educational initiative that brings radiology trainees together and utilizes an institution's own leaders to teach is feasible and effective.
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Affiliation(s)
- Ariadne K DeSimone
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Khushboo Jhala
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David E Osayande
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Camden P Bay
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Steven E Seltzer
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shanna A Matalon
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Portnow LH, Georgian-Smith D, Haider I, Barrios M, Bay CP, Nelson KP, Raza S. Persistent inter-observer variability of breast density assessment using BI-RADS® 5th edition guidelines. Clin Imaging 2022; 83:21-27. [PMID: 34952487 PMCID: PMC8857050 DOI: 10.1016/j.clinimag.2021.11.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/30/2021] [Accepted: 11/30/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Due to most states' legislation, mammographic density categorization has potentially far-reaching implications, but remains subjective based on BIRADS® guidelines. We aimed to determine 1) effect of BI-RADS® 5th edition (5th-ed) vs 4th-edition (4th-ed) guidelines on reader agreement regarding density assessment; 2) 5th-ed vs 4th-ed density distribution, and visual vs quantitative assessment agreement; 3) agreement between experienced vs less experienced readers. METHODS In a retrospective review, six breast imaging radiologists (BIR) (23-30 years' experience) visually assessed density of 200 screening mammograms performed September 2012-January 2013 using 5th-ed guidelines. Results were compared to 2016 data of the same readers evaluating the same mammograms using 4th-ed guidelines after a training module. 5th-ed density categorization by seven junior BIR (1-5 years' experience) was compared to eight experienced BIR. Nelson et al.'s kappas (κm, κw), Fleiss' κF, and Cohen's κ were calculated. Quantitative density using Volpara was compared with reader assessments. RESULTS Inter-reader weighted agreement using 5th-ed is moderately strong, 0.73 (κw, s.e. = 0.01), similar to 4th-ed, 0.71 (κw, s.e. = 0.03). Intra-reader Cohen's κ is 0.23-0.34, similar to 4th-ed. Binary not-dense vs dense categorization, using 5th-ed results in higher dense categorization vs 4th-ed (p < 0.001). 5th-ed density distribution results in higher numbers in categories B/C vs 4th-ed (p < 0.001). Distribution for 5th-ed does not differ based on reader experience (p = 0.09). Reader vs quantitative weighted agreement is similar (5th-ed, Cohen's κ = 0.76-0.85; 4th-ed, Cohen's κ = 0.68-0.83). CONCLUSION There is persistent subjectivity of visually assessed mammographic density using 5th-ed guidelines; experience does not correlate with better inter-reader agreement.
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Affiliation(s)
- Leah H. Portnow
- Brigham and Women's Hospital, Department of Radiology, 75 Francis Street, Boston, MA 02115
| | - Dianne Georgian-Smith
- Brigham and Women's Hospital, Department of Radiology, 75 Francis Street, Boston, MA 02115
| | - Irfanullah Haider
- Brigham and Women's Hospital, Department of Radiology, 75 Francis Street, Boston, MA 02115
| | - Mirelys Barrios
- Brigham and Women's Hospital, Department of Radiology, 75 Francis Street, Boston, MA 02115
| | - Camden P. Bay
- Brigham and Women's Hospital, Department of Radiology, 75 Francis Street, Boston, MA 02115
| | - Kerrie P. Nelson
- Boston University Department of Biostatistics, 801 Massachusetts Avenue 3rd Floor, Boston, MA 02118
| | - Sughra Raza
- Brigham and Women's Hospital, Department of Radiology, 75 Francis Street, Boston, MA 02115
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Voinescu PE, Ehlert AN, Bay CP, Allien S, Pennell PB. Variations in Seizure Frequency During Pregnancy and Postpartum by Epilepsy Type. Neurology 2022; 98:e802-e807. [PMID: 34893557 PMCID: PMC8883510 DOI: 10.1212/wnl.0000000000013056] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 10/25/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To assess whether increased seizure frequency during pregnancy and postpartum is influenced by epilepsy type, seizure location, and antiseizure medications. METHODS Clinical data were collected in a longitudinal prospective database of pregnant women with epilepsy at Brigham and Women's Hospital. Within each individual participant, baseline seizure frequency was calculated for the 9 months before conception, and whether seizure frequency increased during pregnancy or the postpartum period was determined. Seizure frequency was calculated for each 4-week interval during pregnancy. Generalized estimating equations for logistic regression were applied. RESULTS Ninety-nine patients contributing 114 pregnancies were included from 2013 to 2018. Increased seizure frequency occurred more often during pregnancies of women with focal vs generalized epilepsy (21.1% vs 5.3%, odds ratio [OR] 4.70, 95% confidence interval [CI] 1.00-22.00; p = 0.0497). Among women with focal epilepsy, increased seizure frequency occurred more often in those with frontal lobe epilepsy (OR 8.00, 95% CI 2.19-29.21; p = 0.0017). There was no difference in seizure worsening in the postpartum period between the focal and generalized (11.1% vs 9.1%; p = 0.4478) or frontal and other focal (18.8% vs 6.0%; p = 0.1478) epilepsy groups. Pregnancies on polytherapy had higher odds of seizure worsening compared to monotherapy (OR 8.36, 95% CI 2.07-33.84; p = 0.0029), regardless of the medication or epilepsy type. A lack of preconception seizure freedom was also associated with increased seizure frequency during pregnancy (OR 6.418; p = 0.0076). DISCUSSION Women with focal epilepsy have higher likelihood of seizure worsening during pregnancy compared to women with generalized epilepsy; frontal lobe epilepsy poses an especially elevated risk. Polytherapy and lack of preconception seizure freedom are additional predictors for an increased likelihood of seizure worsening.
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Affiliation(s)
- P Emanuela Voinescu
- From the Department of Neurology (P.E.V., S.A., P.B.P.), Division of Epilepsy, Department of Medicine (P.E.V., P.B.P.), Division of Women's Health, Department of Radiology (C.P.B.), and Center for Clinical Investigation (C.P.B.), Brigham and Women's Hospital; Harvard Medical School (P.E.V., C.P.B., P.B.P.); T.H. Chan School of Public Health (A.N.E.), Harvard University; OptumRx (A.N.E.), Boston, MA; and Department of Neurology (P.B.P.), University of Pittsburgh, PA.
| | - Alexa N Ehlert
- From the Department of Neurology (P.E.V., S.A., P.B.P.), Division of Epilepsy, Department of Medicine (P.E.V., P.B.P.), Division of Women's Health, Department of Radiology (C.P.B.), and Center for Clinical Investigation (C.P.B.), Brigham and Women's Hospital; Harvard Medical School (P.E.V., C.P.B., P.B.P.); T.H. Chan School of Public Health (A.N.E.), Harvard University; OptumRx (A.N.E.), Boston, MA; and Department of Neurology (P.B.P.), University of Pittsburgh, PA
| | - Camden P Bay
- From the Department of Neurology (P.E.V., S.A., P.B.P.), Division of Epilepsy, Department of Medicine (P.E.V., P.B.P.), Division of Women's Health, Department of Radiology (C.P.B.), and Center for Clinical Investigation (C.P.B.), Brigham and Women's Hospital; Harvard Medical School (P.E.V., C.P.B., P.B.P.); T.H. Chan School of Public Health (A.N.E.), Harvard University; OptumRx (A.N.E.), Boston, MA; and Department of Neurology (P.B.P.), University of Pittsburgh, PA
| | - Stephanie Allien
- From the Department of Neurology (P.E.V., S.A., P.B.P.), Division of Epilepsy, Department of Medicine (P.E.V., P.B.P.), Division of Women's Health, Department of Radiology (C.P.B.), and Center for Clinical Investigation (C.P.B.), Brigham and Women's Hospital; Harvard Medical School (P.E.V., C.P.B., P.B.P.); T.H. Chan School of Public Health (A.N.E.), Harvard University; OptumRx (A.N.E.), Boston, MA; and Department of Neurology (P.B.P.), University of Pittsburgh, PA
| | - Page B Pennell
- From the Department of Neurology (P.E.V., S.A., P.B.P.), Division of Epilepsy, Department of Medicine (P.E.V., P.B.P.), Division of Women's Health, Department of Radiology (C.P.B.), and Center for Clinical Investigation (C.P.B.), Brigham and Women's Hospital; Harvard Medical School (P.E.V., C.P.B., P.B.P.); T.H. Chan School of Public Health (A.N.E.), Harvard University; OptumRx (A.N.E.), Boston, MA; and Department of Neurology (P.B.P.), University of Pittsburgh, PA
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16
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Lynce F, Yeh ED, Regan MM, Qin L, Bay CP, Krop I, Harrison BT, Nakhlis F, Bellon J, Overmoyer B. Abstract P2-12-18: A phase 2 study of neoadjuvant systemic therapy with eribulin followed by doxorubicin and cyclophosphamide for HER2-negative inflammatory breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p2-12-18] [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: 11/16/2022]
Abstract
Abstract
Background: Inflammatory breast cancer (IBC) is unresectable at presentation, thus neoadjuvant systemic therapy (NAS) is the primary treatment for this aggressive disease. Eribulin (E) (Eisai Co., Ltd) is a synthetic analog of Halichondroin B that suppresses microtubule growth. Its properties of inducing a mesenchymal-to-epithelial transition and normalizing the vasculature of mammary tumors are particularly relevant to IBC. Pre-clinical data revealed changes in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters after exposure to E, thought to reflect tumor vasculature remodeling. We sought to examine the efficacy of E-containing NAS specifically for patients (pts) with HER2- IBC. We also characterized changes in breast DCE-MRI and diffusion weighted MRI (DWI) between baseline and 1 week (wk) after NAS. Methods: Pts with newly diagnosed HER2- IBC received 4 cycles of E 1.4 mg/m2 day (D)1, D8 every 21 D followed by 4 cycles of dose-dense (dd) doxorubicin (A) 60 mg/m2 + cyclophosphamide (C) 600mg/m2 every 2 wk followed by modified radical mastectomy (MRM) + postmastectomy radiation (PMRT) on a phase II prospective study (Cohort A). Primary endpoint was pathologic complete response (pCR) defined as no invasive disease in breast + axillary lymph nodes. Based on a Simon 2-stage design, if ≥ 2 of 16 pts had pCR then enrollment would continue to 25, with the regimen worthy of study if pCR ≥ 0.30 and not if pCR ≤ 0.10 (α=0.10, β=0.10). A second cohort was opened, changing the NAS sequence to ddAC followed by E (Cohort B). All pts had 2 research breast biopsies (rbx) for genomic analysis at baseline and 1 wk after first dose of NAS. An imaging study evaluated breast DCE-MRI and DWI at baseline and 1 wk after first dose of NAS. Tofts 2-compartment pharmacokinetic (PK) model calculated Ktrans, Ve, Kep, and iAUC from DCE. ADC was calculated from DWI. The change in Ktrans, Ve, Kep, iAUC, and ADC between baseline and wk 1 was evaluated using a signed-rank test. The magnitude of these changes was compared between Cohort A and Cohort B using a Wilcoxon rank-sum test. All testing was two-tailed and exact p-values were used; p-value < 0.05 were considered statistically significant. Results: 22 pts were enrolled, 16 pts in Cohort A and 6 pts in Cohort B before the study was closed due to slow accrual. Median age was 58 years, 3 pts (13.6%) had triple negative disease. 13 pts (59%) were postmenopausal. All but 1 had stage III disease. All 22 pts completed NAS followed by MRM + PMRT. 19 pts completed full course of NAS, 1 pt received E followed by 3 cycles of AC and 2 pts received 3 cycles of E in addition to 4 cycles of AC. In Cohort A, 1/16 pts had pCR (6.3%; 80% CI 0,22.2%). At a median follow up of 51 months, 3 pts had distant disease recurrence with 1 death; no local-regional recurrence. 7 pts experienced grade (gd) 3 or 4 adverse event (AE); most common were neutropenia and aminotransferase increase. 10 pts participated in the DCE-MRI and DWI substudy: 5 from Cohort A, 5 from Cohort B. Decrease in value from baseline to wk 1 was detected in Ktrans (median -49), Ve (-128), and iAUC (-57). The magnitude of changes was not different when comparing Cohort A to Cohort B. There was no significant change in Kep or ADC. Given the small size of each group, a lack of statistical significance should not be interpreted as suggestive of no effect. Evaluation of changes in angiogenesis- and EMT-related gene expression in rbx + residual disease is ongoing.Conclusion: A regimen of E + ddAC is tolerable NAS for HER2- IBC. All pts underwent curative surgery despite low pCR rate, commonly observed in ER+ IBC. There were changes in some DCE-MRI parameters after exposure to chemotherapy but may not be specific to E. Studies specifically designed for IBC are needed to enhance the understanding of this disease. Clinical trial: NCT02623972
Citation Format: Filipa Lynce, Eren D. Yeh, Meredith M. Regan, Lei Qin, Camden P. Bay, Ian Krop, Beth T Harrison, Faina Nakhlis, Jennifer Bellon, Beth Overmoyer. A phase 2 study of neoadjuvant systemic therapy with eribulin followed by doxorubicin and cyclophosphamide for HER2-negative inflammatory breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-12-18.
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Affiliation(s)
| | | | | | - Lei Qin
- Dana-Farber Cancer Institute, Boston, MA
| | | | - Ian Krop
- Dana-Farber Cancer Institute, Boston, MA
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17
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Gong J, Castro RRT, Caron JP, Bay CP, Hainer J, Opotowsky AR, Mehra MR, Maron BA, Di Carli MF, Groarke JD, Nohria A. Usefulness of ventilatory inefficiency in predicting prognosis across the heart failure spectrum. ESC Heart Fail 2021; 9:293-302. [PMID: 34931762 PMCID: PMC8788025 DOI: 10.1002/ehf2.13761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/04/2021] [Accepted: 11/24/2021] [Indexed: 01/09/2023] Open
Abstract
Aims The minute ventilation–carbon dioxide production relationship (VE/VCO2 slope) is widely used for prognostication in heart failure (HF) with reduced left ventricular ejection fraction (LVEF). This study explored the prognostic value of VE/VCO2 slope across the spectrum of HF defined by ranges of LVEF. Methods and results In this single‐centre retrospective observational study of 1347 patients with HF referred for cardiopulmonary exercise testing, patients with HF were categorized into HF with reduced (HFrEF, LVEF < 40%, n = 598), mid‐range (HFmrEF, 40% ≤ LVEF < 50%, n = 164), and preserved (HFpEF, LVEF ≥ 50%, n = 585) LVEF. Four ventilatory efficiency categories (VC) were defined: VC‐I, VE/VCO2 slope ≤ 29; VC‐II, 29 < VE/VCO2 slope < 36; VC‐III, 36 ≤ VE/VCO2 slope < 45; and VC‐IV, VE/VCO2 slope ≥ 45. The associations of these VE/VCO2 slope categories with a composite outcome of all‐cause mortality or HF hospitalization were evaluated for each category of LVEF. Over a median follow‐up of 2.0 (interquartile range: 1.9, 2.0) years, 201 patients experienced the composite outcome. Compared with patients in VC‐I, those in VC‐II, III, and IV demonstrated three‐fold, five‐fold, and eight‐fold increased risk for the composite outcome. This incremental risk was observed across HFrEF, HFmrEF, and HFpEF cohorts. Conclusions Higher VE/VCO2 slope is associated with incremental risk of 2 year all‐cause mortality and HF hospitalization across the spectrum of HF defined by LVEF. A multilevel categorical approach to the interpretation of VE/VCO2 slope may offer more refined risk stratification than the current binary approach employed in clinical practice.
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Affiliation(s)
- Jingyi Gong
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Renata R T Castro
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Jesse P Caron
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Camden P Bay
- Brigham and Women's Hospital Center for Clinical Investigation, Boston, MA, USA
| | - Jon Hainer
- Noninvasive Cardiovascular Imaging Program, Department of Medicine (Cardiovascular Division) and Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Alexander R Opotowsky
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.,Heart Institute, Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mandeep R Mehra
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Bradley A Maron
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Marcelo F Di Carli
- Noninvasive Cardiovascular Imaging Program, Department of Medicine (Cardiovascular Division) and Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - John D Groarke
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Anju Nohria
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
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Voinescu PE, Pennell KD, Bay CP, Stowe ZN, Peng L, Frye CA, Tang KY, Pennell PB. Pregnant women with more seizures have lower allopregnanolone concentrations. Epilepsy Res 2021; 177:106778. [PMID: 34597960 DOI: 10.1016/j.eplepsyres.2021.106778] [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: 05/20/2021] [Revised: 09/11/2021] [Accepted: 09/24/2021] [Indexed: 11/19/2022]
Abstract
Neuroactive steroids have rapid, nongenomic effects on neuronal excitability. The effects in humans are less clear. We compared seizure control and concentrations of neuroactive steroids, known to influence neuroexcitability in animal studies, in pregnant women. Participants were prospectively followed throughout pregnancy with seizure-medication diaries and blood samples, assayed for steroid concentrations with gas chromatography-mass spectrometry. Baseline seizure frequency was calculated for the preconception year, and it was determined if seizure frequency was increased in each trimester. The Wilcoxon rank-sum test was used to compare neuroactive steroid concentrations in between the group with increased frequency to the group without, as calculated for the respective trimester, with the Holm-Bonferroni method to correct for multiple comparisons. Among eighty-three pregnancies included, twenty-eight had increased seizure frequency during at least one trimester (15, 18 and 10, respectively) compared to preconception seizure frequency. Allopregnanolone concentrations were lower in the 3rd trimester (p < 0.001), with a similar trend in the 1st (p = 0.08), for pregnancies with increased compared to those with stable seizure frequency. Other neuroactive steroid concentrations were similar. Our findings suggest that lower allopregnanolone concentrations are associated with increased seizure frequency during pregnancy. Validation of these finding in a larger cohort has potential important clinical applications.
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Affiliation(s)
- P Emanuela Voinescu
- Department of Neurology, Division of Epilepsy, Brigham and Women's Hospital, United States; Department of Medicine, Division of Women's Health, Brigham and Women's Hospital, United States; Harvard Medical School, United States.
| | - Kurt D Pennell
- School of Engineering at Brown University, United States
| | - Camden P Bay
- Department of Radiology and the Center for Clinical Investigation at Brigham and Women's Hospital, Boston, MA, United States
| | - Zachary N Stowe
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, United States
| | - Limin Peng
- Rollins School of Public Health, Emory University, United States
| | - Cheryl A Frye
- Department of Psychology, Center for Neuroscience, University at Albany, United States
| | - Kathleen Y Tang
- Harvard School of Public Health, Harvard Pilgrim Health Care Institute, United States
| | - Page B Pennell
- Department of Neurology, Division of Epilepsy, Brigham and Women's Hospital, United States; Department of Medicine, Division of Women's Health, Brigham and Women's Hospital, United States; Harvard Medical School, United States; Department of Neurology, University of Pittsburgh, United States
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19
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Amornsiripanitch N, Chikarmane SA, Bay CP, Giess CS. Patients characteristics related to screening mammography cancellation and rescheduling rates during the COVID-19 pandemic. Clin Imaging 2021; 80:205-210. [PMID: 34340204 PMCID: PMC8320406 DOI: 10.1016/j.clinimag.2021.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/01/2021] [Accepted: 07/19/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To identify patient characteristics associated with screening mammography cancellations and rescheduling during the COVID-19 pandemic. METHODS Scheduled screening mammograms during three time periods were retrospectively reviewed: state-mandated shutdown (3/17/2020-6/16/2020) during which screening mammography was cancelled, a period of 2 months immediately after screening mammography resumed (6/17/2020-8/16/2020), and a representative period prior to COVID-19 (6/17/2019-8/16/2019). Relative risk of cancellation before COVID-19 and after reopening was compared for age, race/ethnicity, insurance, history of chronic disease, and exam location, controlling for other collected variables. Risk of failure to reschedule was similarly compared between all 3 time periods. RESULTS Overall cancellation rate after reopening was higher than before shutdown (7663/16595, 46% vs 5807/15792, 37%; p < 0.001). Relative risk of cancellation after reopening increased with age (1.20 vs 1.27 vs 1.36 for ages at 25th, 50th, and 75th quartile or 53, 61, and 70 years, respectively, p < 0.001). Relative risk of cancellation was also higher among Medicare patients (1.41) compared to Medicaid and those with other providers (1.26 and 1.21, respectively, p < 0.001) and non-whites compared to whites (1.34 vs 1.25, p = 0.03). Rescheduling rate during shutdown was higher than before COVID-19 and after reopening for all patients (10,658/13593, 78%, 3569/5807, 61%, and 4243/7663, respectively, 55%, p < 0.001). Relative risk of failure to reschedule missed mammogram was higher in hospitals compared to outpatient settings both during shutdown and after reopening (0.62 vs 0.54, p = 0.005 and 1.29 vs 1.03, p < 0.001, respectively). CONCLUSION Minority race/ethnicity, Medicare insurance, and advanced age were associated with increased risk of screening mammogram cancellation during COVID-19.
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Affiliation(s)
- Nita Amornsiripanitch
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States of America.
| | - Sona A Chikarmane
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States of America.
| | - Camden P Bay
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States of America.
| | - Catherine S Giess
- Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Boston, MA 02120, United States of America.
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20
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Chen X, Lim-Fat MJ, Qin L, Li A, Bryant A, Bay CP, Gao L, Miskin N, Liu Z, Iorgulescu JB, Xu X, Reardon DA, Young GS. A Comparative Retrospective Study of Immunotherapy RANO Versus Standard RANO Criteria in Glioblastoma Patients Receiving Immune Checkpoint Inhibitor Therapy. Front Oncol 2021; 11:679331. [PMID: 34249718 PMCID: PMC8268004 DOI: 10.3389/fonc.2021.679331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/08/2021] [Indexed: 01/04/2023] Open
Abstract
Objectives Real-time assessment of treatment response in glioblastoma (GBM) patients on immune checkpoint blockade (ICB) remains challenging because inflammatory effects of therapy may mimic progressive disease, and the temporal evolution of these inflammatory findings is poorly understood. We compare GBM patient response during ICB as assessed with the Immunotherapy Response Assessment in Neuro-Oncology (iRANO) and the standard Response Assessment in Neuro-Oncology (RANO) radiological criteria. Methods 49 GBM patients (seven newly diagnosed and 42 recurrent) treated with ICBs at a single institution were identified. Tumor burden was quantified on serial MR scans according to RANO criteria during ICB. Radiographic response assessment by iRANO and RANO were compared. Results 82% (40/49) of patients received anti–PD-1, 16% (8/49) received anti-PD-L1, and 2% (1/49) received anti-PD-1 and anti-CTLA4 treatment. Change in tumor burden and best overall response ranged from −100 to +557% (median: +48%). 12% (6/49) of patients were classified as concordant non-progressors by both RANO and iRANO (best response: one CR, one PR, and four SD). Another12% (6/49) had discordant assessments: 15% (6/41) of RANO grade progressive disease (PD) patients had iRANO grade of progressive disease unconfirmed (PDU). The final classification of these discordant patients was pseudoprogression (PsP) in three of six, PD in two of six, and PDU in one of six who went off study before the iRANO assessment of PDU. iRANO delayed diagnosis of PD by 42 and 93 days in the two PD patients. 76% (37/49) patients were classified as concordant PD by both RANO and iRANO. 12% (6/49) of all patients were classified as PsP, starting at a median of 12 weeks (range, 4–30 weeks) after ICB initiation. Conclusions Standard RANO and iRANO have high concordance for assessing PD in patients within 6 months of ICB initiation. iRANO was beneficial in 6% (3/49) cases later proven to be PsP, but delayed confirmation of PD by <3 months in 4% (2/49). PsP occurred in 12% of patients, starting at up to 7 months after initiation of ICB. Further study to define the utility of modified RANO compared with iRANO in ICB GBM patients is needed.
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Affiliation(s)
- Xin Chen
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, United States.,Department of Radiology, Guangzhou First People's Hospital, The Second Affiliated Hospital of South China University of Technology, Guangzhou, China
| | - Mary Jane Lim-Fat
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
| | - Lei Qin
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA, United States.,Department of Radiology, Harvard Medical School, Boston, MA, United States
| | - Angie Li
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, United States.,Department of Family Medicine, University of California, Riverside School of Medicine, Riverside, CA, United States
| | - Annie Bryant
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Camden P Bay
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, United States
| | - Lu Gao
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, United States.,Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nityanand Miskin
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, United States.,Department of Radiology, Harvard Medical School, Boston, MA, United States
| | - Zaiyi Liu
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - J Bryan Iorgulescu
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, United States
| | - Xiaoyin Xu
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, United States.,Department of Radiology, Harvard Medical School, Boston, MA, United States
| | - David A Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Geoffrey S Young
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, United States.,Department of Imaging, Dana-Farber Cancer Institute, Boston, MA, United States.,Department of Radiology, Harvard Medical School, Boston, MA, United States
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21
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Park H, Qin L, Guerra P, Bay CP, Shinagare AB. Decoding incidental ovarian lesions: use of texture analysis and machine learning for characterization and detection of malignancy. Abdom Radiol (NY) 2021; 46:2376-2383. [PMID: 32728871 DOI: 10.1007/s00261-020-02668-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 07/11/2020] [Accepted: 07/17/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE To compare CT texture features of benign and malignant ovarian lesions and to build a machine learning model to detect malignancy in incidental ovarian lesions. METHODS In this IRB-approved, HIPAA-compliant, retrospective study, 427 consecutive patients with incidental ovarian lesions detected on contrast-enhanced CT (348, 81.5% benign and 79, 18.5% malignant) were included. The following CT texture features were analyzed using commercially available software (TexRAD, Feedback Plc, Cambridge, UK): total pixel, mean, standard deviation (SD), entropy, mean value of positive pixels (MPP), skewness, kurtosis and entropy. Three machine learning models were created by combining texture features and patients' age, and performance of these models was assessed using tenfold cross-validation. Receiver operating characteristics (ROC) were constructed to assess sensitivity and specificity. The cutoff value was picked using a cost-weighted method. RESULTS Total pixels, mean, SD, entropy, MPP, and skewness were significantly different between benign and malignant groups (p < 0.05). With a selected 10 as a cost factor to optimize cutoff value selection, sensitivity 92%, specificity 60% in the random forest (RF) model, sensitivity 91%, specificity 69% in SVM model, and sensitivity 92%, specificity 61% in the logistic regression, respectively. CONCLUSION CT texture analysis could provide objective imaging analysis of incidental ovarian lesions and ML models using CT texture features and age demonstrated high sensitivity and moderate specificity for detection of malignant lesions.
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22
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Jacobson FL, Dezube AR, Bravo-Iñiguez C, Kucukak S, Bay CP, Wee JO, Coppolino AA, Jaklitsch MT, Ducko CT. Preserving NLST mortality benefits and acceptable morbidity for lung cancer surgery in a community hospital. J Surg Oncol 2021; 124:124-134. [PMID: 33844848 DOI: 10.1002/jso.26483] [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: 03/19/2021] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to demonstrate whether academic thoracic surgeons could achieve morbidity and mortality rates in community hospitals equivalent to those seen in National Lung Screening Trial (NLST). METHODS This was a retrospective review of community hospital lung cancer procedures for clinical Stage I-III non-small-cell lung cancers from 2007 through 2014. Variables include age, comorbidities, computed tomography (CT) characterization, and operative techniques. RESULTS There were 177 patients who had lung cancers removed by a minimally invasive approach (79%), including lobectomy in 127 (72%), segmentectomy in 4 (2%), and wedge-resections in 46 (26%). The median patient age was 71 years (interquartile range [IQR], 63-76). The cohort was primarily female (58%), clinical Stage I (82%), with a median tumor size of 2.3 cm (IQR, 1.5-3.3). The median length of stay was 6 days (range: 1-35). Complications were experienced by 78 (44.1%) patients, most commonly atrial fibrillation in 20 (11.3%) followed by air-leak in 19 (10.7%). There were no in-hospital deaths. Tumor location and extent of resection were associated with complications, while larger tumor size, margin contour, and resection method were associated with air-leak (all p < 0.05). Higher clinical stage and larger tumor size were associated with occult Stage III disease (both p < 0.05). CONCLUSIONS The low morbidity and mortality rates from the NLST were achievable in a community setting for early-stage lung cancer. Characterization of cancers using CT imaging identified factors most commonly associated with postoperative complications and the presence of occult Stage III disease.
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Affiliation(s)
- Francine L Jacobson
- Division of Thoracic Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Aaron R Dezube
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Carlos Bravo-Iñiguez
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Suden Kucukak
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Camden P Bay
- Division of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jon O Wee
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Antonio A Coppolino
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael T Jaklitsch
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Christopher T Ducko
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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23
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Huang G, Aroner SA, Bay CP, Gilman SE, Ghassabian A, Loucks EB, Buka SL, Handa RJ, Lasley BL, Bhasin S, Goldstein JM. Sex-dependent associations of maternal androgen levels with offspring BMI and weight trajectory from birth to early childhood. J Endocrinol Invest 2021; 44:851-863. [PMID: 32776198 PMCID: PMC7873156 DOI: 10.1007/s40618-020-01385-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/02/2020] [Indexed: 01/06/2023]
Abstract
CONTEXT In preclinical studies, high androgen levels during pregnancy are associated with low birth weight and rapid postnatal weight gain in the offspring. However, human data linking prenatal androgens with birth weight and early life weight gain in the offspring are scarce. DESIGN We evaluated 516 mother-child pairs enrolled in the New England birth cohorts of the Collaborative Perinatal Project (1959-1966). We assayed androgen bioactivity in maternal sera during third-trimester using a receptor-mediated luciferase expression bioassay. Age and sex-specific BMI Z-scores (BMIz), defined using established standards, were assessed at birth, 4 months, 1 year, 4 years, and 7 years. We used linear mixed models to evaluate the relation of maternal androgens with childhood BMIz overall and by sex. We examined the association of maternal androgens with fetal growth restriction. The association of weight trajectories with maternal androgens was examined using multinomial logistic regression. RESULTS Higher maternal androgen levels associated with lower BMIz at birth (β = - 0.39, 95% CI: - 0.73, - 0.06); this relation was sex-dependent, such that maternal androgens significantly associated with BMIz at birth in girls alone (β = - 0.72, 95% CI: - 1.40, - 0.04). The relation of maternal androgens with fetal growth restriction revealed dose threshold effects that differed by sex. There was no significant association between maternal androgens and weight trajectory overall. However, we found a significant sex interaction (p = 0.01); higher maternal androgen levels associated with accelerated catch-up growth in boys (aOR = 2.14, 95% CI: 1.14, 4.03). CONCLUSION Our findings provide evidence that maternal androgens may have differential effects on the programming of intrauterine growth and postnatal weight gain depending on fetal sex.
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Affiliation(s)
- G Huang
- Section of Men's Health, Aging and Metabolism, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - S A Aroner
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - C P Bay
- Center for Clinical Investigation, Brigham and Women's Hospital, Boston, MA, USA
| | - S E Gilman
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Health, Bethesda, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A Ghassabian
- Departments of Pediatrics, Environmental Medicine, and Population Health, New York University School of Medicine, New York, NY, USA
| | - E B Loucks
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - S L Buka
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - R J Handa
- Department of Biomedical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
- Department of Basic Medical Sciences, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - B L Lasley
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
- Department of Obstetrics and Gynecology, School of Medicine, Center for Health and the Environment, University of California Davis, Davis, CA, USA
- Center for Health and the Environment, University of California, Davis, CA, USA
| | - S Bhasin
- Section of Men's Health, Aging and Metabolism, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - J M Goldstein
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Moreira P, Grimble J, Iftimia N, Bay CP, Tuncali K, Park J, Tokuda J. In vivo evaluation of angulated needle-guide template for MRI-guided transperineal prostate biopsy. Med Phys 2021; 48:2553-2565. [PMID: 33651407 DOI: 10.1002/mp.14816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 01/28/2021] [Accepted: 02/10/2021] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Magnetic resonance imaging (MRI)-guided transperineal prostate biopsy has been practiced since the early 2000s. The technique often suffers from targeting error due to deviation of the needle as a result of physical interaction between the needle and inhomogeneous tissues. Existing needle guide devices, such as a grid template, do not allow choosing an alternative insertion path to mitigate the deviation because of their limited degree-of-freedom (DoF). This study evaluates how an angulated needle insertion path can reduce needle deviation and improve needle placement accuracy. METHODS We extended a robotic needle-guidance device (Smart Template) for in-bore MRI-guided transperineal prostate biopsy. The new Smart Template has a 4-DoF needle-guiding mechanism allowing a translational range of motion of 65 and 58 mm along the vertical and horizontal axis, and a needle rotational motion around the vertical and horizontal axis ± 30 ∘ and a vertical rotational range of - 30 ∘ , + 10 ∘ , respectively. We defined a path planning strategy, which chooses between straight and angulated insertion paths depending on the anatomical structures on the potential insertion path. We performed (a) a set of experiments to evaluate the device positioning accuracy outside the MR-bore, and (b) an in vivo experiment to evaluate the improvement of targeting accuracy combining straight and angulated insertions in animal models (swine, n = 3 ). RESULTS We analyzed 46 in vivo insertions using either straight or angulated insertions paths. The experiment showed that the proposed strategy of selecting straight or angulated insertions based on the subject's anatomy outperformed the conventional approach of just straight insertions in terms of targeting accuracy (2.4 mm [1.3-3.7] vs 3.9 mm [2.4-5.0] {Median IQR } ); p = 0.041 after the bias correction). CONCLUSION The in vivo experiment successfully demonstrated that an angulated needle insertion path could improve needle placement accuracy with a path planning strategy that takes account of the subject-specific anatomical structures.
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Affiliation(s)
- Pedro Moreira
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA, USA
| | - John Grimble
- Physical Sciences Inc., 20 New England Bus Center Dr, Andover, MA, USA
| | - Nicusor Iftimia
- Physical Sciences Inc., 20 New England Bus Center Dr, Andover, MA, USA
| | - Camden P Bay
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA, USA
| | - Kemal Tuncali
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA, USA
| | - Jesung Park
- Physical Sciences Inc., 20 New England Bus Center Dr, Andover, MA, USA
| | - Junichi Tokuda
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA, USA
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25
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Palm KB, Blazar PE, Manna JC, Serig AS, Phillips EA, Bay CP, Casey EJ, Earp BE. Feasibility, effectiveness and patient satisfaction of telerehabilitation after thumb carpometacarpal arthroplasty and reverse total shoulder arthroplasty: A pilot study. J Telemed Telecare 2021:1357633X21999578. [PMID: 33673751 DOI: 10.1177/1357633x21999578] [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: 11/16/2022]
Abstract
INTRODUCTION Telemedicine is an effective, emerging interface to connect practitioners with patients. It facilitates access to healthcare expertise, reduces costs, time demands and health disparities while improving satisfaction. This pilot study evaluated the feasibility, effectiveness and patient satisfaction of telerehabilitation for thumb carpometacarpal (CMC) arthroplasty and reverse shoulder arthroplasty (rTSA). METHODS This prospective investigation was performed at a single academic institution with two hand and upper extremity fellowship-trained orthopaedic surgeons. All patients undergoing CMC arthroplasty or rTSA were eligible for inclusion. Telerehabilitation was delivered by a hybrid model including an in-person post-operative visit, followed by alternating in-clinic and virtual videoconference visits. All patients were offered participation in the study arm; those that preferred in-person therapy were included as a control group. Therapy was initiated two weeks post-operative with an in-clinic evaluation. Patients then participated in alternating in-clinic and virtual visits weekly for eight weeks, followed by one virtual visit at 14-weeks post-operative and one clinical visit at 16-weeks post-operative. Patient reported and functional outcomes were collected at each visit. RESULTS In the CMC group, 19 study and 11 control patients were enrolled. In the rTSA group, five study and 14 control patients were enrolled. No statistically significant differences between telerehabilitation and control for range-of-motion, pain and patient-reported functional outcomes was noted. All patients in the telerehabilitation arms reported high satisfaction. DISCUSSION Utilizing telehealth in rehabilitation may be a viable option in upper extremity recovery. We hope this pilot programme can be a model for development of future telerehabilitation programmes.
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Affiliation(s)
- Kerstin B Palm
- Department of Orthopedic Surgery, Brigham and Women's Hospital, USA
| | - Philip E Blazar
- Department of Orthopedic Surgery, Brigham and Women's Hospital, USA.,Harvard Medical School, USA
| | - James C Manna
- Department of Orthopedic Surgery, Brigham and Women's Hospital, USA
| | - Angela S Serig
- Department of Orthopedic Surgery, Brigham and Women's Hospital, USA
| | - Eric A Phillips
- Department of Orthopedic Surgery, Brigham and Women's Hospital, USA
| | - Camden P Bay
- Center for Clinical Investigations, Brigham and Women's Hospital, USA
| | | | - Brandon E Earp
- Department of Orthopedic Surgery, Brigham and Women's Hospital, USA.,Harvard Medical School, USA
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Giess CS, Raza S, Denison CM, Yeh ED, Gombos EC, Frost EP, Bay CP, Chikarmane SA. Lesion conspicuity on synthetic screening mammography compared to full field digital screening mammography. Clin Imaging 2021; 75:90-96. [PMID: 33508756 DOI: 10.1016/j.clinimag.2021.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/30/2020] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare lesion conspicuity on synthetic screening mammography (SM) plus digital breast tomosynthesis (DBT) versus full field digital mammography (FFDM) plus DBT. MATERIALS AND METHODS Seven breast imagers each prospectively evaluated 107-228 screening mammograms (FFDM, DBT, and SM; total 1206 examinations) over 12 weeks in sets of 10-50 consecutive examinations. Interpretation sessions alternated as follows: SM + DBT, then FFDM, or FFDM + DBT, then SM. Lesion conspicuity on SM versus FFDM (equal/better versus less) was assessed using proportions with 95% confidence intervals. DBT-only findings were excluded. RESULTS Overall 1082 of 1206 (89.7%) examinations were assessed BI-RADS 1/2, and 124 of 1206 (10.3%) assessed BI-RADS 0. There were 409 evaluated findings, including 134 masses, 119 calcifications, 72 asymmetries, 49 architectural distortion, and 35 focal asymmetries. SM conspicuity compared to FFDM conspicuity for lesions was rated 1) masses: 77 (57%) equal or more conspicuous, 57 (43%) less conspicuous; 2) asymmetries/focal asymmetries: 61 (57%) equal or more conspicuous, and 46 (43%) less conspicuous; 3) architectural distortion: 46 (94%) equal or more conspicuous, 3 (6%) less conspicuous; 4) calcifications: 115 (97%) equal or more conspicuous, 4 (3%) less conspicuous. SM had better conspicuity than FFDM for calcifications and architectural distortion and similar conspicuity for most masses and asymmetries. CONCLUSION Compared to FFDM, SM has better conspicuity for calcifications and architectural distortion and similar conspicuity for most masses and asymmetries.
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Affiliation(s)
- Catherine S Giess
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States of America.
| | - Sughra Raza
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States of America
| | - Christine M Denison
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States of America
| | - Eren D Yeh
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States of America
| | - Eva C Gombos
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States of America
| | - Elisabeth P Frost
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States of America
| | - Camden P Bay
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States of America
| | - Sona A Chikarmane
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States of America
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Bay CP, Levy SM, Janz KF, Smith BJ, Shaffer JR, Marazita ML, Burns TL. Genome-Wide Association Analysis of Longitudinal Bone Mineral Content Data From the Iowa Bone Development Study. J Clin Densitom 2021; 24:44-54. [PMID: 31668963 PMCID: PMC7098844 DOI: 10.1016/j.jocd.2019.09.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 11/17/2022]
Abstract
The foundation for osteoporosis risk is, in part, established during childhood, adolescence, and young adulthood, all periods of development when bone mass is acquired rapidly. The relative quantity of bone mass accrued is influenced by both lifestyle and genetic factors, although the genetic component is not yet well understood. The purpose of this study was to use a genome-wide association (GWA) analysis to discover single nucleotide polymorphisms (SNPs) associated with: (1) the sex-specific hip bone mineral content at approximately the age of 19 when the amount of bone accrued is near its peak; and (2) the sex-specific rate of hip bone mineral content accrual during the adolescent growth spurt. The Iowa Bone Development Study, a longitudinal cohort study exploring bone health in children, adolescents, and young adults was the source of data. From this cohort, n = 364 (190 females, 174 males) participants were included in GWA analyses to address (1) and n = 258 participants (125 females and 133 males) were included in GWA analyses to address (2). Twenty SNPS were detected having p < 1.0 × 10-5. Of most biologic relevance were 2 suggestive SNPs (rs2051756 and rs2866908) detected in an intron of the DKK2 gene through the GWA analysis that explored peak bone mass in females.
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Affiliation(s)
- Camden P Bay
- Center for Clinical Investigation, Brigham & Women's Hospital, Boston, MA, USA.
| | - Steven M Levy
- Department of Preventive and Community Dentistry, University of Iowa College of Dentistry, Iowa City, IA, USA; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Kathleen F Janz
- Department of Health and Human Physiology, College of Liberal Arts and Sciences, University of Iowa, Iowa City, IA, USA
| | - Brian J Smith
- Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA, USA; Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA, USA
| | - John R Shaffer
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA; Department of Oral Biology, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary L Marazita
- Center for Craniofacial and Dental Genetics, Department of Oral Biology, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA; Clinical and Translational Science, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Trudy L Burns
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
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Baumrin E, Izaguirre NE, Bausk BP, Feeley MM, Bay CP, Ho VT, Issa NC, Baden LR. 36. Safety and Reactogenicity of the Adjuvanted Recombinant Zoster Vaccine after Allogeneic Hematopoietic Stem Cell Transplantation. Open Forum Infect Dis 2020. [PMCID: PMC7776116 DOI: 10.1093/ofid/ofaa439.081] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Herpes zoster (HZ) is common after allogeneic hematopoietic stem cell transplantation (HCT) and associated with high morbidity. While antiviral prophylaxis reduces incidence, increased risk remains after discontinuation and vaccination strategies are needed. A non-live adjuvanted recombinant zoster vaccine (RZV) has been developed but not yet studied in this population. Methods In this single center prospective observational cohort study, allogeneic HCT recipients ³18 years old and 9–24 months from HCT were eligible to receive 2 doses of RZV separated by ³8 weeks as part of revised institutional vaccination guidelines. The primary endpoint was safety and reactogenicity in the total vaccinated cohort (TVC). The secondary endpoints were incidence and severity of chronic graft versus host disease (cGVHD) in the TVC compared to historical controls and incidence rates of HZ in the TVC and modified total vaccinated cohort (mTVC). Results Of the 158 participants (mean age 55 years, 91 [58%] male) in the TVC, 150 (95%) received second vaccine. 92.1% had solicited reactions with 87.3% injection site reactions (18.7% grade 3) and 82.8% general reactions (26.5% grade 3). In the subgroup receiving first vaccine at 9–12 months after HCT, cumulative incidence of cGVHD was similar to historical controls at predefined time points between 9–15 months (unadjusted incidence rate ratio [IRR] 1.1 [95% CI 0.84–1.44], adjusted IRR 1.05 [95% CI 0.8–1.38]); there was also no difference in severity of cGVHD, or incidence of death or disease relapse. There were 4 (2.5%) HZ cases during the study period with IR 28.34/1000 person-years over median follow up 281 days (IQR 190, 354) in the mTVC. All cases occurred after antiviral prophylaxis discontinuation and one case resulted in death. Conclusion Two doses of RZV after allogeneic HCT was safe and acceptable despite high rates of reactogenicity. There was no evidence of an increase in cGVHD, relapse, or death compared to historical controls and overall low rates of breakthrough HZ similar to those reported after autologous HCT. Immunogenicity studies and placebo-controlled trials are needed to determine vaccine response and efficacy so that timing of RZV and its potential impact on discontinuation of antiviral prophylaxis can be determined. Disclosures Nicolas C. Issa, MD, AiCuris (Scientific Research Study Investigator)Astellas (Scientific Research Study Investigator)GSK (Scientific Research Study Investigator)Merck (Scientific Research Study Investigator)
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Affiliation(s)
| | | | | | | | - Camden P Bay
- Brigham and Women’s Hospital, Boston, Massachusetts
| | - Vincent T Ho
- Dana-Farber Cancer Institute, Boston, Massachusetts
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Magudia K, Bridge CP, Bay CP, Babic A, Fintelmann FJ, Troschel FM, Miskin N, Wrobel WC, Brais LK, Andriole KP, Wolpin BM, Rosenthal MH. Population-Scale CT-based Body Composition Analysis of a Large Outpatient Population Using Deep Learning to Derive Age-, Sex-, and Race-specific Reference Curves. Radiology 2020; 298:319-329. [PMID: 33231527 DOI: 10.1148/radiol.2020201640] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Although CT-based body composition (BC) metrics may inform disease risk and outcomes, obtaining these metrics has been too resource intensive for large-scale use. Thus, population-wide distributions of BC remain uncertain. Purpose To demonstrate the validity of fully automated, deep learning BC analysis from abdominal CT examinations, to define demographically adjusted BC reference curves, and to illustrate the advantage of use of these curves compared with standard methods, along with their biologic significance in predicting survival. Materials and Methods After external validation and equivalency testing with manual segmentation, a fully automated deep learning BC analysis pipeline was applied to a cross-sectional population cohort that included any outpatient without a cardiovascular disease or cancer who underwent abdominal CT examination at one of three hospitals in 2012. Demographically adjusted population reference curves were generated for each BC area. The z scores derived from these curves were compared with sex-specific thresholds for sarcopenia by using χ2 tests and used to predict 2-year survival in multivariable Cox proportional hazards models that included weight and body mass index (BMI). Results External validation showed excellent correlation (R = 0.99) and equivalency (P < .001) of the fully automated deep learning BC analysis method with manual segmentation. With use of the fully automated BC data from 12 128 outpatients (mean age, 52 years; 6936 [57%] women), age-, race-, and sex-normalized BC reference curves were generated. All BC areas varied significantly with these variables (P < .001 except for subcutaneous fat area vs age [P = .003]). Sex-specific thresholds for sarcopenia demonstrated that age and race bias were not present if z scores derived from the reference curves were used (P < .001). Skeletal muscle area z scores were significantly predictive of 2-year survival (P = .04) in combined models that included BMI. Conclusion Fully automated body composition (BC) metrics vary significantly by age, race, and sex. The z scores derived from reference curves for BC parameters better capture the demographic distribution of BC compared with standard methods and can help predict survival. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Summers in this issue.
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Affiliation(s)
- Kirti Magudia
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (K.M., C.P. Bay, N.M., W.C.W., M.H.R.); MGH & BWH Center for Clinical Data Science, Boston, Mass (C.P. Bridge, K.P.A.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass (A.B., L.K.B., B.M.W.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (F.J.F., F.M.T.)
| | - Christopher P Bridge
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (K.M., C.P. Bay, N.M., W.C.W., M.H.R.); MGH & BWH Center for Clinical Data Science, Boston, Mass (C.P. Bridge, K.P.A.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass (A.B., L.K.B., B.M.W.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (F.J.F., F.M.T.)
| | - Camden P Bay
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (K.M., C.P. Bay, N.M., W.C.W., M.H.R.); MGH & BWH Center for Clinical Data Science, Boston, Mass (C.P. Bridge, K.P.A.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass (A.B., L.K.B., B.M.W.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (F.J.F., F.M.T.)
| | - Ana Babic
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (K.M., C.P. Bay, N.M., W.C.W., M.H.R.); MGH & BWH Center for Clinical Data Science, Boston, Mass (C.P. Bridge, K.P.A.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass (A.B., L.K.B., B.M.W.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (F.J.F., F.M.T.)
| | - Florian J Fintelmann
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (K.M., C.P. Bay, N.M., W.C.W., M.H.R.); MGH & BWH Center for Clinical Data Science, Boston, Mass (C.P. Bridge, K.P.A.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass (A.B., L.K.B., B.M.W.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (F.J.F., F.M.T.)
| | - Fabian M Troschel
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (K.M., C.P. Bay, N.M., W.C.W., M.H.R.); MGH & BWH Center for Clinical Data Science, Boston, Mass (C.P. Bridge, K.P.A.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass (A.B., L.K.B., B.M.W.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (F.J.F., F.M.T.)
| | - Nityanand Miskin
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (K.M., C.P. Bay, N.M., W.C.W., M.H.R.); MGH & BWH Center for Clinical Data Science, Boston, Mass (C.P. Bridge, K.P.A.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass (A.B., L.K.B., B.M.W.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (F.J.F., F.M.T.)
| | - William C Wrobel
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (K.M., C.P. Bay, N.M., W.C.W., M.H.R.); MGH & BWH Center for Clinical Data Science, Boston, Mass (C.P. Bridge, K.P.A.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass (A.B., L.K.B., B.M.W.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (F.J.F., F.M.T.)
| | - Lauren K Brais
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (K.M., C.P. Bay, N.M., W.C.W., M.H.R.); MGH & BWH Center for Clinical Data Science, Boston, Mass (C.P. Bridge, K.P.A.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass (A.B., L.K.B., B.M.W.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (F.J.F., F.M.T.)
| | - Katherine P Andriole
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (K.M., C.P. Bay, N.M., W.C.W., M.H.R.); MGH & BWH Center for Clinical Data Science, Boston, Mass (C.P. Bridge, K.P.A.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass (A.B., L.K.B., B.M.W.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (F.J.F., F.M.T.)
| | - Brian M Wolpin
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (K.M., C.P. Bay, N.M., W.C.W., M.H.R.); MGH & BWH Center for Clinical Data Science, Boston, Mass (C.P. Bridge, K.P.A.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass (A.B., L.K.B., B.M.W.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (F.J.F., F.M.T.)
| | - Michael H Rosenthal
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (K.M., C.P. Bay, N.M., W.C.W., M.H.R.); MGH & BWH Center for Clinical Data Science, Boston, Mass (C.P. Bridge, K.P.A.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass (A.B., L.K.B., B.M.W.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (F.J.F., F.M.T.)
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Gong J, Payne D, Caron J, Bay CP, McGregor BA, Hainer J, Partridge AH, Neilan TG, Di Carli M, Nohria A, Groarke JD. Reduced Cardiorespiratory Fitness and Increased Cardiovascular Mortality After Prolonged Androgen Deprivation Therapy for Prostate Cancer. JACC CardioOncol 2020; 2:553-563. [PMID: 34396266 PMCID: PMC8352085 DOI: 10.1016/j.jaccao.2020.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 01/25/2023]
Abstract
Background Prolonged androgen deprivation therapy (ADT) is favored over short-term use in patients with localized high-risk prostate cancer (PC). Objectives This study sought to compare cardiorespiratory fitness (CRF) and cardiovascular (CV) mortality among patients with PC with and without ADT exposure and to explore how duration of ADT exposure influences CRF and CV mortality. Methods Retrospective cohort study of patients referred for exercise treadmill testing (ETT) after a PC diagnosis. PC risk classification was based on Gleason score (GS): high risk if GS ≥8; intermediate risk if GS = 7; and low risk if GS <7. CRF was categorized by metabolic equivalents (METs): METs >8 defined as good CRF and METs ≤8 as reduced CRF. ADT exposure was categorized as short term (≤6 months) versus prolonged (>6 months). Results A total of 616 patients underwent an ETT a median of 4.8 years (interquartile range: 2.0, 7.9 years) after PC diagnosis. Of those, 150 patients (24.3%) received ADT prior to the ETT; 99 with short-term and 51 with prolonged exposure. 504 patients (81.8%) had ≥2 CV risk factors. Prolonged ADT was associated with reduced CRF (odds ratio [OR]: 2.71; 95% confidence interval [CI]: 1.31 to 5.61; p = 0.007) and increased CV mortality (hazard ratio [HR]: 3.87; 95% CI: 1.16 to 12.96; p = 0.028) in adjusted analyses. Although the association between short-term ADT exposure and reduced CRF was of borderline significance (OR: 1.71; 95% CI: 1.00 to 2.94; p = 0.052), there was no association with CV mortality (HR: 1.60; 95% CI: 0.51 to 5.01; p = 0.420) in adjusted Cox regression models. Conclusions Among patients with PC and high baseline CV risk, prolonged ADT exposure was associated with reduced CRF and increased CV mortality.
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Key Words
- ADT, androgen deprivation therapy
- BMI, body mass index
- CI, confidence interval
- CRF, cardiorespiratory fitness
- CV, cardiovascular
- ETT, exercise treadmill test
- HR, hazard ratio
- IQR, interquartile range
- MET, metabolic equivalent
- OR, odds ratio
- PC, prostate cancer
- androgen deprivation therapy
- cardio-oncology
- cardiorespiratory fitness
- cardiovascular mortality
- cardiovascular risk
- prostate cancer
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Affiliation(s)
- Jingyi Gong
- Heart and Vascular Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - David Payne
- Heart and Vascular Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jesse Caron
- Heart and Vascular Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Camden P Bay
- Center for Clinical Investigation, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Bradley A McGregor
- Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jon Hainer
- Noninvasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ann H Partridge
- Adult Survivorship Program, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Tomas G Neilan
- Cardio-Oncology Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marcelo Di Carli
- Noninvasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Anju Nohria
- Heart and Vascular Center, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Adult Survivorship Program, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - John D Groarke
- Heart and Vascular Center, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Adult Survivorship Program, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Aghayev A, Bay CP, Tedeschi S, Monach PA, Campia U, Gerhard-Herman M, Steigner ML, Mitchell RN, Docken WP, DiCarli M. Clinically isolated aortitis: imaging features and clinical outcomes: comparison with giant cell arteritis and giant cell aortitis. Int J Cardiovasc Imaging 2020; 37:1433-1443. [PMID: 33128155 DOI: 10.1007/s10554-020-02087-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/23/2020] [Indexed: 10/23/2022]
Abstract
(1) describe imaging features of CIA, (2) compare dilation rate and wall thickening of aortic aneurysms in patients with CIA versus those with giant cell arteritis/aortitis (GCA), (3) present clinical outcomes of CIA patients. Retrospective search of electronic records from 2004 to 2018 yielded 71 patients, 52 of whom were female, with a mean age of 67.5 ± 9.0 years old, with a new clinical diagnosis of cranial or extracranial GCA (GCA group), and giant cell aortitis revealed by the aortic biopsy (CIA group). Comparisons between groups were conducted using the Wilcoxon rank-sum and Fisher's exact tests. Survival from the date of initial diagnosis to the end of data collection was compared between the two groups through a log-rank test. CIA patients (n = 23; 32%) presented with cardiovascular symptoms, and none had systemic inflammatory symptoms. Inflammatory markers were significantly higher among GCA patients than among CIA patients (p < 0.0001). The CIA group demonstrated thoracic aortic aneurysms without wall thickening. None of the GCA patients (n = 48; 68%) had aneurysmal dilation in the aorta at the time of diagnosis. None of the four CIA patients had FDG uptake in the aorta, while nine out of 13 GCA patients had FDG uptake in the vessels. There was no statistically significant difference in the survival between the two groups (p = 0.12). CIA patients presented with cardiovascular symptoms and was characterized by aneurysm of the aorta without the involvement of the infrarenal aortic segment. The role of FDG-PET/CT in CIA is less certain, though none of the patients in this cohort had FDG uptake in the vessels.
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Affiliation(s)
- Ayaz Aghayev
- Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Camden P Bay
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sara Tedeschi
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul A Monach
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Umberto Campia
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marie Gerhard-Herman
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael L Steigner
- Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Richard N Mitchell
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - William P Docken
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marcelo DiCarli
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Gosangi B, Park H, Thomas R, Gujrathi R, Bay CP, Raja AS, Seltzer SE, Balcom MC, McDonald ML, Orgill DP, Harris MB, Boland GW, Rexrode K, Khurana B. Exacerbation of Physical Intimate Partner Violence during COVID-19 Pandemic. Radiology 2020; 298:E38-E45. [PMID: 32787700 PMCID: PMC7427119 DOI: 10.1148/radiol.2020202866] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [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] [Indexed: 11/11/2022]
Abstract
Background Intimate partner violence (IPV) is a global social and public health problem, but published literature regarding the exacerbation of physical IPV during the coronavirus disease 2019 (COVID-19) pandemic is lacking. Purpose To assess the incidence, patterns, and severity of injuries in IPV victims during the COVID-19 pandemic in 2020 compared with the prior 3 years. Materials and Methods The demographics, clinical presentation, injuries, and radiologic findings of patients reporting physical abuse arising from IPV during the statewide COVID-19 pandemic between March 11 and May 3, 2020, were compared with data from the same period for the past 3 years. Pearson χ2 and Fisher exact tests were used for analysis. Results A total of 26 victims of physical IPV from 2020 (mean age, 37 years ± 13 [standard deviation]; 25 women) were evaluated and compared with 42 victims of physical IPV (mean age, 41 years ± 15; 40 women) from 2017 to 2019. Although the overall number of patients who reported IPV decreased during the pandemic, the incidence of physical IPV was 1.8 times greater (95% CI: 1.1, 3.0; P = .01). The total number of deep injuries was 28 during 2020 versus 16 from 2017 to 2019; the number of deep injuries per victim was 1.1 during 2020 compared with 0.4 from 2017 to 2019 (P < .001). The incidence of high-risk abuse defined by mechanism was two times greater in 2020 (95% CI: 1.2, 4.7; P = .01). Patients who experienced IPV during the COVID-19 pandemic were more likely to be White; 17 (65%) victims in 2020 were White compared with 11 (26%) in the prior years (P = .007). Conclusion There was a higher incidence and severity of physical intimate partner violence (IPV) during the coronavirus disease 2019 (COVID-19) pandemic compared with the prior 3 years. These results suggest that victims of IPV delayed reaching out to health care services until the late stages of the abuse cycle during the COVID-19 pandemic. © RSNA, 2020.
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Affiliation(s)
- Babina Gosangi
- From the Department of Radiology (B.G., H.P., R.T., R.G., C.P.B., S.E.S., G.W.B., B.K.), Violence Intervention and Prevention Programs, Center for Community Health and Health Equity (M.C.B.), Department of Surgery (M.L.M., D.P.O.), and Division of Women's Health (K.R.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Departments of Emergency Medicine (A.S.R.) and Orthopedic Surgery (M.B.H.), Massachusetts General Hospital, Boston, Mass
| | - Hyesun Park
- From the Department of Radiology (B.G., H.P., R.T., R.G., C.P.B., S.E.S., G.W.B., B.K.), Violence Intervention and Prevention Programs, Center for Community Health and Health Equity (M.C.B.), Department of Surgery (M.L.M., D.P.O.), and Division of Women's Health (K.R.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Departments of Emergency Medicine (A.S.R.) and Orthopedic Surgery (M.B.H.), Massachusetts General Hospital, Boston, Mass
| | - Richard Thomas
- From the Department of Radiology (B.G., H.P., R.T., R.G., C.P.B., S.E.S., G.W.B., B.K.), Violence Intervention and Prevention Programs, Center for Community Health and Health Equity (M.C.B.), Department of Surgery (M.L.M., D.P.O.), and Division of Women's Health (K.R.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Departments of Emergency Medicine (A.S.R.) and Orthopedic Surgery (M.B.H.), Massachusetts General Hospital, Boston, Mass
| | - Rahul Gujrathi
- From the Department of Radiology (B.G., H.P., R.T., R.G., C.P.B., S.E.S., G.W.B., B.K.), Violence Intervention and Prevention Programs, Center for Community Health and Health Equity (M.C.B.), Department of Surgery (M.L.M., D.P.O.), and Division of Women's Health (K.R.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Departments of Emergency Medicine (A.S.R.) and Orthopedic Surgery (M.B.H.), Massachusetts General Hospital, Boston, Mass
| | - Camden P Bay
- From the Department of Radiology (B.G., H.P., R.T., R.G., C.P.B., S.E.S., G.W.B., B.K.), Violence Intervention and Prevention Programs, Center for Community Health and Health Equity (M.C.B.), Department of Surgery (M.L.M., D.P.O.), and Division of Women's Health (K.R.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Departments of Emergency Medicine (A.S.R.) and Orthopedic Surgery (M.B.H.), Massachusetts General Hospital, Boston, Mass
| | - Ali S Raja
- From the Department of Radiology (B.G., H.P., R.T., R.G., C.P.B., S.E.S., G.W.B., B.K.), Violence Intervention and Prevention Programs, Center for Community Health and Health Equity (M.C.B.), Department of Surgery (M.L.M., D.P.O.), and Division of Women's Health (K.R.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Departments of Emergency Medicine (A.S.R.) and Orthopedic Surgery (M.B.H.), Massachusetts General Hospital, Boston, Mass
| | - Steven E Seltzer
- From the Department of Radiology (B.G., H.P., R.T., R.G., C.P.B., S.E.S., G.W.B., B.K.), Violence Intervention and Prevention Programs, Center for Community Health and Health Equity (M.C.B.), Department of Surgery (M.L.M., D.P.O.), and Division of Women's Health (K.R.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Departments of Emergency Medicine (A.S.R.) and Orthopedic Surgery (M.B.H.), Massachusetts General Hospital, Boston, Mass
| | - Marta Chadwick Balcom
- From the Department of Radiology (B.G., H.P., R.T., R.G., C.P.B., S.E.S., G.W.B., B.K.), Violence Intervention and Prevention Programs, Center for Community Health and Health Equity (M.C.B.), Department of Surgery (M.L.M., D.P.O.), and Division of Women's Health (K.R.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Departments of Emergency Medicine (A.S.R.) and Orthopedic Surgery (M.B.H.), Massachusetts General Hospital, Boston, Mass
| | - Meghan L McDonald
- From the Department of Radiology (B.G., H.P., R.T., R.G., C.P.B., S.E.S., G.W.B., B.K.), Violence Intervention and Prevention Programs, Center for Community Health and Health Equity (M.C.B.), Department of Surgery (M.L.M., D.P.O.), and Division of Women's Health (K.R.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Departments of Emergency Medicine (A.S.R.) and Orthopedic Surgery (M.B.H.), Massachusetts General Hospital, Boston, Mass
| | - Dennis P Orgill
- From the Department of Radiology (B.G., H.P., R.T., R.G., C.P.B., S.E.S., G.W.B., B.K.), Violence Intervention and Prevention Programs, Center for Community Health and Health Equity (M.C.B.), Department of Surgery (M.L.M., D.P.O.), and Division of Women's Health (K.R.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Departments of Emergency Medicine (A.S.R.) and Orthopedic Surgery (M.B.H.), Massachusetts General Hospital, Boston, Mass
| | - Mitchel B Harris
- From the Department of Radiology (B.G., H.P., R.T., R.G., C.P.B., S.E.S., G.W.B., B.K.), Violence Intervention and Prevention Programs, Center for Community Health and Health Equity (M.C.B.), Department of Surgery (M.L.M., D.P.O.), and Division of Women's Health (K.R.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Departments of Emergency Medicine (A.S.R.) and Orthopedic Surgery (M.B.H.), Massachusetts General Hospital, Boston, Mass
| | - Giles W Boland
- From the Department of Radiology (B.G., H.P., R.T., R.G., C.P.B., S.E.S., G.W.B., B.K.), Violence Intervention and Prevention Programs, Center for Community Health and Health Equity (M.C.B.), Department of Surgery (M.L.M., D.P.O.), and Division of Women's Health (K.R.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Departments of Emergency Medicine (A.S.R.) and Orthopedic Surgery (M.B.H.), Massachusetts General Hospital, Boston, Mass
| | - Kathryn Rexrode
- From the Department of Radiology (B.G., H.P., R.T., R.G., C.P.B., S.E.S., G.W.B., B.K.), Violence Intervention and Prevention Programs, Center for Community Health and Health Equity (M.C.B.), Department of Surgery (M.L.M., D.P.O.), and Division of Women's Health (K.R.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Departments of Emergency Medicine (A.S.R.) and Orthopedic Surgery (M.B.H.), Massachusetts General Hospital, Boston, Mass
| | - Bharti Khurana
- From the Department of Radiology (B.G., H.P., R.T., R.G., C.P.B., S.E.S., G.W.B., B.K.), Violence Intervention and Prevention Programs, Center for Community Health and Health Equity (M.C.B.), Department of Surgery (M.L.M., D.P.O.), and Division of Women's Health (K.R.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; and Departments of Emergency Medicine (A.S.R.) and Orthopedic Surgery (M.B.H.), Massachusetts General Hospital, Boston, Mass
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Santos F, Shu E, Lee DJ, Jung DH, Quesnel AM, Stankovic KM, Abdul‐Aziz DE, Bay CP, Quinkert A, Welling DB. Topical fibroblast growth factor-2 for treatment of chronic tympanic membrane perforations. Laryngoscope Investig Otolaryngol 2020; 5:657-664. [PMID: 32864435 PMCID: PMC7444771 DOI: 10.1002/lio2.395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To determine the efficacy of fibroblast growth factor-2 (FGF-2) in treating chronic nonhealing tympanic membrane (TM) perforations. METHOD Double-blinded, randomized placebo controlled phase 2 clinical trial for patients with chronic TM perforations of more than 3 months duration with a cross-over arm. Patients received either FGF-2 or placebo (sterile water) saturated gelatin sponge in the perforation after rimming the perforation under topical anesthesia. The perforation was then covered with Tisseel fibrin glue. The primary endpoint was complete closure of the TM perforation. Secondary end points included change in hearing and partial TM closure rates. The TM was examined every 3 weeks with otoendoscopy for closure. The treatment was repeated if there was incomplete closure every 3 weeks up to a total of three treatments per arm. RESULTS Seventy four patients were recruited for the study. Fifty seven met eligibility criteria and fifty four completed the study. Ten of 14 perforations closed completely in the placebo group (71.4%) and 23 of 40 perforations closed completely in the FGF-2 treatment group (57.5%), P value = .36. Pure tone averages and word recognition scores were not statistically significantly different between study groups post-treatment. After initial complete closure, re-perforation occurred in seven FGF-2 treated patients and two placebo patients making the effective final closure rate 40% for FGF and 57% for placebo, respectively. CONCLUSION No statistically significant difference in tympanic membrane perforation closure rate was found between the FGF-2 and placebo groups. There were no differences in hearing outcomes between the groups. LEVEL OF EVIDENCE 1b.
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Affiliation(s)
- Felipe Santos
- Department of Otolaryngology Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
- Department of Infectious DiseaseMassachusetts Eye and Ear and Massachusetts General HospitalBostonMassachusettsUSA
| | - Edina Shu
- Department of Otolaryngology Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
- Department of Infectious DiseaseMassachusetts Eye and Ear and Massachusetts General HospitalBostonMassachusettsUSA
| | - Daniel J. Lee
- Department of Otolaryngology Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
- Department of Infectious DiseaseMassachusetts Eye and Ear and Massachusetts General HospitalBostonMassachusettsUSA
| | - David H. Jung
- Department of Otolaryngology Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
- Department of Infectious DiseaseMassachusetts Eye and Ear and Massachusetts General HospitalBostonMassachusettsUSA
| | - Alicia M. Quesnel
- Department of Otolaryngology Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
- Department of Infectious DiseaseMassachusetts Eye and Ear and Massachusetts General HospitalBostonMassachusettsUSA
| | - Konstantina M. Stankovic
- Department of Otolaryngology Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
- Department of Infectious DiseaseMassachusetts Eye and Ear and Massachusetts General HospitalBostonMassachusettsUSA
| | - Dunia E. Abdul‐Aziz
- Department of Otolaryngology Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
- Department of Infectious DiseaseMassachusetts Eye and Ear and Massachusetts General HospitalBostonMassachusettsUSA
| | - Camden P. Bay
- Department of Infectious Disease, Center for Clinical Investigation (CCI)Brigham and Women's HospitalBostonMassachusettsUSA
| | - Amy Quinkert
- Department of Otolaryngology Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
- Department of Infectious DiseaseMassachusetts Eye and Ear and Massachusetts General HospitalBostonMassachusettsUSA
| | - D. Bradley Welling
- Department of Otolaryngology Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
- Department of Infectious DiseaseMassachusetts Eye and Ear and Massachusetts General HospitalBostonMassachusettsUSA
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Hu EY, Levesque VM, Bay CP, Seol JG, Shyn PB. Liver Tumor Ablation Procedure Duration and Estimated Patient Radiation Dose: Comparing Positron Emission Tomography/CT and CT Guidance. J Vasc Interv Radiol 2020; 31:1052-1059. [PMID: 32534979 DOI: 10.1016/j.jvir.2019.11.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/12/2019] [Accepted: 11/28/2019] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To compare procedure duration and patient radiation dose in positron emission tomography/computed tomography (PET/CT) and CT-guided liver tumor ablation procedures. MATERIALS AND METHODS In this retrospective, case-control study, 275 patients underwent 368 image-guided ablation procedures to treat 537 tumors. Radiologists used PET/CT guidance for 117 procedures and CT guidance for 251 procedures. PET/CT-guided procedures were performed by one radiologist (C: P.B.S.). All 3 radiologists (A: J.G.S., B: a radiologist who is not an author on this article, and C: P.B.S.) performed CT-guided procedures. Potential confounders included patient demographics, clinical and tumor characteristics, and procedural variables. RESULTS The mean duration and estimated patient radiation dose of PET/CT-guided procedures performed by radiologist C were 21.5 ± 4.9 minutes longer and 0.7 ± 2.8 mSv higher than CT-guided procedures performed by all radiologists in an unadjusted comparison. Adjusting for confounding, mean duration and estimated dose of PET/CT-guided procedures performed by radiologist C were 28.3 ± 3.8 minutes longer (P < .0001) and 6.2 ± 2.9 mSv higher (P = .03) than CT-guided procedures performed by the same radiologist. Comparing CT-guided procedures performed by all 3 radiologists, adjusted mean durations and estimated patient doses of procedures by the least experienced radiologist, radiologist A, and the second most experienced radiologist, radiologist B, were 24.2 ± 5.1 (P < .0001) and 18.1 ± 8.9 (P = .04) minutes longer and 13.1 ± 3.7 (P < .001) and 14.5 ± 6.4 (P = .02) mSv higher, respectively, than procedures performed by the most experienced radiologist, radiologist C. CONCLUSIONS PET/CT-guided liver ablations had a slightly longer duration with slightly higher estimated patient radiation dose than similar CT-guided liver ablations. Procedure duration and patient dose do not appear to be major impediments to the emerging field of PET/CT-guided tumor ablation.
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Affiliation(s)
- Emmy Y Hu
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Vincent M Levesque
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Camden P Bay
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Julia G Seol
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Paul B Shyn
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115.
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Allen EM, McTague MF, Bay CP, Esposito JG, von Keudell A, Weaver MJ. The effectiveness of germicidal wipes and ultraviolet irradiation in reducing bacterial loads on electronic tablet devices used to obtain patient information in orthopaedic clinics: evaluation of tablet cleaning methods. J Hosp Infect 2020; 105:200-204. [PMID: 32289385 DOI: 10.1016/j.jhin.2020.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/07/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Electronic tablet devices are commonly used in outpatient clinics to obtain patient information for both clinical and research purposes. These devices are often colonized with bacteria; there are many cleaning methods to reduce this bacterial load. AIM The primary purpose of this study was to evaluate whether regular cleaning with either germicidal wipes or ultraviolet (UV) irradiation leads to lower bacterial levels compared with irregular cleaning. METHODS A randomized blinded trial was conducted of tablet cleaning strategies between each patient encounter in orthopaedic clinics. The cleaning method was randomized to either germicidal wipes, UV irradiation, or cleaning only when the tablet was visibly soiled. Research assistants (blinded to the treatment) obtained bacterial cultures from the tablets at the beginning and end of each clinic day. FINDINGS Using germicidal wipes between each patient encounter vs no routine cleaning resulted in a marked decrease in the amount of bacterial contamination (risk ratio (RR) = 0.17 (0.04-0.67)). Similarly, using UV irradiation between each patient encounter led to significantly lower bacterial contamination rates (RR = 0.29 (95% confidence interval (CI) = 0.09-0.95)) compared with no routine cleaning. The majority of bacteria identified were normal skin flora. No meticillin-resistant Staphylococcus aureus was identified and only sparse colonies of meticillin-sensitive S. aureus. CONCLUSION Electronic tablets used in orthopaedic trauma clinics are colonized with bacteria if no routine cleaning is performed. Routine use of either UV irradiation or germicidal wipes significantly decreases this bacterial burden. Providers should implement routine cleaning of tablets between each patient encounter to minimize exposure to potential pathogens.
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Affiliation(s)
- E M Allen
- Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| | - M F McTague
- Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - C P Bay
- Center for Clinical Investigation, Brigham and Women's Hospital, Boston, MA, USA
| | - J G Esposito
- Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA; Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - A von Keudell
- Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - M J Weaver
- Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
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Mollan KR, Trumble IM, Reifeis SA, Ferrer O, Bay CP, Baldoni PL, Hudgens MG. Precise and accurate power of the rank-sum test for a continuous outcome. J Biopharm Stat 2020; 30:639-648. [PMID: 32126888 DOI: 10.1080/10543406.2020.1730866] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Accurate power calculations are essential in small studies containing expensive experimental units or high-stakes exposures. Herein, power of the Wilcoxon Mann-Whitney rank-sum test of a continuous outcome is formulated using a Monte Carlo approach and defining [Formula: see text] as a measure of effect size, where [Formula: see text] and [Formula: see text] denote random observations from two distributions hypothesized to be equal under the null. Effect size [Formula: see text] fosters productive communications because researchers understand [Formula: see text] is analogous to a fair coin toss, and [Formula: see text] near 0 or 1 represents a large effect. This approach is feasible even without background data. Simulations were conducted comparing the empirical power approach to existing approaches by Rosner & Glynn, Shieh and colleagues, Noether, and O'Brien-Castelloe. Approximations by Noether and O'Brien-Castelloe are shown to be inaccurate for small sample sizes. The Rosner & Glynn and Shieh, Jan & Randles approaches performed well in many small sample scenarios, though both are restricted to location-shift alternatives and neither approach is theoretically justified for small samples. The empirical method is recommended and available in the R package wmwpow.
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Affiliation(s)
- Katie R Mollan
- Department of Biostatistics and Center for AIDS Research, The University of North Carolina , Chapel Hill, North Carolina, USA
| | - Ilana M Trumble
- Department of Biostatistics and Center for AIDS Research, The University of North Carolina , Chapel Hill, North Carolina, USA
| | - Sarah A Reifeis
- Department of Biostatistics and Center for AIDS Research, The University of North Carolina , Chapel Hill, North Carolina, USA
| | - Orlando Ferrer
- Department of Biostatistics and Center for AIDS Research, The University of North Carolina , Chapel Hill, North Carolina, USA
| | - Camden P Bay
- Department of Biostatistics and Center for AIDS Research, The University of North Carolina , Chapel Hill, North Carolina, USA
| | - Pedro L Baldoni
- Department of Biostatistics and Center for AIDS Research, The University of North Carolina , Chapel Hill, North Carolina, USA
| | - Michael G Hudgens
- Department of Biostatistics and Center for AIDS Research, The University of North Carolina , Chapel Hill, North Carolina, USA
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Magudia K, Sugi MD, Balthazar P, Donelan K, Bay CP, Gupta R, Maturen K. Prospects of a Fellowship Match for Abdominal Imaging: A National Survey by the Society of Abdominal Radiology. J Am Coll Radiol 2020; 17:804-811. [PMID: 32105644 DOI: 10.1016/j.jacr.2020.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 01/27/2020] [Accepted: 02/01/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE After the Society of Chairs of Academic Radiology Departments timeline and guidelines were released for the 2021 through 2022 fellowship application cycle, the Society of Abdominal Radiology conducted a survey of residents, fellows, and abdominal imaging fellowship program directors (PDs) to assess stakeholders' perceptions of changes in the fellowship application process. METHODS Eligible study participants included fellowship PDs of all US abdominal imaging programs and Society of Abdominal Radiology members-in-training. A questionnaire was developed by content and survey experts, pilot-tested, and administered from August to October 2019. RESULTS Survey response rates were 51.4% among PDs (54 of 103) and 24.2% among trainees (67 of 279), with an overall response rate of 31.8%. Attitudes regarding the abdominal imaging fellowship application process were overall similar between PDs and trainees, including expressed support for a common application. Although trainees and PDs agreed that the Society of Chairs of Academic Radiology Departments 2021 through 2022 cycle timeline is preferable to the prior unstructured system, only 42.4% of PDs and 40.7% of trainees supported moving to a formal match, with a significant number of respondents undecided. Both PDs and trainees favored timing fellowship interviews during the fall of the third year of residency (R3 year), with a 1- to 2-month buffer between the start of interviews and offers. CONCLUSIONS PDs and trainees demonstrate similar attitudes in support of the Society of Chairs of Academic Radiology Departments 2021 through 2022 cycle timeline and a common abdominal imaging fellowship application. Shifting the interview season from winter to fall of R3 year could be considered to meet the preferences of PDs and trainees alike. Moving to a formal match remains controversial.
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Affiliation(s)
- Kirti Magudia
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California.
| | - Mark D Sugi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Patricia Balthazar
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Karen Donelan
- Department of Medicine, Health Policy Research Center, The Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Camden P Bay
- Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rajan Gupta
- Department of Radiology, Duke Medical School, Durham, North Carolina
| | - Katherine Maturen
- Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
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Schwartz HE, Bay CP, McFeeley BM, Krivanek TJ, Daffner KR, Gale SA. The Brain Health Champion study: Health coaching changes behaviors in patients with cognitive impairment. Alzheimers Dement (N Y) 2019; 5:771-779. [PMID: 31763431 PMCID: PMC6861624 DOI: 10.1016/j.trci.2019.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Converging evidence suggests that increasing healthy behaviors may slow or prevent cognitive decline. METHODS We piloted a six-month, randomized, controlled investigation of 40 patients with mild dementia, mild cognitive impairment, or subjective cognitive decline. The intervention consisted of weekly motivational interviewing phone calls and three visits with a "Brain Health Champion" health coach, who guided participants to achieve personalized goals. Changes in behavior were measured using validated questionnaires. RESULTS Compared with the standard-of-care control group, Brain Health Champion participants had statistically significant and clinically meaningful increases in physical activity (Cohen's d = 1.37, P < .001), adherence to the Mediterranean diet (Cohen's d = 0.87, P = .016), cognitive/social activity (Cohen's d = 1.09, P = .003), and quality of life (Cohen's d = 1.23, P < .001). The magnitude of behavior change strongly predicted improvement in quality of life. DISCUSSION Our results demonstrate the feasibility and potential efficacy of a health coaching approach in changing health behaviors in cognitively impaired and at-risk patients.
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Affiliation(s)
- Hope E.M. Schwartz
- Department of Neurology, Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Camden P. Bay
- Center for Clinical Investigation, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brittany M. McFeeley
- Department of Neurology, Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Taylor J. Krivanek
- Department of Neurology, Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Kirk R. Daffner
- Department of Neurology, Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Seth A. Gale
- Department of Neurology, Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
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Gong J, Castro RR, Caron JP, Bay CP, Hainer J, Opotowsky AR, Mehra MR, Nohria A, Maron BA, Di Carli MF, Groarke JD. Predictive Prognostic Value of Ventilatory Inefficiency across the Spectrum of Heart Failure. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.087] [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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Carnahan RM, Daly JM, Minion S, Gryzlak B, Weckmann MT, Levy BT, Bay CP. A Needs Assessment of Family Physicians to Inform Development of Educational Resources on Antipsychotic Use in Dementia. J Prim Care Community Health 2019; 10:2150132719840113. [PMID: 31006318 PMCID: PMC6477762 DOI: 10.1177/2150132719840113] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Objectives of this study were to (1) assess the needs and preferred resources of Iowa physicians to inform the development of educational resources for best practice dementia care and (2) compare the responses of nursing home medical directors with nonmedical directors. METHODS Of 498 physicians, 101 (20%) completed and returned the survey. Family physicians were obtained from a list of family physicians from the Iowa Board of Medical Examiners. Respondent answers were summarized and presented as total numbers and percentages in tables. Significant differences between medical directors and nonmedical directors were evaluated using chi-square tests, Fisher exact tests, and Wilcoxon rank-sum tests. RESULTS Medical directors and nonmedical directors had similar preferences for resources used and information needs. Online resources, pocket guides, a handbook, consulting pharmacists, and facility in-services were the most commonly preferred sources of new information. Medical directors were significantly more aware of the Food and Drug Administration warning on antipsychotic use in dementia and treated more nursing home patients. No differences were observed between groups related to confidence in and use of nondrug strategies instead of antipsychotics to manage behavioral symptoms of dementia. CONCLUSION The results of this survey illustrate physician preferences for information and resources on the management of behavioral and psychological symptoms in dementia. Information was used to inform the development of resources to aid physicians and other health care providers in making decisions about managing these symptoms.
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Daly JM, Bay CP, Xu Y, Levy BT. Effect of Ambient Temperature Variations on Positivity of Manual Fecal Immunochemical Tests. J Prim Care Community Health 2015; 6:243-9. [PMID: 26022208 DOI: 10.1177/2150131915588738] [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: 11/16/2022] Open
Abstract
INTRODUCTION In the United States, many fecal occult blood tests are mailed by patients to a laboratory for analysis. Hemoglobin is not stable in feces and can be affected by the heat. Effects of season and ambient temperature on fecal immunochemical tests (FITs) have demonstrated a decrease in positivity rates during the hottest season. OBJECTIVE To investigate the potential effect of the average of 4-day ambient maximum temperature variations on the positivity of a single sample, one-time Clinical Laboratory Improvement Amendments (CLIA)-waived FIT. SETTING Midwestern tertiary care hospital. METHODS Individuals scheduled for a colonoscopy were invited to complete a qualitative FIT prior to their colonoscopy in 2010 and 2011. FITs were read as positive or negative. RESULTS Valid FITs were received from 1026 individuals over 25 months. The positivity rate was 10.9%. The mean 4-day average of daily maximum ambient temperatures was calculated including the day of receipt for each sample. Fahrenheit temperatures ranged from 16.0 to 96.8. Based on the odds ratio of 1.04 with a confidence interval of 0.94 to 1.14 for a 10°F increase in temperature, there was no statistically significant evidence of an effect of the preceding maximum average 4-day ambient temperature on FIT positivity. CONCLUSION No evidence was found that ambient temperature had an effect on positivity rate over a 25-month period using 4 different qualitative FIT products. Further analysis on effect of ambient temperatures is warranted for the automated FITs and CLIA-waived FITs, including liquid-vial and dry-slide FITs. Primary care providers need to be aware of potential adverse effects of FITs.
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Affiliation(s)
| | | | - Yinghui Xu
- The University of Iowa, Iowa City, IA, USA
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Abstract
Objectives. We assessed the protocols and system processes for colorectal cancer (CRC) screening at federally qualified health centers (FQHCs) in 4 midwestern states. Methods. We identified 49 FQHCs in 4 states. In January 2013, we mailed their medical directors a 49-item questionnaire about policies on CRC screening, use of electronic medical records, types of CRC screening recommended, clinic tracking systems, referrals for colonoscopy, and barriers to providing CRC. Results. Forty-four questionnaires (90%) were returned. Thirty-three of the respondents (75%) estimated the proportion of their patients up-to-date with CRC screening, with a mean of 35%. One major barrier to screening was inability to provide colonoscopy for patients with a positive fecal occult blood test (59%). The correlation of system strategies and estimated percentage of patients up-to-date with CRC screening was 0.43 (P = .01). Conclusions. CRC system strategies were associated with higher CRC screening rates. Implementing system strategies for CRC screening takes time and effort and is important to maintain, to help prevent, or to cure many cases of CRC, the second leading cause of cancer in the United States.
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Affiliation(s)
- Jeanette M Daly
- The authors are with the Department of Medicine, and Jeanette M. Daly, Barcey T. Levy, and Camden P. Bay are also with the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
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Abstract
BACKGROUND Colorectal cancer (CRC) screening reduces the mortality due to CRC. It is important for health care providers to be aware of the variation in the products available for CRC screening. PURPOSE The purpose of this study was to summarize the accuracy of results of individual fecal immunochemical test (FIT) products across pathology proficiency testing programs. METHODS Secondary data analysis of proficiency testing programs' FIT results. RESULTS Four of 7 proficiency testing program's FIT evaluations were obtained for a 2-year period. Fourteen unique FIT brands were evaluated by at least 1 of the 4 proficiency testing programs. Five of the products performed similarly with sensitivities ranging from 98.1% to 98.8% and specificities from 98.1% to 99.6%. Ninety-three percent of the FIT tests completed were manual Clinical Laboratory Improvement Amendments-waived FITs. CONCLUSIONS About two thirds of the commonly used FIT products performed acceptably on spiked samples of human hemoglobin. However, some had low sensitivity and specificity and probably should not be used for population-based or other screening. Further investigation to determine appropriate, reliable products for fecal occult blood testing is warranted.
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